Cost-utility analysis of 5-fluorouracil and capecitabine for adjuvant treatment in locally advanced rectal cancer.

BACKGROUND: Adjuvant chemotherapy at concurrent time with radiation therapy (RT) or at adjuvant time alone in locally advanced rectal cancer (LARC) is used with several regimens. The cost-utility analysis was conducted to compare administration of two 5-FU regimens and capecitabine in the aspect of provider and societal viewpoint. METHODS: Stage II or III rectal cancer patients who received pre-operative or post-operative concurrent chemoradiotherapy and adjuvant chemotherapy were compared by using decision tree model between (I) 5-FU plus leucovorin (LV) for 5 days per cycle (Mayo Clinic regimen); (II) 5-FU continuous infusion (CI) for 120-h per cycle (CAO/ARO/AIO-94 protocol); (III) standard regimen of capecitabine. All probability data were extracted from landmark study. Direct medical costs were the cost from database of Drug Medical Supply Information Center, while direct non-medical cost and utility were interviewed from stage II and III rectal cancer patients. The time horizon of this study was 5 years. Incremental cost-effectiveness ratio (ICER) was the final result in this study, which determined as the numerator of the difference of costs among three drug regimens, and the difference of quality-adjusted life years (QALYs) from each drug was the denominator. RESULTS: 5-FU plus LV was the cheapest and least efficacy for adjuvant treatment of LARC in both provider and societal viewpoint. In provider viewpoint, the ICERs of 5-FU CI and capecitabine were 334,550 THB/QALY (US $9,840/QALY) and 189,935 THB/QALY (US $5,586/QALY), respectively, with the corresponding societal viewpoint of 264,447 THB/QALY (US $7,778/QALY) and 119,120 THB/QALY (US $3,504/QALY) when 5-FU plus LV was used as comparator. The most influential parameter for value of treatment was acquisition cost of capecitabine. At the willingness to pay for one QALY gained in Thailand (160,000 THB or US $4,706), 5-FU plus LV, 5-FU CI and capecitabine had probabilities of cost-effectiveness of 63%, 2% and 35%, respectively. CONCLUSIONS: Capecitabine was the most expensive regimen but produced the higher effectiveness than 5-FU plus LV and 5-FU CI. The most influential parameter in the model was acquisition cost of capecitabine.

Treatment outcomes of concurrent weekly carboplatin with radiation therapy in locally advanced cervical cancer patients.

OBJECTIVE: To evaluate treatment outcomes of locally advanced cervical cancer patients who received concurrent weekly carboplatin with radiation therapy. METHODS: Patients with locally advanced cervical cancer who had primary radiation treatment in concurrent with weekly carboplatin (100mg/m(2) or AUC 2) from 1997 to 2008 were identified. Demographic data, chemotherapy cycles, total treatment time, toxicities, and treatment outcomes were recorded. RESULTS: One hundred and forty-eight patients with stage IIB (50.7%), IIIB (48.0%) and IVA (1.3%) cervical cancer patients were included in the study. Median total treatment time was 53.5 days (range, 45-100 days). Carboplatin was given for a median number of 6 cycles (range, 3-6 cycles). Complete response was achieved in 142 patients (95.9%) while six (4.1%) had persistent diseases. Among the 142 responders, 36 experienced recurrences: pelvic recurrences in seven (4.7%), distant failure in 25 (16.9%), and both pelvic and distant in four (2.7%). The 2-year and 5-year progression-free survival rates were 75.1% and 63.0%, respectively with the corresponding 2-year and 5-year overall survival rates of 81.9% and 63.5%. No grade 3 or 4 hematologic and non-hematologic toxicities were observed during treatment in any patients. Late grade 3-4 gastrointestinal or genitourinary toxicities were 10.1% and 0.7%, respectively. CONCLUSION: Concurrent weekly carboplatin with radiation therapy yields high response rate with modest progression-free and overall survivals in locally advanced cervical cancer. The regimen is feasible with minimal toxicities.

Treatment outcomes and prognostic factors of patients with breast cancer: a retrospective review.

OBJECTIVE: To determine overall survival (OS), disease-free survival (DFS), and prognostic factors for survival in patients with invasive breast cancer treated with combined-modality therapy at BMA Medical College and Vajira Hospital. MATERIAL AND METHOD: The authors retrospectively analyzed the patient-tumor characteristic and treatment outcomes of 615 patients with invasive breast cancer who were treated in our radiation oncology division between 1997 and 2006. The authors used the Kaplan-Meier method to describe OS and DFS. The authors analyzed associations of patients and tumor characteristics with OS using the log-rank test and Cox proportional hazards models. RESULTS: The median follow-up time of 60 months, there were 46 loco-regional relapses, 108 distant relapses, and 129 deaths. The 5-year OS and DFS were 77.5% and 73.8%, respectively. The median times to local recurrence (LR) and to distant recurrence (DR) were 23 months (range, 10-67 months) and 24 months (range, 5-91 months). Characteristic statistically significant associated with decreased OS included lymphocascular invasion (LVI), estrogen receptor (ER) and progesterone receptor (PR) status, tumor stage, nodal stage, lymph node involvement > or =20%, and stage of disease. CONCLUSION: Overall, the prognosis of patients with breast cancer was good However the subgroup of patients who presented with LVI, ER, and PR negative, T3-4 stage, N3-nodal stage, lymph node involvement > OR =20%, and higher stage of disease had a poor long-term outcome.