Toxicity and survival outcomes of adjuvant chemoradiation for gastric and gastroesophageal junction cancer patients treated in period 2006-2009: an institutional experience.

Surgical resection is the mainstay of gastric or gastroesophageal junction cancer treatment and has curative potential for patients with early-stage disease. In order to improve the poor survival rates, there are two complementary treatment strategies used at most - perioperative chemotherapy based on UK Magic trial or adjuvant chemoradiation based on INT-0116 trial. Daily treatment decision making should be led also by institutional experiences with toxicity evaluation. We evaluated survival and toxicity outcomes of 47 consecutive patients who underwent adjuvant chemoradiation in our institution in the years 2006-2009. 45Gy in 5 weeks with concurrent two cycles of FUFA Mayo regimen chemotherapy were administrated as part of combined treatment. The acute toxicity was relatively mild (CTCAE scale): grade 2 nausea in 26%, vomiting in 13%, and diarrhoea grade 1 in 15% and general abdominal discomfort in 57% of patients. Grade 3 haematological and infectious complications in 6% and 2% respectively. Late adverse events were as follows: grade 1 esophageal toxicity in 17%, signs of mild chronic esophageal ulceration and esophageal stenosis in 9% of patients (50% of them had tracheoesophageal fistula). The Kaplan- Meier estimate of the median overall survival was 30.5 months with median 25.7 months disease free survival. The overall survival was statistically significantly affected by the amount of removed positive lymph nodes. For the proper evaluation of radiotherapy role in multimodal treatment approach, results of other clinical trials investigating role of concurrent radiotherapy in administration of perioperative chemotherapy will be necessary. Meanwhile, two equally approaches are possible, all having their pros and cons. Institutional toxicity evaluation is recommended in order to provide the best care possible.

Toxicity and survival outcomes of adjuvant chemoradiation for gastric and gastroesophageal junction cancer patients treated in period 2006-2009: an institutional experience.

Surgical resection is the mainstay of gastric or gastroesophageal junction cancer treatment and has curative potential for patients with early-stage disease. In order to improve the poor survival rates, there are two complementary treatment strategies used at most - perioperative chemotherapy based on UK Magic trial or adjuvant chemoradiation based on INT-0116 trial. Daily treatment decision making should be led also by institutional experiences with toxicity evaluation. We evaluated survival and toxicity outcomes of 47 consecutive patients who underwent adjuvant chemoradiation in our institution in the years 2006-2009. 45Gy in 5 weeks with concurrent two cycles of FUFA Mayo regimen chemotherapy were administrated as part of combined treatment. The acute toxicity was relatively mild (CTCAE scale): grade 2 nausea in 26%, vomiting in 13%, and diarrhoea grade 1 in 15% and general abdominal discomfort in 57% of patients. Grade 3 haematological and infectious complications in 6% and 2% respectively. Late adverse events were as follows: grade 1 esophageal toxicity in 17%, signs of mild chronic esophageal ulceration and esophageal stenosis in 9% of patients (50% of them had tracheoesophageal fistula). The Kaplan- Meier estimate of the median overall survival was 30.5 months with median 25.7 months disease free survival. The overall survival was statistically significantly affected by the amount of removed positive lymph nodes. For the proper evaluation of radiotherapy role in multimodal treatment approach, results of other clinical trials investigating role of concurrent radiotherapy in administration of perioperative chemotherapy will be necessary. Meanwhile, two equally approaches are possible, all having their pros and cons. Institutional toxicity evaluation is recommended in order to provide the best care possible. Keywords: adjuvant chemoradiation, gastric cancer, early toxicity, late toxicity, survival outcomes.

[Results of curative chemoradiotherapy in patients with carcinomas of the anus]. / Výsledky kurativní chemoradioterapie u pacientu s karcinomy anu.

BACKGROUND: Anal carcinoma is a rare cancer. Surgical treatment is applied for small superficial tumors of the anal margin, the more advanced disease is treated with concomitant chemoradiotherapy. The aim of our study was to evaluate treatment outcomes in patients treated at the Masaryk Memorial Cancer Institute in 2006- 2010. PATIENTS AND METHODS: We reviewed the clinical data of 29 newly diagnosed adult patients (aged 40- 84, average 60.7, median 60.6 years) treated between 2006- 2010. Demographic parameters, tumorrelated variables, toxicity of treatment, overall survival were analyzed. RESULTS: Acute dermal toxicity G4 was observed in two patients, G3 in nine patients. Acute intestinal toxicity G4 was not observed in any patient, G3 in four patients. Acute urologic toxicity G3- 4 was not observed in any patient. Acute hematologic toxicity was observed: leukopenia G3/ G4 in 7/ 1 patients, neutropenia G3/ 4 in 9/ 4 patients, anemia G3/ 4 in no patient and thrombocytopenia G3/ 4 in 10/ 0 patients. Severe acute toxicity G3- 4 was observed more frequently in patients treated with concurrent chemoradiotherapy. Chronic dermal toxicity G2 was observed in two patients, G1 in four patients, chronic intestinal toxicity G1 was observed in four patients. One patient had urethral stenosis and three patients had stenosis of anus without invasive solutions. One patient had osteoradionecrosis of the left pubic bone. The 5 years overall survival of all patients was 76%. We failed to demonstrate improved survival due to the small and heterogeneous file in the group of patients in clinical stage I and II compared with patients with clinical stage III disease, or better survival in the group of patients who received concomitant chemoradiotherapy compared with patients treated only with radiotherapy. CONCLUSION: Conservative treatment of locally advanced anal cancer is relatively well tolerated and safe treatment. Efficiency is comparable to surgical therapy, is also advantageous in terms of quality of life of patients due to the sphincter preservation.

[Triple-negative breast cancer: analysis of patients diagnosed and/or treated at the Masaryk Memorial Cancer Institute between 2004 and 2009]. / Triple-negativní karcinom prsu: analýza souboru pacientek diagnostikovaných a/nebo lécených v Masarykove onkologickém ústavu v letech 2004 az 2009.

BACKGROUND: Triple-negative breast cancer (TNBC) represents a heterogeneous group of breast cancers that do not express ER-α, PgR and Her-2 receptors. Generally, these tumors are aggressive and more common in younger women, in which an association of TNBC with mutations in the BRCA1 gene was documented. The aim of our study was to create a representative group of patients with TNBC, which could be analyzed and the data gathered to build basic epidemiological, molecular and clinical characteristics of Czech patients with TNBC. PATIENTS AND METHODS: We performed basic clinical-pathologic correlations in a group of 335 patients diagnosed and/or treated for TNBC at the Masaryk Memorial Cancer Institute between 2004 and 2009. We also performed immunohistochemical examination of expression of cytokeratin 5/6, cytokeratin 14 and EGFR to identify the basal-like subset of TNBC. RESULTS: The median age of patients with TNBC was 56 years, range 25-88 years. A total of 9.25% of TNBC cases were diagnosed in patients under the age of 34, and another 15.22% of cases were in the age group of 35 to 44 years. 'Basal-like' carcinomas accounted for 75% of TNBC. We confirmed the aggressive nature of this disease: in the follow-up period we observed a relapse in 25% of patients: 55% of deaths due to disease progression occured within 2 years after diagnosis of the disease. Treatment strategies include chemotherapy, in most cases (88.4%). Chemotherapy was mostly based on regimens with anthracyclines or in combination with taxanes. The most important negative prognostic factors in relation to OS (disease specific OS) were: higher clinical stage (p < 0.0001), pN - positive status (p < 0.0001), high proliferative activity (as measured by Ki-67, cut-off 50%, HR = 0.4740, p = 0.0411) and positive expression of CK5/6 (HR = 0.4274, p = 0.0338). In relation to DFS, the negative prognostic significance was found for these factors: higher clinical stage (p < 0.0001), pN positive status (p < 0.0001), high proliferative activity (Ki-67, cut-off 50%, HR = 0.04993, p = 0.0240). DFS was longer in patients with a higher number of applied cycles of anthracycline-based chemotherapy (> 4 cycles, HR = 1.7273, p = 0.0467). CONCLUSION: TNBC is an aggressive form of breast cancer, which may occur in patients of all ages, but more frequently in younger patients. Only early detection of disease and intensive treatment gives a high chance of cure. Unfortunately, no reliable predictive factors have been identified so far. Better therapeutic results can be expected from targeted therapy.

[The role of PET in the diagnosis and prediction of the treatment response in patients with cervical carcinoma treated with radiotherapy--results of pilot study]. / Význam PET v diagnostice a predikci lécebné odpovedi karcinomu cervixu u pacientek lécených radioterapií--výsledky pilotní studie.

BACKGROUND: Positron emission tomography (PET) is used to distinguish between benign and malign tumours, to diagnose relapse or post-therapeutic changes and recentlyto predict treatment response. PET is also a complementary method to determine target volumes in radiotherapy. Using the PET in routine oncology practice can change disease management and improve treatment outcomes of cancer patients. We performed a pilot study to validate the role of PET in staging and in radiotherapy treatment planning of cervical carcinoma. PATIENTS AND METHODS: Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. Treatment results were evaluated by PET 3 and 9 months after completion of radiotherapy. RESULTS: The difference in the results of PET and CT was evaluated in this study. In 32 cases (62.75%) the results of initial PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. Comparing the results of PET done before and 3 months after the treatment, we found stable disease in 3 cases (5.88%), progression of disease in 4 cases (7.84%), partial regression in 3 cases (5.88 %) and in 35 cases (68.63 %) both PET scans were negative. There should not occur any false positive results caused by inflammatory reaction persisting 3 months after radiotherapy, as was confirmed by repeating PET 9 months after the treatment. CONCLUSION: The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and for determination of target volumes in radiotherapy. The predictive value of PET has not yet been validated in our study. PET was integrated into the standard staging of cervical carcinoma in Masaryk Memorial Cancer Institute.

[The impact of PET in radiotherapy of the cervical carcinoma--results of pilot study]. / Význam PET v radioterapii karcinomu delozního hrdla--výsledky pilotní studie.

OBJECTIVE: Positron emission tomography (PET) is a complementary method to determine target volumes in radiotherapy. Daily using of PET in the oncology praxis can change treatment strategy and improve its outcome. Results of this pilot study show the role of PET in staging of cervical carcinoma and in the radiotherapeutic planning. METHODS: Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. RESULTS: The difference in the results of PET and CT was evaluated in this study. In 32 cases (62.75%) the results of PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. PET results 3 months after treatment were as follows: in 3 cases (5.88%) stable disease, in 35 cases (68.63%) negative, in 4 cases (7.84%), progression of disease, in 3 cases (5.88%) partial regression. CONCLUSION: The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and in determination of target volumes in radiotherapy. PET was found to be a standard staging examination of cervical carcinoma in Masaryk Memorial Cancer Institute.

The impact of PET with 18FDG in radiotherapy treatment planning and in the prediction in patients with cervix carcinoma: results of pilot study.

Positron emission tomography (PET) is used to distinguish between benign and malign tumors, to diagnose relapse or post-therapeutic changes. Lately, PET is used to predict the treatment response. and also a complementary method to determine target volumes in radiotherapy. Daily using of PET in the oncology praxis can change treatment strategy and improve its outcome. Results of this pilot study show the role of PET with 8-F-fluorodeoxyglucose ((18)FDG) for staging of cervical carcinoma and in the radiotherapeutic planning. Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. Treatment results were evaluated by PET 3 and 9 months after treatment. The differences in the results of PET and CT were evaluated in this study. In 32 cases (62.75%) the results of PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. PET results 3 months after treatment were as follows: in 3 cases (5.88%) stable disease, in 35 cases (68.63 %) negative, in 4 cases (7.84%), progression of disease, in 3 cases (5.88 %) partial regression. There were no false positive results caused by inflammatory reaction persisting 3 months after radiotherapy, as was confirmed by repeating PET 9 months after treatment. The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and in determination of target volumes in radiotherapy. PET was found to be a standard staging examination of cervical carcinoma in Masaryk Memorial Cancer Institute. The predictive value of PET has not yet been validated.