A nationwide retrospective study of perioperative chemotherapy for gastroesophageal adenocarcinoma: tolerability, outcome, and prognostic factors.

BACKGROUND: Recent clinical trials have demonstrated the benefit and feasibility of perioperative chemotherapy for treatment of gastroesophageal adenocarcinoma (GEA). Despite convincing results, patients entering such trials usually represent only a fraction of those who are candidates for treatment. Confirmation of trial-reported effects and tolerability in unselected cohorts is therefore required. The aims of this study were to confirm the safety and efficacy of perioperative chemotherapy for resectable GEA and to delineate risks of treatment failure. METHODS: We conducted a national retrospective cohort analysis of patients admitted for perioperative chemotherapy for resectable GEA. Regimens were epirubicin and capecitabine combined with oxaliplatin or cisplatin. RESULTS: The intention-to-treat analysis included 271 patients. Eighty-seven percent of patients completed preoperative chemotherapy, and 63 % received radical resection. Age >70 years (odds ratio 2.58) and hypoalbuminemia (odds ratio 4.10) were independent predictors of not undergoing scheduled surgery (P = 0.033). Grade 3 or higher febrile neutropenia, fatigue, and diarrhea were common in the oxaliplatin group (n = 128), but hypomagnesaemia and tinnitus/hearing loss were more common in the cisplatin group (n = 135). The median overall survival was 26.4 months, and the 1- and 2-year survival rates were 76 and 53 %, respectively. Performance status >0 (hazard ratio 1.64) and elevated serum lactate dehydrogenase (hazard ratio 3.03) were independent predictors of poor prognosis (P ≤ 0.05). CONCLUSIONS: Perioperative chemotherapy is feasible and well tolerated in patients with good performance status and low incidence of comorbidities.

A phase I study of concurrent chemoradiotherapy and cetuximab for locally advanced esophageal cancer.

AIM: To determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of concurrent chemoradiotherapy and cetuximab in patients with non-resectable locally advanced esophageal cancer. PATIENTS AND METHODS: Escalating doses of oxaliplatin every second week and daily tegafur/uracil were given concurrently with radiotherapy, 59.4 Gy in 33 fractions. Cetuximab was given on day 15 (400 mg/m(2)) and weekly (250 mg/m(2)) during radiotherapy. Fixed doses of oxaliplatin (130 mg/m(2)) and tegafur/uracil (300 mg/m(2)) were administered before, and after radiotherapy. RESULTS: Eleven patients were included in the study; two were excluded due to allergic reactions to cetuximab. In DL2 (tegafur/uracil 300 mg/m(2), oxaliplatin 30 mg/m(2)) two grade 3/4 fistula and one grade 3 neuropathy were observed. Six patients were enrolled in DL1 (tegafur/uracil 150 mg/m(2)/, oxaliplatin 30 mg/m(2)) with no DLTs. Four out of 9 patients had complete response. CONCLUSION: Concomitant chemoradiotherapy and cetuximab had significant activity. DL1 was established as the MTD.

[Delay in implementation of international guidelines for computed tomographies with iodinated contrast media]. / Forsinket implementering af internationale retningslinjer for computertomografi med iodholdigt kontraststof .

INTRODUCTION: This study was conducted to determine the degree to which the clinical practice concerning computed tomographies (CTs) with iodinated contrast media in patients with lung cancer was in accordance with ESUR international guidelines. Lung cancer is treatable with platinum-based cytostatic drugs, which can be nephrotoxic. According to the ESUR s guidelines this adds to the risk of developing contrast-induced nephropathy. MATERIAL AND METHODS: A retrospective study of lung cancer patients at Hillerød Hospital. INCLUSION CRITERIA: Patients in current treatment with platinum-based cytostatic drugs up to and including 20 Sept. 06 who had undergone an elective CT with iodinated contrast media. A total of 51 patients where included. P-creatinine and other potential risk factors for development of contrast-induced nephropathy were collected. RESULTS: In 31.4% of the patients included, P-creatinine was measured no earlier than seven days prior to their CT. 43.1% of the patients included had received a platinum-based cytostatic drug after the latest measurement of their P-creatinine prior to their CT scan. 45.1% of the patients received a platinum-based cytostatic 14 days or less before CT scan. 66.7% had additional risk factors. None needed nephrologic assistance. CONCLUSION: Significant deviations were found between the clinical practice and ESUR international guidelines covering prevention of contrast-induced nephropathy. This study has led to changes in the guidelines and clinical practice regarding contrast-induced nephropathy at Hillerød Hosipital. Now all elective patients have P-creatinine measured no more than seven days prior to CT with iodinated contrast media.