Clinicopathological Characteristics, Treatment Patterns, and Outcomes in Patients with Laryngeal Cancer.

BACKGROUND: Various factors can affect the survival of patients with laryngeal cancer (LC). In this retrospective study, we assessed clinicopathological features, their prognostic value, and treatment modalities for patients with confirmed squamous cell LC. METHODS: We collected patient data on demographics, clinicopathological characteristics, treatment patterns, and outcomes. The primary endpoints were overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional control (LRC). We assessed survival using the Kaplan-Meier method and Cox regression model analyses of potential prognostic parameters. RESULTS: After a median follow-up of 76 months, 28 (33.3%) patients had a recurrence. The median OS was 78 months, with an event recorded in 50% of patients. The DSS median was not reached (NR) with a survival rate of 72.6%, the DFS survival rate was 66.7% with median NR, and the LRC survival rate was 72.6% with median NR. After conducting a multivariate analysis of significant variables, we found that only recurrence and lymphatic invasion had an independent effect on OS and recurrence in DSS, while subsite impacted DFS and LRC. CONCLUSIONS: Survival trends were consistent with other studies, except for OS. Recurrence, lymphatic invasion, and subsite location were significant factors that impacted patient survival.

High Ki67 as negative predictor for response to concurrent radiotherapy plus Capecitabine in chemo-resistant advanced breast cancer.

PURPOSE: The purpose of this study was to evaluate Ki67 as a biomarker for response to concurrent chemo-radiotherapy in previously treated patients with standard chemotherapy protocols in the neoadjuvant setting (NACT). METHODS: Evaluated were 33 patients treated concurrently with radiotherapy and capecitabine. All patients had residual disease after anthracycline-docetaxel based NACT, verified with imaging techniques and clinical exams. Response rate (RR) was evaluated 3 months after completion of the concurrent treatment, and was correlated to tumor immune-histochemical characteristics. Binary logical regression was used for model testing and correlation of Ki67 and RR. An Omnibus test showed the model to be statistically significant and that a set of depending variables can be used as predictors for treatment response with p=0.021. Model -2 log likelihood with Nagelkerke R Square were used to define significance of other tumor characteristics besides Ki67. RESULTS: Only Ki67 showed statistically significant correlation with RR, as high Ki67 predicts that there will be no response to concurrent capecitabine - radiotherapy treatment in chemo-resistant advanced breast cancer. Other characteristics such as histological grade, estrogen or progesterone receptors, HER2 overexpression or lymphovascular or perineural invasion showed no significance. CONCLUSION: High value of Ki67 is a negative predictor for response in concurrent capecitabine-radiotherapy treatment in chemo-resistant advanced breast cancer.

Stereotactic Body Radiation Therapy (SBRT) for Liver Oligometastases: Outcomes and Safety.

OBJECTIVE: The aim of this study was to investigate adverse effects, progression free survival (PFS), one-year local control (LC) and one-year overall survival (OS) of patients with liver oligometastases treated with stereotactic body radiotherapy (SBRT), and whether there was a significant difference in these parameters in patients with primary colorectal cancer compared to other tumor localizations. PATIENTS AND METHODS: Patients were simulated using four-dimensional computed tomography (4DCT). Using volumetric modulated arc therapy (VMAT) technique, SBRT was performed on 16 patients with <3 liver metastases. The prescribed dose was 60 Gy in 8 fractions (BED 105 Gy). Cone beam CT (CBCT) was used for image guidance before each fraction with online correction. RESULTS: There were no adverse effects. Median PFS for all patients, patients with primary colorectal cancer, and patients with primary non-colorectal cancer was 11 months (SE 2.1), 16 months (SE 2.8), 6 months (SE 2.4), respectively. There was no significant difference in the PFS for these two observed groups (P=0.09). The one-year LC was 62.5%. Patients with primary colorectal cancer had one-year LC of 87.5%, while the group of patients with primary non-colorectal cancer had one-year LC of 37.5% (P=0.063). The total one-year OS was 87.5%. In the group of patients with primary colorectal cancer, the one-year OS was 100%, while in the group of patients with primary non-colorectal cancer, the one-year OS was 75% (P=0.317). CONCLUSION: SBRT with 8 × 7.5 Gy can be safely delivered and is effective method of treating liver oligometastases.

Inter-application displacement of brachytherapy dose received by the bladder and rectum of the patients with inoperable cervical cancer.

BACKGROUND: The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1cc and D2cc of the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer. PATIENTS AND METHODS: This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1cc was determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1cc and D2cc of the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. RESULTS: There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1cc and D2cc of the bladder and rectum. CONCLUSIONS: When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1cc and D2cc of the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen.

Impact of chemoradiotherapy on vaginal and sexual function of patients with FIGO IIb cervical cancer.

The opinion regarding sexual and vaginal function of patients with advanced cervical cancer treated primarily by chemoradiotherapy has still not been formed, mainly due to inappropriate methodology as the control group was comprised of healthy women. The aim of this study is to, by means of interview, evaluate vaginal and sexual function of patients with advanced cervical cancer before and after chemoradiotherapy and compare the results. A number of 35 patients were irradiated by teleradiotherapy dose of 45 Gy in 25 fractions over 5 weeks to the pelvis and additional 20-24 Gy in 4-6 fractions were given by intracavitary HDR brachytherapy. Patients received 40 mg/m(2) of cisplatin once a week, which is a total of 4-6 cycles of cisplatin. Patients answered the questions in a form of a questionnaire specifically created for cervical cancer (EORTC-QLQ-Cx 24), for the period immediately before diagnosed cervical cancer (thus being a control group). They also answered the same questions for the period starting 12 months after the completion of concomitant chemoradiotherapy, and were an experimental group at the time. For the testing of statistical significance of differences among the examined groups parameter and non-parameter tests were used (the Wilcoxon signed ranks test and Student's t-test). The difference p<0.05 was considered statistically significant. Vaginal problems of patients after chemoradiotherapy were statistically reduced (44 versus 0; p<0.0001). There is no statistical significance in the vaginal function among the analyzed groups but weaker pain during intercourse was registered after chemoradiotherapy (p=0.009). After chemoradiotherapy, patients' vaginal function is extremely improved whereas there is no difference in the sexual function. Pain during intercourse is statistically reduced after chemoradiotherapy.