Cancer services in Western Australia: A comparison of regional outcomes with metropolitan Perth.

OBJECTIVE: To investigate whether any survival differences existed between advanced cancer patients treated in metropolitan Perth and those treated in regional Western Australia (WA). DESIGN: Retrospective study. SETTING: Advanced cancer patients treated through medical oncology clinics at Royal Perth Hospital and regional cancer centres (Kalgoorlie, Albany, Geraldton and Northam). PARTICIPANTS: Patients diagnosed with advanced melanoma, breast, colorectal, gastro-oesophageal, prostate, lung and pancreatic cancers between 1 January 2007 and 31 December 2011. INTERVENTIONS: Nil. MAIN OUTCOME MEASURE: Median survival. RESULTS: Data were available for 1581 patients with 75% living in a metropolitan setting and 25% in rural WA. Median overall survival was 8.3 months for metropolitan patients and 7.6 months for regional patients (P = 0.06, HR 0.89; 95% CI, 0.78-1.01). There was no statistically significant difference in median survival for different tumour types except pancreatic cancer: breast 22.1 months versus 21.3 months, colorectal 13.1 months versus 16.4 months, lung 5.1 months versus 3.1 months, upper GI 5.6 months versus 7.2 months, pancreatic 4.5 months versus 3 months (P = 0.02, HR 0.57; 95% CI, 0.32-0.99), melanoma 10.4 months versus 10.5 months, prostate 28.6 months versus 15.3 months. Rural cancer patients with breast and pancreatic cancers received fewer lines of anti-cancer therapy compared to metropolitan patients. The three-year survival rates for metropolitan compared to rural breast cancer patients were 34 and 23%, respectively (not statistically significant). CONCLUSION: Our findings suggest a trend towards inferior survival for regional cancer patients in WA compared with metropolitan-based patients.

Cancer in liver transplant recipients: management and outcomes.

AIM: To investigate the management and cancer outcomes of liver transplant recipients. METHOD: An audit of all liver transplant recipients from a single liver transplant center from January 1991 to March 2010. Data were obtained from case notes, cancer registry and clinical databases. RESULTS: 198 transplant recipients were identified and 49 (25%) were confirmed as having post-transplantation malignancies. Of these 32 (16%) patients developed skin malignancies and 17 (9%) developed post-transplant non-skin malignancies. All skin malignancies had local involvement only and none of the patients with skin malignancies developed nodal or distant metastases. All were managed with local treatment. Of those with non-cutaneous malignancies, four were managed with local therapy alone, two with immunosuppression reduction, seven with chemotherapy, including two with chemoradiotherapy, one with a targeted agent and three with supportive care only. None of the patients who were treated with chemotherapy for non-skin malignancies were able to complete the full prescribed dose of chemotherapy as a result of chemotherapy-related toxicities. Of those treated with chemotherapy one died of hepatic failure and one of chemotherapy-related infection. CONCLUSION: Liver transplant recipients are at high risk of cancer. Outcomes for liver transplant recipients with post-transplant malignancy are excellent if detected when they are amenable to local therapy alone. Outcomes are poor, with high rates of treatment-associated toxicity, in patients who require systemic therapy. Further research is required to enable the development of guidelines for the safe administration of systemic treatment in this group.

Survival differences in patients with metastatic colorectal cancer and with single site metastatic disease at initial presentation: results from South Australian clinical registry for advanced colorectal cancer.

BACKGROUND: Colorectal cancer is the third most common cancer in Australia. The median overall survival for metastatic colorectal cancer is nearly 2 years. However, there may be survival differences based on site of metastatic disease. METHODS: Data was collected from the South Australian Registry for Advanced Colorectal Cancer. A total of 1207 patients with single site metastatic disease at initial diagnosis were subclassified into 6 subgroups: liver only (n = 780), pelvic only (n = 148), lung only (n = 142), lymph node only (n = 95), bone only (n = 32), and brain only (n = 10). Univariate and multivariate parametric survival analyses were performed. RESULTS: Median overall survival was 20.3 months for the whole group. The overall survival for lung-only metastases group was 41.1 months followed by liver- and pelvic-only disease groups (22.8 and 23.8 months, respectively). Patients with isolated bone-only and brain-only metastases had poor overall survival (5.1 and 5.7 months, respectively). On multivariate analysis, prognosis was superior for the lung-only group. CONCLUSIONS: Lung only group had the longest median overall survival. Bone and brain sites had a poor outlook. Site of metastatic disease at initial presentation may be prognostic.

Targeted therapy for esophagogastric cancers: a review.

The incidence of esophagogastric cancers is increasing rapidly in the Western population. Despite better understanding of the biology and intense research in the treatment of these cancers, the long-term survival remains poor both in the locally advanced and metastatic settings. The addition of combined modality strategies has resulted in modest improvement in 5-year survival rates. A number of biologic agents targeting epidermal-derived growth factor receptor, vascular endothelial derived growth factor and its receptor, and mammalian target of rapamycin (mTOR) are being currently evaluated in Phase II and III clinical trials. Some of these, like trastuzumab, cetuximab, and bevacizumab, have shown promising results. This review provides a brief overview of the recent developments in biologic agents for the treatment of esophagogastric cancers.

Radiation Induced Leiomyosarcoma Three Decades After Treatment for Wilms' Tumor.

Wilms' tumor is one of the most common pediatric malignancies. Survival rates have increased dramatically over the last few decades. This increased survival means that there is an ever growing population of patients susceptible to the late effects of their initial therapy. Survivors of Wilms' tumor have a substantially higher rate of development of secondary neoplasms compared to general population. We report a case of metastatic radiation induced leiomyosarcoma thirty years after therapy for Wilms' tumor. This case highlights the need for minimizing the risk of late complications and for close surveillance to enable early detection of these complications.