ABSTRACT
BACKGROUND: Guidelines for breast cancer patient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer. PATIENTS: Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation. RESULTS: Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient. CONCLUSION: A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.
Subject(s)
Breast Neoplasms/pathology , Liver Neoplasms/pathology , Lung Neoplasms/pathology , Lymphatic Metastasis/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Adult , Aged , Biomarkers, Tumor/genetics , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/genetics , Breast Neoplasms/mortality , Disease-Free Survival , Female , Follow-Up Studies , Humans , Japan , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Lymphatic Metastasis/diagnostic imaging , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Prognosis , UltrasonographyABSTRACT
BACKGROUND: All patients with peritoneal-free cancer cells (CY1) do not always develop a peritoneal recurrence (P1). The goal of this study was to identify characteristic features of peritoneal-free cancer cells that could develop into peritoneal recurrence. METHODS: Of 1,474 patients, 91 were identified with CY1P0, and the remaining 1,383 with CY0P0. Immunohistochemical staining with anti-phosphorylated Smad 2 (p-Smad2) was performed on paraffin-embedded specimens from the 91 CY1P0 patients. RESULTS: CY1 was significantly correlated with Borrmann's type-4 cancer, clinical T stage, and lymph node metastasis. CY1P0 patients with Borrmann's type-4 cancer more frequently develop peritoneal recurrence than do those with other types of tumors. The 5-year survival rate of patients with Borrmann's type-4 tumors was significantly (p = 0.023) low (6.3%) compared with that of patients with other types of tumors (27.7%). The prognosis for p-Smad2-positive patients was significantly poorer than that of p-Smad2-negative patients. In CY1 and/or P1 patients with Borrmann's type-4 tumors, no significant difference in prognosis was identified between those who had surgery and those who did not. CONCLUSIONS: Activated Smad signaling might be associated with a high potential for peritoneal recurrence in CY1P0 patients. Borrmann's macroscopic criteria and p-Smad2 expression are useful markers for surgeons selecting advanced gastric cancer patients with CY1P0 for gastrectomy.
Subject(s)
Cytodiagnosis , Neoplasm Seeding , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/secondary , Smad2 Protein/metabolism , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Female , Follow-Up Studies , Humans , Immunoenzyme Techniques , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/metabolism , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Peritoneal Neoplasms/metabolism , Phosphorylation , Prognosis , Stomach Neoplasms/metabolism , Survival RateABSTRACT
INTRODUCTION: In vivo studies have shown docetaxel, a new chemotherapeutic agent, enhances radio-sensitivity by causing a cell cycle arrest in the G2/M phase. We report here to evaluate the efficacy and tolerability of weekly docetaxel concurrent with radiotherapy in advanced or relapsed oesophageal cancer patients. MATERIAL AND METHODS: A total of 8 esophageal cancer patients with relapsed mediastinal lymph nodes (6 patients), psychological disease (1 patient) and local advanced tumor (cT4) after initial 5-FU/CDDP therapy (1 patients) received docetaxel (10 mg/m2 weekly) plus concurrent radiotherapy (2 Gy daily, a total dose of 60 Gy). RESULTS: 2 patients achieved a complete response and 5 patients achieved a partial response, for an overall response rate of 87.5%. Median survival length was 13. 3 months and time to disease progression was 6.6 months. No patient experienced grade 3-4 hematological adverse event. There was esophago-mediastinal fistula in 1 patient. CONCLUSIONS: Docetaxel with concurrent radiotherapy was very effective for relapsed or local advanced esophageal cancer. This therapy had no high grade adverse event and a quality of life in esophageal cancer patients could be maintained.
