Factors affecting progression-free survival in non-HIV-related Kaposi sarcoma.

BACKGROUND: Non-HIV related Kaposi sarcoma (NHKS) is a rare indolent neoplasm which is more common around Mediterranean origin. Data concerning factors that influence progression-free survival (PFS) for NHKS are insufficient. The purpose of present retrospective analysis was to distinguish the factors affecting PFS in patients with NHKS. METHODS: A hundred and twenty-eight consecutive patients with NHKS who were treated or observed between 1997 and 2014 at Istanbul University Institute of Oncology were included into the study. Treatment response and progression definitions were determined according to different treatment modalities administered at first line. RESULTS: Majority of patients were male (n = 97, 75.8%). Median age of the whole group was 66 years (28-85). Of the patients, 15 patients were immunosuppressant, whereas 113 patients had no disease that caused immunosuppression. Patients were treated with local excision (n = 57, 44.5%), chemotherapy (n = 32, 25.0%) and/or radiotherapy (n = 13, 10.2%) or observed without treatment (n = 26, 20.3%). At a median follow-up of 28 months, 71 (55.5%) patients had progression, while 3 patients (2.3%) died of NHKS. On univariate analysis, patients who had hypertension (HT) had poorer PFS compared with others (19 ± 12 versus 41 ± 22 months; p = 0.03), whereas plaque formation was associated with better outcome (25 ± 9 versus 54 ± 12 months; p = 0.03). In addition, heavy smoking (≥40 pack-years) had a borderline significance regarding better PFS time (23 ± 24 versus 45 ± 38 months, p = 0.06). On multivariate analysis, none of factors evaluated had any impact on PFS. CONCLUSIONS: HT was correlated with poorer outcome among NHKS patients. Patients with plaque formation and ≥40 pack-years of smoking had better PFS than others.

Fourth versus eighth week surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: Istanbul R-01 study.

BACKGROUND AND PURPOSE: The optimum duration between neoadjuvant radiochemotherapy and transmesorectal excision in locally advanced rectal cancer has not been defined yet. This randomized study was designed to compare the efficacy of four-week versus eight-week delay before surgery. METHODS: One-hundred and fifty-three patients with locally advanced low- or mid-rectum rectal adenocarcinoma were included in this single center prospective randomized trial. Patients were assigned to receive surgical treatment after either four weeks or eight weeks of delay after chemoradiotherapy. Patients were followed for local recurrence and survival, and surgical specimens were examined for pathological staging and circumferential margin positivity. RESULTS: 4-week and 8-week groups did not differ with regard to lateral surgical margin positivity (9.2% vs. 5.1%, P=0.33, respectively), pathological tumor regression rate (P=0.90), overall survival (5-year, 76.5% vs. 74.2%, P=0.60) and local recurrence rate (11.8% vs. 10.3%, 0.77). Overall survival was better in patients with negative surgical margins (78.8% vs. 53.0%, P=0.04). Local recurrence rate was significantly higher among patients with positive surgical margin (28.5% vs. 9.3%, P=0.02). CONCLUSIONS: Intentional prolongation of the chemoradiotherapy-surgery interval does not seem to improve clinical outcomes of patients with locally advanced rectal cancer. Surgical margin positivity seems to be more important with this regard.

Treatment outcome and prognostic factors in non-metastatic esophageal carcinoma.

OBJECTIVE: To investigate the therapeutic outcome and prognostic factors in patients with non-metastatic esophageal carcinoma. METHODS: Between January 1989 and December 2003, 171 patients with non-metastatic esophageal carcinoma patients were retrospectively assessed in the Department of Radiation and Oncology, Institute of Oncology, Turkey. RESULTS: The distribution of the stage at presentation designated 39 stage II patients (23%) and 132 stage III patients (77%). The primary tumors were treated with surgery and postoperative radiotherapy (RT) in 29 patients (17%), with surgery, postoperative RT and chemotherapy (CT) in 17 patients (10%), with radical RT in 40 patients (23%), and with RT and CT in 47 patients (27%). Fourteen patients (8%) did not receive any postoperative adjuvant treatment. Two and three-year survival rates of the whole group were 27.0% and 14.8%, respectively. Clinical staging was the only statistically significant prognostic factor by multivariate analyses (p=0.04). Median survivals by the treatment groups were 12.5 months for surgery alone, 16 months for surgery plus postoperative RT, 15 months in surgery plus postoperative chemoradiotherapy, 9 months in radical RT alone and 17 months in chemoradiotherapy group. Survival advantage was not demonstrated for postoperative RT or RT plus CT. Outcomes were similar between the patients treated with surgery and with chemoradiotherapy (p=0.54). Patients treated with chemoradiotherapy had a longer survival than patients treated with only RT (p=0.05). CONCLUSION: The most important prognostic factor was the stage of the disease. Survival advantage was not demonstrated for postoperative RT or RT plus CT. Outcomes were similar between patients treated by surgery and by chemoradiotherapy.