ABSTRACT
We aimed to compare the value of combined positron emission tomography (PET)/CT, PET+CT (viewed side by side), CT alone and PET alone concerning the rTNM stage and influence on therapy in patients with recurrent breast cancer. 44 patients with suspicion of recurrent breast cancer underwent whole-body [18F]-2-fluoro-2-deoxy-d-glucose (FDG)-PET/CT. Images of combined PET/CT, PET+CT, PET alone and CT alone were evaluated by four blinded reader teams. Diagnostic accuracies and influence on therapy were compared. Histology and a mean clinical follow up of 456 days served as the standard of reference. Differences between the staging procedures were tested for statistical significance by McNemar's test. Overall TNM tumour stage was correctly determined in 40/44 patients with PET/CT, in 38/44 with PET+CT, in 36/44 with PET alone and in 36/44 patients with CT alone. No statistically significant difference was detected between all tested imaging modalities. PET/CT changed the therapy in two patients compared with PET+CT, in four patients compared with PET alone and in five patients compared with CT alone. Combined PET/CT appeared to be more accurate in assessing the rTNM and showed a moderate impact on therapy over PET and CT. Minor improvements were noted when compared with PET+CT. Experienced readers might therefore be able to provide accurate staging results for further therapy from separately acquired studies.
Subject(s)
Breast Neoplasms/pathology , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnostic imaging , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/secondary , Female , Fluorodeoxyglucose F18 , Humans , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Radiopharmaceuticals , Sensitivity and Specificity , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/secondaryABSTRACT
PURPOSE: To define the maximum-tolerated dose (MTD) and to evaluate the dose-limiting toxicities (DLT) of the combination of capecitabine and vinorelbine in patients with metastatic breast cancer who relapse after adjuvant and/or first-line treatment. In addition, we aimed to obtain data on efficacy and safety at the recommended dose. PATIENTS AND METHODS: Patients with measurable metastatic breast cancer after failure of prior chemotherapy (including anthracyclines and/or taxanes) were eligible. Capecitabine was administered with a fixed dose of 1000 mg/m(2) orally twice daily for 2 weeks followed by 1 week rest. One treatment cycle consisted of 6 weeks of treatment containing two treatment periods of capecitabine. Vinorelbine was given intravenously at escalated doses of 25 mg/m(2) (dose level 1) and 30 mg/m(2) (dose level 2) on days 1 and 8, and 22 and 29. RESULTS: Thirty-three patients received a total of 91 cycles of capecitabine and vinorelbine. The median number of administered cycles per patient was three (range one to six). Thirty-one patients were evaluable for toxicity. At dose level 2 four out of seven patients experienced DLTs (nausea/vomiting, febrile neutropenia, grade 4 neutropenia, infection and diarrhea); thus, the MTD was defined. In order to confirm the safety and efficacy, dose level 1 was extended to 24 patients. Two patients [8.3%; 95% confidence interval (CI) 1% to 27%] showed DLTs (hospitalization due to febrile neutropenia and prolonged neutropenia). The main toxicity was neutropenia, which was observed at National Cancer Institute Common Toxicity Criteria grade 3 and 4 in 39% of patients. The overall response rate for capecitabine and vinorelbine was 55% (95% CI 36% to 72.7%), including three patients with a complete remission. The median time to disease progression was 8 months (95% CI 4.3-11.7) with an overall survival of 19.2 months (95% CI 11.3-27.1) based on intention-to-treat analysis. CONCLUSIONS: The combination of capecitabine and vinorelbine can be administered with manageable toxicity and showed significant efficacy for patients with metastatic breast cancer even after failure of a anthracycline- and/or taxane-based therapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Deoxycytidine/analogs & derivatives , Vinblastine/analogs & derivatives , Administration, Oral , Adult , Aged , Breast Neoplasms/pathology , Capecitabine , Deoxycytidine/administration & dosage , Female , Fluorouracil/analogs & derivatives , Humans , Infusions, Intravenous , Maximum Tolerated Dose , Middle Aged , Neoplasm Metastasis , Neutropenia/chemically induced , Treatment Outcome , Vinblastine/administration & dosage , VinorelbineABSTRACT
The purpose of this prospective trial was to study a combined-modality treatment including local consolidation by surgery or radiotherapy and high-dose chemotherapy (HDC) followed by peripheral-blood stem-cell (PBSC) transplantation. In all, 48 patients with oligometastatic breast cancer amenable to local treatment after induction chemotherapy with epirubicin and cyclophosphamide or paclitaxel and cisplatin, depending on prior adjuvant chemotherapy, were enrolled. The median follow-up was 41 months (range, 7-85 months). PBSC were collected in 47 patients, and 40 received one or two courses of HDC. Local therapy was given in 37 patients. No treatment-related deaths occurred. Of 47 evaluable patients, 36 (75% of intention-to-treat population) had no evidence of disease or complete remission after completion of therapy. Six patients (12.5%) had partial response, two patients (4%) no change, and three patients (6%) progressive disease. The median time to progression and overall survival was 17.5 (95% confidence interval (CI), 14-21 months) and 42.2 months (95% CI, 33-52 months), respectively, and 27% of patients were progression free after 5 years. In conclusion, patients with oligometastatic breast cancer can be treated safely with this combined modality protocol with promising relapse-free survivals.
