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1.
Medicine (Baltimore) ; 99(3): e18745, 2020 Jan.
Article in English | MEDLINE | ID: mdl-32011455

ABSTRACT

Elderly women with early-stage, nonmetastatic breast cancer do not always receive recommendations for definitive surgical treatment. The reasons vary and include patient and provider-related reasons.We queried the surveillance, epidemiology, and end results database from 2010 to 2013 for women age 60 and older with stage I/II/III invasive breast cancer for whom local treatment was known. We divided the patients into 3 groups: patients for whom surgery was performed; patients for whom surgery was recommended but not performed; patients for whom surgery was not recommended and not performed. We used Kaplan-Meier method to generate OS curves and the Cox proportional hazard test to compare survival outcomes.A total of 119,404 patients were eligible for study with a median age between 70 and 74 years old. Compared with patients who received breast surgery, patients who did not receive surgery had a worse overall survival (OS) (hazard ratio [HR], 7.39; 95% confidence interval [CI], 6.98-7.83, P < .001). Patients who were recommended but ultimately did not undergo surgery had better OS than those who were recommended against surgery (adjusted HR, 0.60; 95% CI, 0.53-0.69). However, their survival was significantly inferior to patients who underwent surgery (adjusted HR, 2.81; 95% CI 2.48-3.19). Similar results were found regardless of age, tumor stage, estrogen receptor, or human epidermal growth factor receptor 2 status and were recapitulated in analyses of cancer-specific survival.Upfront definitive breast surgery should be performed in medically-fit elderly patients with early-stage, nonmetastatic breast cancer given significant survival benefit.


Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Mastectomy, Segmental/statistics & numerical data , Mastectomy/statistics & numerical data , Aged , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , SEER Program , United States
2.
Cancer Invest ; 33(3): 53-60, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25634242

ABSTRACT

A retrospective review of 32 patients with stage III nonsmall cell lung cancer who underwent chemoradiation with image-guided radiotherapy (IGRT) was recorded. Acute grade 3-4 hematologic and esophageal toxicities developed in 6 and 13 patients respectively. At a median follow-up of 14.5 months, only one patient developed grade 3 pneumonitis. The median survival was estimated to be 17 months. Five patients (15%) developed loco-regional recurrences, and 17 patients (53%) distant metastases. Grade 3-4 toxicities remained significant during chemoradiation with IGRT. However, the reduced rate of severe pneumonitis despite a high tumor dose is encouraging and needs to be investigated in future prospective studies.


Subject(s)
Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Chemoradiotherapy , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Radiotherapy, Image-Guided/methods , Retrospective Studies , Survival Analysis
3.
Front Oncol ; 3: 289, 2013.
Article in English | MEDLINE | ID: mdl-24324932

ABSTRACT

BACKGROUND: To assess the tolerance of patients with small cell lung cancer undergoing chemoradiation with tomotherapy-based image-guided radiotherapy (IGRT). MATERIALS AND METHODS: A retrospective review of the toxicity profile for nine patients with small cell lung cancer of the limited stage who underwent chemoradiation delivered with helical tomotherapy (HT) has been conducted. RESULTS: Acute grade 3-4 hematologic and esophagitis toxicities developed in two and three patients respectively. One patient developed a pulmonary embolism during radiotherapy. Seven patients had weight loss ranging from 0 to 30 pounds (median: 4 pounds). Three patients had treatment breaks ranging from 2 to 12 days. At a median follow-up of 11 months (range: 2-24 months), no patients developed any radiation related toxicities such as grade 3-4 pneumonitis or other long-term complications. The median survival was estimated to be 15 months. There were two local recurrences, three mediastinal recurrences, and six distant metastases. CONCLUSION: Grade 3-4 toxicities remained significant during chemoradiation when radiation was delivered with tomotherapy-based IGRT. However, the absence of grade 3-4 pneumonitis is promising and the use of HT needs to be investigated in future prospective studies.

4.
Anticancer Res ; 30(3): 953-61, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20393019

ABSTRACT

Standard of care for locally advanced non-small cell lung cancer has been concurrent chemoradiation. However, optimal chemotherapy regimen, radiation therapy dose and treatment volume have not been clearly defined despite 30 years of controlled clinical trials. This review analyzes survival and failure pattern reported from randomized studies of chemoradiation for non-small cell lung cancer. Despite introduction of new chemotherapy agents, survival remained poor; rates of both locoregional failures and distant metastasis remained high. The current radiation dose appears insufficient to reliably establish local control. Stereotactic body radiotherapy may allow radiation dose escalation and should be tested in future clinical trials.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Radiosurgery/methods , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Combined Modality Therapy , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Treatment Failure
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