Experience of Definitive Chemoradiation for Oesophageal Cancer Within a Large Regional Cancer Treatment Centre: Improving Outcomes and Tolerability.

AIMS: To review delivery of definitive chemoradiation (dCRT) for patients with oesophageal cancer within a large regional cancer centre. To assess toxicity, tolerability and outcomes and compare with published data. MATERIALS AND METHODS: A retrospective review of patients undergoing dCRT between November 2009 and November 2014 was carried out. Data were collected regarding treatment completion, radiotherapy plans, toxicity, failure and death. Kaplan-Meier survival curves with a Log-rank test for significance were used for survival analysis. RESULTS: In total, 179 patients were analysed. The median age at diagnosis was 70 years. Forty-four (24.6%) patients had T1 or T2 tumours, 113 (63.1%) T3 and 18 (10.1%) T4; 117 (65.4%) patients were node positive on initial staging. One hundred and forty patients were treated before 2012 with CRT and two adjuvant cycles of cisplatin and capecitabine. Of these, only 50% completed both adjuvant cycles of chemotherapy. Thirty-nine patients were treated after 2012 with neoadjuvant cisplatin and capecitabine followed by CRT. Of these, 92% completed all planned chemotherapy. Ninety-five per cent of patients completed radiotherapy without interruption, but only 46% completed concurrent capecitabine. The mean planning target volume (PTV) length was 13 cm (range 6.9-22.2 cm) and 27 (15%) patients had a PTV length greater than 16 cm. After a median follow-up of 19.6 months (range 3.0-71.9), 83 patients (46%) had relapsed, with 43 (24%) patients having isolated locoregional recurrence. The median overall survival was 26 months (95% confidence interval 20.2-31.8) with a 5 year overall survival rate of 19.7% (95% confidence interval 10.4-31.2). CONCLUSIONS: Our series shows comparable survival rates with published data despite an unselected population. The transition to neoadjuvant chemotherapy before CRT has improved tolerability and increased rates of completion of treatment. The locoregional failure rate remains significant and strategies for improving this, such as changing the chemotherapy back bone and radiation dose escalation, are eagerly awaited within the SCOPE-2 study.

Reducing febrile neutropenia rates in early breast cancer. Experience of two UK cancer centres.

PURPOSE: Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) is used in many institutions across the UK due to unacceptable febrile neutropenia (FN) rates with FEC-D (fluorouracil, epirubicin, cyclophosphamide-docetaxel). The resultant reduction in FN rate is thought to maintain dose intensity and improve patient experience. This retrospective study was performed to assess whether the addition of G-CSF primary prophylaxis into daily clinical practice has achieved these aims. METHODS: Collaborative audit performed in two UK cancer centres before and after the integration of G-CSF primary prophylaxis with FEC-D. The primary objective was FN rate. RESULTS: Data from 342 patients were analysed, 151 before routine use of primary G-CSF and 191 after. The FN rates were 30 and 11%, respectively. Despite the 99% adherence to primary G-CSF policy, there were more dose reductions (8 increased to 13%) and dose delays (11 increased to 23%) following the use of G-CSF primary prophylaxis. This appeared to be due to non-FN toxicities. Inpatient days decreased substantially from 93 to 16 and antibiotic courses from 28 to 13 (per hundred patients). CONCLUSIONS: Near universal adherence to the G-CSF policy in FEC-D treatment has led to a reduction in FN rate and inpatient days but has not translated into improved dose intensity. This collaborative audit allows sufficient data to give insight into current practice and generate hypotheses for further investigation.