Factors influencing progression-free survival in gastrointestinal stromal tumors with special reference to pathologic features, cytogenetics, and radiologic response.

BACKGROUND: Treatment of gastrointestinal stromal tumors (GISTs) changed significantly with the advent of targeted therapy with imatinib. Clear markers predictive of response to imatinib therapy and disease-free survival in patients with GIST have not been identified. Even RECIST criteria are inadequate for predicting response to therapy, especially in patients with stable disease. Data collected at a tertiary care cancer center from 2003 to 2005 in south India were analyzed retrospectively to assess clinical, pathologic, and cytogenetic profiles of patients with GIST. In addition, radiologic responses to therapy were evaluated for correlation with the disease-free survival. METHODS: GIST was defined as a mesenchymal spindle/epitheloid cell lesion arising in the GI tract with CD117 positivity. Only data from patients with locally advanced or metastatic disease were analyzed. Clinical and pathologic details of the patients were noted from case records. NCCN guidelines were followed for the treatment. Radiologic response to therapy was reassessed according to RECIST, and progression-free survival calculated for all analyzed patients using intent-to-treat analysis. RESULTS: The mean age of presentation was 42.8 ± 5.3 years (24-60), with a male-to-female ratio of 1.5:1. Small intestine was the most common disease site (60%), followed by stomach (20%), mesentery (7.2%), colorectal regions (7.2%), and other sites (5.6%). The most frequent pathologic finding in patients having recurrence was high mitotic rate. Initial tumor size (either in the metastatic setting or in local recurrence) had no bearing on progression-free or overall survival, nor did initial anatomic location or site of metastasis. Histologically, however, patients with a mixed-cell morphology had shorter survival compared to the other morphologies. Those patients having any cytogenetic abnormality had worse outcome compared to those with normal karyotype. Similarly, among patients who achieved remission, those who did so within 12 weeks had better overall survival than did those with a delayed time to remission. Overall survival of patients having stable disease and late partial responses (after 3 months) was similar and superior to survival for patients whose disease progressed while on therapy. CONCLUSION: GISTs characterized by a high mitotic rate and mixed-cell morphology and any cytogenetic abnormalities are associated with poorer outcome. Similarly, shorter time to response was more important than the actual response to therapy. Initial disease site, the site of metastasis, and tumor size had no bearing on outcomes to therapy.

Risk-scoring system for predicting mucositis in patients of head and neck cancer receiving concurrent chemoradiotherapy [rssm-hn].

BACKGROUND: One of the most distressing complications of head and neck cancer patients on chemoradiotherapy is mucositis. There is no proper tool to predict its occurrence in these patients. AIM: This study was conducted to develop a risk-scoring system to predict probable incidence and severity of mucositis in head and neck cancer patients on chemoradiotherapy. MATERIALS AND METHODS: This is a retrospective analysis conducted at a tertiary care cancer center with approximately 2,000 new cases of head and neck cancer patients annually. We Hypothesized were age, comorbid conditions, leukocyte count, nutritional status, oral hygiene, tobacco use, erythrocyte sedimentation rate (ESR); Eastern cooperative oncology group (ECOG) performance status (PS) and TNM (tumor, node, metastasis) stage as possible risk factors. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data. RESULTS: A total of 218 patients on chemoradiation receiving cisplatin 40 mg/m2 /week along with local radiation of 60-70 Gy depending on primary site were analyzed. Based on ROC analysis, the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/µL, elevated ESR, albumin < 3 gm/dL and > stage III disease. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above risk factors. For patients, the final score of 3 or less there is 17% probability of developing grade 3 or 4 mucositis, while patients having score of 6 or more have 76% probability. CONCLUSION: The current tool is fairly accurate in predicting development of mucositis in head and neck cancer patients on chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.

Transrectal ultrasonography versus computed tomography in staging rectal carcinoma.

BACKGROUND: Since therapy of rectal carcinoma depends on the extent of disease, staging becomes important. AIM: To assess the ability of transrectal ultrasonography (TRUS) and computed tomography (CT) to stage rectal carcinoma. METHODS: Ten patients with rectal carcinoma were examined by TRUS and plain and contrast-enhanced CT scan; their findings were compared with each other and with those at surgery. RESULTS: TRUS identified wall invasion in all ten cases and perirectal fat infiltration in all five cases in whom these were present. Node involvement was detected in five cases on TRUS and two of six cases on CT. Metastasis to bladder (one case) was not recognized by TRUS but was seen on CT. CONCLUSION: TRUS is inexpensive and superior to CT in staging early rectal carcinoma; limited depth of penetration is its major limitation. CT is useful for the diagnosis of advanced disease.