Multimodal kreftbehandling av gastrointestinal stromal tumor.

Gastrointestinal stromal tumour (GIST) is a subtype of sarcoma that may occur in any part of the gastrointestinal system, most frequently in the stomach and small intestine. The most common symptoms are bleeding and abdominal pain. In this clinical review, we summarise the progress made with this condition and discuss the recommended diagnostics and treatment of GIST.

Prediction of long-term survival in patients with metastatic gastrointestinal stromal tumor: analysis of a large, single-institution cohort.

BACKGROUND: A subset of patients with metastatic GIST become long-term survivors, and a more precise prediction of outcome could improve clinical decision-making. MATERIAL AND METHODS: One-hundred and thirty-three patients diagnosed with metastatic GIST from 1995 to 2013 were identified from the sarcoma database at Oslo University Hospital. Clinical data prospectively registered in the database were supplemented with retrospective review of medical records. Factors associated with survival were analyzed using Kaplan-Meier curves, log-rank test, univariate and multivariate Cox regression analyses. RESULTS: One-hundred and fifteen patients with metastatic GIST were included in the final study cohort. Median overall survival (OS) was 6.9 years (95% CI 5.6-8.3). Factors associated with long-term survival in univariate analysis were good baseline performance status (ECOG ≤1; p < .001), young age (p = .022), oligometastatic disease (OMD) (≤3 metastases; p < .001), maximum tumor diameter <5 cm (p < .001), surgery for metastatic disease (p = .005), surgery of the primary tumor (p < .001), normal baseline hemoglobin level (p = .05), normal baseline albumin level (p = .001) and normal baseline neutrophil count (p = .03). On multivariate analysis, good performance status, small tumor diameter and, OMD were the factors associated with long-term survival. Five and 10-year OS for patients with OMD were 89% and 71%, respectively, compared to 38% and 20% for patients with polymetastatic disease (p < .001). CONCLUSIONS: In this single-institution cohort of patients, OMD was as a strong prognostic factor in patients with metastatic GIST. Patients with OMD had an outcome similar to patients with high-risk localized disease, and should be regarded as a separate category among patients with metastatic GIST.

Radiotherapy for management of extremity soft tissue sarcomas: why, when, and where?

This critical review will focus on published data on the indications for radiotherapy in patients with extremity soft tissue sarcomas and its role in local control, survival, and treatment complications. The differences between pre- and postoperative radiotherapy will be discussed and consensus recommendations on target volume delineation proposed.

Radiation therapy induced changes in male sex hormone levels in rectal cancer patients.

BACKGROUND AND PURPOSE: To determine the effect of curative radiation therapy (46-50 Gy) on the sex hormone levels in male rectal cancer patients. MATERIALS AND METHODS: Twenty-five male rectal cancer patients (mean age 65 years), receiving pelvic radiation therapy (2 Gyx23-25 fractions in 5 weeks) were included. Serum testosterone, FSH and LH were determined before start of treatment, at the 10th and 25th fractions, and 4-6 weeks after completed radiotherapy. The testicular dose was determined by thermoluminescent dosimetry. RESULTS: Five weeks of radiation therapy (46-50 Gy) resulted in a 100% increase in serum FSH, a 70% increase in LH, and a 25% reduction in testosterone levels. After treatment, 35% of the patients had serum testosterone levels below lower limit of reference. The mean radiation dose to the testicles was 8.4 Gy. A reduction in testosterone values was observed already after a mean dose of 3.3 Gy (10th fraction). CONCLUSION: Radiation therapy (46-50 Gy) for rectal cancer resulted in a significant increase in serum FSH and LH and a significant decrease in testosterone levels, indicating that sex hormone production is sensitive to radiation exposure in patients with a mean age of 65 years.

Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study.

BACKGROUND: The therapeutic gain of surgery for recurrent rectal cancer is not clear, particularly with regard to the addition of intraoperative radiotherapy (IORT). METHODS: Patients (107) with isolated pelvic recurrence of rectal cancer received preoperative external radiotherapy of 46-50 in 2 Gy fractions. At surgery 59 patients had IORT 12-18 Gy. Survival and local recurrence was analysed with regard to surgical resection stages and IORT. RESULTS: Patients (44) had R0- and 39 R1-resections, 24 R2-resections or exploratory laparotomy. IORT was given most often after R1-resections, least in R0-patients. Estimated 5-year survival was overall around 30%, around 60% in the R0-, around 25% for R1- and 0% in R2-patients. Local recurrence was around 30% in the R0- and around 65% in R1-stage patients. R0-/R1-stage patients survived statistically significantly longer than the R2-group otherwise there was no statistical significant difference between IORT and non-IORT groups in any R-stages regarding overall survival or local recurrence. CONCLUSIONS: Macroscopic removal of the recurrence improves survival. Whether R0- is better than R1-resections is not clear. The effect of IORT is not a major one. IORT need be evaluated in randomised controlled trials.

Dose-effect relationship of bolus 5-fluorouracil in the treatment of advanced colorectal cancer.

The effect of different dose intensities of 5-fluorouracil (5-FU) in advanced colorectal cancer was investigated. A total of 312 patients were randomized to receive 400 mg/m2 (group A), 500 mg/m2 (group B) or 600 mg/m2 (group C) of 5-FU with leucovorin 60 mg/m2 on two consecutive days every second week. Treatment continued to progression. Pharmacokinetic analyses with calculation of the area under the concentration (AUC) were performed in 91 patients. The primary endpoint was survival, and secondary endpoints were time to disease progression, toxicity and, if the disease was measurable, tumour response. The study was well balanced in the three groups with respect to a number of patient characteristics. Crude survival as estimated by Kaplan-Meier plots was not statistically significantly different (p = 0.07) but tended to show the best results in the intermediate dose group (median survival 10, 12.5 and 10 months, respectively). Analyses of time to progression or death showed significant differences among the three groups (p = 0.02) with the longest progression-free interval in the intermediate group receiving 500 mg/m2. The objective response rates were 23%, 39% and 28%, respectively (p = 0.02). The actual/projected dose intensity (mg/m2/week) was 92%, 92% and 84%, respectively. AUC did not correlate with response or survival. The frequency of severe side effects in group C was significantly higher than that of groups A and B. The study indicated that an increase from 800 to 1000 mg/m2 of bolus 5-FU fortnightly improved the treatment results but a further increase only worsened the toxicity.