Predictors of Acute and Late Toxicity in Patients Receiving Chemoradiation for Unresectable Pancreatic Cancer

Pancreatic Cancer Patients Supportive Care Needs: A Qualitative Analysis

OBJECTIVE

Pancreatic cancer (PaCa) patients face a 5-year survival rate of just 13%. Most patients present with unresectable disease and endure aggressive treatments with significant chronic and debilitating side effects. PaCa patients also experience significant unmet supportive care needs (e.g., physical, psychological, informational/educational); however, limited qualitative studies have explored the specific needs of racially and ethnically diverse PaCa populations.

AIMS

This study identified supportive care needs in a racially and ethnically diverse sample of PaCa survivors.

METHODS

As part of a larger project to develop a psychosocial symptom management intervention, semi-structured qualitative interviews were conducted with PaCa survivors to explore the supportive care needs at diagnosis and after treatment. Qualitative data were analyzed using Rapid Qualitative Analysis, and personal/medical characteristics were analyzed using descriptive statistics.

RESULTS

PaCa survivors (n = 18; Mage = 64) participated, with the majority identifying as female (66.7%), White (88.9%), and Hispanic (55.6%). Over one-third completed interviews in Spanish. Four themes emerged: (1) information/health system needs, including difficulty understanding complex medical concepts, limited holistic care, post-treatment symptom management, and health behaviors; (2) psychosocial needs related to quality of life and relationships with family and healthcare providers; (3) physical and functional needs, including persistent side effects and lifestyle changes; and (4) positivity and gratitude.

CONCLUSIONS

We emphasize the themes of unmet supportive care needs in a racially and ethnically diverse sample of PaCa survivors. These findings underscore the importance of developing interventions to address these gaps and improve the overall quality of life for diverse PaCa patients.

Impact of Retroperitoneal Lymphadenopathy (RPLN) on the Outcomes of Locally Advanced Gall Bladder Cancer (GBC) Following Chemotherapy (CT) or Chemotherapy Followed by Consolidation Chemoradiotherapy (CTRT)

INTRODUCTION

Retroperitoneal lymphadenopathy is considered a metastatic disease in GBC; however, some surgical series of radical surgery with enlarged RPLN who underwent RPLN dissection have shown results marginally inferior to those without enlarged RPLN. Radiological RPLN comprises a major proportion of advanced non-metastatic GBC. There is dilemma in the intent of treatment to be offered in such cases. We are reporting our series of outcome of GBC with RPLN treated with first-line CT followed by consolidation CTRT.

MATERIALS AND METHODS

Non-metastatic locally advanced GBC with good performance status (KPS ≥ 80) were initiated on first-line CT (cisplatin-gemcitabine), and thereafter, responders were evaluated by CECT-angiography and PET-CT scan for resectability. If found unresectable, they were offered consolidation CTRT to a dose of 45 Gy by conventional fractionation (3D-CRT technique) along with concurrent capecitabine at 1250 mg/m2 to GBC and regional lymphatics including RPLN. Thereafter, boost dose of 9 Gy/5# was given to GBC only. Response assessment was done using CECT abdomen by RECIST criteria v 1.1. Outcomes (overall survival) of the two groups (RPLN vs non-RPLN) were computed with Kaplan-Meier survival curves and chi-square tests using SPSS v 20.

RESULTS

Among 189 patients of advanced non-metastatic GBC recruited from 2011 to 2022, 80 had RPLN. The demographic features of both groups were comparable. Overall, 68% of the patients were women, 30% underwent upfront stenting for obstructive jaundice, and 90% had T3 and T4 disease. Only 10% had undergone upfront laparoscopic staging and had pathologically proven RPLN. Forty percent of the patients received four cycles of CT only and 50% of the patients received six cycles or more and 33% received CTRT. By RECIST criteria, 10% vs 16% achieved complete response (CR), 39% vs 41% achieved partial response (PR), 16% vs 15% achieved stable disease (SD), 2.7% vs 6% had disease progression (PD), and 14.5% vs 3.7% were non-evaluable in non-RPLN group vs RPLN group, respectively. 12% vs 6% could undergo radical surgery in non-RPLN group vs RPLN group (p = 0.03). The median OS was 9 months (95% CI 7.6-10.3 months) vs 10 months (95% CI 8-9.8 months) (p = NS) in non-RPLN group vs RPLN group, respectively. In those who received CT only, the median OS was 7 months vs 8 months, while in those who received CT followed by CTRT, the median OS was 14 months vs 13 months (p = 0.65) in non-RPLN group vs RPLN group, respectively.

CONCLUSIONS

Based on this analysis, we conclude that RPLN constitutes a major proportion of advanced non-metastatic GBC and has outcomes similar to those without RPLN if treated with radical intent. RPLN should not be considered a metastatic disease and should be treated with radical intent.

Artificial Intelligence Algorithms in Predictive Factors for Hematologic Toxicities During Concurrent Chemoradiation for Cervical Cancer

The most recent research conducted for the International Federation of Gynecology and Obstetrics indicates that, depending on the stage of cervical cancer (CC), several therapies can provide similar overall survival and progression-free survival rates. To determine the hematologic toxicities during concurrent chemotherapy for cervical cancer, we evaluated these two therapies (cisplatin or carboplatin). Hematologic markers have been studied using statistical models and descriptive statistics. Artificial intelligence models were built using the treatment data and all the information gathered from each patient after one or more administrations to forecast the CC stage. The information was gathered from stage III cervical cancer patients and provided by Oncohelp Hospital from the West Region of Romania. Many traditional machine learning techniques, such as naïve Bayes (NB), random forest (RF), decision trees (DTs), and a trained transformer called TabPFN, were used in the current study to obtain the tabular data. The algorithms NB, RF, and DTs yielded the greatest classification score of 100% when it came to cervical cancer prediction. On the other hand, TabPFN demonstrated an accuracy of 88%. The effectiveness of the models was evaluated by computing the computational complexity of traditional machine learning methods. Early detection increases the likelihood of a good prognosis during the precancerous and malignant stages. Being aware of any indications and symptoms of cervical cancer can also help to prevent delays in diagnosis. These hematologic toxicities, which have been demonstrated to grow linearly with lowering hematologic markers below their normal expectations, would significantly impair patients' quality of life.

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

BACKGROUND

Patients with unresectable pancreatic cancer (PC) sometimes experience gastrointestinal bleeding (GIB) due to tumor invasion of the gastrointestinal tract (tumor bleeding); no standard treatment has been established yet for this complication. Palliative radiotherapy (PRT) could be promising, however, there are few reports of PRT for tumor bleeding in patients with unresectable PC. Therefore, we evaluated the outcomes of PRT for tumor bleeding in patients with unresectable PC.

METHODS

We reviewed the medical records of patients with unresectable PC diagnosed at our institution between May 2013 and January 2022, and identified patients with endoscopically confirmed tumor bleeding who had received PRT. PRT was administered at a total dose of 30 Grays (Gy) in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction, and the dose selection was left to the discretion of the attending radiation oncologists.

RESULTS

During the study period, 2562 patients were diagnosed as having unresectable PC at our hospital, of which 225 (8.8%) developed GIB. Among the 225 patients, 63 (2.5%) were diagnosed as having tumor bleeding and 20 (0.8%) received PRT. Hemostasis was achieved in 14 of the 20 patients (70%) who received PRT, and none of these patients developed grade 3 or more adverse events related to the PRT. The median time to hemostasis was 8.5 days (range 7-14 days). The rebleeding rate was 21.4% (3/14). The median hemoglobin level increased significantly (p < 0.001) from 5.9 to 9.1 g/dL, and the median volume of red blood cell transfusion tended (p = 0.052) to decrease, from 1120 mL (range 280-3360 mL) to 280 mL (range 0-5560 mL) following the PRT. The median overall survival (OS) was 52 days (95% confidence interval [CI] 39-317). Of the 14 patients in whom hemostasis was achieved following PRT, chemotherapy could be started/resumed in seven patients (50%), and the median OS in these patients was 260 days (95% CI 76-not evaluable [NE]). Three patients experienced rebleeding (21.4%), on days 16, 22, and 25, after the start of PRT.

CONCLUSION

This study showed that PRT is an effective and safe treatment modality for tumor bleeding in patients with unresectable PC.