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Caparica R, Amorim L, Amaral P, Uratani L, Muniz D, Hendlisz A, de Azambuja E, Glasberg J, Takahashi TK, Filho EA, Canellas R, Saragiotto D, Sabbaga J, Mak M. Malignant bowel obstruction: effectiveness and safety of systemic chemotherapy. BMJ Support Palliat Care 2020:bmjspcare-2020-002656. [PMID: 33334819 DOI: 10.1136/bmjspcare-2020-002656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although systemic chemotherapy is often administered to patients with malignant bowel obstruction (MBO), its benefit remains unknown. This study assessed the outcomes of patients who received systemic chemotherapy as part of MBO treatment. METHODS For this retrospective cohort study, data were extracted from records of patients hospitalised due to MBO in a tertiary cancer centre from 2008 to 2020. Eligible patients were not candidates for surgery and received systemic chemotherapy targeting the underlying malignancy causing MBO. Primary objective was to assess patient outcomes after chemotherapy; secondary objectives were rates of intestinal function recovery, hospital discharge and grade ≥3 toxicities. The primary endpoint was overall survival (OS). RESULTS A total of 167 patients were included: median age was 55 (18-81) years, 91% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2, 75.5% had gastrointestinal tumours and 70% were treatment-naive. The median OS after chemotherapy was 4.4 weeks (95% CI 3.4 to 5.5) in the overall population. No OS difference was observed according to treatment line (p=0.24) or primary tumour (p=0.13). Intestinal function recovery occurred in 87 patients (52%), out of whom 21 (24.1%) had a reobstruction. Hospital discharge was possible in 74 patients (44.3%). Grade≥3 adverse events occurred in 26.9% of the patients, and a total of 12 deaths (7%) attributed to toxicities were observed after chemotherapy. CONCLUSIONS MBO was associated with a dismal prognosis in this mostly treatment-naive population. The administration of chemotherapy yielded a significant risk of toxicities, whereas it did not appear to provide any relevant survival benefit in this scenario.
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Affiliation(s)
- Rafael Caparica
- Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Larissa Amorim
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Amaral
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas Uratani
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - David Muniz
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | | | - João Glasberg
- Department of Medical Oncology, Hospital Sao Luiz Anália Franco, Oncologia D'or, Sao Paulo, Brazil
| | | | - Elias Abdo Filho
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo Canellas
- Department of Radiology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Saragiotto
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jorge Sabbaga
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milena Mak
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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