Who may benefit from prophylactic cranial irradiation amongst stage III non-small cell lung cancer patients?

PURPOSE

To identify a high risk group of non-small cell lung cancer (NSCLC) patients who may benefit from preventive strategies in order to reduce the rate of brain metastasis.

METHODS

Two-hundred stage IIIA (47.5%) and IIIB (52.5%) NSCLC patients were analysed (median age 61 years, range 29-82). Pathological diagnosis consisted of 27% adenocarcinomas, 48.5% squamous cell carcinomas, and 24.5% non-small cell lung carcinomas. Brain metastasis rate was calculated and compared in relation to age, gender, stage, histology, chemotherapy and surgery.

RESULTS

Median follow-up was 15 months (range 2-65), and the 2-year survival rate was 35%. Two-year incidence of brain metastasis was 23%. In univariate analysis, 32.9% of the patients younger than 60 years of age developed brain metastasis, in contrast to 15.3% of those older than 60 years (p=0.003). Brain was the first metastatic site in younger patients (44.4%) which was significantly higher than in the older age group (23%) (p=0.03). Adenocarcinoma had higher risk (39.6%) than squamous cell carcinoma (15.7%) for brain metastasis (p<0.0001). Patients 60 years old or younger with adenocarcinoma (53.3%) had higher risk for brain metastasis than all the others (18%; p<0.0001).

CONCLUSION

In locally advanced NSCLC patients, age and adenocarcinoma histology represent high risk factors for early development of brain metastasis. Many of the failures are isolated brain lesions and future studies are required to assess the benefit of preventive strategies in selected patients.

Gamma knife radiosurgery in non small cell lung cancer patients with brain metastases: treatment results and prognostic factors

PURPOSE

To evaluate the efficacy of gamma knife radiosurgery (GKRS) for the treatment of brain metastases from non small cell lung cancer (NSCLC) and find out the prognostic factors for overall survival.

METHODS

Between February 1997 and August 2003 100 patients underwent treatment for 184 brain metastases from NSCLC, either for recurrence (n=49) or with a new diagnosis (n=51). Median age was 55 years and 77 patients were male. Seventy-eight of the patients received whole brain radiotherapy (WBRT) prior to or after GKRS and 26 patients had surgical removal of the metastasis. Imaging and clinical status were monitored every 3 months following treatment. Kaplan-Meier survival curves, Cox proportional hazards regression for risk factor analysis were used.

RESULTS

The median follow up after the procedure was 8 months and after the diagnosis 11 months. The median overall survival for all patients was 9 months from the date of GKRS and 14 months from the diagnosis of brain metastasis. Local tumor control was achieved in 95% of the lesions. In multivariate analysis, adenocarcinoma histology, Karnofsky performance status (KPS) score > 80, 1-3 metastases and tumor diameter <2 cm were related to longer survival. Addition of WBRT did not have any effect on overall survival.

CONCLUSION

Gamma knife surgery appears to be effective in treating patients with brain metastases from NSCLC, either alone or with WBRT in selected groups of patients.

Impact of percent positive random biopsies on biochemical outcome in prostate cancer patients treated with external beam radiotherapy with or without androgen deprivation

PURPOSE

To identify the prognostic factors for biochemical outcome in patients with localized prostatic adenocarcinoma treated with external beam radiotherapy (EBRT) with or without androgen deprivation (AD) and to investigate the impact of percent positive prostate core biopsies (PCB%).

METHODS

From 1998 through 2003, 333 patients with newly diagnosed localized prostate cancer were retrospectively analyzed. The patients were treated in two institutions with definitive EBRT to a median dose of 72 Gy and 80% of them received short- or long-term AD. Biochemical failure was defined using ASTRO criteria with 3 consecutive rises in prostate specific antigen (PSA).

RESULTS

Median follow up was 36 months. Gleason score, initial PSA, risk grouping, PCB%, AD and total duration of AD were found to be significant predictors for biochemical outcome in univariate analysis. Independent predictors for PSA failure on multivariate analysis were PCB% and duration of AD. Among 3 risk groups, in the intermediate risk group the biochemical control was significantly better in patients with < 67% positive core biopsies. In the subgroup analysis of patients who received a prostatic dose <or= 70.2 Gy, and patients with no hormonal or short-term hormonal manipulation the 5-year biochemical outcome was significantly reduced in patients with >or= 67% positive core biopsies. These significant differences did not exist in patients receiving > 70.2 Gy and long-term hormonal therapy.

CONCLUSION

Our results suggest that high PCB% could be a predictor of biochemical relapse, especially in the intermediate risk group. The role of PCB% in prostate cancer should be investigated in further trials.

Dosimetric analysis for thyroid disorders after radiotherapy to the neck

e17025

Background: In our study, we aimed to evaluate the possible predictors of thyroid disorders after radiotherapy to the neck, focusing on radiation dose-volume factors. Methods: Thyroid function was measured in 65 patients treated with radiation ports including the thyroid, between 2005 and 2008. All of the radiation-induced thyroid dysfunction was determined with an endpoint of abnormal thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and thyroxine (fT4), thyroglobulin antibodies (ATG), thyroid peroxidase antibodies (TPA), thyroid binding globulin (TBG) levels. In 65 patients, radiation dose-volume parameters were calculated; e.g. total volume of the thyroid, mean radiation dose to the thyroid, and percentage of the thyroid volume which received radiation doses of no less than 10–50 Gy (V10-V50). The evaluated risk factors for thyroid dysfunction included these dose-volume parameters, sex, age, treatment modality and primary disease. Results: Most patients (72.3%) had a normal thyroid function, 17 (26.2%) hypothyroidism, 1 (1.5%) hyperthyroidism, and 12 (18.4%) thyroiditis with normal thyroid function. Four of 17 patients with hypothyroidism had overt hypothyroidism. In our analysis, DVHs (dose volume histograms) were calculated and no associations were found between the V10, V20, V40, and V50 percentages and thyroid disorders. V30 and minimum absorbed thyroid dose (Dmin) more than 25 Gy appeared to be correlated with high TSH values (p = 0.01 and p = 0.04, respectively). The patients with hypothyroidism were between 40–60 years. Female gender was associated with a higher incidence of TBG abnormality. Baseline TSH values were available in 16 patients, and hypothyroidism was diagnosed in 4 (25%) of them. No correlation was found between tumor-related variables and incidence of thyroid disorders. Conclusions: Thyroid disorders after radiation therapy to the neck still represent a clinically underestimated problem. Further prospective well designed studies on dose-effect relationship for radiotherapy-induced thyroid toxicity are therefore needed, and thyroid should be considered as an organ at risk in all patients treated for head and neck tumors.

No significant financial relationships to disclose.

Efficacy of protracted dose-dense temozolomide (TMZ) in patients with progressive high-grade glioma

e13018

Background: The study was aimed to evaluate the efficacy of TMZ on a protracted dose-dense schedule after standard 5-day TMZ regimen in patients with progressive high-grade glioma. Methods: In this phase II prospective study, patients who had progression on standard 5-day TMZ for recurrence (group 1) or recurrence after concurrent radiotherapy+TMZ and ≥ 2 cycles of adjuvant TMZ (group 2) for high-grade glioma received TMZ 100 mg/m2× 21 q28 days until progression according to MacDonald's criteria. Patients were included in the study after ethical committee approval and written informed consent. The primary end-point was 6 months PFS. Secondary end-points were OS and toxicity. Results: Between October 2006 and October 2008, 25 patients were included in the study. Nine of the patients were group 1 and 16 of them were group 2. Male/female ratio was 18/7. The median age was 50 (range, 18–70) and median KPS score was 80 (range, 50–100). The histopathology was glioblastoma in 18 and grade 3 glioma (anaplastic astrocytoma, anaplastic oligoastrocytoma or anaplastic oligodendroglioma) in 7. The median cycles of 5-day TMZ received before study entry was 6 (range, 2–18) in group 1 and 6 (2–7) in group 2. With a median follow up of 6 months (1–14 months) the median number of 21-day TMZ cycles received was 2 (range, 1–8). Radiological evaluation could not be performed in 5 patients because of early clinical progression. The best response during treatment was partial response in 2 (8%), stable disease in 9 (36%), and progression in 9 (36%) out of 20 patients assessed. The median time to progression was 2 months (1–8 months) and 6 months PFS rate was 11%. The median OS time was 8 months and 1 year OS rate was 38%. Out of 80 cycles received there was no anemia; 5 (6%) grade 1, 8 (10%) grade 2, 2 (3%) grade 3 leucopenia; 1 (1%) grade 1, 2 (3%) grade 2, 1 (1%) grade 3, 1 (1%) grade 4 thrombocytopenia; 9 (11%) grade 1, 7 (9%) grade 2, 32 (40%) grade 3, and 11 (14%) grade 4 lymphopenia. Study was terminated in 2 patients (one with grade 4 thrombocytopenia and the other with grade 4 hepatic toxicity). There was no dose reduction in the study drug due to toxicity. Conclusions: Protracted dose-dense TMZ after 5-day schedule for recurrent or progressive disease has modest efficacy with tolerable toxicity.

No significant financial relationships to disclose.

Concomitant administration of uracil-tegafur and leucovorin during adjuvant radiotherapy for locally advanced rectal cancer

PURPOSE

We report the feasibility and toxicity profile, and the impact on local control, disease-free survival and overall survival rates of our study which consisted of postoperative concurrent chemoradiotherapy, followed by adjuvant chemotherapy using uracil-tegafur (UFT)/leukovorin (LV) in locally advanced rectal cancer patients.

PATIENTS AND METHODS

Thirty-one patients operated for rectal adenocarcinoma (pT3/4 or N+) were enrolled onto the study. Twenty-three patients were males and 8 females with median age 62 years (range 21-85). Radiotherapy (RT) to the pelvis with conformal technique and individual blocks was delivered within 8 weeks following surgery. Total RT dose was 50.4 Gy and was given in a conventional single fraction of 1.8 Gy per day. Chemotherapy was administered concomitantly and consisted of UFT (300 mg/m(2)/day) and LV (30 mg/day) during RT-days. Following chemoradiotherapy, chemotherapy alone was administered for 4 cycles in the same dose for 28 days every 35 days.

RESULTS

No lethal toxicity occurred. All patients completed the scheduled RT. Concurrent chemotherapy continued in 22 (70.9%) patients until the end of RT. Seventeen (54.8%) patients completed the whole concurrent chemoradiotherapy and adjuvant chemotherapy as planned. No grade 3-4 stomatitis/mucositis or haematological toxicities were observed during the whole treatment period. During concomitant therapy grade 1-2 toxicities were: nausea/vomiting 60%, dyspepsia/gastric pain 39%, diarrhea 39% and dysuria 10%, whereas grade 3 nausea and diarrhea occurred in 6% and 19%, respectively. Median follow-up was 22 months. Two-year local control, disease-free survival and overall survival rates were 96.3%, 72.3% and 83.2%, respectively.

CONCLUSION

The acute toxicity profile of UFT/LV, local control, disease-free survival and overall survival in the concurrent chemoradiotherapy setting for operated, locally advanced rectal cancer seem comparable with the standard 5-fluorouracil (5-FU)-based therapies.

Tolerability assessment of urasil-tegafur (UFT)/folinic acid (FA) as concurrent chemoradiation (CRT) in adjuvant rectal cancer treatment

13559

Background: The objective of the present phase II study was to evaluate the feasibility of UFT and FA as a concomittant CRT administration for rectal cancer in the adjuvant setting. Methods: Between October 2003 and December 2005 thirty-one (10 female; 21 male) patients were treated. All the patients were locally advanced (T2N1–2M0 (2), T3N0M0 (12), T3–4N1M0 (9), T3–4N2M0 (7)) and median age was 62 (range, 21–85). Inclusion criteria were WHO 0–1, age ≥ 18, complete tumor resection, stage T3/4 or N+, adequate CBC, liver function tests and signed informed consent form. RT was performed in 8 weeks following the surgery and the dose was 50.4 Gy given at 1.8 Gy daily. Chemotherapy consisted of UFT (300 mg/m2/day) and FA (30 mg/day) during week-days of radiotherapy and continued 4 cycles with same dose (D1–28/35days) after CRT. Acute toxicity was assessed according to CTC 2.0 criteria. Results: Median follow-up for all patients was 12 months (between 3–27 months). No toxic death occurred. CRT related side effects were diarrhea Gr 2 (25%) and Gr 3 (25%); emesis Gr 2 (29%) and Gr 3 (10%); dysuria Gr 2 (10%) and Gr 3 (10%). All patients completed radiotherapy but 21 out of 31 (67%) continued with UFT/LV until the end of concurrent treatment. The full compliance to the adjuvant CT part was 63%. During the adjuvant CT period there were diarrhea Gr 3–4 (10%), emesis Gr 3 (10%) and no Gr 3–4 hematological toxicity observed during the whole treatment. During the study period none of the patients failed locally, 3 patients developed distant metastases (2 liver, 1 bone), and 3 patients died (1 with disease, 2 without). Two-year disease-free and overall survival rates were 84% and 71%, respectively. Conclusion: The acute and subacute toxicity of CRT with UFT/LV is acceptable and seems comparable to infusional 5-FU based combined modality treatments.

No significant financial relationships to disclose.