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White MJ, Kolbow M, Prathibha S, Praska C, Ankeny JS, LaRocca CJ, Jensen EH, Tuttle TM, Hui JYC, Marmor S. Chemotherapy refusal and subsequent survival in healthy older women with high genomic risk estrogen receptor-positive breast cancer. Breast Cancer Res Treat 2023; 198:309-319. [PMID: 36692668 DOI: 10.1007/s10549-023-06862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC. METHODS Retrospective review of the National Cancer Database (2010-2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane-Armitage test, multivariable logistical regression modeling, the Kaplan-Meier method, and Cox's proportional hazards modeling. RESULTS 6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014-2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65-74 (92% vs 95%) and 75-79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04-1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80-1.51). CONCLUSIONS Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65-79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.
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Affiliation(s)
- McKenzie J White
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Madison Kolbow
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Saranya Prathibha
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Corinne Praska
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
- School of Medicine and Public Health, Department of Surgery, Clinical Science Center, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Jacob S Ankeny
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Christopher J LaRocca
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Eric H Jensen
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Jane Y C Hui
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA.
- Center for Clinical Quality & Outcomes Discovery & Evaluation (C-QODE), University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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Kwok CCH, Wong WH, Chan LL, Wong SPY, Wang F, Wong MCS, Tse SLA. Effects of primary granulocyte-colony stimulating factor prophylaxis on neutropenic toxicity and chemotherapy dose delivery in Chinese patients with breast cancer who received adjuvant docetaxel plus cyclophosphamide chemotherapy: a retrospective cohort study. Hong Kong Med J 2022; 28:438-446. [PMID: 36261264 DOI: 10.12809/hkmj219439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION This study was performed to examine the effects of primary granulocyte-colony stimulating factor (G-CSF) prophylaxis on neutropenic toxicity, chemotherapy delivery, and hospitalisation among Chinese patients with breast cancer in Hong Kong. METHODS This retrospective study included patients with breast cancer who received adjuvant docetaxel plus cyclophosphamide chemotherapy from November 2007 to October 2013 at Princess Margaret Hospital. Data were collected regarding the usage of G-CSF prophylaxis; incidences of grade 3 or 4 neutropenia, febrile neutropenia, non-neutropenic fever, and infection; hospital admissions, and chemotherapy dose delivery. Patients who began to receive G-CSF prophylaxis during the first cycle of chemotherapy and continued such prophylaxis in subsequent cycles were regarded as the primary G-CSF prophylaxis group. RESULTS In total, 231 female Chinese patients with breast cancer were included in the analysis. Overall, 193 (83.5%) patients received primary G-CSF prophylaxis. The demographics and tumour characteristics were comparable between patients with and without primary G-CSF prophylaxis. Primary G-CSF prophylaxis significantly reduced febrile neutropenia incidence from 31.6% to 14.5% (relative risk=0.45, 95% confidence interval=0.25-0.81). Primary G-CSF prophylaxis also significantly reduced the incidence of grade 3 or 4 neutropenia from 57.9% to 24.7% (relative risk=0.43, 95% confidence interval=0.30-0.62) and the incidence of febrile neutropenia-related hospital admission from 31.6% to 12.4% (P=0.025). Finally, it enabled more patients to receive adequate chemotherapy dose delivery. CONCLUSION Primary G-CSF prophylaxis effectively reduced the incidences of grade 3 or 4 neutropenia and febrile neutropenia, while enabling adequate chemotherapy dose delivery and reducing hospital admissions among Chinese patients with breast cancer who received adjuvant docetaxel plus cyclophosphamide chemotherapy.
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Affiliation(s)
- C C H Kwok
- Department of Oncology, Princess Margaret Hospital, Hong Kong
| | - W H Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong
| | - L L Chan
- Department of Oncology, Princess Margaret Hospital, Hong Kong
| | - S P Y Wong
- Department of Surgery, Princess Margaret Hospital, Hong Kong
| | - F Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - M C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - S L A Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Wiesweg M, Eberhardt WE, Schuler M, Plönes T. [Treatment of early and locally advanced stages of non-small cell lung cancer]. Inn Med (Heidelb) 2022; 63:717-723. [PMID: 35925268 DOI: 10.1007/s00108-022-01366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
Treatment concepts for patients with localized and locally advanced non-small cell lung cancer (NSCLC) are based on local treatment, surgery and/or radiotherapy, with curative intent. An adjuvant systemic treatment is added after primary resection of an operable NSCLC primarily to reduce the systemic risk of relapse. Locally advanced stages with mediastinal lymph node involvement carry a substantial risk of local and distant recurrence and require multimodal treatment strategies in an interdisciplinary approach. Recently, immunotherapy with programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) checkpoint inhibitors is increasingly being integrated into adjuvant, neoadjuvant or perioperative treatment concepts.
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Affiliation(s)
- Marcel Wiesweg
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - Wilfried E Eberhardt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Martin Schuler
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Till Plönes
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
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Yang MX, Li QL, Wang DQ, Ye L, Li KM, Lin XJ, Li XS, Fu C, Ma XM, Guo YK, Yin RT, Yang ZG. Myocardial microvascular function assessed by CMR first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies. Eur Radiol 2022. [PMID: 35579712 DOI: 10.1007/s00330-022-08823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Cancer chemotherapy potentially increases the risk of myocardial ischemia. This study assessed myocardial microvascular function by cardiac magnetic resonance (CMR) first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies. METHODS A total of 81 patients treated with chemotherapy for gynecologic malignancies and 39 healthy volunteers were prospectively enrolled and underwent CMR imaging. Among the patients, 32 completed CMR follow-up, with a median interval of 6 months. The CMR sequences comprised cardiac cine, rest first-pass perfusion, and late gadolinium enhancement. RESULTS There were no significant differences in the baseline characteristics between the patients and normal controls (all p > 0.05). Compared with the normal controls, the patients had a lower myocardial perfusion index (PI) (13.62 ± 2.01% vs. 12% (11 to 14%), p = 0.001) but demonstrated no significant variation with an increase in the number of chemotherapy cycles at follow-up (11.79 ± 2.36% vs. 11.19 ± 2.19%, p = 0.234). In multivariate analysis with adjustments for clinical confounders, a decrease in the PI was independently associated with chemotherapy treatment (β = - 0.362, p = 0.002) but had no correlation with the number of chemotherapy cycles (r = - 0.177, p = 0.053). CONCLUSION Myocardial microvascular dysfunction was associated with chemotherapy treatment in patients with gynecologic malignancies, and can be assessed and monitored by rest CMR first-pass perfusion. KEY POINTS • Chemotherapy was associated with but did not aggravate myocardial microvascular dysfunction in patients with gynecologic malignancies. • Rest CMR first-pass perfusion is an ideal modality for assessing and monitoring alterations in myocardial microcirculation during chemotherapy treatment.
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Vermeulin T, Lahbib H, Lucas M, Czernichow P, Jusot F, Di Fiore F, Merle V. Are patients living far from hospital at higher risk of late adjuvant chemotherapy for colon cancer? Br J Clin Pharmacol 2022; 88:3903-3910. [PMID: 35293007 DOI: 10.1111/bcp.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/23/2021] [Revised: 02/10/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Late adjuvant chemotherapy (aCT) administration after colectomy (> 56 days) is known to be associated with impaired prognosis. We aim to identify risk factors associated with late aCT, especially the travel time between patients' home and hospital. METHOD We performed a retrospective monocentre cohort study. Patients included had a colectomy for a stage III or "high risk" stage II colon cancer between 2009 and 2015 performed at a French university hospital. Risk factors for late aCT were identified using a fractional polynomial logistic regression. RESULTS Ninety-four patients were included. The risk of late aCT was associated with travel time length, emergent colectomy, the need for scheduled care before aCT, and length of time between colectomy and postoperative multidisciplinary meeting advising aCT. CONCLUSION Our study suggests that, in patients with colon cancer, factors unrelated to disease severity and complexity could be associated with a higher risk of late aCT.
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Affiliation(s)
- Thomas Vermeulin
- Centre Henri Becquerel, Department of Medical Information, Rouen, France.,Rouen University Hospital, Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France.,Paris sciences et lettres, Paris-Dauphine University, Leda-Legos, Paris, France
| | - Hana Lahbib
- Rouen University Hospital, Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France
| | - Mélodie Lucas
- Rouen University Hospital, Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France.,Le Havre Hospital, Le Havre, France
| | - Pierre Czernichow
- Rouen University Hospital, Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France
| | - Florence Jusot
- Paris sciences et lettres, Paris-Dauphine University, Leda-Legos, Paris, France
| | - Frédéric Di Fiore
- Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.,Centre Henri Becquerel, Department of Oncology, Rouen, France
| | - Véronique Merle
- Rouen University Hospital, Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France.,Normandie Univ, UNICAEN, Inserm U 1086, Caen, France
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Choi J, Oh JY, Lee YS, Min KH, Shim JJ, Choi SI, Park DW, Park CK, Kang EJ, Yong HS, Shin BK, Kim HK, Lee SY. Clinical efficacy of adjuvant chemotherapy in stage IB (< 4 cm) non-small cell lung cancer patients with high-risk factors. Korean J Intern Med 2022; 37:127-136. [PMID: 32872735 PMCID: PMC8747921 DOI: 10.3904/kjim.2020.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Adjuvant chemotherapy is the standard of care for resected stage II-IIIA non-small cell lung cancer (NCSLC). The efficacy of adjuvant chemotherapy in stage IB (< 4 cm) NSCLC with high-risk factors is controversial. METHODS This retrospective multicenter study included 285 stage IB NSCLC patients with high-risk factors according to the 8th edition tumor, node, metastasis (TNM) classification from four academic hospitals. High-risk factors included visceral pleural invasion, vascular invasion, lymphatic invasion, lung neuroendocrine tumors, and micropapillary histology patterns. RESULTS Of the 285 patients, 127 (44.6%) were included in the adjuvant chemotherapy group and 158 (55.4%) were included in the non-adjuvant chemotherapy group. The median follow-up was 41.5 months. Patients in the adjuvant chemotherapy group had a significantly reduced recurrence rate and risk of mortality than those in the non-adjuvant chemotherapy group (hazards ratio, 0.408; 95% confidence interval, 0.221 to 0.754; p = 0.004 and hazards ratio, 0.176; 95% confidence interval, 0.057 to 0.546; p = 0.003, respectively). Adjuvant chemotherapy should be particularly considered for the high-risk factors such as visceral pleural involvement or vascular invasion. Based on the subgroup analysis, adjuvant chemotherapy should be considered when visceral pleural involvement is present, even if the tumor size is < 3 cm. CONCLUSION Adjuvant chemotherapy may be useful for patients with stage IB NSCLC with high-risk factors and is more relevant for patients with visceral pleural involvement or vascular invasion.
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Affiliation(s)
- Juwhan Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Jeong Shim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sue In Choi
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Kwon Park
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Bong Kyung Shin
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Sung Yong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
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Kim SI, Kim JY, Wee CW, Lee M, Kim HS, Chung HH, Lee TS, Jeon HW, Park NH, Song YS, Kim TH. Survival impact of additional chemotherapy after adjuvant concurrent chemoradiation in patients with early cervical cancer who underwent radical hysterectomy. BMC Cancer 2021; 21:1260. [PMID: 34809599 PMCID: PMC8609857 DOI: 10.1186/s12885-021-08940-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH). METHODS We included high- or intermediate-risk patients from two institutions, with 2009 FIGO stage IB-IIA, who underwent primary RH and pelvic lymphadenectomy between January 2007 and June 2020, and had completed adjuvant CCRT. Survival outcomes were compared between patients who received additional chemotherapy (study group) and those who did not (control group). RESULTS A total of 198 patients were included in this analysis. The study (n = 61) and control groups (n = 137) had similar patient age, histologic cancer type, 2009 FIGO stage, and tumor size. However, minimally invasive surgery was performed less frequently in the study group than in the control group (19.7% vs. 46.0%, P < 0.001). The presence of pathologic risk factors was similar, except for lymph node metastasis, which was more frequent in the study group (72.1% vs. 46.0%; P = 0.001). In survival analyses, no differences in the disease-free survival (DFS; P = 0.539) and overall survival (OS; P = 0.121) were observed between the groups. Multivariate analyses adjusting for surgical approach and other factors revealed that additional chemotherapy was not associated with DFS (adjusted HR, 1.149; 95% CI, 0.552-2.391; P = 0.710) and OS (adjusted HR, 1.877; 95% CI, 0.621-5.673; P = 0.264). The recurrence patterns did not differ with additional chemotherapy. Consistent results were observed in a subset of high-risk patients (n = 139). CONCLUSIONS Additional chemotherapy after CCRT might not improve survival outcomes in patients with early cervical cancer who undergo RH.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeong Yun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hye Won Jeon
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Tae Hun Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Ahn HR, Kang SY, Youn HJ, Jung SH. Hyperglycemia during Adjuvant Chemotherapy as a Prognostic Factor in Breast Cancer Patients without Diabetes. J Breast Cancer 2020; 23:398-409. [PMID: 32908790 PMCID: PMC7462816 DOI: 10.4048/jbc.2020.23.e44] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Breast cancer treatments, including chemotherapy, administered in combination with glucocorticoids can induce hyperglycemia. This study aimed to investigate the effect of hyperglycemia during adjuvant chemotherapy on the prognosis of breast cancer patients without a known history of diabetes. Methods In this study, 936 patients who underwent breast cancer surgery from 2010 to 2015 were initially selected as participants. Chemotherapy-related hyperglycemia was defined as fasting plasma glucose levels ≥ 100 mg/dL or random blood glucose levels ≥ 140 mg/dL during 2 or more cycles of adjuvant chemotherapy. After dividing the patients into the euglycemia and hyperglycemia groups, univariate and multivariate analyses were performed, and survival outcomes were analyzed by propensity score matching. Results The mean age of the patients was 47.4 ± 7.7 years, and the median follow-up period was 70.1 months. Eighty-two patients (19.4%) were diagnosed as having hyperglycemia. There were significant differences between the euglycemia and hyperglycemia groups with respect to age, hypertension, body mass index, axillary surgery extents, nodal stage, and total steroid dosage. T stage, vascular invasion, and hyperglycemia were identified as prognostic factors of relapse-free survival (RFS). The 5-year RFS rates were 92.0% and 82.3% in the euglycemia and hyperglycemia groups, respectively, and there was a statistically significant difference between the 2 groups (p = 0.011). The 5-year overall survival rates were 94.6% and 92.0% in the euglycemia and hyperglycemia groups, respectively, showing no statistically significant difference between the 2 groups (p = 0.113). Conclusion These data suggest that hyperglycemia during adjuvant chemotherapy is a prognostic factor for RFS in breast cancer patients without diabetes.
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Affiliation(s)
- Ha Rim Ahn
- Department of Surgery, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University and Biomedical Research Institute, Jeonju, Korea
| | - Sang Yull Kang
- Department of Surgery, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University and Biomedical Research Institute, Jeonju, Korea
| | - Hyun Jo Youn
- Department of Surgery, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University and Biomedical Research Institute, Jeonju, Korea
| | - Sung Hoo Jung
- Department of Surgery, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University and Biomedical Research Institute, Jeonju, Korea
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Niemetz I, Faß J, Wolf M. [Multiple recurrent retroperitoneal liposarcoma in a 66-year-old man]. Internist (Berl) 2020; 61:217-22. [PMID: 31712872 DOI: 10.1007/s00108-019-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this article, the authors present the case of a 66-year-old man who was diagnosed with the first recurrence of his retroperitoneal liposarcoma 7 years after initial diagnosis. In the following 10 years, he needed a total of eight operations, chemotherapy, and radiotherapy because of another seven recurrences. This is the first report on a patient with eight recurrences of a retroperitoneal liposarcoma being in a relatively good general condition even 17 years after initial diagnosis.
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Wang YT, Li B, Li XG, Ma SK, Zhang R, Wu LY. [Efficacy and side effect analysis of paclitaxel liposome for neoadjuvant chemotherapy in locally advanced cervical cancer]. Zhonghua Fu Chan Ke Za Zhi 2019; 54:588-594. [PMID: 31550774 DOI: 10.3760/cma.j.issn.0529-567x.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the efficacy and side effect of paclitaxel liposome for neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer. Methods: This study were included 265 cervical cancer patients staging Ⅰb2 and Ⅱa2 who underwent paclitaxel-platinum NACT followed by radical surgery from June 2008 to December 2016 in the Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. All patients were classified into two groups with 106 patients in paclitaxel liposome group and 159 patients in traditional paclitaxel group. The difference in clinicopathologic characteristics, efficacy and side effect were analyzed retrospectively between the two groups. Results: (1) Clinicopathologic characteristics: there were no significant difference in clinicopathologic characteristics between the two groups, including age, body mass index, clinical stage, pathological histology, cycles of NACT, combined platinum regimen, lymph-vascular space invasion, lymph node metastasis, deep stromal invasion, and postoperative adjuvant therapy (all P>0.05). (2) Efficacy: after NACT, the overall response occurred in 90 (15 complete response plus 75 partial response) of 106 cases in the paclitaxel liposome group versus 131 (21 complete response plus 110 partial response) of 159 cases in the traditional paclitaxel group without statistical significance (84.9% vs 82.4%; χ(2)=0.291, P=0.590). A total of 248 patients received surgery after NACT and were evaluable in survival. The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of these patients was 85.1% and 88.2%. The 5-year RFS rate in the paclitaxel liposome group was 85.9% compared with 85.2% in the traditional paclitaxel group, while the corresponding 5-year OS rate was 88.5% and 88.7%, respectively. There was no statistically significant difference in efficacy between the two groups (P=0.968, P=0.797). (3) Side effect: the incidence of allergic reaction between the paclitaxel liposome group and the traditional paclitaxel group was 0 versus 1.9% (3/159) without statistical significance (P=0.277). But the incidence of neurotoxicity in the paclitaxel liposome group significantly decreased compared with the traditional paclitaxel group (6.6% vs 15.7%, P<0.05), as well as the incidence of alopecia (67.9% vs 79.2%, P<0.05) and myalgia (17.9% vs 28.9%, P<0.05). However, significant differences were not found in terms of hematological toxicity, gastrointestinal reaction, and hepatic function damage (P>0.05). Conclusion: In paclitaxel-platinum NACT of local advanced cervical cancer, paclitaxel liposome can achieve similar efficacy compared with traditional paclitaxel, but paclitaxel liposome is helpful in decreasing the toxicity of neurotoxicity, alopecia and myalgia.
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Affiliation(s)
- Y T Wang
- Department of Gynecologic Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
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Topolovec Z, Horvat T, Vidosavljević D, Šijanović S, Müller-Vranješ A, Ugljarević M, Milojković D, Topolovec S. Prognostic SIGNIFICANCE of Cytoreductive Therapy of Ovarian Cancer - eastern Croatia experience. Acta Clin Croat 2019; 58:311-320. [PMID: 31819328 PMCID: PMC6884378 DOI: 10.20471/acc.2019.58.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this retrospective study was to present the impact of successful optimal cytoreductive therapy on the overall prognosis of ovarian cancer treatment. Several factors were analyzed, including clinical (stage, age and parity), histopathologic/cytological (histologic type and grade of tumors, cytological findings of ascites or peritoneal washout), and therapeutic (surgery performed with the degree of cytoreduction, adjuvant chemotherapy and response to therapy). The study included 126 patients treated during a 5-year period at the Department of Gynecology and Obstetrics, Osijek University Hospital Centre in Osijek. Patient age ranged from 29 to 82, total 5-year survival was 55.5% and median survival was 76.2 months. Optimal cytoreduction (residual tumor <1 cm) was performed in 49.2% of patients. On data analysis, the life chart method, χ2-test and Cox regression analysis were used. The level of significance was set at p<0.05. Parity, histologic tumor grade, presence of malignant cells in ascites and peritoneal washout, as well as clinical stage yielded statistical significance on univariate analysis. Cytoreductive ovarian cancer therapy turned out to be a significant prognostic factor and on multivariate analysis proven to be an independent prognostic factor. Optimal cytoreduction, besides direct effect on survival, improved the quality of therapeutic response of the tumor to chemotherapy.
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Affiliation(s)
| | - Teodora Horvat
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Domagoj Vidosavljević
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Siniša Šijanović
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Andrijana Müller-Vranješ
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Margareta Ugljarević
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Dimitrije Milojković
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Stjepan Topolovec
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Osijek University Hospital Centre, Osijek, Croatia; 3Department of Obstetrics and Gynecology, Vukovar General Hospital, Vukovar, Croatia; 4Department of English Language and Literature, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Baek SH, Bae SJ, Yoon CI, Park SE, Cha CH, Ahn SG, Kim YS, Roh TS, Jeong J. Immediate Breast Reconstruction Does Not Have a Clinically Significant Impact on Adjuvant Treatment Delay and Subsequent Survival Outcomes. J Breast Cancer 2019; 22:109-119. [PMID: 30941238 PMCID: PMC6438834 DOI: 10.4048/jbc.2019.22.e7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/25/2018] [Indexed: 01/11/2023] Open
Abstract
Purpose The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. Methods We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. Results Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. Conclusion IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.
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Affiliation(s)
- Seung Ho Baek
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ik Yoon
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - So Eun Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Hwan Cha
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Departments of Plastic & Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Departments of Plastic & Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Shen J, Guo SW, Jin G. [Progress in clinical research of pancreatic cancer: from "resection" to "cure"]. Zhonghua Wai Ke Za Zhi 2019; 57:72-77. [PMID: 30612395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Because of the high malignancy of pancreatic ductal adenocarcinoma, the cancer-related mortality of pancreatic ductal adenocarcinoma is increasing year by year. Despite advance in surgical techniques, the 5-year survival rate of patients after resection is still less than 30%. Recent studies have found that pancreatic ductal adenocarcinoma is a systemic disease, which may not be cured completely by up-front resection, but requires perioperative multidisciplinary therapy. With the concept of "potentially curable pancreatic cancer" , clinicians need to evaluate the resectability of pancreatic ductal adenocarcinoma accurately before operation, and use the innovative multidisciplinary therapy including neoadjuvant chemoradiotherapy,surgery and adjuvant chemoradiotherapy to improve the R0 resection rate and reduce the risk of early metastasis. Therefore, the therapeutic goal of pancreatic ductal adenocarcinoma is no longer "simple resection" , but long survival through perioperative multidisciplinary treatment. In this article, we briefly introduce the progress of resectability assessment, surgical techniques and perioperative adjuvant therapy of "potentially curable pancreatic cancer" .
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Affiliation(s)
- J Shen
- Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China (Shen Jing is working on the Department of General Surgery, No.971 Hospital of NAVY, Qingdao 266071, China)
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Wu YJ, Qin R, He JM, Cao ZY, Dong LG, Yang B. [The influence of chemotherapy-induced leucopenia on the disease-free survival of gastric cancer patients after radical gastrectomy]. Zhonghua Yi Xue Za Zhi 2018; 98:1919-1922. [PMID: 29996282 DOI: 10.3760/cma.j.issn.0376-2491.2018.24.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the association between chemotherapy-induced leucopenia and patients' disease-free survival in gastric cancer patients who received radical gastrectomy. Methods: The clinical data of 273 gastric cancer patients who received radical gastrectomy and postoperative adjuvant chemotherapy between January, 2010 and December, 2015 in PLA 309(th) hospital was reviewed retrospectively. Results: A total of 195 (71.4%) patients experienced at least one time of leucopenia, while it was absent in the other 78 (28.6%) patients. The median disease-free survival of patients with or without leucopenia was 49.7 and 44.0 months respectively (P=0.009), leucopenia was an independent factor influencing patients' disease-free survival (HR=2.758, P=0.022), but there was no statistical difference between the disease-free survival of patients with different degrees and frequency of leucopenia (P=0.446, 0.123). Conclusion: Chemotherapy-induced leucopenia is a predictor of good prognosis for gastric cancer patients who receive radical gastrectomy.
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Affiliation(s)
- Y J Wu
- Department of General Surgery, PLA 309th Hospital, Beijing 100091, China
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15
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Hurtz HJ, Tesch H, Göhler T, Hutzschenreuter U, Harde J, Kruggel L, Jänicke M, Marschner N; TMK-Group (Tumour Registry Breast Cancer). Persistent impairments 3 years after (neo)adjuvant chemotherapy for breast cancer: results from the MaTox project. Breast Cancer Res Treat 2017; 165:721-31. [PMID: 28677012 DOI: 10.1007/s10549-017-4365-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/27/2017] [Indexed: 12/20/2022]
Abstract
Purpose Although treatment for early breast cancer improved prognosis greatly, it can have significant long-term consequences, which must be considered during treatment decision. Methods 453 patients with neoadjuvant or adjuvant treatment intention were recruited into the MaTox project within the prospective, multicentre, population-based German TMK cohort study (Tumour Registry Breast Cancer) between 2008 and 2009. Patient-reported outcomes (PROs) on 26 treatment-related symptoms were assessed via a specifically designed questionnaire at 4 weeks, 6 months, 18 months and 3 years after start of systemic treatment. Results The results show that alterations in smell, taste and appetite were clearly improved 3 years after treatment. In contrast, post-surgical symptoms, restrictions in memory/attention, musculoskeletal system and polyneuropathy worsened substantially over time and were persistent after 3 years: 78% of the patients recorded impairment in memory, 73% muscle pain, 67% pain at the operated site and 57% paraesthesia in fingers or toes. A logistic regression model showed that risk factors for developing persistent paraesthesia symptoms were age, early paraesthesia symptoms and taxane-based therapy. Conclusions Our data show that most patients with breast cancer have persistent impairments negatively influencing their daily life even 3 years after treatment. Furthermore, we highlight areas requiring special attention in follow-up care. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4365-7) contains supplementary material, which is available to authorized users.
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Abstract
INTRODUCTION Neoadjuvant chemotherapy is commonly used in stage III breast cancer for disease down-staging. Its use has now been extended to early breast cancer to increase the rate of breast-conserving surgery. This study aimed to evaluate the effectiveness of neoadjuvant chemotherapy in early operable cancers. METHODS A retrospective study was carried out at the Hong Kong Sanatorium & Hospital of 102 patients with stage I to III primary breast cancer. All patients who underwent neoadjuvant chemotherapy followed by definitive breast surgery between January 2004 and July 2013 were included. Their pathological complete response and rate of breast-conserving surgery were studied. Data were compared using Chi squared test and Student's t test. RESULTS After neoadjuvant chemotherapy, 23% of patients achieved a pathological complete response, of whom 80% had human epidermal growth factor receptor 2 (HER2)-positive disease or triple-negative disease. Hormonal receptor negativity was associated with a higher pathological complete response rate (P<0.05) that was in turn associated with a higher likelihood of breast-conserving surgery (P=0.028). Patients with stage II disease were more likely to convert from mastectomy to breast-conserving surgery following neoadjuvant chemotherapy. CONCLUSIONS Neoadjuvant chemotherapy is a useful treatment to downsize tumour in early breast cancer, thereby increasing the rate of breast-conserving surgery. It is especially effective in patients with HER2-positive/oestrogen receptor-negative disease or triple-negative disease.
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Affiliation(s)
- V Cm Man
- Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | - P Sy Cheung
- Breast Care Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
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Yeung WW, Ma BB, Lee JF, Ng SS, Cheung MH, Ho WM, Tsang MW, Chu S, Lam DC, Mo FK. Clinical outcome of neoadjuvant chemoradiation in locally advanced rectal cancer at a tertiary hospital. Hong Kong Med J 2016; 22:546-55. [PMID: 27795447 DOI: 10.12809/hkmj154788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review the clinical outcome of locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by definitive surgery with or without adjuvant chemotherapy and to elucidate the prognostic factors for treatment outcome. METHODS This historical cohort study was conducted at a tertiary public hospital in Hong Kong. All patients who had undergone neoadjuvant chemoradiation for locally advanced rectal cancer in our department from November 2005 to October 2014 were recruited. Local recurrence-free survival, distant metastasis-free survival, disease-free survival, and overall survival of patients were documented. RESULTS A total of 135 patients who had received neoadjuvant chemoradiation during the study period were reviewed. There were 130 patients who had completed neoadjuvant chemoradiation and surgery. The median follow-up time was 35.1 months. The 3- and 5-year local recurrence-free survival, distant metastasis-free survival, disease-free survival, as well as overall survival rates were 91.8% and 86.7%, 73.9% and 72.1%, 70.1% and 64.6%, as well as 86.5% and 68.4%, respectively. The rate of pathological complete response was 13.8%. The T and N downstaging rate was 49.2% and 63.1%, respectively. The rate of conversion from threatened circumferential resection margin to clearance of margin was 90.6%. Of the 42 cases that were initially deemed to require abdominal perineal resection, 15 (35.7%) were converted to sphincter-sparing surgery. CONCLUSIONS The treatment outcome of neoadjuvant chemoradiation for locally advanced rectal cancer was comparable with overseas data in terms of local control rate and overall survival. This strategy may increase the chance of achieving a clear surgical margin by downstaging the tumour, especially in patients who presented with threatened circumferential margin.
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Affiliation(s)
- W Wk Yeung
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - B By Ma
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J Fy Lee
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - S Sm Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - M Hy Cheung
- Department of Surgery, North District Hospital, Sheung Shui, Hong Kong
| | - W M Ho
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - M Wk Tsang
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - S Chu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - D Cm Lam
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - F Kf Mo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lubberts S, Boer H, Altena R, Meijer C, van Roon AM, Zwart N, Oosting SF, Kamphuisen PW, Nuver J, Smit AJ, Mulder AB, Lefrandt JD, Gietema JA. Vascular fingerprint and vascular damage markers associated with vascular events in testicular cancer patients during and after chemotherapy. Eur J Cancer 2016; 63:180-8. [PMID: 27322917 DOI: 10.1016/j.ejca.2016.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/26/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Metastatic testicular cancer (TC) can be cured with bleomycin, etoposide and cisplatin (BEP) chemotherapy. This comes at the price of an increased cardiovascular disease risk, not only years afterwards, but also during and shortly after chemotherapy. To prevent cardiovascular events, high-risk patients should be identified. The aim of this study was to assess BEP-chemotherapy induced vascular damage and to find risk factors for early vascular events. PATIENTS AND METHODS A prospective cohort study was performed in (B)EP treated TC patients. Development of venous and arterial vascular events was assessed. Vascular damage markers (von Willebrand factor [vWF], coagulation factor VIII [FVIII], intima media thickness [IMT]) and cardiovascular risk factors were assessed before and until 1 year after chemotherapy. Before start of chemotherapy a vascular fingerprint was estimated. Presence of ≥3 risk factors was defined as high-risk vascular fingerprint: body mass index >25 kg/m(2), current smoking, blood pressure >140/90 mm Hg, total cholesterol >5.1 and/or low-density lipoprotein >2.5 mmol/L or glucose ≥7 mmol/L. RESULTS Seventy-three patients were included. Eight (11%) developed vascular events (four arterial events, four pulmonary embolisms). vWF and FVIII increased during chemotherapy, especially in patients with vascular events. Sixteen patients (22%) had a high-risk vascular fingerprint before start of chemotherapy. These patients had arterial events more often (3/16 [19%] versus 1/57 [2%]; p = 0.031) and higher vWF levels and IMT. CONCLUSIONS Endothelial activation and upregulation of procoagulant activity seem important mechanisms involved in early (B)EP-chemotherapy-induced vascular events. Before chemotherapy, a quarter already had cardiovascular risk factors. A vascular fingerprint could identify patients at risk for arterial events. This vascular fingerprint, when validated, can be used as a tool to select patients who may benefit from preventive strategies.
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Affiliation(s)
- S Lubberts
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Boer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Altena
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C Meijer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A M van Roon
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N Zwart
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P W Kamphuisen
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Nuver
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A J Smit
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A B Mulder
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J D Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Reichardt P. [Soft tissue sarcomas and gastrointestinal stromal tumors]. Internist (Berl) 2016; 57:245-56. [PMID: 26907871 DOI: 10.1007/s00108-016-0021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Soft tissue sarcomas are rare tumors that represent a major challenge due to varying clinical presentations and often interdisciplinary treatment concepts. Gold standard for the treatment of localized resectable soft tissue sarcomas is complete surgical removal. In metastatic soft tissue sarcoma, systemic therapy is the treatment of choice. The most active drugs are anthracyclines and ifosfamide. Combination chemotherapy has improved both response rate and progression-free survival at the cost of increased toxicity. Imatinib at a dose of 400 mg/day is the gold standard for patients with advanced or metastatic gastrointestinal stromal tumors (GIST). In patients with a mutation in KIT exon 9, 800 mg/day is the recommended dose. In imatinib refractory or intolerant patients, sunitinib is recommended. Regorafenib has been approved for third-line therapy.
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Kim JH, Bae JM, Oh HJ, Lee HS, Kang GH. Pathologic Factors Associated with Prognosis after Adjuvant Chemotherapy in Stage II/III Microsatellite-Unstable Colorectal Cancers. J Pathol Transl Med 2015; 49:118-28. [PMID: 26148739 PMCID: PMC4367107 DOI: 10.4132/jptm.2015.02.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 12/16/2022] Open
Abstract
Background: Although there are controversies regarding the benefit of fluoropyrimidine-based adjuvant chemotherapy in patients with microsatellite instability–high (MSI-H) colorectal cancer (CRC), the pathologic features affecting postchemotherapeutic prognosis in these patients have not been fully identified yet. Methods: A total of 26 histopathologic and immunohistochemical factors were comprehensively evaluated in 125 stage II or III MSI-H CRC patients who underwent curative resection followed by fluoropyrimidine-based adjuvant chemotherapy. We statistically analyzed the associations of these factors with disease-free survival (DFS). Results: Using a Kaplan- Meier analysis with log-rank test, we determined that ulceroinfiltrative gross type (p=.003), pT4 (p<.001), pN2 (p=.002), perineural invasion (p=.001), absence of peritumoral lymphoid reaction (p=.041), signet ring cell component (p=.006), and cribriform comedo component (p=.004) were significantly associated with worse DFS in patients receiving oxaliplatin-based adjuvant chemotherapy (n=45). By contrast, pT4 (p<.001) and tumor budding-positivity (p=.032) were significant predictors of poor survival in patients receiving non-oxaliplatin–based adjuvant chemotherapy (n=80). In Cox proportional hazards regression model-based univariate and multivariate analyses, pT category (pT1-3 vs pT4) was the only significant prognostic factor in patients receiving non-oxaliplatin–based adjuvant chemotherapy, whereas pT category, signet ring cell histology and cribriform comedo histology remained independent prognostic factors in patients receiving oxaliplatin-based adjuvant chemotherapy. Conclusions: pT4 status is the most significant pathologic determinant of poor outcome after fluoropyrimidine-based adjuvant chemotherapy in patients with stage II/III MSI-H CRC.
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Affiliation(s)
- Jung Ho Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jeong Oh
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gyeong Hoon Kang
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Cheung PSY, Tong AC, Leung RCY, Kwan WH, Yau TCC. Initial experience with the Oncotype DX assay in decision-making for adjuvant therapy of early oestrogen receptor-positive breast cancer in Hong Kong. Hong Kong Med J 2014; 20:401-6. [PMID: 24948666 DOI: 10.12809/hkmj134140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the impact of the 21-gene Oncotype DX Breast Cancer Assay on the adjuvant treatment decision-making process for early-stage breast cancer in Hong Kong. DESIGN Retrospective study. SETTING Private hospital, Hong Kong. PATIENTS Study included cases of early-stage breast cancer (T1-2N0-1M0, oestrogen receptor-positive, human epidermal growth factor receptor 2-negative) that were presented at a multidisciplinary breast meeting at a single site. Cases were selected for Oncotype DX testing with the assistance of Adjuvant! Online. The recommendations for adjuvant therapy before and after obtaining the Oncotype DX Recurrence Score results were analysed. RESULTS A total of 154 cases that met the inclusion criteria were discussed at our multidisciplinary breast meeting. Of these, 64 cases with no clear recommendation by the Meeting Panel were selected for this study and reviewed. The distribution of Recurrence Score results was similar to that reported by others, with a somewhat higher proportion of low Recurrence Scores. Treatment recommendation was changed for 20 (31%) patients after the Oncotype DX result was received. Of the changes in treatment decisions, 16 (80%) were changes to lower-intensity regimens (either equipoise or hormonal therapy). The number of cases receiving an equipoise recommendation decreased by nine (82%), based on the additional information provided by the Oncotype DX test. CONCLUSION The Oncotype DX Recurrence Score information impacts the decision-making process for adjuvant therapy for early-stage breast cancer in the multidisciplinary care setting in Hong Kong. A larger-scale study is required to gain more experience, evaluate its impact more thoroughly, and assess its cost-effectiveness.
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Affiliation(s)
- Polly S Y Cheung
- Breast Care Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Adam C Tong
- St George's University of London, St George's Healthcare Trust, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Roland C Y Leung
- Division of Medical Oncology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W H Kwan
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Thomas C C Yau
- Division of Medical Oncology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Seok JP, Kim YJ, Cho HM, Ryu HY, Hwang WJ, Sung TY. A retrospective clinical study: complications of totally implanted central venous access ports. Korean J Thorac Cardiovasc Surg 2014; 47:26-31. [PMID: 24570862 PMCID: PMC3928259 DOI: 10.5090/kjtcs.2014.47.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 11/23/2022]
Abstract
Background When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.
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Affiliation(s)
- June Pill Seok
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Young Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Hyun Min Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Korea
| | - Han Young Ryu
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Wan Jin Hwang
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Tae Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Korea
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Portillo-Sanchez J, Hessein-Abdou Y, Puga-Alcalde E, Perez-Martinez MA, Del Carmen Jimenez-Meneses M, Camacho-Pedrero A, Valdepeñas-Herrero LR. Primary pulmonary artery sarcoma extending retrograde into the superior vena cava. Tex Heart Inst J 2011; 38:77-80. [PMID: 21423477 PMCID: PMC3060731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary pulmonary artery sarcoma is a rare tumor that is highly fatal. It can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. Herein, we report the case of a 22-year-old woman with a preoperative diagnosis of pulmonary embolism and superior vena caval thrombosis. Intraoperatively, an extensive sarcoma was seen to extend retrograde from the pulmonary artery, past the right ventricle and right atrium, and into the superior vena cava. Surgical resection of the tumor and reconstruction of the central pulmonary arteries, followed by adjuvant chemotherapy, relieved the clinical symptoms. The patient remained free of cancer at 14 months postoperatively. We believe that this is the 1st report of a primary pulmonary artery sarcoma that extended retrograde into the superior vena cava.
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Affiliation(s)
- José Portillo-Sanchez
- Departments of Internal Medicine, Hospital General Ciudad Real, 10034 Ciudad Real, Spain
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