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1.
Gretchen G. Kimmick Xiangrong Li Steven T. Fleming Susan A. Sabatino J. Frank. Wilson Joseph Lipscomb Rosemary Cress Carmen Bergom Roger T. Anderson Xiao-Cheng Wu 《Journal of Geriatric Oncology》2018,9(3):214-220
Objectives
To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death.Materials and methods
Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan–Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses.Results
Of 5852 patients, 76% were under 70 years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p < 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95% CI 1.08–5.24), but not in younger patients (HR = 1.78, 95% CI 0.87–3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95% CI 1.52–3.62), and those with severe comorbidity (HR = 3.79, 95% CI 1.72–8.33).Conclusions
Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk–benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups. 相似文献2.
Chantal Quinten C. Kenis M. Hamaker A. Coolbrandt B. Brouwers L. Dal Lago P. Neven P. Vuylsteke G. Debrock H. Van Den Bulck A. Smeets P. Schöffski A. Bottomley U. Wedding H. Wildiers 《Journal of Geriatric Oncology》2018,9(2):152-162
Objectives
We aim to assess short and long term effects of chemotherapy on patient-reported quality of life (QOL) and patient versus clinician symptom reporting in older patients with breast cancer adjusted for tumour and aging parameters.Material and Methods
In this prospective, multicentre, non-interventional, observational study, women aged ≥ 70 years were enrolled after surgery and assigned to a TC chemotherapy (docetaxel and cyclophosphamide) group or a control group depending on their planned adjuvant treatment. Longitudinal multivariate models were used to assess the statistical and minimal clinically important difference (MCID) in the impact of TC chemotherapy over time on QOL and symptom burden adjusted for baseline aging and tumour parameters. Statistical significance was set at 5% and MCID at 10 points.Results
In total, 57 patients were enrolled in the chemotherapy and 52 patients in the control group. Within the chemotherapy group, clinical deterioration was reported at 3 months for Fatigue (17.73), Dyspnoea (17.05), Diarrhoea (12.06) and Appetite Loss (17.05) scores (all p < 0.001). However, the scores had returned to baseline (or even better for Role Functioning) at year 1. No clinical deterioration was reported in the control group. Symptom scores as reported by patients were significantly (p < 0.05) higher than those reported by the clinicians, even more so for Fatigue, Dyspnoea, and Pain.Conclusion
Our results show that symptom burden and diminished QOL in an older breast cancer population receiving adjuvant TC chemotherapy are short-lived and disappear after a while with no long-term differences compared to a similar population not receiving chemotherapy. 相似文献3.
Vicki A. Morrison Linda McCall Hyman B. Muss Aminah Jatoi Harvey J. Cohen Constance T. Cirrincione Jennifer A. Ligibel Jacqueline M. Lafky Arti Hurria 《Journal of Geriatric Oncology》2018,9(3):228-234
Objective
Actual weight-based (AWB) chemotherapy dosing is recommended for obese patients in the 2012 ASCO Clinical Practice Guideline. CALGB 49907, which utilized ABW-based adjuvant chemotherapy dosing, was a phase 3 trial in women age ≥ 65 years with early stage breast cancer, providing the opportunity to examine impact of such dosing on toxicities and outcome in older patients with breast cancer.Materials and Methods
Adverse event data were available for 615 of 633 enrolled patients. Objectives were to assess grade ≥ 3 hematologic/non-hematologic toxicities by treatment arm, age, study entry BSA/BMI, and relapse-free (RFS) and overall survival (OS) by BSA/BMI.Results
The 615 patients were sub-grouped by BSA (quartiles) and standard BMI categories, with BMI underweight/normal weight categories combined. Overall, grade ≥ 3 non-hematologic and hematologic toxicities occurred in 39.8% and 28.3% of patients, respectively. There were no significant differences in grade ≥ 3 toxicities among BSA quartiles. However, more grade ≥ 3 hematologic toxicities occurred in the underweight/normal weight BMI subgroup compared to overweight/obese subgroups (p = 0.048). Type of chemotherapy and age had no impact on toxicity occurrence by BSA/BMI categories. RFS was superior in the 25th–50th BSA percentile patients in univariate analysis (p = 0.042), as was OS in both univariate and multivariate analyses (p = 0.007, p = 0.009, respectively). No differences in RFS or OS were found by BMI categories.Conclusion
Obesity was not correlated with adverse relapse or survival outcome, and grade ≥ 3 toxicities were not greater with ABW-based dosing. This supports safety and efficacy of ABW-based dosing as per the 2012 ASCO clinical practice guideline.ClinicalTrials.gov Identifier: NCT00024102 (49907). 相似文献4.
Schroder Sattar Shabbir M.H. Alibhai Margaret Fitch Monika Krzyzanowska Natasha Leighl Martine T.E. Puts 《Journal of Geriatric Oncology》2018,9(1):47-52
Purpose
Little is known about the perspectives of older adults (OAs) with newly-diagnosed cancer on their experiences with cancer treatment decision-making. The objective of this study was to explore the factors that were important for accepting or refusing cancer treatment by older adults undergoing chemotherapy and/or radiation therapy.Patients and methods
A qualitative study using semi-structured interviews with 20 OAs aged ≥ 65 years with newly diagnosed cancer (< 6 months) receiving either curative or palliative chemotherapy and/or radiation or who had declined therapy. The COREQ reporting guideline was utilized.Results
The majority of patients accepted the recommended cancer treatment. Most OAs followed their oncologist's recommendation, but spoke of making their own decisions and felt confident about their decisions. Second opinions were not commonly sought. Themes emerged can be divided into two categories: 1) pertaining to cancer treatment decision-making, which includes: “Trust in oncologist”, “prolong life”, “expected outcomes of treatment”, “other people's experience”, skeptical about going online” and “assertion of independence”, and 2) pertaining to oncologist-patient interactions, which includes “communication”.Conclusion
Older patients largely followed their cancer specialists' treatment recommendations. Most patients were satisfied with their treatment decision and were confident in their decisions. Seeking of second opinions was rare. More needs to be done to address the communication gaps and support needs of this population. 相似文献5.
I. Cho J.W. Park B. Cho J. Kwak S.M. Yoon J.P. Nesseler J. Park J.H. Kim 《Cancer radiothérapie》2018,22(8):754-762
Purpose
Stereotactic body radiation therapy is a promising treatment modality for locally advanced pancreatic cancer. To determine the optimal radiation treatment, we compared the plan characteristics of volumetric-modulated arc therapy and intensity-modulated radiation therapy when administered with stereotactic body radiation therapy to treat pancreatic cancer.Patients and methods
Fifteen patients with locally advanced pancreatic cancer were treated by stereotactic body radiation therapy at a dose of 24–32 Gy in four fractions with marker-guided gated volumetric-modulated arc therapy. Four dimensional-computed tomography scans were used to assess the target and surrounding normal organs. The same images, contours, and dose constraints were used for dual-arc volumetric-modulated arc therapy and 9-field intensity-modulated radiation therapy planning. Plans were compared using dosimetric parameters and treatment performance.Results
Volumetric-modulated arc therapy required significantly lower monitor units (1726 vs. 4188; P < 0.001) and shorter treatment delivery time in comparison with intensity-modulated radiation therapy (22.5 min vs. 52.4 min; P < 0.001). Regarding target volume coverage, both modalities demonstrated comparable results (V95%, 99.3% vs. 99.4%; P = 0.796). Both modalities satisfied the dosimetric determinants for duodenal toxicity and the maximum and mean doses administered to normal organ were also statistically similar.Conclusion
In comparison with 9-field intensity-modulated radiation therapy, volumetric-modulated arc therapy significantly reduces the number of monitoring units and treatment delivery times while administering similar dosimetric quality. Based on these results, volumetric-modulated arc therapy might be an appropriate treatment for locally advanced pancreatic cancer when combined with stereotactic body radiation therapy. 相似文献6.
Lore Decoster Cindy Kenis Benedicte Naessens Ghislain Houbier Marc De Man Guy Lambrecht Els Monsaert Veerle Moons Philippe Vergauwe Hans Prenen Eric Van Cutsem Hans Wildiers 《Journal of Geriatric Oncology》2018,9(2):93-101
Objectives
This study aims to investigate the use of chemotherapy with or without bevacizumab in older patients with metastatic colorectal cancer (mCRC) in current daily practice and to identify predictive parameters for treatment-related outcomes.Patients and Methods
This is a Belgian multi-centre, observational cohort study. Patients ≥ 70 years old with mCRC considered suitable for first-line chemotherapy were eligible for inclusion. At baseline geriatric screening and assessment was performed. Treatment choice was at the discretion of the investigator. Treatment duration, Progression Free Survival (PFS) and safety were recorded.Results
Between August 2011 and July 2013, 252 patients with mCRC were included of which 50.8% were treated with bevacizumab. Median treatment duration was 5.5 months and median PFS was 8.9 months. Approximately 50% of patients experienced severe adverse events, most frequently diarrhea. In multivariate analysis, baseline Eastern Cooperative Oncology Group (ECOG)-performance status (PS) was predictive for treatment duration (p = 0.0047), PFS (p < 0.0001) and severe toxicity and baseline nutritional status for PFS (p = 0.0007). In patients with a good ECOG-PS, nutritional status was predictive for PFS.Conclusions
In current daily practice in Belgium, half of older patients with colorectal cancer treated with chemotherapy also receive bevacizumab. Nearly half of older patients presented with severe toxicity during treatment. Baseline nutritional status is a predictive marker for PFS. Patients with a baseline ECOG-PS ≥ 2 have shorter PFS and higher risk of severe toxicity and should therefore be treated with caution. 相似文献7.
Maren Schmidt Rahel Eckardt Sarah Altmeppen Klaus-Dieter Wernecke Claudia Spies 《Journal of Geriatric Oncology》2018,9(1):53-59
Objective
To investigate the prognostic value of elements of the Geriatric Assessment, in particular the Timed Up and Go (TUG) Test and the Barthel Index of Activities of Daily Living (ADL) for one-year post-operative mortality in elderly patients with cancer.Materials and Methods
This prospective cohort study included patients 65 years of age or older undergoing elective major surgery for cancer between June 2008 and June 2010. Preoperative functional status was measured by the TUG Test and the Barthel Index of ADL Cognitive state was assessed by the Mini Mental State Examination (MMSE). Complications were recorded prospectively. The degree of resection was noted.Results
Data from 131 patients (56% women; median age, 71 years) were analysed at 1 year of follow-up. Mortality after 1 year was 28.2%. Twenty-nine patients (22.3%) were dependent in ADLs, and 43 (35.2%) impaired in TUG. Thirteen patients (10.7%) were both, dependent in ADLs and impaired in TUG. Short-term complications after surgery occurred in 66% of patients, and major complications occurred in 29%. Patients who were dependent in ADLs and impaired in TUG had significantly higher 1-year mortality (OR, 4.5; 95% CI, 1.21–18.25; p = 0.034). Lower scores on the MMSE (OR, 0.64; 95% CI, 0.43–0.95; p = 0.048) and incomplete surgical resection (OR, 3.25; 95% CI, 1.15–9.20; p = 0.026) were independently associated with higher 1-year mortality.Conclusion
Functional assessments, such as ADL and TUG scores, as well as mild cognitive impairment, are predictors of long-term outcome in elderly cancer patients.Trial Registration
German Clinical Trials Register (DRKS 00005150) 相似文献8.
Enrique Soto-Perez-De-Celis Heeyoung Kim María Patricia Rojo-Castillo Can-Lan Sun Yanin Chavarri-Guerra Ana Patricia Navarrete-Reyes James R. Waisman José Alberto Avila-Funes Álvaro Aguayo Arti Hurria 《Journal of Geriatric Oncology》2018,9(2):145-151
Objectives
Older adults with cancer in developing countries face challenges accessing healthcare due to a lack of personnel and infrastructure. A decline in physical activity (defined as a decrease in the number of daily steps) may be a novel method for the timely detection of toxicity in older adults receiving chemotherapy in resource-constrained settings.Materials and Methods
In this feasibility study, patients aged ≥ 65 years starting first-line chemotherapy for solid tumors were given a smartphone with a pedometer application. Daily steps were monitored daily for one cycle. If a ≥ 15% decrease from baseline was identified, the patient was called and the presence of toxicity assessed. The intervention would be feasible if ≥ 75% of the subjects recorded steps for ≥ 75% of the planned chemotherapy days.Results
Forty patients (median age 73; 57% [N = 23] female) were included. Seventy percent (N = 28) had stage III-IV disease with 45% (N = 18) gastrointestinal, 23% (N = 9) breast, and 32% (N = 13) other malignancies. Mean pre-treatment daily steps was 3111 (Standard Deviation [SD] 1731), and median follow-up was 21 days (range 2–28). Despite having limited exposure to mobile technology, most (93%) patients used the smartphone appropriately, and 85% found it easy to use. Sixty percent of patients (N = 24) had toxicities managed over the phone, 27.5% (N = 10) were sent for urgent medical attention and 15% (N = 6) were hospitalized.Conclusion
Using smartphones to monitor older adults with cancer receiving chemotherapy in a resource-constrained setting is feasible and acceptable. A decrease in the number of daily steps was common and helped to identify chemotherapy toxicity. 相似文献9.
Esteban T.D. Souwer Norbert M. Verweij Frederiek van den Bos Esther Bastiaannet Rob M.E. Slangen Willem H. Steup Marije E. Hamaker Johanna E.A. Portielje 《Journal of Geriatric Oncology》2018,9(2):110-114
Background
Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated.Objective
To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70 years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality.Study Design and Methods
Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤ 14 and/or ISAR-HP ≥ 2. Odds ratio (OR) is given with 95% CI.Results
Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7 years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1–5.4, p = 0.03), readmission OR 3.4 (1.1–11.0), cardiopulmonary complications OR 5.9 (1.6–22.6), longer hospital stay (10.3 versus 8.9 day) and six-months mortality OR 4.9 (1.1–23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value.Conclusions
ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality.Key Points
Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined. 相似文献10.
H.A.H. Mohamed M.A. Salem M.S. Elnaggar A. Gabr A.M. Abdelrheem 《Cancer radiothérapie》2018,22(3):236-240
Purpose
A prospective phase II study carried out to evaluate hypofractionated radiotherapy with concurrent gemcitabine for bladder preservation in the elderly patient with bladder cancer.Patients and methods
Thirty-one patients were enrolled, age ≥ 65 years, diagnosed with transitional cell carcinoma of the urinary bladder, after a maximum safe transurethral resection of a bladder tumour. They received 52.5 Gy in 20 fractions using 3D conformal radiotherapy with concurrent 100 mg/m2 gemcitabine weekly as a radiosensitizer.Results
All patients completed their radiation therapy course, while seven patients received their chemotherapy irregularly due to grade 3 toxicities. Twenty-five patients (80.6%) achieved a complete response. At 2-years, overall survival was 94.4% and disease-free survival was 72.6%. T3 and residual after transurethral resection are factors that adversely affect disease-free survival.Conclusion
Hypofractionated radiotherapy and gemcitabine as a radiosensitizer in elderly as organ preservation for transitional cell carcinoma bladder cancer have acceptable toxicity profile with good response rate and disease-free survival, keeping salvage cystectomy for persistence or recurrence of invasive cancer. 相似文献11.
Idalid Franco Yu-Hui Chen Fallon Chipidza Vishesh Agrawal John Romano Elizabeth Baldini Aileen Chen Yolonda Colson Ying Hou David Kozono Jon Wee Raymond Mak 《Journal of Geriatric Oncology》2018,9(2):130-137
Objectives
Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT).Materials and Methods
Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0–1) or frail (≥ 2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk.Results
Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0–7)]. Median age and pack-year history was 74 and 46 years, respectively. Median follow-up among survivors was 38.5 months (range 4.0–74.1 months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p = 0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p = 0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥ 2: 2.25 (1.14–4.44); p = 0.02].Conclusion
Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5 years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery. 相似文献12.
Objective
Few studies have examined the impact of cancer treatment on cognitive trajectories in the growing population of older adults diagnosed with and surviving cancer. This study examined whether recent cancer and its treatment accelerated memory decline in older adults.Materials and Methods
We conducted a secondary analysis of observations drawn from the Health and Retirement Study (2002–2012), a population-based sample of older adults in the United States. Changes in immediate (IWR) and delayed word recall (DWR) scores were estimated by latent growth modeling in individuals who never had cancer (n = 10,939) or had been diagnosed with cancer between 2000 and 2002 and received treatment with some combination of radiation and/or surgery (n = 240), chemotherapy only (n = 34), or chemotherapy and some combination of radiation and/or surgery (n = 64).Results
In the period immediately following treatment, individuals reporting a recent cancer treated with chemotherapy and surgery/radiation experienced significantly more rapid decline in IWR (b = ? 0.34, SE = 0.17, p = 0.047) and DWR (b = ? 0.38, SE = 0.19, p = 0.049) than the non-cancer group. Sensitivity analyses addressing mortality selection and memory-related disease at baseline attenuated the strength of these associations. There were no other statistically significant differences in estimated linear or quadratic slope by cancer status or treatment.Conclusion
Our results support a potential association between recent cancer treatment and trajectories of memory decline in older adults and provide guidance on the interpretation of statistical estimates from panel studies of health and aging. 相似文献13.
David M. Guttmann Nandita Mitra James M. Metz John Plastaras Weiwei Feng Samuel Swisher-McClure 《Journal of Geriatric Oncology》2018,9(1):40-46
Objectives
The aim of this study was to characterize outcomes associated with neoadjuvant chemoradiation prior to esophagectomy, compared to esophagectomy alone, in older patients with esophageal cancer.Materials and Methods
We conducted an observational cohort study in patients ≥ 70 years with locally-advanced esophageal cancer undergoing esophagectomy ± neoadjuvant chemoradiation between 2006 and 2012 using the National Cancer Database. A Cox proportional hazards model with inverse probability of treatment weighting (IPTW) using the propensity score was developed to assess the association between trimodality therapy and overall survival. Perioperative complications and pathologic outcomes associated with trimodality therapy were identified with multivariable logistic regression.Results
1364 patients were included; the mean age was 75 (range 70–90). 904 (66%) were treated with trimodality therapy and 460 (34%) were treated with esophagectomy alone. On IPTW Cox analysis, neoadjuvant chemoradiation was associated with improved overall survival (HR = 0.76, 95%CI [0.70–0.82], p ≤ 0.001). Further, trimodality therapy was associated with lower rates of margin-positive resection (5% vs. 18%; OR = 0.26, 95%CI [0.18–0.37], p < 0.001) and in 18% of trimodality patients, there was no detectable tumor at surgery. 90-day mortality rates were not statistically different (14% vs. 12%; OR = 0.99, 95%CI [0.73–1.36], p = 0.22). Neoadjuvant chemoradiation was associated with lower 30-day readmission rates (5% vs. 8%; OR = 0.48, 95%CI [0.31–0.73], p = 0.004) and shorter surgical hospital stay (median 10 vs. 12 days, p < 0.001) compared to esophagectomy alone.Conclusion
In older patients with esophageal cancer, trimodality therapy, compared to esophagectomy alone, is associated with improved overall survival and favorable pathologic and perioperative outcomes. Further studies are needed to identify which older patients are most suitable for trimodality therapy. 相似文献14.
G.A. Turgeon L. Souhami N. Kopek V. Hirsh L. Ofiara S.L. Faria 《Cancer radiothérapie》2017,21(2):89-98
Purpose
Many Canadian institutions treat limited-disease small cell lung cancer with 40 Gy in 15 fractions delivered once-a-day in 3 weeks concomitantly with chemotherapy. This regimen is convenient and seems to be effective. Here, we report and compare with a literature review the outcomes of patients with limited-stage small cell lung cancer treated in our institution with this hypofractionated regimen.Patients and methods
From January 2004 to December 2012, patients with limited-stage small cell lung cancer treated curatively with platinum-based chemotherapy and concurrent thoracic radiotherapy at a dose of 40 Gy in 16 fractions once-a-day were eligible for this review.Results
Sixty-eight patients fit the analysis criteria, including ten patients with small pleural effusion. The median age was 66 years old. After a median follow-up of 77 months for those alive, the median survival was 28 months. At 3 and 5 years respectively, the locoregional control rates were 67 and 64%, while the overall survival rates were 40 and 35%. Prophylaxis cranial irradiation was delivered to 68% of the patients. Grade 2 and 3 acute esophagitis occurred in respectively 49 and 9% of the patients. There was no grade 4 radiation-induced toxicity. All patients, except for one, completed their thoracic irradiation course without interruption.Conclusion
Once-a-day hypofractionated radiation with concurrent chemotherapy followed by prophylactic cranial irradiation is a practical regimen. Based on our experience and the published literature, it appears to be similarly effective as regimens using twice-daily fractionation in 3 weeks, or once-daily in 6 to 7 weeks with higher radiotherapy doses. Further prospective comparisons of hypofractionation with the current recommendations are needed. 相似文献15.
Emad Moussa Manal Zamzam Ahmed Kamel Zeinab Salah Iman Attia Lina Gaber Ranin Soliman Sameera Ezzat 《Journal of the Egyptian National Cancer Institute》2017,29(1):53-56
Introduction
Anthracycline chemotherapy contributes to improved outcomes in Ewing sarcoma; however, the most feared complication is cardiotoxicity. Echocardiograms were routinely used to monitor cardiac function after anthracycline treatment. Nevertheless, indices chosen to assess cardiac toxicity vary significantly among different centers, and no uniform protocol has been accepted as ideal.Methods
This retrospective study included children with Ewing sarcoma treated at Children’s Cancer Hospital Egypt over 4 years. All echocardiograms and related clinical assessments were reviewed.Results
In total, 149 patients (median age 11 years; range 1–18 years) were included. Although all patients had a reduced ejection fraction compared with their baseline echocardiogram, only 39 patients developed cardiotoxicity (26%): 43% acute-onset, 36% chronic early-onset, and 21% chronic late-onset. There were no statistically significant association between the frequency of myocardial dysfunction and risk factors, including age, sex, follow-up duration, cumulative doxorubicin dose, and mediastinal irradiation. Over one-third (39%) of the patients with cardiac toxicity regained normal cardiac parameters, whereas seven patients died of acute cardiac toxicity.Conclusion
The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed. 相似文献16.
Jean Lacau St Guily Éric Bouvard Bruno Raynard François Goldwasser Brigitte Maget Alain Prevost David Seguy Olivier Romano Bérengère Narciso Charles Couet Jean-Michel Balon Damien Vansteene Sébastien Salas Philippe Grandval Emmanuel Gyan Xavier Hebuterne 《Journal of Geriatric Oncology》2018,9(1):74-80
Objectives
To compare the prevalence of malnutrition and nutritional management between elderly (≥ 70 years old) and younger patients (< 70 years) with cancer.Patients and Methods
This is a post-hoc analysis of NutriCancer 2012 study; a one-day cross-sectional nationwide survey conducted to assess malnutrition in adult patients with cancer in France. Patients diagnosed with cancer at the study date in both inpatient and outpatient settings were included. Data collection was performed by means of questionnaires completed by the physician, the patient and the caregiver.Results
This post-hoc analysis compared 578 elderly patients (27.6%) vs. 1517 younger patients (72.4%). There were significant differences in cancer localization between the groups particularly in gastrointestinal cancer (27% in younger patients vs. 42% in elderly), breast cancer (17% vs 8% in elderly) and oropharyngeal (15% vs. 9% in elderly). Weight loss was significantly more reported in the elderly than in younger patients (73.6% vs. 67.6%, p = 0.009). Elderly patients were more frequently malnourished than younger patients (44.9% vs. 36.7%, p = 0.0006). Food intake was comparable between the groups; however, physicians overestimated the food intake, particularly in the elderly. The malnutrition management was more frequently proposed in elderly, as dietary advice and oral nutritional supplements, than in younger patients; however, enteral nutrition was significantly less undertaken in the elderly.Conclusion
Malnutrition is prevalent in elderly patients with cancer, and more frequent than in younger patients. There is a need for an early integration of the nutritional counselling in patients with cancer, and particularly in the elderly. 相似文献17.
Friedemann Honecker Nadia Harbeck Claudia Schnabel Ulrich Wedding Dirk Waldenmaier Steffen Saupe Elke Jäger Marcus Schmidt Rolf Kreienberg Lothar Müller Burkhard Otremba Julia Dorn Mathias Warm Salah-Eddin Al-Batran Maike de Wit 《Journal of Geriatric Oncology》2018,9(2):163-169
Objectives
To determine predictive/prognostic factors for patients with metastatic breast cancer (MBC) receiving first-line monochemotherapy using biomarker analysis and geriatric assessment (GA).Materials and Methods
Karnofsky Performance Status (KPS) and GA as clinical parameters, and prognostic inflammatory and nutritional index (PINI), and Glasgow prognostic score (GPS) as biomarkers were analyzed for association with clinical outcome within the randomized phase III PEg-LIposomal Doxorubicin vs. CApecitabin iN MBC (PELICAN) trial of first-line pegylated liposomal doxorubicin (PLD) or capecitabine.Results
Of 210 patients, 38% were > 65 years old. GA (n = 152) classified 74% as fit, 10% as compromised, and 16% as frail. Biomarkers showed no age dependency. In multivariate analysis (n = 70) KPS, GA, cumulative illness rating scale-geriatrics (CIRS-G), and GPS were significantly associated with time to progression, and KPS, CIRS-G, and instrumental activities of daily living (IADL) from GA, and PINI showed a significant correlation with overall survival.Conclusion
GA evaluation was feasible. KPS significantly correlated with efficacy outcomes. Items of a GA and biomarkers of inflammation and nutrition may have prognostic significance in patients with MBC. 相似文献18.
Radical radiation therapy for oligometastatic breast cancer: Results of a prospective phase II trial
Marco Trovo Carlo Furlan Jerry Polesel Francesco Fiorica Stefano Arcangeli Niccolò Giaj-Levra Filippo Alongi Alessandro Del Conte Loredana Militello Elena Muraro Debora Martorelli Simon Spazzapan Massimiliano Berretta 《Radiotherapy and oncology》2018,126(1):177-180
Background and purpose
We conducted a prospective phase II multicentric trial to determine if radical radiation therapy to all metastatic sites might improve the progression-free survival (PFS) in oligometastatic breast cancer patients. Secondary endpoints were local control (LC), overall survival (OS) and toxicity.Methods and materials
Inclusion criteria were the following: oligometastatic breast cancer with ≤5 metastatic sites, FDG-PET/CT staging, no brain metastases, primary tumor controlled. Radiotherapy could be delivered using stereotactic body radiotherapy (SBRT) technique or fractionated intensity modulated radiotherapy (IMRT). SBRT consisted of 30–45 Gy in 3 fractions, while IMRT was delivered to a total dose of 60 Gy in 25 fractions. We hypothesized that radical radiation therapy could increase the PFS from 30% (according to the published literature) to 50% at two years.Results
54 Patients with 92 metastatic lesions were enrolled. Forty-four were treated with SBRT, and 10 with IMRT. Forty-eight (89%) patients received a form of systemic therapy concomitantly to radiation therapy. Sites of metastatic disease were the following: bones 60 lesions, lymph nodes 23 lesions, lung 4 lesions, liver 5 lesions. After a median follow-up of 30 months (range, 6–55 months), 1- and 2-year PFS was 75% and 53%, respectively. Two-year LC and OS were 97% and 95%, respectively. Radiation therapy was well tolerated, and no Grade ≥3 toxicity was documented. Grade 2 toxicity were pain and fatigue in 2 cases.Conclusions
Patients with oligometastatic breast cancer treated with radical radiotherapy to all metastatic sites may achieve long-term progression-free survival, without significant treatment-related toxicity. While waiting for data from randomized trials, the use of radical radiation therapy to all metastatic sites in patients with oligometastatic breast cancer should be considered a valuable option, and its recommendation should be individualized. 相似文献19.
Iosif Strouthos Nikolaos Tselis Georgios Chatzikonstantinou Saeed Butt Dimos Baltas Dimitra Bon Natasa Milickovic Nikolaos Zamboglou 《Radiotherapy and oncology》2018,126(2):270-277
Background and purpose
To evaluate the oncological outcome of a three-implant high dose rate (HDR) brachytherapy (BRT) protocol as monotherapy for clinically localised prostate cancer.Material and methods
Between February 2008 and December 2012, 450 consecutive patients with clinically localised prostate cancer were treated with HDR monotherapy. The cohort comprised of 198 low-, 135 intermediate- and 117 high risk patients being treated with three single-fraction implants of 11.5 Gy delivered to an intraoperative real-time, transrectal ultrasound defined planning treatment volume up to a total physical dose of 34.5 Gy with an interfractional interval of 21 days. Fifty-eight patients (12.8%) received ADT, 32 of whom were high- and 26 intermediate-risk. Biochemical failure was defined according to the Phoenix Consensus Criteria and genitourinary/gastrointestinal toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 3.0.Results
The median follow-up time was 56.3 months. The 60-month overall survival, biochemical control and metastasis-free-survival rates were 96.2%, 95.0% and 99.0%, respectively. Toxicity was scored per event with late Grade 2 and 3 genitourinary adverse events of 14.2% and 0.8%, respectively. Late Grade 2 gastrointestinal toxicity amounted 0.4% with no instances of Grade 3 or greater late adverse events to be reported.Conclusions
Our results confirm HDR BRT to be a safe and effective monotherapeutic treatment modality for clinically localised prostate cancer. 相似文献20.