The potential of proton beam radiation therapy in prostate cancer, other urological cancers and gynaecological cancers

A group of Swedish oncologists and hospital physicists have estimated the number of patients in Sweden suitable for proton beam therapy. The estimations have been based on current statistics of tumour incidence, number of patients potentially eligible for radiation treatment, scientific support from clinical trials and model dose planning studies and knowledge of the dose-response relations of different tumours and normal tissues. In prostate cancer it is estimated that annually about 300 patients and in gynaecological cancer about 50 patients, are candidates for proton beam therapy. Owing to major uncertainties, it has not been possible to give an estimate of the number of potential patients with urinary bladder cancer

Sequential topotecan and oral etoposide in recurrent ovarian carcinoma pretreated with platinum-taxane - Results from a multicenter phase I/II study

BACKGROUND. The objectives of this study were to determine the maximum tolerable dose (MTD), toxicity, efficacy, and feasibility of a sequential regimen of fixed-dose topotecan (1.00 mg/m(2) on Days 1-5) and increasing doses of oral etoposide (50 mg, 75 mg, and 100 mg on Days 6-12 or Days 6-19) in patients with recurrent ovarian carcinoma. METHODS. This multicenter, open-label study was planned as a Phase I-II study that included patients with epithelial ovarian carcinoma who failed or who developed recurrent disease 1 week, or neutropenic fever 38.5 degrees C for > 24 hours/sepsis, or Grade 4 thrombocytopenia for > 1 week, or thrombocytopenia with bleeding, or Grade 3-4 nonhematologic toxicity. RESULTS. The MTD, as defined in the protocol, could not be settled because of unpredictable toxicity, because DLT was found at all dose levels except the starting dose level. In 28 patients (Phase I), 155 cycles were evaluable for toxicity. The main DLT was neutropenia Grade 4 for > 1 week or neutropenic fever/sepsis. Overall, neutropenia Grade 4 that lasted > 1 week and sepsis were noticed in 3% and 2% of cycles, respectively. Because no MTD was reached, the planned Phase II trial was not initiated. However, the patients from Phase I were followed until they developed progressive disease and, among them, 9 patients (32%) obtained an objective response (according to Response Evaluation Criteria in Solid Tumors (RECIST) or CA125 response criteria). CONCLUSIONS. Combined topotecan and oral etoposide was inappropriate in patients with recurrent ovarian carcinoma because of unpredictable hematologic toxicity. However, the high objective response rate highlighted the potential additive effect of topoisomerase I and II inhibitors

Two BRCA1-positive epithelial ovarian tumors with metastases to the central nervous system: a case report

BACKGROUND: Cerebral metastasis secondary to ovarian cancer is a rare phenomenon. While no clear relationship to known prognostic factors is found, others suggest this as a biologically diverse behavior of ovarian cancer. CASES: In a pilot study, 37 invasive epithelial ovarian cancer samples were analyzed to detect the frequency of BRCA1/BRCA2 mutations in the south of Sweden (results published). A retrospective follow-up revealed that 2 of these (2/37; 5.4%) patients developed central nervous system metastases during the course of their disease. Both patients had advanced surgical stage disease at the time of diagnosis, with histopathological serous type tumors that were negative for estrogen and progesterone receptors. One of these patients carried a germline BRCA1 mutation, whereas a somatic BRCA1 mutation was identified in the other patient. CONCLUSIONS: To the best of our knowledge the molecular genetic profile of these tumors is not found in the literature and it is suggested that such analyses could provide some insight for a better understanding of this rare phenomenon

FDG-PET in cervical cancer: staging, re-staging and follow-up.

Abstract is not availabl

A systematic overview of radiation therapy effects in uterine cancer (corpus uteri)

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for uterine cancer is based on data from one randomized study Moreover, data from two prospective studies and seven retrospective studies were used. In total, 10 scientific articles are included, involving 3446 patients. The results were compared with those of a similar overview from 1996 including 13597 patients. The conclusions reached can be summarized as: There is fairly good evidence that there is no need for adjuvant radiotherapy in patients with good risk uterine cancer. There is fairly good evidence that adjuvant radiotherapy reduces the relapse rate in high-risk patients but has no impact on survival. There is substantial documentation showing that medically inoperable patients and patients with locally recurrent uterine cancer can be treated with radiotherapy alone with curative effect

A systematic overview of radiation therapy effects in ovarian cancer

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for ovarian cancer is based on data from six randomized trials. Moreover, data from one prospective study and three retrospective studies were used. In total, 10 scientific articles are included, involving 1282 patients. The results were compared with those of a similar overview from 1996 including 15042 patients. The conclusions reached can be summarized in the following points: There is no scientific documentation supporting adjuvant radiotherapy for early-stage, low-risk patients. No studies have been reported where adjuvant radiotherapy has been compared with no adjuvant therapy in early-stage, high-risk patients. Adjuvant radiotherapy, either whole abdominal irradiation or intraperitoneal p(32), has been compared with adjuvant chemotherapy in early-stage, high-risk patients. There is no scientific evidence to show that there is a difference in efficacy. There is some evidence to suggest that adjuvant radiotherapy after radical surgery leads to an increase in disease-free survival rate for patients with advanced-stage ovarian cancer. There is little documentation on long-term side effects (second malignancy) after adjuvant radiotherapy and no conclusions can be drawn

A systematic overview of radiation therapy effects in cervical cancer (cervix uteri)

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for cervical cancer is based on data from 1 meta-analysis and 34 randomized trials. In total, 35 scientific articles are included, involving 7952 patients. The results were compared with those of a similar overview from 1996 including 34 024 patients. The conclusions reached can be summarized in these points: There are limited scientific data supporting that postoperative pelvic radiotherapy improves disease-free survival in early cervical cancer. No firm conclusion can be drawn. There is moderate scientific evidence that external beam radiotherapy combined with brachytherapy gives a similar disease-free and overall survival rate as radical hysterectomy in early cervical cancer. There is strong scientific evidence that concomitant radiochemotherapy improves disease-free and overall survival compared to radiotherapy alone in early cervical cancer. The NCI has recently published an announcement stating that cisplatin-based chemotherapy should be used concomitantly with radiotherapy in cervical cancer. No solid documentation for this statement can be found concerning locally advanced stages ( >IIB). There is a strong scientific evidence that cisplatin-based chemotherapy given concomitantly with radiotherapy is superior to concomitant chemotherapy with hydroxyurea. There is no scientific evidence to show that neoadjuvant chemotherapy followed by radiotherapy improves disease-free or overall survival compared to radiotherapy alone in patients with localized cervical cancer. There is moderate scientific evidence that high-dose-rate brachytherapy gives the same local control rate as low-dose-rate brachytherapy but with fewer rectal complications