Darbepoetin Versus Epoetin Alfa for the Correction of Anemia in Cancer Patients Receiving Radiotherapy or Chemoradiotherapy Treatment

Introduction Anemia is the most frequent hematological disturbance in cancer patients, with prevalence between 30% and 90%, depending on the type of tumor, the antitumor treatment, and other factors (infection, malnutrition, bleeding, tumor infiltration of the bone marrow). A number of erythropoietic agents have shown to be effective in increasing the hemoglobin (Hb) levels, reducing the requirements for transfusion, and improving quality of life. The objective of this study is to compare darbepoetin alfa and epoetin alfa when used to correct anemia in cancer patients who are receiving radiotherapy or radiochemotherapy. Material and methods A prospective study of 125 consecutive patients with anemia (Hb < 13 g/dL in males or < 12 g/dL in females) who were undergoing treatment with radiotherapy (RT) or radiochemotherapy (RCT) in our department were enrolled between March 2003 and March 2005. The treatment for the anemia was either darbepoetin alfa 150 mcg/week (62 patients, group 1) or epoetin alfa 40,000 IU/week (63 patients, group 2). Patients received iron supplements in both groups. Treatment was administered in a consecutive manner depending on tumor type. If the increase in Hb was < 1 g/dL after 4 weeks of treatment, the dose was increased to 300 mcg/week in group 1 or to 60,000 IU/week in group 2. The treatment was terminated when a Hb value of ≥ 15 g/dL was reached during RT treatment, a Hb value of ≥ 14 g/dL was reached if the RT had been completed, or after 16 weeks of treatment whatever the Hb value. The mean age of patients was 63.36 ± 11.27 years, 67% were male. No significant differences were observed between the 2 groups in tumor type or stage, previous treatments, or intent to treat with RT or RCT. Results Comparing group 1 and group 2 by intent to treat, the mean Hb at the start of treatment with the study drug was 12.1 g/dL vs 11.8 g/dL, the proportion of patients whose dose was increased was19.7% vs 24.6%, the need for transfusion was 3.2% in each group, the duration of erythropoietic treatment was 6.5 weeks in both groups, and 2 patients in group 2 restarted treatment with epoetin alfa. The percentage of patients who responded (defined as an increase in the Hb ≥ 2 g/dL in the absence of transfusions) was of 72.6% and 66.7%, respectively. Four vascular adverse events were observed, 2 in each group. No significant differences were observed with respect to the baseline, week 4, and week 12 levels of endogenous erythropoietin, serum iron,% saturation, and ferritin. The increase in Hb 1 month after the final administration of the study drug was 2.21 g/dL in group 1 and 2.46 g/dL in group 2 (p = ns). Conclusions The results of our study demonstrate that both treatments are equally effective in correcting anemia in cancer patients undergoing RT or RCT

SIMBOSPROST: Prevalence of metabolic syndrome and osteoporosis in prostate cancer patients treated with radiotherapy and androgen deprivation therapy: A multicentre, cross-sectional study

AimTo assess the prevalence of metabolic syndrome (MetS) and osteoporosis in patients with prostate cancer (PCa) treated with radical radiotherapy (RT) with or without androgen deprivation therapy (ADT).BackgroundWorldwide, the prevalence of MetS is estimated to range from 20% to 25% of the adult population. However, prevalence rates are much higher in PCa patients (pts) who undergo ADT.Materials and methodsMulticentre cross-sectional study of 270 pts in Spain with PCa. Patients were divided into 3 groups based on the duration of ADT (6, 12–18, ≥24 months) and compared to a control group without ADT. MetS was defined according to NCEP ATP III criteria. Osteoporosis was assessed by DEXA.ResultsA total of 270 pts, treated from November 2011 to October 2012, were included. Of these, 122 pts (47%) fulfilled the criteria for MetS. The median age of this group was significantly higher (71.3 vs. 69.38 years, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.028). MetS prevalence was 50% in the control group. In pts who received ADT, prevalence was 44.8% after 6 months of ADT, 45.3% after 12–18 months, and 50% after ≥24 months (pns). Most pts (168/270; 62%) underwent DEXA. Of those tested, 78 (46.4%) had osteopenia and only 11 (6.5%) had osteoporosis.ConclusionsThe prevalence of MetS in pts with PCa treated with radical RT was higher (47%) than in the general population. However, there were no significant differences in the duration of ADT administration. The prevalence of osteoporosis was low. These findings suggest that the prevalence of MetS in PCa patients may be higher than previously reported

Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patientsSin financiación2.737 JCR (2019) Q3, 157/244 Oncology0.833 SJR (2019) Q2, 178/367 Oncology, 720/2754 Medicine (miscellaneous); Q3, 143/214 Cancer ResearchNo data IDR 2019UE

EP-1359: Preoperative high doses chemoradiotherapy in stage IIIA-N2 NSCLC on behalf of GOECP/SEOR-GICOR

Sin financiación5.252 JCR (2018) Q1, 46/230 Oncology2.023 SJR (2018) Q1, 17/137 HematologyNo data IDR 2018UE

Neoadjuvant Treatment Followed by Surgery Versus Chemoradiation in Stage IIIA-N2 Non–small Cell Lung Cancer on Behalf of GOECP/SEOR-GICOR

Purpose/Objective(s) A subset analyses of randomized intergroup trial (INT0139) published in 2009, suggested that surgery after neoadjuvant treatment in patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC) may increase the survival. Due to the difficulty in recruiting this subset of patients in clinical trials, we have designed a retrospective multicenter observational study to compare neoadjuvant treatment based on chemoradiation or chemotherapy followed by surgery (CRTS) with definitive chemoradiation (CRT). Materials/Methods 297 NSCLC patients with stage T1-T3N2M0 underwent CRTS or CRT between January 2005 and December 2014, in 15 hospitals in Spain. In both arms, chemotherapy was platinum-based. Minimum radiation dose was 45 Gy in the CRTS group and 60 Gy in the CRT group. It was delivered in daily fractions of 1.8-2 Gy/day, with 3D conformal radiotherapy (N=237), intensity modulated radiation therapy (N=3) or volumetric modulated arc therapy (N=5). Patient and tumor characteristics were balanced by propensity score analysis method. The primary endpoint was overall survival (OS). Results 117 patients (median age 62 years, range 41-78) were treated with CRTS and 180 patients (65 years, range 37-82) with definitive CRT. Comparing CRTS with CRT patients, performance status was 0-1 in 99.1% vs. 97.2%; 60.6% vs. 64.4% were T1 or T2 tumors, (p=0.014); 38.4% vs. 57.2% presented two or more positive nodal stations (p=0.005); and 6.8% vs. 14.4% showed a positive nodal size ≥ 3 cm (p=0.044). Histopathological confirmation of mediastinal lymph nodes was performed in 58.1% and 65% patients, respectively. In CRTS group, 52.13% patients were treated with neoadjuvant CRT and 82.0% underwent lobectomy. Median follow-up was 27 months (43 months in CRTS and 23 months in CRT). Median OS was 58 months in CRTS vs. 27 months in CRT (hazard ratio [HR] 0.36, 95% CI: 0.23-0.56; p1 week, (37 vs. 30 months, p=0.03), were associated with higher OS in a regression analisys. Progression-free survival (PFS) was better in CRTS than CRT group, median 57 months vs. 14 months, HR 0.35, (95% CI 0.22-0.54; p 3 oesophagitis and pneumonitis were similar in both arms, grade >3 hematological toxicity was greater in CRT group (2.9% vs. 21.1%, p=0.001). Adjusted treatment-related mortality was 6.1% (2/77) in CRTS group vs. 7% (4/77) in CRT, (p=0.846). Conclusion Neoadjuvant chemoradiation treatment followed by surgery in stage IIIA-N2 NSCLC patients showed a better PFS and OS compared with definitive CRT patients. Furthermore, treatment-related mortality was similar in both treatment arms.Sin financiación5.554 JCR (2017) Q1, 41/223 Oncology2.485 SJR (2017) Q1, 31/230 Cancer ResearchNo data IDR 2017UE

Consensus statement from the Spanish Brachytherapy Group (GEB) on accelerated partial breast irradiation using multicatheter interstitial brachytherapy

AimTo establish consensus guidelines for a safe clinical practice of accelerated partial breast irradiation (APBI) interstitial multicatheter brachytherapy (BT).BackgroundAPBI with interstitial multicatheter BT has proved to be effective in the treatment of early stage breast cancer. This paradigm shift in the approach to early breast cancer conservative treatment, along with the existing controversies on the clinical practice of APBI, prompted the Spanish Brachytherapy Group (GEB) of the Spanish Societies of Radiation Oncology (SEOR) and Medical Physics (SEFM) to address BT APBI in a consensus meeting.Materials and methodsPrior to the meeting, a survey with 27 questions on indication, inclusion criteria, BT modality, implant technique, image guidance and simulation, CTV and OAR definition, dose prescription and fractionation, dose calculation, implant quality metrics and OAR dose constrains was distributed. Items not reaching a level of agreement of 70% were discussed and voted during the meeting.Results26 Institutions completed the survey, 60% of them perform APBI procedures. The analysis of the survey showed consensus reached on approximately half the questions. An expert panel discussed the remaining items; thereafter, a voting established the definite consensus.ConclusionsThis document summarizes the consensus guidelines agreed during the meeting of the Spanish Brachytherapy Group SEOR-SEFM. Institutions with BT facilities available should offer interstitial BT APBI as a treatment option to patients fulfilling the inclusion criteria. Institutions willing to implement interstitial BT APBI are encouraged to follow the consensus guidelines established herein