Utility of Prophylactic Percutaneous Gastrostomy in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy: A Multicenter Analysis

Introduction: Patients with head and neck cancer (HNC) have an elevated incidence of cachexia and malnutrition due to the tumor's location interfering with oral feeding. Concurrent chemoradiation (CCRT) can have an emetic effect and cause dysphagia and oral mucositis. Adequate nutrition improves immunity, raises the response to therapy, reduces adverse effects, and improves survival. Numerous studies have suggested the utility of nutritional support from percutaneous endoscopic gastrostomy (PEG) in HNC patients. Although PEG is usually considered a safe procedure, it has a mortality rate of 0-2.2% and a risk of other procedure-related complications of 17-40%. Our work intends to evaluate the utility of PEG in patients with locally advanced HNC who underwent CCRT. Methods: We performed a cohort study at three institutions. We included patients with HNC who underwent definitive CCRT treatment from January 2013 to December 2022. The study consisted of an observational, descriptive, retrospective analysis of prespecified clinical data. Descriptive statistics were used to compare the data between the PEG group and the non-PEG group. Analysis of covariance (ANCOVA) was used for covariance analysis. Fisher's exact test was used to compare proportional data and Student's t-test was used to assess the differences in continuous data. Survival analysis was performed using the Kaplan-Meier estimator. P-values of <0.05 were considered to be indicative of statistical significance. The SPSS Statistics version 28.0 (Armonk, NY: IBM Corp.) was used to perform all statistical evaluations. Results: We identified 90 eligible patients diagnosed with local advanced HNC who had received definitive CCRT with three weekly cycles of cisplatin as follows: 44 with a prophylactic PEG tube and 46 without a prophylactic PEG tube. Most patients were male (84.4%) and 50% of patients were diagnosed with stage IVa HNC at the time of diagnosis. There wasn't an effect of PEG placement on BMI at the end of CCRT after controlling for the effect of baseline BMI (F {1.84}=0.065 {p=0.799}). In the study population, BMI was significantly lower after CCRT (21.30 kg/m2 vs. 23.97 kg/m2), t (86)=12.389, p<0.001. In the subgroup with baseline BMI <18.5 kg/m2 (15 patients), 90% of patients with prophylactic PEG were able to complete the three planned cycles of chemotherapy vs. 66.7% in the non-PEG group. Ten patients in the PEG group (22.7%) referred feeding tube dependency. Patients with dysphagia were 3.2 times more likely to have placed prophylactic PEG (p=0.007). The difference in overall survival and progression-free survival between the two groups was not statistically significant (p=0.57 and p=0.497, respectively). Conclusion: In this study using real-world data, we found a potentially protective effect of PEG in underweight patients with locally advanced HNC performing CCRT in order to complete three cycles of treatment.info:eu-repo/semantics/publishedVersio

Prevalence of PgR, ER and HER2+ receptors among women with breast cancer by age in Poland

Introduction. Prevalence of estrogen (ER), progesterone (PgR) and human epidermal growth factor receptors (HER2) vary by age among women with breast cancer (BC). Such variation has a large significance for the prognosis and treatment process. This study characterizes the prevalence of breast cancer subtypes by age in a hospital sample in Poland. Material and methods. The study population included 735 women with BC aged 27–91 years old (ICD-10: C50) and treated in the years 2009–2011 in the Military Institute of Medicine in Warsaw. Subjects were divided into 2 age categories — 27–44 and 45+ — which included 66 (9%) and 669 (91%) women respectively. In each group prevalence of PgR, ER and HER2+ receptors was investigated. Results. In both age groups the most frequent BC subtype was luminal A (hormone dependent BC — with PgR and ER receptor expression) — 27–44 years old — 44% and 45+ years old — 56%. The lowest number of cases in the age group 27–44 was luminal B (triple positive breast cancer) — about 15% of cases and for 45+ age group — HER2+ BC — about 11%. Discussion. Performed research shows relationship between growing age of diagnosis and presence of more desirable features of BC among women aged 55 and more, such as expression of steroid receptors or lack of expression of HER2 receptors, which is a good prognostic indicator for treatment outcomes. In the same time, many studies suggest that more aggressive types of breast cancer (basal-like — triple negative) are more characteristic for younger age groups (under 45 years old and younger women in perimenopausal age). Same results have been obtained in own study. Conclusions. A high incidence of BC in older age groups (45+) and more frequent occurrence of aggressive types of BC among younger women (27–44 years old) indicate the need to educate women from both age groups about risk factors and early symptoms of the disease. As we still have not recognized all BC risk factors, education about well-known agents, such as alcohol intake, overweight and obesity, play significant role in decrease of BC incidence and mortality

Tumor Phyllodes de la mama

&nbsp;Introduction Phyllodes tumor (PT) is a rare tumor of the breast, representing less than 1% of all breast neoplasms (1) and 2 to 3% of fibroepithelial tumors (7). This neoplasm is classified as: Benign PT, Borderline PT and Malignant PT (Norris and Taylor-WHO) (9). Objective To carry out a review about the diagnosis and treatment of phyllodes tumor.&nbsp;Development PTs are fibroepithelial neoplasms that according to stromal cellularity, nuclear atypia, mitotic rate, heterologous elements are classified as: benign, borderline and malignant (1). The maximum incidence occurs between 35-55 years. Imaging diagnosis is based on the use of mammography, ultrasound, magnetic resonance imaging and radioguided core biopsy. Optimal surgical management is the fundamental tool in PT. There is controversy about the use of adjuvant treatment with radiotherapy and chemotherapy. Conclusions: PT is a benign neoplasm of the breast, surgery is the treatment of choice. The free edge greater than 1 cm recommended by the NCCN is predictive of a lower percentage of local recurrence. Complementary treatments with radiotherapy and chemotherapy are controversial.&nbsp;Introducción: El tumor phyllodes (TP) es un tumor raro de la mama, representa menos del 1% de todas las neoplasias de la mama (1) y el 2 a 3 % de los tumores fibroepiteliales (7). Esta neoplasia se clasifica en: TP Benigno, TP Borderline y TP Maligno (Norris y Taylor-OMS) (9). Objetivo: Realizar una revisión acerca del diagnóstico y tratamiento del tumor phyllodes. Desarrollo: Los TP son neoplasias fibroepiteliales qué de acuerdo a la celularidad estromal, atipia nuclear, tasa mitótica, elementos heterólogos son clasificados como: benignos, borderline y malignos (1). La máxima incidencia se da entre los 35-55 años. El diagnóstico por imágenes se basa en el uso de mamografía, ecografía, resonancia magnética y biopsia core radioguiada. El óptimo manejo quirúrgico constituye la herramienta fundamental en TP. Existe controversia acerca del uso de tratamiento adyuvante con radioterapia y quimioterapia. &nbsp;Conclusiones: TP es una neoplasia benigna de la mama, la cirugía es el tratamiento de elección. El borde libre mayor de 1 cm recomendado por la NCCN es predictivo para un menor porcentaje de recurrencia local. Los tratamientos complementarios con radioterapia y quimioterapia son controversiales

Colorectal cancer liver metastases : management and five-year survival in a South African patient cohort

BACKGROUND : Approximately 25% of patients with colorectal cancer (CRC) will be diagnosed with CRC liver metastases (CRCLM) during the course of their disease. No data regarding CRCLM presentation, management and survival outcomes has been published from either the private or public health care sectors in South Africa. This study aimed to address this deficit, reporting on a private sector cohort. METHODS : A retrospective review of a private health care funder’s database from 1 January 2008 to 31 December 2015 was performed. ICD-10 diagnosis codes were used to identify CRC and CRCLM. Procedure codes assigned to hospital admissions were used to identify the type of surgical treatment. Chemotherapy was identified by the WHO Anatomical Therapeutic Chemical classification system of medicines. Treatment patterns were assessed and five-year overall survival (OS) was calculated. Survival was estimated using the Kaplan–Meier method, and Cox proportional-hazards regression was used for between group survival comparisons. RESULTS : Six hundred and one (601) of 3 412 patients presenting with CRC (17.6%) were diagnosed with CRCLM at presentation or during the follow-up period. Sixty patients with CRCLM (10.0%) underwent resection of the primary CRC and liver resection for metastases, 281 (46.8%) underwent CRC resection only, 180 (30%) received chemotherapy only, and 47 (7.8%) received no treatment. Five-year OS for these groups were 57.3%, 15.6%, 9.8% and 0% respectively. CONCLUSION : Five-year OS of the various CRCLM treatment pathways in a South African private sector population compares to results published in international series. However, a smaller proportion of patients with CRCLM underwent liver resection, compared to international studieshttp://sajs.redbricklibrary.com/index.php/sajsdm2022Surger

Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium

Background: There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. Objective: To determine the benefit of CN in synchronous metastatic papillary RCC. Design, setting, and participants: Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. Outcome measurements and statistical analysis: Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. Results and limitations: In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. Conclusions: The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. Patient summary: In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.ope

Elevated Pre-Treatment Serum MMP-7 Levels Are Associated with the Presence of Metastasis and Poor Survival in Upper Tract Urothelial Carcinoma

Upper tract urothelial carcinoma (UTUC) is a rare cancer with a barely predictable clinical behaviour. Serum MMP-7 is a validated prognostic marker in urothelial bladder cancer, a tumour entity with large clinical, histological, and molecular similarity to UTUC. The serum MMP-7 levels have not yet been investigated in UTUC. In the present study, we determined MMP-7 concentrations in an overall number of 103 serum samples from 57 UTUC patients who underwent surgical or systemic (platinum or immune checkpoint inhibitor) therapy by using the ELISA method. In addition to pre-treatment samples, the serum samples collected at predefined time points after or during therapy were also investigated. Serum MMP-7 concentrations were correlated with clinicopathological and follow-up data. Our results revealed significantly, two-fold elevated pre-treatment serum MMP-7 levels in metastatic cases of UTUC in both the radical surgery- and the chemotherapy-treated cohorts (p = 0.045 and p = 0.040, respectively). In addition, high serum MMP-7 levels significantly decreased after radical surgery, and high pre-treatment MMP-7 concentrations were associated with shorter survival both in the surgery- and chemotherapy-treated cohorts (p = 0.029 and p = 0.001, respectively). Our results revealed pre-treatment serum MMP-7 as a prognostic marker for UTUC, which may help to improve preoperative risk-stratification and thereby improve therapeutic decision-making

Combined Chemoradiation Therapy With Twice-Weekly Gemcitabine and Cisplatin for Organ Preservation in Muscle-Invasive Bladder Cancer: Long-Term Results of a Phase 1 Trial.: Conservative bladder cancer treatment

International audiencePURPOSE: Concomitant treatment with radiation therapy and cisplatin (CDDP) remains the gold standard for bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC). We present the long-term results of a phase 1 clinical trial to assess the association of twice-weekly gemcitabine with CDDP and radiation therapy in this setting. METHODS AND MATERIALS: Patients with pT2-pT4N0M0 MIBC without hydronephrosis or diffuse carcinoma in situ were enrolled in this study. After maximal transurethral resection of the bladder tumor, patients received concomitant radiation therapy (63 Gy in 1.8 fractions) and chemotherapy (CDDP 20 mg/m²/day over 4 days every 21 days and gemcitabine twice a week). The starting dose of gemcitabine was 15 mg/m² with dose escalation to 20, 25, and 30 mg/m². The primary endpoint was the maximum tolerated dose (MTD). Secondary endpoints included toxicity and tumor control. RESULTS: Fourteen patients were enrolled. Dose-limiting toxicity occurred in 2 patients treated with 30 mg/m² gemcitabine (grade 4 thrombocytopenia and severe impairment of World Health Organization performance status, respectively). Nine patients received the complete chemoradiation therapy protocol. The recommended dose of gemcitabine was 25 mg/m². The median follow-up time was 53 months, and the overall and disease-specific 5-year survival rates were 62% and 77%, respectively. Among the patients who received the complete treatment, bladder-intact survival was 76% at 5 years, and the median overall survival was 69.6 months. CONCLUSIONS: This regimen was well tolerated. The gemcitabine MTD was 25 mg/m². Bladder preservation and disease control were promising. A multicenter phase 2 randomized trial is ongoing