Queensland Centre for Gynaecological Cancer: Outcome data statistical report 2008

This statistical report represents a quarter of a century of data collection, from 1982 until 2007, from the Queensland Centre for Gynaecological Cancer (QCGC), located at Royal Brisbane and Women’s Hospital and Mater Hospital, Brisbane, Australia. This report is the culmination of over a year’s work in compiling and analysing prospectively collected data from patients’ management, and would not have been possible but for the dedication and hard work of the gynaecological oncologists who work under its banner. The QCGC has the largest and most detailed gynaecological cancer database of records in Australia, and quite possibly the world. Perusal of these reports shows survival curves out to 192 months, or 16 years. Mr Jackson collated the data and edited this report, Mr Tripcony performed detailed statistical analyses, and Dr Kondalsamy-Chennakesavan helped in interpreting and discussing the findings. This of course provides invaluable information not only on standard five-year survival and median survival but also on long term survival. The database software used, the clinical administration system or CAS from Mirrabooka Systems Pty Ltd (http://www.mirrabooka.com/cas.shtml) has provided the means to accumulate this extensive and detailed collection of data. A number of interesting findings have come out of this analysis. For each site, we have compared the outcomes for two nine-year periods, 1984-1993 and 1994-2003. It is reassuring to see that for ovarian and uterine cancer the outcome in terms of survival has improved significantly with time. The analysis of ovarian cancer showed some very interesting results. The amount of residual disease left at the end of cytoreductive surgery was a very powerful determinant of survival, second only to disease stage. The results presented here are in respect to all stages of ovarian cancer. It was realised that nil residuum would do extremely well because it would contain all of the stage I and stage II cases. However, this has also been shown to be the case for stage IIIC ovarian cancer; it seems that with stage IIIC of the disease, unless residual disease is reduced to less than one centimetre, there is little beneficial effect on survival. Detailed figures are not presented here as they will be the subject of a separate scientific publication, however, it does suggest that to date gynaecological oncologists have been too conservative in our approach to ovarian cancer surgery

A double-blind randomised controlled trial of a natural oil-based emulsion (Moogoo Udder Cream) containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer

Background: Radiation-induced skin reaction (RISR) is one of the most common and distressing side effects of radiotherapy in patients with cancer. It is featured with swelling, redness, itching, pain, breaks in skin, discomfort, and a burning sensation. There is a lack of convincing evidence supporting any single practice in the prevention or management of RISR. Methods/Designs: This double-blinded randomised controlled trial aims to investigate the effects of a natural oil-based emulsion containing allantoin (as known as Moogoo Udder Cream®) versus aqueous cream in reducing RISR, improving pain, itching and quality of life in this patient group. One group will receive Moogoo Udder Cream®. Another group will receive aqueous cream. Outcome measures will be collected using patient self-administered questionnaire, interviewer administered questionnaire and clinician assessment at commencement of radiotherapy, weekly during radiotherapy, and four weeks after the completion of radiotherapy. Discussion: Despite advances of radiologic advances and supportive care, RISR are still not well managed. There is a lack of efficacious interventions in managing RISR. While anecdotal evidence suggests that Moogoo Udder Cream® may be effective in managing RISR, research is needed to substantiate this claim. This paper presents the design of a double blind randomised controlled trial that will evaluate the effects of Moogoo Udder Cream® versus aqueous cream for managing in RISR in patients with cancer. Trial registration: ACTRN 1261200056881

Cutaneous Carcinoma of the Head and Neck with Clinical Features of Perineural Infiltration Treated with Radiotherapy

Aims: To review the outcome of patients with non-melanomatous carcinoma of the skin of the head and neck with perineural infiltration (PNI) with clinical features treated with radiotherapy. Materials and methods: Between 1991 and 2004, 56 patients with non-melanomatous skin carcinoma with PNI with clinical features were identified from the institution's oncology database. All patients had radiotherapy as either definitive or adjuvant treatment. The factors that affected outcome were analysed. The primary end point was the 5 year relapse-free survival (RFS) from the time of diagnosis of PNI. Results: The overall 5 year RFS for the whole group was 48%. Squamous histology had a more unfavourable outcome than basal cell histology (5 year RFS: 39% versus 80%; P = 0.07). Tumours located in the distribution of the cranial nerves V1 and V2 had a worse outcome than tumours at other sites (5 year RFS: 33% versus 72%, P = 0.056). Those with multiple cranial nerve involvement did worse than those with single nerve involvement (27% versus 62%, P = 0.1). The pattern of relapse was predominantly local (87%), with a low rate (15%) of successful salvage. Conclusion: Radiotherapy with or without surgery is curative in about half head and neck cutaneous non-melanomatous carcinomas with clinical PNI. The frequent local failure suggests that improvements in local treatment are required

Factors influencing relapse-free survival in merkel cell carcinoma of the lower limb—A review of 60 cases

Purpose: Factors affecting relapse-free survival (RFS) in patients with Merkel cell carcinoma (MCC) of the lower limb were reviewed. Methods and Materials: The records of 60 patients from 1986 to 2005 with a diagnosis of MCC of the lower limb or buttock were retrospectively reviewed. The patients were treated with curative intent with surgery, radiation, or chemotherapy. Results: The 5-year overall survival, disease-specific survival, and RFS were 53%, 61%, and 20%, respectively. Factors influencing RFS were analyzed using univariate analysis. It appeared that recurrent disease worsened RFS (p = 0.03) and the addition of any radiotherapy improved RFS (

Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: a phase 3, double-blind, randomized, controlled trial

Purpose To investigate the effects of a natural oil-based emulsion containing allantoin versus aqueous cream for preventing and managing radiation-induced skin reactions. Methods and Materials A total of 174 patients were randomized and participated in the study. Patients received either cream 1 (the natural oil-based emulsion containing allantoin) or cream 2 (aqueous cream). Skin toxicity, pain, itching, and skin-related quality of life scores were collected for up to 4 weeks after radiation treatment. Results Patients who received cream 1 had a significantly lower average level of Common Terminology Criteria for Adverse Events at week 3 (PConclusion The natural oil-based emulsion containing allantoin seems to have similar effects for managing skin toxicity compared with aqueous cream up to week 5; however, it becomes significantly less effective at later weeks into the radiation treatment and beyond treatment completion (week 6 and beyond). There were no major differences in pain, itching, and skin-related quality of life. In light of these results, clinicians and patients can base their decision on costs and preferences. Overall, aqueous cream seems to be a more preferred option

Treatment decisions in T3N0M0 glottic carcinoma

Purpose: To analyze the results of T3N0M0 glottic carcinoma treated with radiotherapy, surgery, or both

Effect of surgery on normal tissue toxicity in patients treated with accelerated radiotherapy

The aim of this study was to assess the effect of surgery on normal tissue toxicity in head and neck cancer patients treated with accelerated radiotherapy. Toxicity data from two trials of accelerated radiotherapy were compared. The first group was taken from a phase III trial of definitive radiotherapy and the second group from a phase II trial of postoperative radiotherapy. The general eligibility criteria (apart from surgery), data collection and radiotherapy details for both trials were similar. The definitive group included 172 eligible patients and the postoperative group 52 eligible patients. At 3 weeks into treatment, by which time the dose and rate of dose accumulation were identical, there was no difference in acute toxicity. Analysis of late toxicity showed greater subcutaneous fibrosis in the postoperative group

A phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue

The aim of the study was to see if topical aloe vera gel would be beneficial in reducing the identified skin side-effects of radiation therapy, including erythema, pain, itching, dry desquamation, and moist desquamation, when compared with aqueous cream. The secondary aim was to assess the effect of other factors known to predict severity of radiation skin reaction, le, breast size, smoking habit, and one or more drainages of lymphocele after surgery, on other skin side effects.A Phase III study was conducted involving 225 patients with breast cancer after lumpectomy or partial mastectomy, who required a course of radiation therapy using tangential fields. Patients were randomized to either topical aloe vera gel or topical aqueous cream to be applied 3 times per day throughout and for 2 weeks after completion of radiation treatment. Weekly skin assessments were performed by nursing staff.Aqueous cream was significantly better than aloe vera gel in reducing dry desquamotion and pain related to treatment. Subjects with D cup or larger size breasts experienced significantly more erythema, regardless of treatment arm. For subjects who had undergone lymphocele drainage, the aloe vera group experienced significantly more pain than the aqueous cream group. Within the aqueous cream arm, smokers were significantly more likely to experience itching within the treatment field than were nonsmokers. Within the aloe vera arm, subjects who had undergone one or more lymphocele drainages after surgery were significantly more likely to experience erythema and itching within the treatment field than those who did not have drainage.In this study, aloe vera gel did not significantly reduce radiation-induced skin side effects. Aqueous cream was useful in reducing dry desquamation and pain related to radiation therapy

Weekly carboplatin reduces toxility during synchronous chemotherapy for merkel cell carcinoma of skin

Purpose: The toxicity of radiotherapy (RT) combined with weekly carboplatin and adjuvant carboplatin and etoposide was prospectively assessed in a group of patients with high-risk Stage I and II Merkel cell carcinoma of the skin. This regimen was compared with the Trans-Tasman Radiation Oncology Group 96:07 study, which used identical eligibility criteria but carboplatin and etoposide every 3 weeks during RT