Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of Neuro-Oncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care

Lokal İleri ve Metastatik Küçük Hücreli Dışı Akciğer Kanseri Hastalarının Değerlendirilmesi Marmara Üniversitesi Deneyimi

Lokal İleri ve Metastatik Küçük Hücreli Dışı Akciğer Kanseri Hastalarının Değerlendirilmesi Marmara Üniversitesi DeneyimiDr. P. Fulden YUMUK1, Dr. M. Salih İYİKESİCİ1, Dr. Mahmut GÜMÜŞ1, Dr. Mehmet ALİUSTAOĞLU1, Dr. Faysal DANE1, Dr. Gül BAŞARAN1, Dr. Meltem EKENEL1, Dr. Ufuk ABACIOĞLU2, Dr. N. Serdar TURHAL11Marmara Üniversitesi Tıp Fakültesi, Medikal Onkoloji Bilim Dalı, İstanbul2Marmara Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi ABD, İstanbulNisan 1997 ile Şubat 2004 tarihleri arasında onkoloji kliniğimizde tedavi alan 175 KHDAK tanılı hasta retrospektif incelendi. Tüm hastaların performans durumu (PD)≤2'ydi. İlk seçim tedavi olarak 138 hasta cisplatin içeren bir kombinasyon rejimini radyolojik yanıta bağlı olarak 3-6 kür aldı. Torasik radyoterapi evre IIIB hastalarında ilk seçim kemoterapi sonrasında ve semptomatik evre IV hastalarda palyatif amaçla yapıldı. Uygun olan evre IIIA hastalar (%8.6) opere edildi. Medyan yaş 60 ve 132 hasta erkekti. PD %77.5 hastada 0'dı. Sırasıyla 16/39/120 hastanın evreleri IIIA/IIIB/IV'dü. Kırksekiz hastaya lokal radyoterapi yapıldı. Ortanca 11 aylık (1-63 ay) izlemde medyan genel sağkalım (GS) süresi 13±1ay, 1-yıllık GS oranı %51 iken medyan progresyona kadar geçen süre 3ay, 1-yıllık progresyonsuz sağkalım oranı %16'ydı. Kadınların, iyi PD olanların, cerrahi ve primer radyoterapi yapılabilecek hastaların daha uzun GS'ı olduğu görüldü (sırasıyla, p=0.005, p=0.0001, p=0.044 ve p=0.0002). Aynı değişkenler bağımsız prognostik faktörler olarak belirlendi. Kliniğimizin sonuçları dünya literatürü ile uyumludur.Anahtar Kelimeler :&nbsp;Küçük hücreli dışı akciğer kanseri; Antineoplastik kombine kemoterapi protokolleri; Sağkalım analiziOUTCOME OF LOCALLY ADVANCED AND METASTATIC NON-SMALL CELL LUNG CANCER PATIENTS - MARMARA UNIVERSITY EXPERIENCEDr. P. Fulden YUMUK1, Dr. M. Salih İYİKESİCİ1, Dr. Mahmut GÜMÜŞ1, Dr. Mehmet ALİUSTAOĞLU1, Dr. Faysal DANE1, Dr. Gül BAŞARAN1, Dr. Meltem EKENEL1, Dr. Ufuk ABACIOĞLU2, Dr. N. Serdar TURHAL11Marmara Üniversitesi Tıp Fakültesi, Medikal Onkoloji Bilim Dalı, İstanbul2Marmara Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi ABD, İstanbulTreatment outcomes of the 175 advanced and metastatic NSCLC patients who were given chemotherapy since April 1997 were retrospectively evaluated. In 138 patients, a platinum analogue was used in combination with etoposide, vinorelbine, paclitaxel, docetaxel or gemcitabine. The thoracic radiotherapy was given to stage IIIB patients after completion of first line chemotherapy and to symptomatic stage IV patients with palliative intent. Eligible stage IIIA patients (8.6%) were operated. Median age was 60 and 132 patients were male. Performance status was 0 in 77.5% and stage was IIIA/IIIB/IV in 16/39/120 patients. Forty-eight patients received local RT. At a median follow-up of 11 months, median overall survival (OS) was 13 months, 1-year OS ratio was 51%. Women, patients with good performance status, having resectable tumors and who received local radiotherapy lived significantly longer (p=0.005, p=0.0001, p=0.044 and p=0.0002, respectively). The independent factors influencing the OS were identical. Our results are consistent with the world literature.Anahtar Kelimeler :&nbsp;Carcinoma, Non-Small-Cell Lung; Antineoplastic Combined Chemotherapy Protocols; Survival Analysis</p

CECOG experts' recommendations on the use of denosumab in the prevention of skeletal-related events in bone metastases of lung cancer

Purpose Skeletal-related events represent a substantial burden for patients with advanced cancer. Randomized, controlled studies suggested superiority of denosumab over zoledronic acid in the prevention of skeletal-related events in metastatic cancer patients, with a favorable safety profile. Experts gathered at the 2012 Skeletal Care Academy in Istanbul to bring forward practical recommendations, based on current evidence, for the use of denosumab in patients with bone metastases of lung cancer. Recommendations Based on current evidence, use of denosumab in lung cancer patients with confirmed bone metastases is recommended. It is important to note that clinical judgment should take into consideration the patient’s general performance status, overall prognosis, and live expectancy. Currently, the adverse event profile reported for denosumab includes hypocalcemia and infrequent occurrence of osteonecrosis of the jaw. Therefore, routine calcium and vitamin D supplementation, along with dental examination prior to denosumab initiation are recommended. There is no evidence for renal function impairment due to denosumab administration. At present, there is no rationale to discourage concomitant use of denosumab and surgery or radiotherapy

Information for Decision Making by Patients With Early-Stage Prostate Cancer: A Comparison Across 9 Countries

Purpose: To describe decisional roles of patients with early-stage prostate cancer in 9 countries and to compare the information they rated important for decision making (DM). Method: A survey of recently treated patients was conducted in Canada, Italy, England, Germany, Poland, Portugal, Netherlands, Spain, and Turkey. Participants indicated their decisional role in their actual decision and the role they would prefer now. Each participant also rated (essential/desired/no opinion/avoid) the importance of obtaining answers, between diagnosis and treatment decision, to each of 92 questions. For each essential/desired question, participants specified all purposes for that information (to help them: understand/decide/plan/not sure/other). Results: A total of 659 patients participated with country-specific response rates between 58%-77%. Between 83%-96% of each country's participants recalled actually taking an active decisional role and, in most countries, that increased slightly if they were to make the decision today; there were no significant differences among countries. There was a small reliable difference in the mean number of questions rated essential for DM across countries. More striking, however, was the wide variability within each country: no question was rated essential for DM by even 50% of its participants but almost every question was rated essential by some. Conclusions: Almost all participants from each country want to participate in their treatment decisions. Although there are country-specific differences in the amount of information required, wide variation within each country suggests that information that patients feel is essential or desired for DM should be addressed on an individual basis in all countries

Information needs of early-stage prostate cancer patients: A comparison of nine countries

Background and purpose: Providing information to patients can improve their medical and psychological outcomes. We sought to identify core information needs common to most early-stage prostate cancer patients in participating countries. Material and methods: Convenience samples of patients treated 3-24 months earlier were surveyed in Canada, England, Italy, Germany, Poland, Portugal, Netherlands, Spain, and Turkey. Each participant rated the importance of addressing each of 92 questions in the diagnosis-to-treatment decision interval (essential/desired/no opinion/avoid). Multivariate modelling determined the extent of variance accounted by covariates, and produced an unbiased prediction of the proportion of essential responses for each question. Results: Six hundred and fifty-nine patients responded (response rates 45-77%). On average, 35-53 questions were essential within each country; similar questions were essential to most patients in most countries. Beyond cross-country similarities, each country showed wide variability in the number and which questions were essential. Multivariate modelling showed an adjusted R-squared with predictors country, age, education, and treatment group of only 6% of the variance. A core of 20 questions were predicted to be essential to >2/3 of patients. Conclusions: Core information can be identified across countries. However, providing the core should only be a first step; each country should then provide information tailored to the needs of the individual patient. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 94 (2010) 328-33