Advanced soft tissue sarcoma: prognostic factors and aspects of trial methodology

A general description of soft tissue sarcomas and their treatments is given in Chapter 1. The chapter also provides an introduction to the work on prognostic factors that is described in this thesis.A general description of soft tissue sarcomas and their treatments is given in Chapter 1. The chapter also provides an introduction to the work on prognostic factors that is described in this thesis. In chapter 2, we have identified the characteristics of the patients (and of their disease) influencing the survival expectation and the probability to respond to first line chemotherapy for advanced disease. Not surprisingly, advanced age is an adverse prognostic factor of survival and response to therapy. Poor performance adversely affects survival but not the probability of response to first line therapy. The number and size of the lesions does not affect response and neither survival, at the time of diagnosis of advanced disease. The survival prognosis is more favorable if the sarcoma was diagnosed at least 2 years before chemotherapy was needed. Patients who were initially diagnosed with low grade disease have a longer survival expectation, despite the fact that they respond less frequently to chemotherapy; and they are probably not appropriate candidates to test the activity of new drugs, especially if response is used as principal end-point

Epirubicin is not Superior to Doxorubicin in the Treatment of Advanced Soft Tissue Sarcomas.The Experience of the EORTC Soft Tissue and Bone Sarcoma Group

Purpose. Doxorubicin (dox) still appears to be one of the most active drugs in the treatment of soft tissue sarcomas. However, treatment duration is limited due to cumulative cardiotoxicity. A number of small studies from single institutions have suggested activity of other analogues. In two studies the EORTC STBSG tested whether epirubicin (epi) is an alternative to standard dose dox in the treatment of chemonaive patients with advanced soft tissue sarcoma. The present report gives the final results of these studies

Réaction oscillante de Belousov: 1. Cinétique de la réaction bromate céreux

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Papillary and follicular thyroid carcinoma. Individualization of the treatment according to the prognosis of the disease.

A retrospective study of a continuous series of 152 patients is presented: the patients were treated between 1 January 1955 and 31 December 1981 for a papillary or a follicular thyroid carcinoma. The prognostic index, proposed by the EORTC Thyroid Cancer Cooperative Group in 1979, was calculated for each patient. According to the survival curves and recurrences after treatment, the study shows a clear-cut difference in prognosis if the prognostic index is below 50 or is equal to or above 50. This observation supports the proposal of minimal treatment for less aggressive tumors and extensive treatment for the high risk patients. The actual treatment plan is: (1) total lobectomy when the tumor is unilateral and the prognostic index below 50, but total thyroidectomy in the other cases; (2) lymph node surgery only in cases of node involvement. Instead of a radical neck dissection, a more conservative procedure should be performed, removing the lymphatic chains and preserving the sterno-cleidomastoid muscle, the internal jugular vein and the spinal accessory nerve; (3) no postoperative radioiodine for low risk patients with complete removal of the tumor; (4) postoperative thyroid hormone at doses suppressing secretion of TSH for all patients.Journal Articleinfo:eu-repo/semantics/publishe

Progression-free rate as the principal end-point for phase II trials in soft-tissue sarcomas

We have estimated progression-free rates (PFR) for various groups of soft-tissue sarcoma patients from our clinical trials database, to provide reference values for conducting phase II studies with PFR as the principal end-point. In 146 pretreated patients receiving an active agent, the PFR estimates were 39 and 14% at 3 and 6 months, with inactive regimens (234 patients), those estimates were 21 and 8% respectively. In 1154-non-pretreated patients, PFR estimates varied from 77% (synovial sarcoma) to 57% (malignant fibrous histiocytoma (MFH)) at 3 months, and from 56% (synovial sarcoma) to 38% (MFH ) at 6 months. In 61 leiomyosarcomas from gastrointestinal origin, the corresponding figures were 44 and 30%, respectively. Consequently, for first-line therapy, a 6-month PFR of greater than or equal to 30-56% (depending on histology) can be considered as a reference value to suggest drug activity; for second-line therapy, a 3-month PFR of greater than or equal to 40% would suggest a drug activity, and less than or equal to 20% would suggest inactivity. (C) 2002 Elsevier Science Ltd. All rights reserved

Concomitant cisplatin and radiotherapy in a conventional and modified fractionation schedule in locally advanced head and neck cancer: A randomised phase II EORTC trial

A randomised phase II trial was initiated to explore the feasibility of concomitant cisplatin and radiotherapy with conventional fractionation (CF) or multiple fractions per day (MFD) for patients with locally advanced head and neck malignancies. The MFD schedule was designed to achieve higher tumour concentrations of cisplatin at the time of irradiation by reducing the number of radiation treatment weeks from 7 to 3, allowing recovery from side-effects of both irradiation and cystostatic drugs during the rest periods, while keeping the same total dose and overall treatment time. Patients were randomised between a conventional fractionation scheme (CF) of 70 Gy in 7 weeks with 2 Gy per fraction with a daily dose of 6 mg/m(2) cisplatin and a modified fractionation scheme (MFD) delivering three fractions of 1.6 Gy per day, in weeks 1, 4 and 7, keeping the same overall treatment time and total dose. In the modified treatment regime, a daily dose of 10 mg/m2 cisplatin was administered. 53 patients were entered in this trial and radiotherapy was given according to the schedule to all patients in both treatment arms. Cisplatin was given during the whole course of radiotherapy to only one quarter of the patients in the CF arm, stopping mostly after 5-6 weeks due to bone marrow depression and kidney toxicity, while patients in the MFD arm received it according to schedule. No difference was observed in acute and late toxicity in both treatment arms, while a similar or even better tumour response was obtained with MFD. A 67% higher daily dose of cisplatin concomitant with irradiation could be given in a 3-week multiple fractionation per day schedule, as opposed to the cisplatin given in the conventional daily fractionation schedule of 7 weeks with the same total radiation dose. Similar acute and late toxicities were seen in both treatment arms. (C) 2002 Elsevier Science Ltd. All rights reserved