Tumor volume as outcome determinant in patients with locally advanced esophage cancer treated with chemoradiation.

Objective: The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume. Methods: Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively. Median age was 65.7 years (range, 35.5-85.5 years). Most patients had SCC (84.5%). Using the computed tomography (CT) scan classification, tumors were recorded as follows: 1 T1, 42 T2, 93 T3, 6 T4, 2 Nx, 72 N0, 74 N1. Tumor volume from the CT scans was determined as the sum of 2 opposed truncated cones. Median tumor volume was 57.5 cm3 (range, 0.6-288 cm3). Results: Median follow-up was 15.1 month (range, 0.3-82.8 months). Survival rates at 1, 2, and 3 years were 42.5%, 21.6%, and 8%, respectively. Prognostic factors identified by univariate analysis were: dysphagia grade ≥2, other histology than squamous cell, tumor location below the carina, age <65 years and tumor volume ≥100 cm3. Prognostic factors identified with multivariate analysis were: dysphagia grade ≥2 (P = 0.013), weight loss ≥10% (P = 0.047), tumor location below the carina (P = 0.002), and tumor volume ≥100 cm3 (P = 0.041). Conclusions: For patients that the TNM staging system is not applicable, tumor volume is a new powerful determinant of survival. Further clinical trials need to be carried out to validate this prospectively

Tumor volume as outcome determinant in patients with locally advanced esophage cancer treated with chemoradiation.

Objective: The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume. Methods: Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively. Median age was 65.7 years (range, 35.5-85.5 years). Most patients had SCC (84.5%). Using the computed tomography (CT) scan classification, tumors were recorded as follows: 1 T1, 42 T2, 93 T3, 6 T4, 2 Nx, 72 N0, 74 N1. Tumor volume from the CT scans was determined as the sum of 2 opposed truncated cones. Median tumor volume was 57.5 cm3 (range, 0.6-288 cm3). Results: Median follow-up was 15.1 month (range, 0.3-82.8 months). Survival rates at 1, 2, and 3 years were 42.5%, 21.6%, and 8%, respectively. Prognostic factors identified by univariate analysis were: dysphagia grade ≥2, other histology than squamous cell, tumor location below the carina, age <65 years and tumor volume ≥100 cm3. Prognostic factors identified with multivariate analysis were: dysphagia grade ≥2 (P = 0.013), weight loss ≥10% (P = 0.047), tumor location below the carina (P = 0.002), and tumor volume ≥100 cm3 (P = 0.041). Conclusions: For patients that the TNM staging system is not applicable, tumor volume is a new powerful determinant of survival. Further clinical trials need to be carried out to validate this prospectively

Chimiothérapie et radiothérapie concomitantes ou séquentielles après chirurgie conservatrice des cancers du sein de stades I-II ; résultats de l'essai clinique français de phase III randomisé ARCOSEIN.

International audienceEn 1996, un essai français multicentrique de phase III a été débuté ; il comparait l'effet sur la survie sans maladie de la chimiothérapie et radiothérapie séquentielles par rapport à la chimioradiothérapie concomitante, après chirurgie conservatrice de cancers du sein de stades I–II. Nous rapportons les résultats cliniques avec un recul médian de 60 mois. Patientes et méthodes. – De février 1996 à avril 2000, 716 patientes ont été incluses dans cet essai. Le traitement adjuvant devait débuter dans les six semaines suivant la chirurgie, et comparait une chimiothérapie suivie de radiothérapie et une chimioradiothérapie concomitante. La chimiothérapie comportait de la mitoxantrone (12 mg/m2), du 5-fluoro-uracile (500 mg/m2) et du cyclophosphamide (500 mg/m2) pendant six cycles espacés de trois semaines. La radiothérapie délivrait dans le sein 50 ± 10–20 Gy de complément, si indiqué (une irradiation des aires ganglionnaires pouvait aussi être délivrée). Résultats. – À dose médiane de chimiothérapie était similaire entre les deux bras, ainsi que la dose totale médiane de radiothérapie. La toxicité aiguë était modérée dans les deux bras. Il n'y avait pas de différence statistiquement significative de survie sans maladie (p = 0,94), ni de survie sans métastases (p = 0,26), ni de survie globale (p = 0,99) entre les deux bras. Le taux de mortalité à cinq ans était de 9,6 % dans les deux bras. Il n'y avait pas de différence entre les deux bras en termes d'intervalle libre sans métastases. Néanmoins, dans le sous-groupe des patientes qui avait un envahissement ganglionnaire (n = 389), la chimioradiothérapie concomitante engendrait une diminution significative du risque de rechute locorégionale de 39 % (Hazard Ratio : 0,61 ; intervalle de confiance à 95 % : 0,38– 0,93). Conclusion. – Ce protocole thérapeutique est une option attrayante pour de nombreuses patientes atteintes de cancers du sein de stades III à haut risque de rechute. Des associations concomitantes avec des radiosensibilisants et les nouvelles chimiothérapies et/ou les thérapeutiques ciblées sont attendues dans le traitement des cancers du sein

[Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conservative surgery enhances late toxicities]

International audiencePURPOSE: In 1996, a multicenter randomized study comparing after breast-conservative surgery, sequential vs concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) was initiated (ARCOSEIN study). Seven hundred sixteen patients were included in this trial. After a median follow-up of 6.7 (4.3-9) years, we decided to prospectively evaluate the late effects of these two strategies. PATIENTS AND METHODS: A total of 297 patients were asked to follow-up from the five larger including institutions. Seventy-two percent (214 patients) were eligible for late toxicity. After breast-conserving surgery with axillary dissection, patients were treated either with sequential treatment with CT first followed by RT (arm A) or CT administered concurrently with RT (arm B). In all patients, CT regimen combined mitoxantrone (12 mg/m(2)), 5-FU (500 mg/m(2)), and cyclophosphamide (500 mg/m(2)), 6 cycles (day 1-day 21). In arm B, patients received concurrently the first 3 cycles of CT with RT. In arm A, RT started 3 to 5 weeks after the 6th cycle of CT. Conventional RT was delivered to the whole breast using a 2 Gy-fraction protocol to a total dose of 50 Gy (+/-boost to the primary tumour bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist according to the LENT-SOMA scale. Skin pigmentation was also evaluated using a personal 5-points scoring system (excellent, good, moderate, poor, very poor). RESULTS: Among the 214 evaluated patients, 107 were treated in each arm. The two populations were homogeneous for patients', tumors' and treatment characteristics. Subcutaneous fibrosis (SF), telengectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in arm B. Twenty patients experienced grade superior or equal to 2 (SF) in arm B vs five in arm A (P=0.003). Twenty-five and seven patients showed grade superior or equal to 2 (T) in arm B and A, respectively (P=0.001). Forty-four and twenty patients showed grade superior or equal to 2 (BA) in arm B and A, respectively (P=0.0006). Thirty patients experienced grade superior or equal to 3 (SP) in arm B vs fifteen in arm A (P=0.02). No statistical difference was observed between the two arms concerning grade superior or equal to 2 pain, breast oedema, and lymphoedema. No deaths were caused by late toxicity. CONCLUSION: Following breast conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of grade 2 or greater late side effects