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{"title":"Implementation and Results of a Test Dose Program with Taxanes","authors":"J. Krieger, B. L. Stanford, E. Ballard, I. Rabinowitz","doi":"10.1097/00130404-200207000-00010","DOIUrl":"https://doi.org/10.1097/00130404-200207000-00010","url":null,"abstract":"PURPOSEA pilot taxane test-dose policy was developed and implemented to determine whether the severity of patient hypersensitivity reaction and drug waste would be reduced. PATIENTS AND METHODSData from 206 eligible cancer patients undergoing first-dose taxane chemotherapy were analyzed. The severity of hypersensitivity reactions before and after the implementation of taxane test dose was graded (scale 1–4) and analyzed for statistical differences between groups. Average drug wastage was calculated before and after program initiation. RESULTSTwenty-two of 206 patients (10.7%) experienced a hypersensitivity reaction. The mean hypersensitivity reaction severity for reacting patients who did not receive a test dose (N = 12) was 3.3, and for those who were given a test dose (N = 10), it was 1.5. Only one of five patients who experienced a hypersensitivity reaction that required hospitalization was from the test-dose group. The value of drug alone wasted before test-dose utilization was about $1794 per reacting patient, and the use of taxane test doses saved approximately $1784 per reacting individual. This represented more than a $178 savings for every patient receiving a taxane for the first time. These figures do not include resuscitation, hospital, and other subsequent other costs associated with morbidity. CONCLUSIONSImplementation of a taxane test-dose policy significantly reduced hypersensitivity reaction severity, drug wastage, and hospitalizations.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80949557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical Outcome for Hormone‐Naïve Patients with High‐Risk Prostate Cancer Managed with Permanent Interstitial Br achy therapy and Supplemental External‐Beam Radiation","authors":"G. Merrick, W. Butler, J. Lief, R. Galbreath, E. Adamovich","doi":"10.1097/00130404-200207000-00008","DOIUrl":"https://doi.org/10.1097/00130404-200207000-00008","url":null,"abstract":"PURPOSEThe purpose of this article is to report the 5-year biochemical disease-free outcome for hormone-naive patients with high-risk disease who underwent permanent prostate brachytherapy. Multiple clinical and treatment parameters were also evaluated to determine whether any of these influence biochemical outcome. MATERIALS AND METHODSSixty-six hormone-naïve patients underwent transperineal ultrasound-guided permanent prostate brachytherapy with generous periprostatic margins by use of either 103Pd or 125I for high-risk prostate cancer from April 1995 to October 1999. High-risk patients presented with two or three of the following risk factors: Gleason score ≥ 7, prostate-specific antigen ≥ 10 ng/mL, and clinical stage ≥ T2b, 1997 AJCC. No patient underwent pathological lymph node staging. Only one patient was implanted with monotherapy, whereas 65 patients received supplemental external-beam radiation therapy before a prostate brachytherapy boost. The median patient age was 69 years (range, 50–81 years). No patient was lost to follow-up. The mean follow-up and median follow-up were 53.2 ± 14.9 months and 53.7 months, respectively (range, 19.8–79.7 months). Follow-up was calculated from the day of implantation. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. Clinical parameters evaluated for biochemical disease-free survival included patient age, clinical stage, Gleason score, and pretreatment prostate-specific antigen. Treatment parameters included use of supplemental external-beam radiation therapy and choice of isotope. RESULTSThe 5-year actuarial biochemical disease-free survival rate was 79.9%. In multivariate analysis, preimplantation prostate-specific antigen (P = 0.008) was the only clinical or treatment parameter that predicted for biochemical failure. The mean and median posttreatment prostate-specific antigen levels were 0.13 ± 0.22 ng/mL and < 0.1 ng/mL, respectively. DISCUSSIONAt a median follow-up of 53.7 months, hormone-naive patients with high-risk disease who undergo permanent prostate brachytherapy have a high probability of 5-year biochemical disease-free survival and an apparent plateau on the biochemical disease-free survival curve.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82851086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Basic Fibroblast Growth Factor Levels in Nipple Aspirate Fluid Are Correlated with Breast Cancer","authors":"Robbin Hsiung, Weizhu Zhu, G. Klein, Wenyi Qin, A. Rosenberg, P. Park, E. Rosato, E. Sauter","doi":"10.1097/00130404-200207000-00006","DOIUrl":"https://doi.org/10.1097/00130404-200207000-00006","url":null,"abstract":"PURPOSEThe angiogenic basic fibroblast growth factor (bFGF) and vascular endothelial growth factor are important in malignant breast epithelial growth. Nipple aspirate fluid (NAF) is a physiologic fluid collected noninvasively that contains proteins secreted by the breast ductal epithelium and may contain markers of breast cancer. The purpose of this study was to determine whether high concentrations of bFGF and vascular endothelial growth factor in NAF would be associated with in situ and invasive breast cancer, and whether prostate-specific antigen, a marker in NAF associated with breast cancer, would improve our ability to determine which subjects had the disease. METHODSBoth bivariate and multivariate analyses were performed to determine the effects of race, menopausal status, bFGF concentration, and prostate-specific antigen on cancer risk. Bivariate analysis was also performed to determine the relationship between vascular endothelial growth factor concentration and cancer risk. RESULTSMean NAF bFGF levels were higher in women with breast cancer than in those without (19.2 vs 1.74 ng/g). Vascular endothelial growth factor was not associated with breast cancer. Race and menopausal status did not significantly affect the relationship between bFGF and cancer risk. bFGF, race, and menopausal status were each independent predictors of breast cancer, with bFGF being the most important. With knowledge of all three variables, the model was 89.9% sensitive and 69.0% specific in predicting which women had breast cancer. Adding prostate-specific antigen increased the sensitivity to 90.9% and the specificity to 83.3%. In subjects with NAF bFGF > 150 ng/g and prostate-specific antigen < 100 ng/g, 94.1% (32/34) of subjects had cancer. For women with NAF prostate-specific antigen > 100 ng/ g and bFGF < 150 ng/g, 90.5% were cancer free. CONCLUSIONSbFGF concentration in NAF is directly associated with breast cancer, regardless of race and menopausal status. NAF bFGF may prove helpful in the early detection of breast cancer.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91219602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Infusional Gemcitabine and Radiation in the Treatment of Advanced Unresectable GI Malignancy: A Phase I Study","authors":"M. Mohiuddin, M. Kudrimoti, W. Regine, P. Mcgrath, N. Hanna, W. John","doi":"10.1097/00130404-200205000-00009","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00009","url":null,"abstract":"PURPOSEPreclinical studies have demonstrated significant synergistic tumor cell death when gemcitabine is combined with radiation therapy. The optimal mode for concomitant delivery of drug and radiation therapy remains to be determined. A phase I/II study was undertaken to establish the maximum tolerated dose of infusional gemcitabine when combined with radiation therapy in advanced gastrointestinal malignancies and to assess the response to treatment. MATERIALS AND METHODSTwenty-five patients with advanced or recurrent gastrointestinal malignancy were entered in this dose-escalation study. The initial dose of gemcitabine was 50 mg/m2 as a 24-hour continuous intravenous infusion given weekly × 3 with concurrent radiation therapy. The patients were given a week off chemotherapy after the third injection. The radiation therapy was continued during that week. Gemcitabine was thereafter resumed weekly for another 3 weeks or until the patient completed the radiation therapy (whichever was earlier). Five patients were treated at each dose level. The dose of the drug was escalated in increments of 50 mg/m2 if the toxicity was acceptable at the previous level until the maximum tolerated dose was established. Thirteen patients with advanced unresectable colorectal cancer and 12 patients with advanced unresectable pancreaticobiliary cancers were enrolled on the study. Radiation was delivered at 180 cGy/fraction to a total dose of 4000 cGy ± boost. Because toxicity was severe at the 150 mg/m2 dose level, three additional patients were entered at this dose level. The dose was then dropped to 125 mg/m2, and five more patients were entered at this dose level. Two additional patients were then added in orderto assess toxicity. Patient follow-up ranged from 4 to 22 months, and the median was 8 months. RESULTSAll patients were evaluable for toxicity. The doses of 50 and 100 mg/m2 were well tolerated, but at 150 mg/m2, six of eight patients experienced grade 3 or greater toxicity. The dose was de-escalated to 125 mg/m2, and three of seven patients showed grade 3 diarrhea and weight loss. Clinical tumor response was evaluable in 20 patients. Ten patients had a complete clinical response (50%), five patients had a partial response (25%), three patients had no response, and two patients had progression of disease. No patients experienced late toxicities related to either gemcitabine administration or radiation therapy. Twelve patients are currently alive. CONCLUSIONBased on these results, it appears that the maximum tolerated dose for weekly 24-hour infusion of gemcitabine combined with radiation therapy is 100 mg/m2. Gemcitabine appears to be a potent radiation sensitizer, and when combined with radiation therapy, it has shown encouraging tumor responses. In this study, we found an overall response rate of 75% in patients with locally advanced stage of disease. Further evaluation of gemcitabine at 100 mg/m2 is being undertaken in preparation for a confirmatory multi","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74297148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological Response to Preoperative Chemoradiation Worsens with Anemia in Non‐‐‐Small Cell Lung Cancer Patients","authors":"T. J. Robnett, M. Machtay, S. Hahn, J. Shrager, J. Friedberg, L. Kaiser","doi":"10.1097/00130404-200205000-00010","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00010","url":null,"abstract":"PURPOSEPositive links between hemoglobin level and therapeutic tumor response are well documented in carcinoma of the cervix and the head and neck, but little evidence of such a link exists for lung cancer. We analyzed our series of patients treated with preoperative chemoradiation for stage MIA non-small cell lung carcinoma. PATIENTS AND METHODSBetween June 1992 and February 2000, 41 consecutive patients with clinical stage IIIA (N2, documented by mediastinoscopy or another invasive procedure) non-small cell lung carcinoma received preoperative-intent chemoradiation. The median preoperative radiation dose was 48.6 Gy, and all patients received cisplatin- or paclitaxel-based chemotherapy. Response was graded on a four point scale: (1) progressive disease before surgery and/or technically inoperable; (2) stable disease with resection performed, but specimen containing > 50% viable tumor; (3) partial response with specimen containing < 50% tumor; and (4) complete response or near-complete response: RO resection with no residual carcinoma or pTINO with only microscopic residual foci. Pretreatment hemoglobin values were correlated with pathological outcome using ANOVA and the non-parametric test for trend across ordered groups. RESULTSThe mean hemoglobin level for groups 1 through 4 was 11.8, 12.1, 12.5, and 13.2 respectively, and the association was statistically significant. If the analysis was limited to patients actually undergoing surgery (eliminating group 1), the association remained significant. The nonparametric test for trend across ordered groups was also significant with and without group 1. DISCUSSIONOur analysis supports the hypothesis that response to chemoradiation of non-small cell lung carcinoma improves with increasing hemoglobin levels.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84843710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Value of Invariant Chain (Ii) and Her‐2/neu Expression in Curatively Resected Colorectal Cancer","authors":"H. A. Rossi, Qin Liu, B. Banner, C. Hsieh, L. Savas, D. Savarese","doi":"10.1097/00130404-200205000-00011","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00011","url":null,"abstract":"BACKGROUNDCurrent methods to predict outcome for patients with curatively resected colorectal cancer are not ideal. The combined use of molecular markers and clinicopathologic features may better identify patients who are at risk for recurrence. The Her-2/neu and invariant chain molecules may be important in cancer development and progression, but their usefulness as clinical predictors of outcome in colorectal cancer has not been well studied. METHODSWe used immunohistochemistry to determine the expression of Her-2/neu, invariant chain, p27, and p53 in primary tumor samples from 156 patients with curatively resected stage l-lll colorectal cancer. The association between expression and clinical outcomes was assessed by univariate and multivariate analysis. RESULTSHer-2/neu expression was detected in only 24% of cases, and high levels of invariant chain were detected in only 15%. Although patients whose tumors over expressed Her-2/neu survived longer than those with non-overexpressing tumors, neither Her-2/neu nor invariant chain were independently associated with survival. Consistent with previous reports, high p27 expression was associated with improved outcome, whereas overexpression of p53 was associated with worse outcome. CONCLUSIONSOur study did not reveal a statistically significant association between Her-2/neu or invariant chain expression and clinical outcomes in patients with curatively resected colorectal cancer. However, the data suggest that Her-2/neu could be a favorable prognostic variable. Because of the low frequency of Her-2/neu expression, larger numbers of patients need to be studied for this question to be adequately answered.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87210019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Phase II Trial of Either Fluorouracil, Parenteral Hydroxyurea, Interferon‐αt‐2a, and Filgrastim or Doxorubicin/Docetaxel in Patients with Advanced Gastric Cancer with Quality‐of‐Life Assessment: Eastern Cooperative Oncology Group Study E6296","authors":"S. Wadler, C. Brain, P. Catalano, A. Einzig, D. Cella, A. Benson","doi":"10.1097/00130404-200205000-00013","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00013","url":null,"abstract":"PURPOSEThe Eastern Cooperative Oncology Group conducted a randomized phase II trial to determine the objective response rates, toxicities, and overall survival and to assess effects on quality of life for two combination regimens in patients with advanced gastric cancer. PATIENTS AND METHODSAll patients had biopsy-proven, untreated metastatic gastric cancer with measurable disease. The FHIG arm employed infusional fluorouracil (F), 2.6 g/m2, given intravenously over 24 hours once per week for 6 weeks; infusional hydroxyurea (H), 4.3g/m2, given intravenously over 24 hours once per week for 6 weeks; and interferon-a-2a (I), 9 MU given subcutaneously three times per week, once perweekfor6weeks. The AD arm employed doxorubicin (A), 50 mg/m2, and docetaxel (D), 75 mg/m2, both given intravenously every 21 days. Quality of life was measured by the FACT-Fatigue scale and a novel questionnaire assessing interferon-mediated fatigue. RESULTSTwenty-nine patients were enrolled; 23 were eligible and evaluable. Twelve were enrolled on FHIG and 11 on AD. The major grade ≥ 3 toxicities were neuromotor (46%) in patients receiving FHIG and granulocytopenia (91%) in those receiving AD. There were two fatalities in the AD arm. There was one partial responder on FHIG (8.3%) and none on AD. The median survival was 6.6 months for FHIG and 10.1 months for AD. Quality-of-life analysis did not show substantial cumulative fatigue in patients treated with FHIG. CONCLUSIONSNeither regimen demonstrated enough activity to serve as a platform for the development of further clinical regimens against gastric carcinoma. A subset of patients receiving interferon was able to tolerate therapy without deterioration in quality of life.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78583512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ki‐67 Index and Survival in Non‐‐‐Small Cell Lung Cancer: A Review and Relevance to Positron Emission Tomography","authors":"Jeffrey M. Pugsley, R. Schmidt, H. Vesselle","doi":"10.1097/00130404-200205000-00003","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00003","url":null,"abstract":"PURPOSEWe reviewed the current literature to discover the range of studies covering tissue-based and noninvasive methods for determining tumor stage and the prognostic value of staging in non-small cell lung cancer. DESIGNDespite refinements in staging of non-small cell lung cancer, each stage remains heterogeneous because each stage contains patients who are at higher risk for recurrence than other patients within the same stage. Tissue-based and noninvasive methods have been investigated to complement tumor stage in assessing non-small cell lung cancer prognosis. The prognostic significance of tumor proliferation assessed by Ki-67 protein expression has been demonstrated in non-small cell lung cancer. RESULTRecent positron emission tomography studies have also shown both prognostic value in non-small cell lung cancer uptake of [F-18] fluorodeoxyglucose (FDG) and correlation between non-small cell lung cancer FDG uptake and tumor proliferation. DISCUSSIONWe reviewed the prognostic significance of Ki-67 expression in non-small cell lung cancer and related it to positron emission tomography.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79869903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mammographically Detected Breast Cancers and the Risk of Axillary Lymph Node Involvement: Is It Just the Tumor Size?","authors":"R. Heimann, Melissa A. Munsell, R. McBride","doi":"10.1097/00130404-200205000-00012","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00012","url":null,"abstract":"PURPOSEIn early breast cancer the knowledge of the risk of axillary node involvement is important in determining local as well as systemic therapy. Because of the increased acceptance of mammography, there has been an increase in the diagnosis of small, mammographically detected tumors. The objective of this study is to determine whether mammographically detected breast cancers have a lower risk of axillary node involvement compared to those detected clinically. PATIENTS AND METHODSFrom our patient database of stage I and II breast cancer we identified 980 patients with tumors <2cm whom had axillary node dissection. Four hundred thirty-five (44%) patients presented with abnormal mammograms without clinically palpable tumors; 545 (56%) patients had clinically detected tumors. The median size of the mammographically detected tumors is 1.0 cm, and the median size of the clinically detected tumors is 1.5 cm. The median age of the patients with mammographically detected tumors is 61 (range: 29–87) compared to 53 (range: 27–88) in those with palpable tumors. RESULTSFourteen percent of the patients with mammographically detected tumors had positive axillary nodes compared to 26% of those with clinically detected tumors. Eight percent of patients with mammographically detected tumors had a single positive, while the clinically detected tumors 11% had a single positive node. Thirteen percent of patients with ≤1 cm tumors and 25% with tumors 1.1 cm to 2 cm had positive axillary nodes. Because the smaller size of the mammographically detected tumors could explain the lower proportion of positive axillary nodes, we analyzed separately the ≤ 1 cm tumors. In the group of ≤ 1 cm tumors, 9% had positive axillary nodes if they were mammographically detected compared to 19% if clinically detected. Four percent had a single positive node while 5% had multiple positive nodes. If the tumors were palpable and ≤ 1 cm 9% had a single positive node and 10% had multiple positive nodes. Mammographically detected tumors ≤ 1 cm had similargrade to clinically detected tumors. In multivariate analysis, method of detection remains a significant variable impacting on the risk of axillary node involvement even in tumors ≤ 1 cm. DISCUSSIONThe risk of axillary node involvement is lower in mammographically detected tumors compared to clinically detected tumors independent of tumor size or grade. Mammography detects tumors early in their metastatic progression. The majority of the axillary node-positive patients who are mammographically detected have a single positive axillary node. Method of detection may need to be considered when assessing the risk of axillary node involvement and incorporated in the staging.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89698898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postprostatectomy Salvage Radiation Therapy for Prostate Cancer: Impact of Pathological and Biochemical Variables and Prostate Fossa Biopsy","authors":"M. R. Mosbacher, P. Schiff, K. Otoole, M. Benson, C. Olsson, R. Brody, R. Ennis","doi":"10.1097/00130404-200205000-00007","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00007","url":null,"abstract":"PURPOSEA subgroup of prostate cancer patients who have experienced biochemical relapse after radical retropubic prostatectomy (RRP) can benefit from radiation therapy to the prostate fossa. These patients demonstrate biochemical relapse secondary to local failure in the absence of distant failure. In order to define this subgroup, we investigated the impact of pathological and biochemical variables and pre-radiation therapy biopsy of the prostate fossa on biochemical disease-free survival (bNED) and initial prostate-specific antigen response. METHODSSixty-two patients with localized prostate cancer who had biochemical relapse after RRP were treated with post-RRP radiation therapy localized to the prostate fossa (median dose, 6120 cGy) and were subsequently followed up for a median time of 47 months. Cox regression analyses and Kaplan-Meier estimates for bNED were used to identify prognostic variables. The Fisher's exact test was used to test the interaction of initial prostate-specific antigen response with identified prognostic variables. RESULTSCox regression analysis of bNED as a function of pathological and biochemical parameters showed that only Gleason's score was a significant predictor of bNED. On univariate analysis, seminal vesicle involvement was also found to be a significant predictor. Prostate fossa biopsy result was not significantly related to bNED. Because of the overall high rates of biochemical failure, we wished to identify a high-risk subgroup that did not have local relapse as a component of biochemical relapse after RRP. We assessed initial biochemical response following radiation therapy as a surrogate for local relapse. A complete biochemical response was observed in 50% of patients, and a partial biochemical response was observed in an additional 34%, yielding an overall biochemical response rate of 84%. When stratified by Gleason's score, seminal vesicle, pre-radiation therapy prostate-specific antigen, and biopsy result, response rates greater than 50% were seen for all subgroups. CONCLUSIONSGleason's score and seminal vesicle involvement predicted bNED after post-RRP radiation therapy in our cohort. Overall biochemical response rates were high in all subgroups, suggesting that all subgroups demonstrated a high likelihood of residual local disease as a component of failure. Pre-radiation therapy biopsy was predictive of neither bNED nor overall biochemical response.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88692821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}