American Journal of Clinical Oncology最新文献

{"title":"A Phase II Study of Celecoxib With Irinotecan, 5-Fluorouracil, and Leucovorin in Patients With Previously Untreated Advanced or Metastatic Colorectal Cancer.","authors":"Emerson Y Chen,&nbsp;Charles D Blanke,&nbsp;Daniel G Haller,&nbsp;Al B Benson,&nbsp;Tomislav Dragovich,&nbsp;Heinz-Josef Lenz,&nbsp;Carlos Robles,&nbsp;Hong Li,&nbsp;Motomi Mori,&nbsp;Nora Mattek,&nbsp;Rachel E Sanborn,&nbsp;Charles D Lopez","doi":"10.1097/COC.0000000000000465","DOIUrl":"https://doi.org/10.1097/COC.0000000000000465","url":null,"abstract":"<p><strong>Objective: </strong>Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Cyclooxygenase-2 (COX-2) overexpression is associated with increased tumor invasiveness and proliferation in CRC, and COX-2 inhibition has demonstrated chemopreventive activity. This study investigated the addition of celecoxib, a selective COX-2 inhibitor, to the irinotecan, 5-fluorouracil, and leucovorin (IFL) regimen for patients with previously untreated metastatic CRC.</p><p><strong>Patients and methods: </strong>Forty-seven patients enrolled in this single-arm phase II study received celecoxib at 400 mg orally twice daily in combination with weekly irinotecan (125 mg/m(2)), 5-fluorouracil (500 mg/m(2)), and leucovorin (20 mg/m(2)) for 4 weeks every 6 weeks. The primary endpoint was response rate (RR) as measured by Response Evaluation Criteria in Solid Tumors. The protocol was amended midway to additionally exclude patients with Eastern Cooperative Oncology Group performance status 2 and require all patients with specific cardiovascular risk factors to take daily aspirin (81 mg).</p><p><strong>Results: </strong>The objective RR was 31.9% (95% confidence interval [CI], 19%-47%). Median progression-free survival was 8.7 months (95% CI, 5.8-10.6), and the median overall survival was 19.7 months (95% CI, 15.4-22.8). All cardiac events were observed before protocol modification. The median overall survival before and after protocol modification was 11.4 versus 24.2 months, respectively (P<0.0001); tumor RR and progression-free survival were not statistically different before or after protocol modification. The trial was halted after an interim analysis demonstrated that the primary endpoint would not be met.</p><p><strong>Conclusions: </strong>Celecoxib plus IFL chemotherapy for patients with metastatic CRC is tolerable, but does not appear to increase the efficacy of IFL.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1193-1198"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40529649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-agent Bevacizumab in Recurrent Glioblastoma After Second-line Chemotherapy With Fotemustine: The Experience of the Italian Association of Neuro-Oncology.","authors":"Francesco Pasqualetti,&nbsp;Andrea Pace,&nbsp;Alessandra Gonnelli,&nbsp;Veronica Villani,&nbsp;Martina Cantarella,&nbsp;Durim Delishaj,&nbsp;Caterina Vivaldi,&nbsp;Alessandro Molinari,&nbsp;Sabrina Montrone,&nbsp;Alessia Pellerino,&nbsp;Federica Franchino,&nbsp;Davide Baldaccini,&nbsp;Giuseppe Lombardi,&nbsp;Ivan Lolli,&nbsp;Francesca Catania,&nbsp;Elena Bazzoli,&nbsp;Riccardo Morganti,&nbsp;Alessandra Fabi,&nbsp;Vittorina Zagonel,&nbsp;Guido Bocci,&nbsp;Maria Grazia Fabrini,&nbsp;Roberta Rudà,&nbsp;Riccardo Soffietti,&nbsp;Fabiola Paiar","doi":"10.1097/COC.0000000000000464","DOIUrl":"https://doi.org/10.1097/COC.0000000000000464","url":null,"abstract":"<p><strong>Objectives: </strong>Bevacizumab is an anti-vascular endothelial growth factor antibody used in the treatment of recurrent glioblastoma (GBM). Despite the large number of studies carried out in patients with recurrent GBM, little is known about the administration of this angiogenesis inhibitor after the failure of the second-line chemotherapy.</p><p><strong>Materials and methods: </strong>In this retrospective multicenter study, on behalf of the Italian Association of Neuro-Oncology, we reported the results obtained in 51 patients with recurrent GBM treated with single-agent bevacizumab after the failure of second-line chemotherapy with fotemustine.</p><p><strong>Results: </strong>In March 2016, at the time of data analysis, 3 patients (14.4%) were still alive with stable disease, whereas 48 died due to disease progression. Kaplan-Meier estimated median survival from the diagnosis of GBM was 28 months (95% confidence interval [CI], 22.1-33.9 mo). Median survival measured from the beginning of fotemustine and bevacizumab therapy were 11.3 (95% CI, 8.4-13.6 mo) and 6 months (95% CI, 3.8-8.1 mo), respectively. The 6- and 12-month progression free survival rates from the beginning of bevacizumab treatment were 18% and 13%, respectively.</p><p><strong>Conclusions: </strong>On the basis of our data, in patients with recurrent GBM, the failure of a second-line chemotherapy with cytotoxic agents might not exclude the administration of bevacizumab as third-line chemotherapy.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1272-1275"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40437441","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":"BRCA1 Mutations Associated With Increased Risk of Brain Metastases in Breast Cancer: A 1: 2 Matched-pair Analysis.","authors":"Peter J Zavitsanos,&nbsp;David E Wazer,&nbsp;Jaroslaw T Hepel,&nbsp;Yihong Wang,&nbsp;Kamaljeet Singh,&nbsp;Kara L Leonard","doi":"10.1097/COC.0000000000000466","DOIUrl":"https://doi.org/10.1097/COC.0000000000000466","url":null,"abstract":"<p><strong>Background: </strong>Brain metastases (BM) occur in ∼5% of breast cancer patients. BRCA1-associated cancers are often basal-like and basal-like cancers are known to have a predilection for central nervous system metastases. We performed a matched-pair analysis of breast cancer patients with and without BRCA mutations and compared the frequency of BM in both groups.</p><p><strong>Materials and methods: </strong>From a database of 1935 patients treated for localized breast cancer at our institution from 2009 to 2014 we identified 20 patients with BRCA1 or BRCA2 mutations and manually matched 40 patients without BRCA mutations accounting for age, stage, estrogen receptor expression, and human epidermal growth factor receptor 2 (HER2) expression. Comparisons of freedom from brain metastasis, brain metastasis-free survival, and overall survival were made using the log rank test. Testing for a basal-type phenotype using the immunohistochemistry definition (ER/PR/HER2 and either CK 5/6 or EGFR) was performed for BRCA patients who developed BM and their matched controls.</p><p><strong>Results: </strong>We analyzed 60 patients: 20 BRCA and 40 were matched controls. Median follow-up was 37 and 49 months, respectively. Three years freedom from brain metastasis was 84% for BRCA patients and 97% for BRCA controls (P=0.049). Three years brain metastasis-free survival was 84% and 97% for the BRCA+ and controls, respectively (P=0.176). Mean time to brain failure was 11 months from diagnosis for the BRCA patients. All 3 BRCA1 patients who developed BM were of a basal-type triple negative phenotype.</p><p><strong>Conclusions: </strong>Breast cancer patients with germline BRCA1 mutations appear to have a shorter interval to brain progression while accounting for confounding factors.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1252-1256"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40437970","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":"Regional Lymph Node Metastases in Groin Sarcomas: A Diagnostic and Therapeutic Challenge.","authors":"Deanna Wan Jie Ng,&nbsp;Ye Xin Koh,&nbsp;Grace Hwei Ching Tan,&nbsp;Khee Chee Soo,&nbsp;Melissa Ching Ching Teo","doi":"10.1097/COC.0000000000000462","DOIUrl":"https://doi.org/10.1097/COC.0000000000000462","url":null,"abstract":"<p><strong>Introduction: </strong>The evaluation of lymph nodes and the role of groin dissection for groin sarcomas has been controversial where there have not been previous studies or guidelines published. In this study, we aim to first formulate a clinical approach in the evaluation of regional lymph nodal metastases. Second, we aim to also evaluate the role of regional lymphadenectomy in the setting of pathologically involved regional lymph nodes for groin sarcomas.</p><p><strong>Materials and methods: </strong>In total, 43 consecutive patients with groin sarcomas underwent treatment at the National Cancer Centre Singapore between 2002 and 2015. Univariate comparisons were performed using the log-rank test. A Cox multivariate analysis was performed for disease-specific survival to identify independent prognostic factors.</p><p><strong>Results: </strong>The median disease-free survival was 18 months (range, 1 to 180 mo). The median overall survival (OS) was 28 months (range, 3 to 180 mo). In total, 28 patients underwent a groin dissection. Of the 28 patients who underwent groin dissections, 15 had negative lymph node involvement, 7 had positive lymph node involvement and 6 had lymphovascular invasion.On univariate analysis, grade (P=0.047) and clinical and/or radiological involvement (P=0.039) were significant for regional lymph nodal metastases.The 5-year OS for patients with positive lymph nodes was 31%.</p><p><strong>Conclusions: </strong>Our study suggests that the evaluation of lymph nodes via groin dissections in groin sarcomas in the Asian population should be based primarily on clinical and radiologic evidence. Regional lymph node dissection seems to confer OS benefit in patients with these high-risk tumors and can improve local control of disease.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1162-1167"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438324","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 Utility of Diagnostic Laparoscopy in Patients Being Evaluated for Cytoreductive Surgery and Hyperthermic Peritoneal Chemotherapy.","authors":"Raquel Bravo,&nbsp;Mehnareh D Jafari,&nbsp;Alessio Pigazzi","doi":"10.1097/COC.0000000000000463","DOIUrl":"https://doi.org/10.1097/COC.0000000000000463","url":null,"abstract":"<p><strong>Background: </strong>To assess the role of diagnostic laparoscopy (DL) to evaluate candidates for optimal cytoreduction surgery of peritoneal carcinomatosis (PC) combined with hyperthermic intraperitoneal chemotherapy in a consecutive series.</p><p><strong>Methods: </strong>The characteristics of 31 patients undergoing DL between August 2012 and October 2016 for a diagnosis of PC secondary to digestive neoplasms were retrospectively reviewed.</p><p><strong>Results: </strong>Laparoscopic evaluation was successful and well-tolerated in 100% patients (N=31). In 17 patients (54.8%) the PC was deemed unresectable. A cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy was performed in 10 of 12 patients with PC considered resectable at laparoscopy wity a positive predictive value of 83.3%. One patient was diagnosed with more extensive disease than that as assessed by the DL at the time of laparotomy and 1 patient elected not to have further surgery. There were no port-site recurrences and morbidity at mean follow-up of 19.3 months.</p><p><strong>Conclusions: </strong>Laparoscopic assessment of PC is a useful tool to assess the complete resectability of peritoneal surface disease in patients for whom there is inadequate information concerning disease extent. DL also helps selected patients to avoid an unnecessary laparotomy.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1231-1234"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438339","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":"Breast-conservation Therapy After Neoadjuvant Chemotherapy Does Not Compromise 10-Year Breast Cancer-specific Mortality.","authors":"Renee L Arlow,&nbsp;Lisa E Paddock,&nbsp;Xiaoling Niu,&nbsp;Laurie Kirstein,&nbsp;Bruce G Haffty,&nbsp;Sharad Goyal,&nbsp;Thomas Kearney,&nbsp;Deborah Toppmeyer,&nbsp;Antoinette M Stroup,&nbsp;Atif J Khan","doi":"10.1097/COC.0000000000000456","DOIUrl":"https://doi.org/10.1097/COC.0000000000000456","url":null,"abstract":"<p><strong>Objectives: </strong>Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery by downstaging disease in patients with breast cancer. The aim of this study was to determine whether patients who received neoadjuvant chemotherapy have equal survival after breast-conservation therapy compared with mastectomy.</p><p><strong>Material and methods: </strong>Using the New Jersey State Cancer Registry (NJSCR) patients with a primary breast cancer diagnosed between 1998 and 2003 who underwent neoadjuvant chemotherapy were selected (n=1,468). Of those, only patients who received lumpectomy plus radiation (n=276) or mastectomy without radiation (n=442) were included in the analysis. The main outcome measured included 10-year breast cancer-specific mortality, with 90% of patients with known vital status through the end of 2011.</p><p><strong>Results: </strong>Baseline characteristics did not differ significantly between the breast-conservation and mastectomy without radiation groups except with respect to summary stage and lymph node involvement. After propensity score matching these differences were no longer statistically significant; however, both estrogen and progesterone status achieved statistical significance. The Kaplan-Meier survival curve showed that the breast-conservation group had significantly higher breast cancer-specific survival than the mastectomy group (P=0.0046). After adjusting for the propensity score in the regression model, the breast-conservation group continued to show significantly better survival than the mastectomy group (hazard ratios, 0.46; 95% confidence interval, 0.27-0.78).</p><p><strong>Conclusions: </strong>This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer-specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1246-1251"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer: An Institutional Experience.","authors":"Dustin B Manders,&nbsp;Travis T Sims,&nbsp;April Bailey,&nbsp;Lindsay Hwang,&nbsp;Debra L Richardson,&nbsp;David S Miller,&nbsp;Siobhan M Kehoe,&nbsp;Kevin V Albuquerque,&nbsp;Jayanthi S Lea","doi":"10.1097/COC.0000000000000458","DOIUrl":"https://doi.org/10.1097/COC.0000000000000458","url":null,"abstract":"<p><strong>Objective: </strong>Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN.</p><p><strong>Methods: </strong>A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy.</p><p><strong>Results: </strong>Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirty-nine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter ≥1 cm was a significant negative prognostic indicator for overall survival.</p><p><strong>Conclusions: </strong>Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN ≥1 cm in size.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1225-1230"},"PeriodicalIF":2.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40527633","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 Role of Provider Characteristics in the Selection of Surgery or Radiation for Localized Prostate Cancer and Association With Quality of Care Indicators.","authors":"Raj Satkunasivam, Mary Lo, Mariana Stern, Inderbir S Gill, Steven Fleming, Xiao-Cheng Wu, Roger T Anderson, Trevor D Thompson, Ann S Hamilton","doi":"10.1097/COC.0000000000000442","DOIUrl":"10.1097/COC.0000000000000442","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to identify the role of provider and facility characteristics in receipt of radical prostatectomy (RP) or external beam radiation therapy (EBRT) and adherence to quality of care measures in men with localized prostate cancer (PCa).</p><p><strong>Materials and methods: </strong>Subjects included 2861 and 1630 men treated with RP or EBRT, respectively, for localized PCa whose records were reabstracted as part of the Centers for Disease Control and Prevention Breast and Prostate Patterns of Care Study. We utilized multivariable generalized estimating equation regression analysis to assess patient, clinical, and provider (year of graduation, urologist density) and facility (group vs. solo, academic/teaching status, for-profit status, distance to treatment facility) characteristics that predicted use of RP versus EBRT as well as quality of care outcomes.</p><p><strong>Results: </strong>Multivariable analysis revealed that group (vs. solo) practice was associated with a decreased risk of RP (odds ratio, 0.47; 95% confidence interval, 0.25-0.91). Among RP patients with low-risk disease, receipt of a bone scan that was not recommended was significantly predicted by race and insurance status. Surgical quality of care measures were associated with physician's year of graduation and receiving care at a teaching facility.</p><p><strong>Conclusions: </strong>In addition to demographic factors, we found that provider and facility characteristics were associated with treatment choice and specific quality of care measures. Long-term follow-up is required to determine whether quality of care indicators are related to PCa outcomes.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1076-1082"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192857/pdf/nihms945648.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39985810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Androgen Deprivation Therapy on Overall Mortality in Prostate Brachytherapy Patients With Low Pretreatment Testosterone Levels.","authors":"Al V Taira,&nbsp;Gregory S Merrick,&nbsp;Robert W Galbreath,&nbsp;Wayne M Butler,&nbsp;Edward Adamovich","doi":"10.1097/COC.0000000000000340","DOIUrl":"https://doi.org/10.1097/COC.0000000000000340","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether the use of androgen deprivation therapy (ADT) in prostate brachytherapy patients impacts overall mortality (OM) in patients with lower pretreatment serum testosterone levels compared with those with normal or high baseline serum testosterone.</p><p><strong>Materials and methods: </strong>From October 2001 to May 2014, 1916 patients underwent brachytherapy and had a pretreatment serum testosterone. Baseline serum testosterone values were collected prospectively before initiation of therapy. Median follow-up was 7.2 years. In total, 26% of the patients received ADT, primarily men with higher risk disease. OM and prostate cancer-specific mortality were examined to determine whether men with lower baseline serum testosterone were at increased risk of mortality when ADT was used, compared with men with baseline normal or higher testosterone.</p><p><strong>Results: </strong>Prostate cancer-specific mortality and OM at 10 years was 0.8% and 22.0%. Age, tobacco use, diabetes, cardiovascular disease, and percent positive biopsies were the strongest predictors of OM. ADT use by itself was not associated with an increased risk of OM on multivariate analysis (P=0.695). However, ADT use in men with lower baseline testosterone was associated with a significantly higher risk of OM (P<0.01). ADT use in men with normal or higher baseline testosterone was not associated with an increased OM risk (P=0.924).</p><p><strong>Conclusions: </strong>Men with lower baseline testosterone may be at increased risk of premature death when ADT is utilized compared with men with baseline normal or higher testosterone. Further analysis of this potential risk factor is warranted to further identify subsets of men who may be at higher risk of long-term adverse sequelae from ADT.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"667-673"},"PeriodicalIF":2.6,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39975428","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":"Intraoperative Radiotherapy in the Era of Intensive Neoadjuvant Chemotherapy and Chemoradiotherapy for Pancreatic Adenocarcinoma.","authors":"Florence K Keane,&nbsp;Jennifer Y Wo,&nbsp;Cristina R Ferrone,&nbsp;Jeffrey W Clark,&nbsp;Lawrence S Blaszkowsky,&nbsp;Jill N Allen,&nbsp;Eunice L Kwak,&nbsp;David P Ryan,&nbsp;Keith D Lillemoe,&nbsp;Carlos Fernandez-Del Castillo,&nbsp;Theodore S Hong","doi":"10.1097/COC.0000000000000336","DOIUrl":"https://doi.org/10.1097/COC.0000000000000336","url":null,"abstract":"<p><strong>Objectives: </strong>Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic pancreatic adenocarcinoma (PDAC) have prompted incorporation of these regimens into neoadjuvant treatment of locally advanced unresectable PDAC. Whereas some patients remain unresectable on surgical exploration, others are able to undergo resection after intensive neoadjuvant treatment. We evaluated outcomes and toxicity associated with use of intensive neoadjuvant treatment followed by intraoperative radiotherapy (IORT) in combination with resection or exploratory laparotomy.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with locally advanced unresectable or borderline-resectable PDAC who received intensive neoadjuvant treatment with induction chemotherapy and chemoradiotherapy followed by exploratory laparotomy in an IORT-equipped operating suite between 2010 and 2015. Surgical outcomes and overall survival (OS) were compared.</p><p><strong>Results: </strong>Of 68 patients, 41 (60.3%) underwent resection, 18 (26.5%) had unresectable disease, and 9 (13.2%) had distant metastases. Of 41 resectable patients, 22 received IORT for close/positive resection margins on intraoperative frozen section. There was no significant difference in operative times or morbidity with addition of IORT to resection. Median OS was 26.6 months for all patients who underwent resection, 35.1 months for patients who underwent resection and IORT, and 24.5 months for patients who underwent resection alone (P=NS). Of 18 patients with unresectable disease, all but 1 received IORT, with median OS of 24.8 months. IORT was associated with increased hospital stay (4 vs. 3.5 d), but no significant difference in operative times or morbidity.</p><p><strong>Conclusions: </strong>IORT in addition to intensive neoadjuvant chemotherapy and chemoradiotherapy was not associated with increased toxicity when used with resection or exploratory laparotomy, and was associated with encouraging survival rates in patients with close/positive margins and patients with unresectable disease.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"607-612"},"PeriodicalIF":2.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39975995","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}