American Journal of Clinical Oncology最新文献

{"title":"Impact of Primary Care Access on Mortality of Lung Cancer Patients in an Underserved Community.","authors":"Christopher T Su,&nbsp;Vincent Chau,&nbsp;Balazs Halmos,&nbsp;Chirag D Shah,&nbsp;Rasim A Gucalp,&nbsp;Stuart H Packer,&nbsp;Kevin Wilson,&nbsp;Bruce D Rapkin,&nbsp;Roman Perez-Soler,&nbsp;Haiying Cheng","doi":"10.1097/COC.0000000000000516","DOIUrl":"https://doi.org/10.1097/COC.0000000000000516","url":null,"abstract":"<p><strong>Background: </strong>Lack of access to primary care physicians (PCPs) may be an important contributor to mortality differences attributed to race/ethnicity. This study examined the effects of primary care access on mortality of lung cancer patients in an underserved community.</p><p><strong>Methods: </strong>Medical records of all newly diagnosed patients with primary lung cancer from 2012 to 2016 at a National Cancer Institute (NCI)-designated center in Bronx, New York were reviewed. Demographic data, PCP status, and residence in primary care shortage areas (PCSAs) were collected. Survival data from time of first imaging to death or the end of follow-up on January 1, 2018 were recorded. Survival analysis was performed using Kaplan-Meier and Cox hazards modeling.</p><p><strong>Results: </strong>Among 1062 patients, 874 (82%) were PCSA residents, 314 (30%) were Hispanic, and 445 (42%) were African American. PCSA residents were likely Hispanics (P<0.001), African Americans (P<0.001), of lower income (P<0.001), and had advanced disease at diagnosis (P=0.01). Patients without established PCPs had more comorbidities (P=0.04), more advanced disease (P<0.001), and less in-network cancer treatment (P<0.001). PCSA residence (P=0.03, hazard ratio [HR]=1.27) and no established PCP (P<0.001, HR=1.50) were associated with increased mortality. In multivariable modeling, lack of established PCP remained a predictor of increased mortality (P=0.02, HR=1.25).</p><p><strong>Discussion: </strong>Among newly diagnosed lung cancer patients, lack of established PCP is associated with increased mortality. Hispanics and African Americans increasingly resided in PCSAs, suggesting race/ethnicity mortality differences may be mediated by primary care shortage. Patients without PCPs had worse health outcomes. Effective health policy efforts to reduce mortality in lung cancer patients must include approaches to improve primary care access.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"298-303"},"PeriodicalIF":2.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36871903","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":"A Phase II Study Evaluating Bone Marrow-Sparing, Image-guided Pelvic Intensity-Modulated Radiotherapy (IMRT) With Cesium-131 Brachytherapy Boost, Adjuvant Chemotherapy, and Long-Term Hormonal Ablation in Patients With High Risk, Nonmetastatic Prostate Cancer.","authors":"Stephanie R Rice,&nbsp;Gloribel Olexa,&nbsp;Arif Hussain,&nbsp;Heather Mannuel,&nbsp;Michael J Naslund,&nbsp;Pradip Amin,&nbsp;Young Kwok","doi":"10.1097/COC.0000000000000520","DOIUrl":"https://doi.org/10.1097/COC.0000000000000520","url":null,"abstract":"<p><strong>Purpose/objective(s): </strong>Management of localized high-risk prostate cancer remains challenging. At our institution we performed a prospective phase II study of 2 years of androgen deprivation therapy (ADT), pelvic radiation, Cesium (Cs)-131 brachytherapy boost, and adjuvant docetaxel in high risk, localized prostate cancer with a primary endpoint of 3-year disease-free survival.</p><p><strong>Materials/methods: </strong>Acute/chronic hematologic, gastrointestinal (GI) and genitourinary (GU) toxicities were scored based on the CTCAE v3.0/RTOG-EORTC criteria, respectively. Actuarial biochemical recurrence free survival (bRFS), bRFSdisease free survival (DFS) and overall survival (OS) were calculated. Patients had a median age of 62 years (range, 45 to 82), median Gleason score 8 (74% Gleason 8-10), median PSA of 11.2 (range, 2.8 to 96), and 47% cT2-T3a stage disease. Androgen deprivation was given for 2 years, 45 Gy whole-pelvis IMRT was followed by an 85 Gy Cs-131 boost to the prostate gland, and adjuvant docetaxel was given for 4 cycles.</p><p><strong>Results: </strong>In total 38 patients enrolled from 2006 to 2014, with 82% completing protocol specified treatment, and 84.2% completing 4 cycles of docetaxel. Median follow-up for the entire and alive cohorts were 44 months and 58 months (range, 3.4 to 118), respectively. Acute grade ≥2 GI and GU toxicity rates were 18.4% and 23.7%, respectively. Chronic grade ≥2 GI and GU toxicity rates were 2.6% and 2.6%, respectively. Twelve patients (31.6%) developed grade 4 hematologic toxicity, with no grade 5 toxicity. The 5-year DFS, bRFS and OS rates were 74.1%, 86.0%, and 80.3%, respectively.</p><p><strong>Conclusions: </strong>This aggressive pilot multimodal approach appears to be safe and well-tolerated, providing disease control in a significant proportion of patients with particularly high-risk prostate cancer.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"285-291"},"PeriodicalIF":2.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36893110","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":"Pattern of Marginal Local Failure in a Phase II Trial of Neoadjuvant Chemotherapy and Stereotactic Body Radiation Therapy for Resectable and Borderline Resectable Pancreas Cancer.","authors":"Jordan Kharofa,&nbsp;Michelle Mierzwa,&nbsp;Olugbenga Olowokure,&nbsp;Jeffrey Sussman,&nbsp;Tahir Latif,&nbsp;Anumeha Gupta,&nbsp;Changchun Xie,&nbsp;Sameer Patel,&nbsp;Hope Esslinger,&nbsp;Brian Mcgill,&nbsp;Eric Wolf,&nbsp;Syed A Ahmad","doi":"10.1097/COC.0000000000000518","DOIUrl":"https://doi.org/10.1097/COC.0000000000000518","url":null,"abstract":"<p><strong>Objectives: </strong>The main objectives of this study were to prospectively evaluate the safety and efficacy of stereotactic body radiation therapy (SBRT) in the neoadjuvant setting for resectable or borderline resectable pancreatic cancer.</p><p><strong>Materials and methods: </strong>Eighteen patients were enrolled from November 2014 to June 2017. Following 3 cycles of chemotherapy, SBRT was delivered to the tumor and abutting vessel and a 3 mm planning target volume (PTV) margin to 33 Gy (6.6 Gy×5) with an optional elective PTV to 25 Gy (5 Gy×5) customized to the nodal space and mesenteric vessels. The primary endpoint is ≥grade 3 acute and late gastrointestinal toxicity.</p><p><strong>Results: </strong>Fifteen patients had borderline resectable tumors due to arterial abutment (n=7) or superior mesenteric vein encasement (n=8); 3 patients had resectable tumors. There were no ≥grade 3 acute or late gastrointestinal events. Following SBRT, surgery was performed in 12 patients (67%) with 11 (92%) R0 resections. The median overall survival and progression-free survival was 21 months (95% CI: 18-29) and 11 months (95% CI: 8.4-16). Progression occurred in 83% (10/12) of resected patients (distant [n=4, 40%], local-only [n=4, 40%], and local and distant [n=2, 20%]). The cumulative incidence of local failure (LF) at 12 months from resection was 50% (95% CI: 20-80). All LF were outside to the PTV33.</p><p><strong>Conclusions: </strong>Neoadjuvant SBRT was well tolerated, however LFs were predominantly observed outside the PTV33 volume that would have been covered with conventional RT volumes. The durability of local control after SBRT in the neoadjuvant setting merits examination relative to chemoradiation before incorporation into routine practice.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"247-252"},"PeriodicalIF":2.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36981252","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":"Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma).","authors":"Dongfeng Zeng,&nbsp;Aakash Desai,&nbsp;Fangfang Yan,&nbsp;Tiejun Gong,&nbsp;Haige Ye,&nbsp;Makhdum Ahmed,&nbsp;Krystle Nomie,&nbsp;Jorge Romaguera,&nbsp;Richard Champlin,&nbsp;Shaoying Li,&nbsp;Michael Wang","doi":"10.1097/COC.0000000000000427","DOIUrl":"https://doi.org/10.1097/COC.0000000000000427","url":null,"abstract":"<p><p>The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"304-316"},"PeriodicalIF":2.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35810478","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":"Factors Associated With Head and Neck Cancer Hospitalization Cost and Length of Stay-A National Study.","authors":"Eric Adjei Boakye,&nbsp;Kenton J Johnston,&nbsp;Thiago A Moulin,&nbsp;Paula M Buchanan,&nbsp;Leslie Hinyard,&nbsp;Betelihem B Tobo,&nbsp;Sean T Massa,&nbsp;Nosayaba Osazuwa-Peters","doi":"10.1097/COC.0000000000000487","DOIUrl":"https://doi.org/10.1097/COC.0000000000000487","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to estimate hospitalization cost, and factors associated with hospitalization costs and length of stay (LOS) of patients treated for head and neck cancer in the United States.</p><p><strong>Methods: </strong>Data on 71,440 weighted hospital admissions from the 2014 National Inpatient Sample with a diagnosis of head and neck cancer were examined. Multivariable linear regression models estimated factors associated with hospitalization costs, and negative binomial regression models were used to identify factors associated with hospital LOS. Factor variables included characteristics of the patient, clinical, and hospital characteristics.</p><p><strong>Results: </strong>The average hospitalization cost was US $18,371 and the average LOS was 6.6 days. LOS was significantly associated with admissions involving bacterial infection, major operating procedures, chemo procedure, and radiation procedure as well as admissions at medium or small bed size hospitals, and rural hospitals. Admissions among black patients, elective admissions, admissions involving bacterial infection, major operating procedures, chemo procedure, radiation procedure, and advance comorbidities were associated with increased hospitalization costs. In contrast, admissions at urban nonteaching or rural had increased hospitalization costs.</p><p><strong>Conclusions: </strong>Admissions that involve higher number of comorbidities, metastasis, bacterial infection, radiation, and chemo procedures had longer hospital stay and higher cost whereas admissions are rural hospitals had shorter hospital stay and lower cost. Understanding these factors associated with increased LOS and hospitalization cost will help efforts to decrease health care cost and improve quality of care.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"172-178"},"PeriodicalIF":2.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40444524","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":"How to Optimize Cancer Treatment in Older Patients: An Overview of Available Geriatric Tools.","authors":"Frédéric Pamoukdjian,&nbsp;Evelyne Liuu,&nbsp;Philippe Caillet,&nbsp;Stéphane Herbaud,&nbsp;Mathilde Gisselbrecht,&nbsp;Johanne Poisson,&nbsp;Pascaline Boudou-Rouquette,&nbsp;Laurent Zelek,&nbsp;Elena Paillaud","doi":"10.1097/COC.0000000000000488","DOIUrl":"https://doi.org/10.1097/COC.0000000000000488","url":null,"abstract":"<p><p>Cancer is a disease of older people, but this age group has often been excluded from clinical trials of cancer, which leads to poor transportability of standardized treatments in older cancer patients. One of the main reasons for the exclusion is the heterogeneity of older people in several domains: social environment, comorbidities, dependency, functional status, nutritional status, cognition status, and mood status. Comprehensive geriatric assessment aims to assess this heterogeneity and has identified frequent health problems often unknown before therapeutic decisions, which allows for targeted geriatric interventions with or without follow-up and appropriate cancer treatment selection. Several tools and scores have been developed for a complementary approach. These tools have the following characteristics: they screen for vulnerability to select patients who may benefit from a comprehensive geriatric assessment; are predictive tools for survival, postoperative complications, or chemotherapy-related toxicity; are decisional algorithms for cancer treatment; or define a core set of geriatric data to be collected in clinical cancer trials. Here, we present an overview of the geriatric tools that were published in PubMed from 2000 to 2017, that could help in the therapeutic decision-making for older cancer patients.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"109-116"},"PeriodicalIF":2.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40444831","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":"Factors Affecting Racial Disparities in End-of-Life Care Costs Among Lung Cancer Patients: A SEER-Medicare-based Study.","authors":"Siddharth Karanth,&nbsp;Suja S Rajan,&nbsp;Frances L Revere,&nbsp;Gulshan Sharma","doi":"10.1097/COC.0000000000000485","DOIUrl":"https://doi.org/10.1097/COC.0000000000000485","url":null,"abstract":"<p><strong>Objectives: </strong>Racial disparities exist in end-of-life lung cancer care, which could potentially lead to considerable racial differences in end-of-life care costs. This study for the first time estimates the racial differences in end-of-life care costs among lung cancer patients, and identifies and quantifies factors that contribute the most to these differences using a statistical decomposition method.</p><p><strong>Methods: </strong>This is a retrospective analysis of patients 66 years and older, diagnosed with stage I-IV lung cancer, who died on or before December 31, 2013, using the Surveillance Epidemiology and End Result-Medicare data from 1991 to 2013. Ordinary least square regression of logarithmically transformed cost was used to estimate racial differences in end-of-life care costs among lung cancer patients. Blinder-Oaxaca decomposition was used to identify and quantify factors that contributed the most to these differences.</p><p><strong>Results: </strong>Non-Hispanic blacks had 10% to 13% higher end-of-life care costs as compared with non-Hispanic whites. Geographic variations, baseline comorbidity indices and stage at diagnosis contributed the most to explaining the racial differences in costs, with geographic variation explaining most of the differences. However, the observed factors could only explain 25% to 32% of the racial differences in end-of-life care costs.</p><p><strong>Conclusions: </strong>Geographic differences in access to timely and appropriate care, and provider practice patterns, should be examined to understand the reasons behind geographic variations in racial disparity. Provider-level educational interventions to reduce small area practice variations and differential management of patients by race, as well as racially sensitive patient-level educational and navigational interventions might be critical in improving quality of care and reducing costs during end-of-life.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"143-153"},"PeriodicalIF":2.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40444912","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":"Utilization of an Alternative Docetaxel-based Intraperitoneal Chemotherapy Regimen in Patients With Ovarian, Fallopian Tube or Primary Peritoneal Carcinoma: A Continued Need for Ovarian Cancer Patients.","authors":"David A Becker,&nbsp;Charles A Leath,&nbsp;Christen L Walters-Haygood,&nbsp;Brentley Q Smith,&nbsp;Kerri S Bevis","doi":"10.1097/COC.0000000000000468","DOIUrl":"https://doi.org/10.1097/COC.0000000000000468","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to report the tolerability and toxicity of a regimen consisting of intravenous (IV) docetaxel and intraperitoneal (IP) cisplatin and paclitaxel with granulocyte colony-stimulating factor support.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study of patients with surgical stage II-IV epithelial ovarian, fallopian tube or primary peritoneal carcinoma treated with an outpatient IP chemotherapy regimen consisting of docetaxel 75 mg/m IV and cisplatin 75 mg/m IP day 1 followed by paclitaxel 60 mg/m IP day 8 every 21 days. Grade 3 and 4 toxicity, dose delays and reductions, port complications, and tolerability are reported. Outcomes, including response rate, progression-free survival (PFS), overall survival (OS) are also reported.</p><p><strong>Results: </strong>A total of 60 patients received this IP regimen. Most common toxicities included neutropenia (47%), gastrointestinal (28%), and anemia (25%). Most patients (85%) experienced no IP port complications. Dose delay or reduction was required in 30% of patients. Two-thirds completed all prescribed cycles, with 80% of total planned cycles completed. Complete response was achieved for 88%, and 43% are currently without evidence of disease. Median PFS for all patients was 25.5 months (95% confidence interval [CI], 20.4-30.5 mo) while OS for all patients was 56.8 months (95% CI, 47.7-65.9 mo). For the 44 patients with stage III disease, median PFS was 22.1 months (95% CI, 16.3-28.0 mo), while median OS was 56.8 months (95% CI, 47.3-66.3 mo).</p><p><strong>Conclusions: </strong>This docetaxel-based IP chemotherapy regimen demonstrates an improved tolerability profile compared with GOG172. Additional evaluations on alternative IP regimens remain warranted. Short follow-up time limits survival assessment, but results are encouraging.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"12-16"},"PeriodicalIF":2.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40529053","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":"Neoadjuvant Interdigitated Chemoradiotherapy Using Mesna, Doxorubicin, and Ifosfamide for Large, High-grade, Soft Tissue Sarcomas of the Extremity: Improved Efficacy and Reduced Toxicity.","authors":"Mudit Chowdhary,&nbsp;Neilayan Sen,&nbsp;Elizabeth B Jeans,&nbsp;Luke Miller,&nbsp;Marta Batus,&nbsp;Steven Gitelis,&nbsp;Dian Wang,&nbsp;Ross A Abrams","doi":"10.1097/COC.0000000000000467","DOIUrl":"https://doi.org/10.1097/COC.0000000000000467","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with large, high-grade extremity soft tissue sarcoma (STS) are at high risk for both local and distant recurrence. RTOG 95-14, using a regimen of neoadjuvant interdigitated chemoradiotherapy with mesna, doxorubicin, ifosfamide, and dacarbazine followed by surgery and 3 cycles of adjuvant mesna, doxorubicin, ifosfamide, and dacarbazine, demonstrated high rates of disease control at the cost of significant toxicity (83% grade 4, 5% grade 5). As such, this regimen has not been widely adopted. Herein, we report our institutional outcomes utilizing a modified interdigitated chemoradiotherapy regimen, without dacarbazine, and current radiotherapy planning and delivery techniques for high-risk STS.</p><p><strong>Materials and methods: </strong>Adults with large (≥5 cm; median, 12.9 cm), grade 3 extremity STS who were prospectively treated as part of our institutional standard of care from 2008 to 2016 are included. Neoadjuvant chemoradiotherapy consisted of 3 cycles of mesna, doxorubicin, and ifosfamide (MAI) and 44 Gy (22 Gy in 11 fractions between cycles of MAI) after which patients underwent surgical resection and received 3 additional cycles of MAI.</p><p><strong>Results: </strong>Twenty-six patients received the MAI treatment protocol. At a median follow-up of 47.3 months, 23 (88.5%) patients are still alive. Three year locoregional recurrence-free survival, disease-free survival, and overall survival are 95.0%, 64.0%, and 95.0%, respectively. There have been no therapy-related deaths or secondary malignancies. The nonhematologic grade 4 toxicity rate was 7.7%.</p><p><strong>Conclusions: </strong>Neoadjuvant interdigitated MAI radiotherapy followed by resection and 3 cycles of adjuvant MAI has resulted in acceptable and manageable toxicity and highly favorable survival in patients at greatest risk for treatment failure.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"1-5"},"PeriodicalIF":2.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000467","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438751","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":"Comparison of Outcomes in Patients With Muscle-invasive Bladder Cancer Treated With Radical Cystectomy Versus Bladder Preservation.","authors":"Jim Zhong,&nbsp;Jeffrey Switchenko,&nbsp;Naresh K Jegadeesh,&nbsp;Richard J Cassidy,&nbsp;Theresa W Gillespie,&nbsp;Viraj Master,&nbsp;Peter Nieh,&nbsp;Mehrdad Alemozaffar,&nbsp;Omer Kucuk,&nbsp;Bradley Carthon,&nbsp;Christopher P Filson,&nbsp;Mehmet A Bilen,&nbsp;Ashesh B Jani","doi":"10.1097/COC.0000000000000471","DOIUrl":"https://doi.org/10.1097/COC.0000000000000471","url":null,"abstract":"<p><strong>Purpose: </strong>Radical cystectomy currently remains the standard of care for muscle-invasive bladder cancer. However, surgery can be associated with considerable morbidity and mortality, including the removal of the bladder. An alternative strategy is to preserve the bladder through concurrent chemoradiation following a maximal transurethral resection of the tumor. National protocols using a bladder-preservation approach have demonstrated disease-specific outcomes comparable to radical cystectomy in selected patients, but these results have not been replicated in previously reported population-based series. Here, we describe an outcomes analysis of patients with muscle-invasive bladder cancer treated with either radical surgery or bladder-preserving chemoradiation (BPCRT) for those patients meeting BPCRT criterion using the National Cancer Database (NCDB).</p><p><strong>Materials and methods: </strong>Using the NCDB, patients with American Joint Commission on Cancer clinical T2-3, N0, M0 urothelial carcinoma diagnosed between 2004 and 2013 were included for analysis. Only patients treated with definitive intent with either radical cystectomy or concurrent chemotherapy and radiation after a maximal transurethral tumor resection were included. Propensity-score matching was used.</p><p><strong>Results: </strong>Among 8454 eligible patients, 7276 (86%) underwent radical cystectomy, and 1178 (14%) underwent BPCRT. Patients undergoing BPCRT were significantly older (median age, 77 vs. 68 y; P<0.001) and had higher Charlson-Deyo comorbidity scores (P=0.002). Using propensity-matched analysis, 1002 patients remained in each cohort, and there was no significant difference in survival found between the 2 cohorts (median overall survival, 2.7 vs. 3.0 y [P=0.20]; 4-year overall survival, 39.1% and 42.6% [P=0.15], for BPCRT and surgery, respectively). In addition, the hazard ratio (HR) of surgery versus BPCRT decreased over time, with an initial HR of 1.27 favoring BPCRT which decreased by a factor of 0.85 per year.</p><p><strong>Conclusions: </strong>From 2004 to 2013, ∼14% of patients from the NCDB who potentially met bladder-preservation criteria underwent the procedure. Our propensity-matched analysis is the only report of its kind to demonstrate similar survival outcomes with bladder preservation when patients are properly selected. This study is also the first to demonstrate a dynamic HR between radical surgery and BPCRT over time.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"36-41"},"PeriodicalIF":2.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40440833","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}