Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer

Lisa N. Abaid,Mark A. Rettenmaier,John V. Brown III,John P. Micha,Alberto A. Mendivil,Marie A. Wabe,Bram H. Goldstein 대한부인종양학회 2012 Journal of Gynecologic Oncology Vol.23 No.1

Objective: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary. Objective: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.

Impact of Chemotherapy on Hypercalcemia in Breast and Lung Cancer Patients

Hassan, Bassam Abdul Rasool,Yusoff, Zuraidah Binti Mohd,Hassali, Mohamed Azmi,Othman, Saad Bin,Weiderpass, Elisabete Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.9

Introduction: Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. Methods: We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. Results: Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. Conclusion: Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D₂ Resection for Stage III Gastric Cancer

Yu, Yuanyuan,Zhang, Zicheng,Meng, Qianhao,Wang, Ke,Li, Qingwei,Ma, Yue,Yao, Yuanfei,Sun, Jie,Wang, Guangyu The Korean Gastric Cancer Association 2022 Journal of gastric cancer Vol.22 No.2

Purpose: We aimed to explore whether the prognosis of patients treated with capecitabine and oxaliplatin (XELOX) or S-1 and oxaliplatin (SOX) regimens who received fewer cycles of chemotherapy after D2 radical resection for gastric cancer (GC) would be non-inferior to that of patients who received the standard number of cycles of chemotherapy. Materials and Methods: Data on patients who received XELOX or SOX chemotherapy after undergoing D2 radical resection at Harbin Medical University Cancer Hospital between January 2011 and May 2016 were collected. Results: In patients who received 4, 6, and 8 cycles of chemotherapy, the 5-year overall survival (OS) rates were 59.4%, 64.8%, and 62.7%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (hazard ratio [HR], 0.882; 95% confidence interval [CI], 0.599-1.299; P=0.52) or 8 cycles (HR, 0.882; 95% CI, 0.533-1.458; P=0.62) of chemotherapy did not exhibit significantly prolonged OS. The 3-year disease-free survival (DFS) rate of patients who received 4, 6, and 8 cycles of chemotherapy was 62.1%, 67.2%, and 60.8%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (HR, 0.835; 95% CI, 0.572-1.221; P=0.35) or 8 cycles (HR, 0.972; 95% CI, 0.606-1.558; P=0.91) of chemotherapy did not show significantly prolonged DFS. However, the 3-year DFS and 5-year OS rates of patients who received 6 cycles of chemotherapy appeared to be superior to those of patients who received 4 and 8 cycles of chemotherapy. Conclusions: For patients with stage III GC, 4 to 6 cycles of XELOX or SOX chemotherapy may be a favorable option. This study provides a rationale for further randomized clinical trials.

화학요법을 받는 암환자의 증상 및 통증조절 현황

정영,나덕미,김진선,양경미,Chung, Young,Na, Duck-Mi,Kim, Jin-Sun,Yang, Kyung-Mi 한국호스피스완화의료학회 2003 한국호스피스.완화의료학회지 Vol.6 No.2

목적 : 본 연구의 목적은 화학요법을 받는 암환자의 증상과 통증조절을 위한 약물사용 및 그 치료방법의 현황을 살펴보기 위해 실시하였다. 방법 : 2001년 8월 7일부터 24일까지 광주광역시 일개 대학교 부속병원 혈액종양 내과병동에 입원치료중인 암환자와 주사실에서 화학요법을 받고 있는 전체환자 가운데 연구에 동의하고 질문에 응답을 허락한 66명과 chart audit 및 담당의사 19명을 대상으로 하였다. 대상의 일반적 특성 및 증상의 정도와 통증조절에 사용된 약물의 종류, 투여경로, 평균 투여량, 투여방법에 대하여 조사하였다. 일반적 특성은 수와 백분율로 제시하였으며, 증상의 빈도는 평균과 표준편차로 제시하였다. 진통제의 종류, 규칙적 또는 일시적(pm) 사용여부, 투여경로는 수와 백분율로 제시하였다. 결과 : 66명의 조사대상자 중 남성 35명(53.0%), 여성 31명(47.0%)이었고, 연령은 $61{\sim}69$세가 23명(34.8%)으로 가장 많았다. 진단명은 위암 19명(28.8%), 대장 직장암 17명(25.8%), 비뇨기계암 11명(16.7%) 순으로 나타났다. 진단명 기수는 3기 14명(29.2%), 2기 12명(25.0%), 1기 11명(22.9%), 4기 11명(22.9%) 순이었고, 진단기간은 3개월 이내가 25명(37.9%)로 가장 많은 것으로 나타났다. 화학요법을 받는 암환자의 증상으로는 '쇠약'($2.4193{\pm}1.2220$), '통증'($1.9333{\pm}1.2194$), '수면장애'($1.7142{\pm}1.0384$점), '성격변화'($1.5806{\pm}0.8971$) 순으로 나타났다. 화학요법을 받는 암환자의 통증조절을 위한 진통제는 마약성 진통제 66.2%, 비마약성 진통제 33.8%를 사용하고 있었다. 진통제의 규칙적인 투여는 21%, 일시적(pm)인 투여는 31.6%, 규칙적으로 투여하면서 필요시마다 pm으로 투여한 경우는 47.4%이었다. 진통제의 투여 경로는 경구 투여한 경우 50.7%, 주사로 투여한 경우 41.8%, 패치를 사용한 경우가 7.5%로 나타났다. 결론 : 화학요법을 받는 암환자의 증상으로는 쇠약과 통증을 가장 많이 호소하고 있었다. 그리고 통증조절을 위해서는 마약성 진통제를 우선적으로 사용하였지만 임상의사들의 21%에서만 진통제에 대한 규칙적인 투여가 이루어지는 것으로 나타나 통증조절 충분하다고 볼 수 없다. 이 같은 점을 고려하여 통증의 적절한 평가와 통증조절에 대한 실무와 교육이 필요하다고 생각된다. Purpose : The purpose of this study was to identify the current status of symptom and pain control in cancer patients treated with chemotherapy. Methods : The study population consisted of 66 cancer patients treated with chemotherapy and the data was collected by chart audit and using questionnaire from 19 clinicians in an university hospital during the period of August 7 to 24, 2001. The degree of symptom, analgesics type, dose, administration route, and pain control method of cancer patients treated with chemotherapy was investigated. The collected data were analyzed by frequency, percent, mean, and SD using SPSS $PC^+$ program. Results : The number of cancer patients treated with chemotherapy was 66, male 35 (53.0%), female was 31 (47.0%). The largest of age group was $61{\sim}69$(34.8%) years old. Most frequent cancer site was stomach 19 case (28.8%), cole-rectal 17 case (25.8%), urinary 11 case (16.7%) in the respective order. The most common stage of cancer was stage 3, 14 case (29.2%). The most frequent duration of diagnosis was under 3 month, 25 (37.9%). The frequent symptom of cancer patients treated with chemotherapy was marasmus ($2.4193{\pm}1.2220$), pain ($1.9333{\pm}1.2194$), sleep disorders ($1.7142{\pm}1.0384$), personality change ($1.5806{\pm}0.8971$) in the respective order. 3) The analgesics used for pai control were narcotic analgesics 66.2% and nonnarcotic analgesics 33.8%. Pain control method were regular basis+as needed 47.4%, as needed 31.6%, regular basis 21.0% in order. Administration route were oral 50.7%, injection 41.8%, patch 7.5% in order. Conclusion : The most frequent symptom of cancer patients treated with chemotherapy were marasmus and pain. The frequent analgesics was narcotic analgesics but 21% of the clinician regularly prescribed analgesics for pain control. Thus this prescription was insufficient for pain control. Administration route that were used more oral or injection than patch. Based on this evidence, it seemed that more active practice and education about evaluation and pain control of cancer patients treated with chemotherapy are needed.

항암 약물치료의 현재와 미래

김예희 인제대학교 1999 仁濟醫學 Vol.20 No.1

항암 약물치료의 현재와 미래

김예회 인제대학교 1999 仁濟醫學 Vol.20 No.1S

1971년 national cancer act가 선포된 이래 300억 달러 이상의 연구비가 암 퇴치 사업에 사용되었으나 미국에서는 암으로 인한 사망율이 1990년까지 계속 증가세를 유지하다가 1991년에 들어 처음으로 감소추세로 돌아섰다. 미국에서는 1년에 약 100만명의 암환자가 발생하며 그중 약 45%의 환자는 치유 되리라고 추산되고 있다. 항암화학치료로 생명을 건질 수 있는 환자는 6% 정도에 불과하며 대다수 환자는 아직도 외과적 또는 방사산 치료에 의존하고 있다. 약물로 암을 치유할 수 있음이 입증된 것은 1955년 methotrexate로 융모상피종을 성공적으로 치료함으로써 비롯되었다. 같은 해에 미국에서는 national cancer chemotherapy program이 제정되면서 암의 약물치료에 대한 연구 지원이 활발히 이루어지기 시작하였고 combination chemotherapy, adjuvant chemotherapy, high-dose chemotherapy with hematopoietic stem-cell support 등의 개념이 암의 약물치료에 성공적으로 도입되면서 치유율을 점차 높여 나가고 있다. 그동안 70만 이상의 물질에 대하여 항암성의 존재여부에 대한 검사가 이루어졌으며 현재 약 60여종의 항암약물이 임상에 사용되고 있다. 그러나 지금까지의 암의 약물요법의 성과는 기대에 못 미치고 있다. 근래에 와서 분자생물학과 유전공학 기법의 발전으로 세포의 분열 증식에 관하여 수많은 새로운 기초 지식이 알려지고 있다. 암은 유전자의 변이에 의하여 발생하게 되며 발암 과정에는 수많은 oncogene과 tumor suppressor gene이 관여한다. 이들 암 발생과 관계가 있는 유전자들의 산물로써 비정상적인 세포분열증식에 관여하는 molecules, 예컨대 세포막에 위치하는 plasma membrane receptors, 세포형질에 존재하는 signal transduction pathway enzymes 및 그들과 연관이 있는 binding proteins, 세포핵내에 있는 cell-cycle progression regulators 등을 표적으로 그들의 잘못된 기능을 억제하는 약물을 개발하려는 molecular therapy에 대한 연구가 활발히 진행되고 있으며 일부는 임상실용단계에 와 있다. cancer gene therapy의 본래의 의도는 암발생의 원인인 잘못된 유전자를 새로운 유전자로 대치해 줌으로써 변이된 유전자를 바로 잡아보려는 데에 목적이 있지만 또 다른 한편에서는 새로운 유전자를 암세포조직에 삽입하여 줌으로써 항암제에 대한 암의 감수성을 높여 준다든가 또는 암세포의 면역반응 기능을 증가시켜 면역치료의 효과를 높이려는 연구도 진행되고 있다. Since 1971 when the National Cancer Act was passed in the United Sates Congress, more than 30 billion dollars has been spent to support researches to reduce the incidence, morbidity and mortality from cancer. Despite intensive basic and clinical researches and trials of new therapeutic regimens. motality due to cancer continued to increase until 1991, then plateaued and began to decrease. Current cancer chemotherapy is highly effective in approximately 15% of human malignancy and majority of patient with solid tumor receives only marginal benefit from existing therapeutic regimen. Newer gfeneration of drugs must be developed with improved efficacy for further progress to be made in the war against cancer. Recent advances in the techniques of molecular biology have revolutionized our basic understanding of human cancer. Yet to date this knowledge explosion has failed to bring major improvements in combating cancer death and major breakthroughs are not expected in near future. Therefore existing cancer during therapy will remain the mainstay of cancer treatment for the foreseeable future.

Role of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

Zhao, Dan,Wu, Ling-Ying,Wang, Xiao-Bing,Li, Xiao-Guang Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

Objective: To analyze efficacy of neoadjuvant chemotherapy for advanced ovarian cancer. Materials and Methods: A total of 107 patients with advanced ovarian cancer undergoing cytoreductive surgery were divided into a neoadjuvant chemotherapy group (n=61) and a primary debulking group (n=46) and retrospectively analyzed. Platinum-based adjuvant chemotherapy was applied to both groups after cytoreductive surgery ande overall and progression-free survival times were calculated. Results: No significant difference was observed in duration of hospitalization ($20.8{\pm}6.1$ vs. $20.2{\pm}5.4$ days, p>0.05). The operation time of neoadjuvant chemotherapy group was shorter than the initial surgery group ($3.1{\pm}0.7$ vs. $3.4{\pm}0.8$ h, p<0.05). There were no significant differences in median overall survival time between neoadjuvant chemotherapy group and surgery group (42 vs. 55 months, p>0.05). Similarly, there was no difference in median progression-free survival between neoadjuvant chemotherapy group and surgery group (16 vs. 17 months, p>0.05). The surgical residual tumor size demonstrated no significant difference between initial surgery and neoadjuvant chemotherapy groups (p>0.05). Multivariate analysis showed that more than 3 cycles of regimen with neoadjuvant chemotherapy was associated with more resistance to chemotherapy compared with patients without receiving neoadjuvant chemotherapy (OR: 5.962, 95%CI: 1.184-30.030, p<0.05). Conclusions:Neoadjuvant chemotherapy can shorten the operation time. However, it does not improve survival rates of advanced ovarian cancer patients.

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases

Uyan, Mikail,Koca, Bulent,Yuruker, Savas,Ozen, Necati Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. Materials and Methods: A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into <10 and ${\geq}10$. The variables to be compared were analysed using the program SPSS 15.0 with P<0.05 accepted as significant. Results: Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 (0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of <10 lymph nodes. Conclusions: The number of dissected lymph nodes from the patients with breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.

Acupuncture as a Complementary Treatment for Cancer Patients Receiving Chemotherapy

Tas, Demet,Uncu, Dogan,Sendur, Mehmet Ali,Koca, Nuran,Zengin, Nurullah Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.7

Background: Medical treatment for eliminating the side effects of cancer therapy may not always be efficacious. Acupuncture is one of the most widely accepted alternative and complementary therapies in use today. In this study, we investigated the efficacy of acupuncture in patients experiencing cancer treatment side effects, including nausea, vomiting, pain, poor sleep quality and anxiety. Materials and Methods: A total of 45 inpatients who underwent chemotherapy between February and April 2013 in the Oncology Department of Numune Hospital were included in our study. Acupuncture was administered to the patients one day prior to chemotherapy, on the day of chemotherapy and one day after chemotherapy. The patients were evaluated on nausea, vomiting, pain, sleep quality and anxiety before the chemotherapy and on the $4^{th}$ day of chemotherapy. Results: Of the 45 patients included in the study, 18 (40%) were female and 27 (60%) were male. A total of 25 (55.6%) had an elementary school education; 32 patients (71%) had stage 4 cancer and were treated with palliative chemotherapy (the patient characteristics are shown in Table 1). Statistically significant decreases (p<0.001) in pain, nausea, vomiting, insomnia and anxiety scores were observed after the acupuncture treatment compared to baseline. There were no differences in the age, gender, education level, stage or metastasis levels between the patient groups whose symptoms improved or were unchanged. Conclusions: Our study showed that acupuncture has positive effects in cancer treatment patients who experience nausea, vomiting, pain, poor sleep quality and anxiety as side effects of chemotherapy. Chemotherapy-related side effects in cancer patients could be decreased by the concurrent use of acupuncture.

Update of Adjuvant Chemotherapy for Resected Gastric Cancer

Oh, Sang-Cheul The Korean Gastric Cancer Association 2012 Journal of gastric cancer Vol.12 No.1

Gastric cancer is the second cause of cancer that is related to death and the fourth most common cancer, worldwide. Complete resection of cancer is the only curative treatment for gastric cancer. However, even if complete resection is possible, recurrence is frequently observed in Gastric patients. Therefore, adjuvant treatment modality for resectable gastric cancer is needed to increase the survival of patients. This study wants to describe the role of adjuvant chemotherapy for resectable gastric cancer, with updated data of recent studies. Several meta-analysis studies demonstrated a benefit of adjuvant chemotherapy for resectable gastric cancer. Due to the heterogeneity of the population and regimens, there is no consensus regarding the adjuvant chemotherapy. Recently published, well designed phase III studies demonstrated the statistically significance of adjuvant chemotherapy for the resectable gastric cancer, with the extended lymph node dissection. Further phase III trials, to determine the best regimen and schedule of adjuvant chemotherapy, was suggested to use the fluoropyrimidine based regimen as control group.