Survival Benefit of Intervention Treatment in Advanced Anaplastic Thyroid Cancer

Background. The management of anaplastic thyroid cancer (ATC) is controversial; thus, proper treatment and prognostic factors should be investigated. Objectives. To compare the survival outcomes of the intervention and palliative treatment in ATC patients. Methods. A hospital-based retrospective study was conducted at a single tertiary university hospital. The medical record charts were retrieved from November 20, 1987, to December 31, 2016. The final follow-up ended by December 31, 2017. The patients’ demographic data, laboratory data, clinical presentation, and treatment modality results were analyzed. Results. One hundred twenty-one records were analyzed with a one-year overall survival rate of 3.5% (median survival time: 77 days); however, 16 cases had insufficient data to classify staging and treatment modalities. Therefore, 105 ATC patients (37 with stage IVa, 39 with stage IVb, and 29 with stage IVc disease) were included with a one-year overall survival rate of 4.0% (median survival time of 82 days). Intervention treatment allowed longer median survival times ( p < 0.05 ) and a better survival rate ( p < 0.05 ). Among the interventional treatment groups, postoperative chemoradiation yielded the longest median survival time (187 days) and the highest survival rate (20%) ( p < 0.05 ). The intervention modality allowed a better median survival time at all stages, particularly in stage IVa ( p < 0.05 ). Unfavorable prognostic factors were adjusted for in a multiple Cox regression model showing that significant factors included age ≥65 years (hazard ratio HR: 2.57), palliative treatment (HR: 1.85), and leukocytosis ≥10,000 cells/mm3 (HR: 2.76). Conclusions. Intervention treatment provided a better survival outcome in all stages, particularly in stage IVa, with a significantly better median survival time. Among interventional treatments, postoperative chemoradiation led to the longest survival rate, suggesting that this treatment should be considered in ATC patients with resectable tumors and no poor prognostic factors, such as older age and leukocytosis.

Isocitrate dehydrogenase 1 mutant glioblastomas demonstrate a decreased rate of pseudoprogression: a multi-institutional experience

Background Pseudoprogression (psPD) represents false radiologic evidence of tumor progression and is observed in some glioblastoma (GBM) patients after postoperative chemoradiation (CRT) with temozolomide (TMZ). The ambiguity of the psPD diagnosis confounds identification of true progression and may lead to unnecessary interventions. The association between psPD and isocitrate dehydrogenase 1 (IDH1) mutational (mut) status is understudied, and its incidence may alter clinical decision making. Methods We retrospectively evaluated 120 patients with IDH1-mut (n = 60) and IDH1–wild-type (IDH-WT; [n = 60]) GBMs who received postoperative CRT with TMZ at 4 academic institutions. Response Assessment in Neuro-Oncology criteria were used to identify psPD rates in routine brain MRIs performed up to 90 days after CRT completion. Results Within 90 days of completing CRT, 9 GBM patients (1 [1.7%] IDH1-mut and 8 [13.3%] IDH1-WTs) demonstrated true progression, whereas 17 patients (3 [5%] IDH1-muts and 14 [23.3%] IDH1-WTs) demonstrated psPD (P = .004). IDH1-mut GBMs had a lower probability of psPD (hazard ratio: 0.173, 95% CI, 0.047-0.638, P = .008). Among the patients with radiologic signs suggestive of progression (n = 26), psPD was found to be the cause in 3 of 4 (75.0%) of the IDH1-mut GBMs and 14 of 22 (63.6%) of the IDH1-WT GBMs (P = .496). Median overall survival for IDH1-mut and IDH1-WT GBM patients was 40.3 and 23.0 months, respectively (P < .001). Conclusions IDH1-mut GBM patients demonstrate lower absolute rates of psPD expression. Irrespective of GBM subtype, psPD expression was more likely than true progression within 90 days of completing CRT. Continuing adjuvant treatment for IDH1-mut GBMs is suggested if radiologic progression is suspected during this time interval.

Rectal cancer

Chapter 8 assesses the role of radiation therapy in rectal cancer, with emphasis on preoperative imaging, patient selection for preoperative chemoradiotherapy and short-course preoperative radiotherapy, and postoperative chemoradiation. The various available planning techniques are described. More conformal techniques such as intensity-modulated radiotherapy, volume-modulated arc therapy, and brachytherapy are also covered. In addition, the chapter reviews chemoradiation and radiotherapy as an adjunct to local excision and endoluminal irradiation.

THE RESULTS OF TREATMENT OF STAGE II-III DISTAL GASTRIC ADENOCARCINOMA UNDERWENT SURGERY AND POSTOPERATIVE CHEMORADIATION THERAPY

Objectives: To evaluate the survival outcome, patterns of failure, and complications in patients treated with postoperative chemoradiation therapy in stages II-III of distal gastric cancer. Materials & methods: Prospective study on 58 patients with stages II-III gastric adenocarcinoma, underwent distal gastrectomy and D1 or D2 dissection, completed post operative chemoradiation therapy with capecitabine and 4-6 cycles with EOX regimen at Oncology center of Hue central hospital from 01/2013 to 12/2015. Results: Mean age was 55.16 ± 9.1, male/female ratio: 3/1, recurrence was common in the first year after treatment (62.5%), the average time of recurrence and metastasis were 13.50 ± 7.29 months and 18.75 ± 8.97 months, respectively. The mean overall survival was 41.21 ± 21.06 months. The mean disease free survival was 36.22 ± 22.64 months. The mean overall survival: stage II was 41.88 ± 20.78 months; stage III was 39.59 ± 22.27. The mean overall survival for extention of primary tumors: T3 was 40.79 ± 19.61 months; T4 was 41.33 ± 24.80 months. The mean overall survival for extensive of lymph nodes: N (-) was 41.16 ± 20.51 months, N (+) was 41.26 ± 22.06 months. Toxicity levels recorded as follow: leukopenia was mainly on grade 1 and 2 (33.6%), neutropenia was mostly on grade 1 and 2 (26.8%), as well as thrombocytopenia (8.6%); hemoglobin decrease was on grade 1 and 2 in most cases (41.4%); toxicity symptoms on digestive system like nausea-vomitting, diarrhea was mainly on grade 1 and 2. Conclusion: Postoperative chemoradiation therapy helps to improve local and regional recurrence in locally advanced gastric cancer with acceptable toxicities. Key words: Distal gastric adenocarcinoma, postoperative chemoradiation therapy