The overall prognosis for cancers of unknown primary (CUP) is poor, median overall survival (OS) being 6-12 months. We evaluated our multicentric retrospective experience for CUP administered ...docetaxel and cisplatin combination therapy.
A total of 29 patients that were pathologically confirmed subtypes of CUP were included in the study. The combination of docetaxel (75 mg/m2, day 1) and cisplatin (75 mg/m2, day 1) was performed as a first line regimen every 21 days.
The median age was 51 (range: 27-68). Some 17 patients had multimetastatic disease on the inital diagnosis. Histopathological diagnoses were well-moderate differentiated adenocarcinoma (51.7%), undifferentiated carcinoma (27.6%), squamous cell cancer (13.8%), mucoepidermoid carcinoma (3.4%) and neuroendocrine differentiated carcinoma (3.4%). Median number of cycles was 3 (range: 1-6). Objective response rate was 37.9% and clinical benefit was 58.6%. Median progression free survival (PFS) and overall survival (OS) were 6 months (range: 4.3-7.7 months) and 16 months (range: 8.1-30.9 months), respectively. Fourteen patients (60.8%) were treated in a second line setting. There was no treatment related death. Most common toxicities were nausia-vomiting (44.6%) and fatigue (34.7%), serious cases (grade 3/4) suffering nausia-vomiting (10.3%), neutropenia (13.8%) and febrile neutropenia (n=1).
The combination of cisplatin and docetaxel is an effective regimen for selected patients with CUP.
We investigated the clinicopathological features in patients with recurrent RCC within 5 years or more than 5 years after nephrectomy and determined predictors of survival and response treatment ...after recurrence.
We retrospectively evaluated 144 patients with disease recurrence; 73 had recurrence more than 5 years after radical nephrectomy. We compared clinicopathological characteristics in patients with disease recurrence before vs. after 5 years. In addition, we investigated predictors of survival and response to treatment after recurrence.
Seventy-one patients (49%) were diagnosed with recurrence within 5 years after radical nephrectomy (early recurrence) and 73 patients (51%) were diagnosed with recurrence more than 5 years after radical nephrectomy (late recurrence). Fuhrman grade, tumor necrosis and lymphovascular invasion were statistically significantly different between the two groups (p<0.001, p=0.013, p=0.026, respectively). The late recurrence patients were significantly associated with the Memorial Sloan Kettering Cancer Center (MSKCC) favorable risk group compared to patients with early recurrence (p=0.001). From the time of disease recurrence, median Overall Survival (OS) was 36.0 (95% Confidence Interval (CI) 30.7-41.2) months in the late recurrence group, and 19 (95% CI 15.4-22.5) months in the early recurrence group (p=0.01). The median Progression Free Survival (PFS) was 6 (95% CI 3.87-8.12) months in the early recurrence group, and 18 (95% CI 15.4-20.5) months for the late recurrence group (p<0.001).
Early recurrence was significantly associated with Fuhrman grade 3-4, tumor necrosis, lymphovascular invasion, MSKCC poor-risk group compared to patients with late recurrence. The study also demonstrated a potential prognostic value of late recurrence in terms of PFS and OS.
Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics ...related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19–86). Docetaxel was the most commonly used (20.9 %,
n
= 189) single agent, while gemcitabine–platinum was the most commonly used (6.7 %,
n
= 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2–3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0–7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months (
p
= 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors (
p
= 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.
INTRODUCTION: Urinary incontinence impacts the lives of older individuals and it is considered one of the most important and recurrent geriatric syndromes. The aim of this study is to determine the ...prevalence of urinary incontinence in cancer patients and to evaluate its association with age and quality of life. METHODS: One hundred and thirty three patients with cancer were assessed at hematology/oncology outpatient clinic. The validated form of the Turkish version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence and quality of life (QOL). Descriptive statistics were used. The association between urinary incontinence and age, gender, cancer type and quality of life were evaluated with chi square. RESULTS: A total of 133 patients including 84 male and 49 female were evaluated. The mean age of patients was 62.5±12.3. While 45.9% of patients are older than 65, 54.1% of them are less than 64. The rate of urinary incontinence was found 40.6% (n=54). The association between urinary incontinence and age, quality of life has been shown statistically significant with chi square (P<0.001, P><0.001 respectively). The mean of ICI-Q and QOL score is 7.6±3.1 and 3.2±1.7 respectively. The most common type of urinary incontinence is urge incontinence following by stress, mix and overflow (12.8%, 12%, 11.3% and 4.5% respectively).> DISCUSSION AND CONCLUSION: Our results suggest that urinary incontinence is a significant problem which is underdiagnosed and undertreated in cancer patients. It inversely affects the quality of life. While focusing on cancer and chemotherapy, this important problem should not be underestimated. This leaves incontinent patients with unresolved physical, functional, and psychological morbidity, and diminished quality of life. The study suggests that awareness and education regarding incontinence should be increased among cancer patients and screening of Urinary Incontinence is an important part of their assessment.
It is well established that adjuvant treatment reduces mortality after early breast cancer. However, the optimal timing of adjuvant treatment is not well described. To determine the optimal timing of ...adjuvant treatment, 402 breast cancer patients who received adjuvant treatment at Ankara Oncology Research and Training Hospital between January 1995 and August 2002 were evaluated retrospectively. Three hundred and fifty-seven (88.8%) patients received adjuvant chemotherapy, 204 (50.7%) of these patients received only adjuvant chemotherapy and 153 (38%) patients received tamoxifen following chemotherapy. Remaining 45 (11.2%) patients received only adjuvant tamoxifen. The median time to start adjuvant treatment after surgery was day 21 (range, days 4 to days 258), and the median follow-up was 50 months (range, 6–105 months). The patients were divided into 5 groups according to starting time of chemotherapy (shorter than 14 days, between days 15–29, between days 30–44, between days 45.−59 and more than 59 days). Overall survival (OS) and disease-free survival (DFS) were not shown significantly different between for 5 groups (
P
> 0.05). Secondly, patients were divided into two groups as starting adjuvant treatment equal to or shorter than 44 days and longer than 44 days (
n
= 344, 85.6% and vs.
n
= 58, 14.4%, respectively). OS was significantly better in patients who started to receive adjuvant treatment within 44 days after surgery compared to patients who received adjuvant treatment after 44 days (92 vs. 83.3%,
P
= 0.03) for 5 years, but DFS was not significantly different between two groups (83.4 vs. 82.2%,
P
> 0.05). According to our study, adjuvant treatment of breast cancer should be initiated earlier after surgery.
Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors ...for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis.
We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy.
Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascular invasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS), and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related with disease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) and the presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceral pleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS.
Although adjuvant chemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage I and IIA patients without lymph node metastasis.
The aim of this study was to evaluate the efficacy and toxicity of long-term, low-dose oral etoposide as an advanced treatment option in patients with platinum resistant epithelial ovarian cancer.
...For the purposes of this study, 51 patients with histologically-confirmed, recurrent or metastatic platinum-resistant epithelial ovarian cancer (EOC) treated at six different centers between January 2006 and January 2011 were retrospectively evaluated. Patients were treated with oral etoposide (50 mg/day for a cycle of 14 days, repeated every 21 days).
Among the 51 platinum-resistant patients, 17.6% demonstrated a partial response and 25.5% a stable response. The median progression-free survival (PFS) was 3.9 months (95% CI, 2.1-5.7), while the median overall survival was 16.4 months (11.8-20.9). No significant relationship was observed between the pre-treatment CA 125 levels, post-treatment CA-125 levels and the treatment response rates (p=0.21). Among the 51 patients who were evaluated in terms of toxicity, grade 1 or 4 hematologic toxicity was observed in 19 (37.3%); and grade 1-4 gastrointestinal toxicity occurred in 15 patients (29.4%).
Chronic low-dose oral etoposide treatment is generally effective and well-tolerated in platinum-resistant ovarian cancer patients.
Non-epithelial malignant ovarian tumors and clear cell carcinomas, Brenner tumors, transitional cell tumors, and carcinoid tumors of the ovary are rare ovarian tumors (ROTs). In this study, our aim ...was to determine the clinicopathological features of ROT patients and prognostic factors associated with survival.
A total of 167 patients with ROT who underwent initial surgery were retrospectively analyzed. Prognostic factors that may influence the survival of patients were evaluated by univariate and multivariate analyses.
Of 167 patients, 75 (44.9%) were diagnosed with germ-cell tumors (GCT) and 68 (40.7%) with sex cord-stromal tumors (SCST); the remaining 24 had other rare ovarian histologies. Significant differences were found between ROT groups with respect to age at diagnosis, tumor localization, initial surgery type, tumor size, tumor grade, and FIGO stage. Three-year progression-free survival (PFS) rates and median PFS intervals for patients with other ROT were worse than those of patients with GCT and SCST (41.8% vs 79.6% vs 77.1% and 30.2 vs 72 vs 150 months, respectively; p=0.01). Moreover, the 3-year overall survival (OS) rates and median OS times for patients with both GCT and SCST were better as compared to patients with other ROT, but these differences were not statistically significant (87.7% vs 88.8% vs 73.9% and 170 vs 122 vs 91 months, respectively; p=0.20). In the univariate analysis, tumor localization (p<0.001), FIGO stage (p<0.001), and tumor grade (p=0.04) were significant prognostic factors for PFS. For OS, the univariate analysis indicated that tumor localization (p=0.01), FIGO stage (p=0.001), and recurrence (p<0.001) were important prognostic indicators. Multivariate analysis showed that FIGO stage for PFS (p=0.001, HR: 0.11) and the presence of recurrence (p=0.02, HR: 0.54) for OS were independent prognostic factors.
ROTs should be evaluated separately from epithelial ovarian cancers because of their different biological features and natural history. Due to the rarity of these tumors, determination of relevant prognostic factors as a group may help as a guide for more appropriate adjuvant or recurrent therapies for ROTs.
Primary metastatic breast cancer (PMBC) comprises 3–10 % of all BCs. PMBC is a heterogeneous disease. To date, little is known about the tumor characteristics, treatment results, and overall survival ...(OS) of patients with PMBC. Patients were considered to have PMBC if distant metastasis was evident within 3 months of the initial diagnosis of BC. Between September 2007 and April 2013, 466 PMBC patients were included in this study and analyzed retrospectively. The median age of the patients was 50 (18–90) years. Bone/soft tissue metastases were more frequent in the hormone receptor (HR)(+) human epidermal growth factor receptor (HER)2(−) group compared with the HR(−)HER2(−) and HR(−)HER2(+) groups (
p
< 0.001), whereas visceral organ metastasis was more frequent in the HR(−)HER2(−) and HR(−)HER2(+) groups (
p
< 0.001). The OS was affected by Eastern Cooperative Oncology Group performance status, tumor histology, receptor status, and the site of metastasis (
p
< 0.001,
p
< 0.001,
p
< 0.001, and
p
= 0.011, respectively). According to the first-line systemic treatment choices of the patients, the longest median OS was observed in the HR(+)HER2(+) group who received hormonotherapy combined with trastuzumab after chemotherapy (86 months, 95 % CI 23.8–148.1) and the shortest median OS was observed in the HR(−)HER2(−) group who received chemotherapy only (24 months, 95 % CI 17.9–30.0) (
p
< 0.001). Bisphosphonate therapy or radiotherapy had no significant effect on OS (
p
= 0.733, 0.603). In multivariate analysis, hormonotherapy, chemotherapy + trastuzumab, trastuzumab + hormonotherapy following chemotherapy, and surgery were the most important prognostic factors for OS, respectively (
p
< 0.001,
p
= 0.025,
p
= 0.027,
p
= 0.029). The general characteristics of the primary tumor are important for the prognosis and survival of patients with PMBC. Interestingly, patients who underwent primary breast tumor surgery, even those at the metastatic stage upon admission, had the longest survival.
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