Current Oncology

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Open AccessEditorial

Truth Be Told—Perspectives on Openness

by R.E. Hughes and J. Richards

Curr. Oncol. 2014, 21(3), 525-527; https://doi.org/10.3747/co.21.1734 - 01 Jun 2014

Viewed by 323

Abstract

In the field of oncology, [...]
Full article

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Open AccessCase Report

Metastatic Renal Cell Carcinoma without Evidence of a Primary Renal Tumour

by R.M. Kumar, T. Aziz, H. Jamshaid, J. Gill and A. Kapoor

Curr. Oncol. 2014, 21(3), 521-524; https://doi.org/10.3747/co.21.1914 - 01 Jun 2014

Cited by 18 | Viewed by 582

Abstract

Although metastases are common in patients with renal cell carcinoma (rcc), it is extremely rare for patients to present with metastatic rcc (mrcc) without evidence of a primary mass in the kidney. Two cases of mrcc with no [...] Read more.

Although metastases are common in patients with renal cell carcinoma (rcc), it is extremely rare for patients to present with metastatic rcc (mrcc) without evidence of a primary mass in the kidney. Two cases of mrcc with no detectable primary renal mass are reported here. Both patients had bilateral native kidneys in situ and no significant prior urologic history. The first patient presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mrcc. Multiple scans by computed tomography (ct) and confirmatory imaging by magnetic resonance demonstrated no renal mass. This first patient had disease stabilization for 18 months on sunitinib and was still alive at last follow-up. The second patient was diagnosed with clear-cell mrcc after thickened synovium was discovered and biopsied during a knee arthroplasty. Multiple scans by ct in this second patient demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were initiated, but unfortunately, the patient deteriorated clinically and passed away from disease progression shortly after diagnosis. Because of the rare nature of these cases, a standardized course of action has not yet been established. However, we hypothesize that it is reasonable to manage metastases in these patients by following established mrcc protocols. Full article

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Open AccessCase Report

Hormonal Manipulation with Letrozole in the Treatment of Metastatic Malignant pecoma

by P. Le, A. Garg, G. Brandao, A. Abu-Sanad and L. Panasci

Curr. Oncol. 2014, 21(3), 518-520; https://doi.org/10.3747/co.21.1849 - 01 Jun 2014

Cited by 10 | Viewed by 437

Abstract

Perivascular epithelioid cell tumours (PEComas) are rare mesenchymal tumours. Some have a benign course; others metastasize. Treatment of malignant PEComas is challenging, and little is known about treatment for patients with metastatic disease. Here, we report a case of metastatic [...] Read more.

Perivascular epithelioid cell tumours (PEComas) are rare mesenchymal tumours. Some have a benign course; others metastasize. Treatment of malignant PEComas is challenging, and little is known about treatment for patients with metastatic disease. Here, we report a case of metastatic malignant PEComa with estrogen and progesterone receptor expression that showed a favourable and sustained response to letrozole. Full article

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Open AccessPerspective

Kissing and hpv: Honest Popular Visions, the Human Papilloma Virus, and Cancers

by L.Z.G. Touyz

Curr. Oncol. 2014, 21(3), 515-517; https://doi.org/10.3747/co.21.1970 - 01 Jun 2014

Cited by 4 | Viewed by 435

Abstract

Kissing is among the multitude of functions of the lips [...] Full article

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Open AccessGuidelines

Evidence-Based Guidance on Venous Thromboembolism in Patients with Solid Tumours

by M.A. Shea–Budgell, C.M.J. Wu, J.C. Easaw and

Curr. Oncol. 2014, 21(3), 504-514; https://doi.org/10.3747/co.21.1938 - 01 Jun 2014

Cited by 12 | Viewed by 515

Abstract

Venous thromboembolism (vte) is a serious, life-threatening complication of cancer. Anticoagulation therapy such as low molecular weight heparin (lmwh) has been shown to treat and prevent vte. Cancer therapy is often complex and ongoing, making the management of [...] Read more.

Venous thromboembolism (vte) is a serious, life-threatening complication of cancer. Anticoagulation therapy such as low molecular weight heparin (lmwh) has been shown to treat and prevent vte. Cancer therapy is often complex and ongoing, making the management of vte less straightforward in patients with cancer. There are no published Canadian guidelines available to suggest appropriate strategies for the management of vte in patients with solid tumours. We therefore aimed to develop a clear, evidence-based guideline on this topic. A systematic review of clinical trials and meta-analyses published between 2002 and 2013 in PubMed was conducted. Reference lists were handsearched for additional publications. The National Guidelines Clearinghouse was searched for relevant guidelines. Recommendations were developed based on the best available evidence. In patients with solid tumours, lmwh is recommended for those with established vte and for those without established vte but with a high risk for developing vte. Options for lmwh include dalteparin, enoxaparin, and tinzaparin. No one agent can be recommended over another, but in the setting of renal insufficiency, tinzaparin is preferred. Unfractionated heparin can be used under select circumstances only (that is, when rapid clearance of the anticoagulant is desired). The most common adverse event is bleeding, but major events are rare, and with appropriate follow-up care, bleeding can be monitored and appropriately managed. Full article

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Open AccessArticle

Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

by X. Kostaras, F. Cusano, G.A. Kline, W. Roa, J. Easaw and CNS Tumour Team the Alberta Provincial

Curr. Oncol. 2014, 21(3), 493-503; https://doi.org/10.3747/co.21.1769 - 01 Jun 2014

Cited by 102 | Viewed by 2005

Abstract

Background: Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. [...] Read more.

Background: Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. Few prospective clinical trials have set out to determine the optimal dose and schedule for dexamethasone in patients with primary brain tumours, and subsequently, fewer clinical practice guideline recommendations have been formulated. Method: A review of the scientific literature published to November 2012 considered all publications that addressed dexamethasone use in adult patients with brain tumours. Evidence was selected and reviewed by a working group comprising 3 clinicians and 1 methodologist. The resulting draft guideline underwent internal review by members of the Alberta Provincial cns Tumour Team, and feedback was incorporated into the final version of the guideline. Recommendations: Based on the evidence available to date, the Alberta Provincial cns Tumour Team makes these recommendations: Treatment with dexamethasone is recommended for symptom relief in adult patients with primary high-grade glioma and cerebral edema. After surgery, a maximum dose of 16 mg daily, administered in 4 equal doses, is recommended for symptomatic patients. This protocol should ideally be started by the neurosurgeon. A rapid dexamethasone tapering schedule should be considered where appropriate. Patients who have high-grade tumours, are symptomatic, or have poor life expectancy, can be maintained on a 0.5–1.0 mg dose of dexamethasone daily. Side effects with dexamethasone are common, and they increase in frequency and severity with increased dose and duration of therapy. Patients should be carefully monitored for endocrine, muscular, skeletal, gastrointestinal, psychiatric, and hematologic complications, and for infections and other general side effects. Full article

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Open AccessReview

The Role of Interventional Radiology in the Management of Hepatocellular Carcinoma

by N. Molla, N. AlMenieir, E. Simoneau, M. Aljiffry, D. Valenti, P. Metrakos, L.M. Boucher and M. Hassanain

Curr. Oncol. 2014, 21(3), 480-492; https://doi.org/10.3747/co.21.1829 - 01 Jun 2014

Cited by 42 | Viewed by 1280

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced HCC [...] Read more.

Background: Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced HCC or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications. Methods: A systemic search of PubMed, MEDLINE, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review. Results: Needle core biopsy is a highly sensitive, specific, and accurate method for HCC grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child–Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities—transarterial chemoembolization (TACE), drug-eluting beads, and transarterial radioembolization (TARE)—TACE is the method of choice in Child–Pugh A disease, and TARE is the method of choice in HCC cases with portal vein thrombosis. Conclusions: The existing data support the importance of a multidisciplinary approach in HCC management. Large randomized controlled studies are needed to provide clear indication guidelines for each method. Full article

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Open AccessReview

Survivorship Care Plans: A Work in Progress

by H.M.L. Daudt, C. van Mossel, D.L. Dennis, L. Leitz, H.C. Watson and J.J. Tanliao

Curr. Oncol. 2014, 21(3), 466-479; https://doi.org/10.3747/co.21.1781 - 01 Jun 2014

Cited by 35 | Viewed by 724

Abstract

Background: Health agencies across the world have echoed the recommendation of the U.S. Institute of Medicine (iom) that survivorship care plans (scps) should be provided to patients upon completion of treatment. To date, reviews of scps have been [...] Read more.

Background: Health agencies across the world have echoed the recommendation of the U.S. Institute of Medicine (iom) that survivorship care plans (scps) should be provided to patients upon completion of treatment. To date, reviews of scps have been limited to the United States. The present review offers an expanded scope and describes how scps are being designed, delivered, and evaluated in various countries. Methods: We collected scps from Canada, the United States, Europe, the United Kingdom, Australia, and New Zealand. We selected for analysis the scps for which we could obtain the actual scp, information about the delivery approach, and evaluation data. We conducted a content analysis and compared the scps with the iom guidelines. Results: Of 47 scps initially identified, 16 were analyzed. The scps incorporated several of the iom’s guidelines, but many did not include psychosocial services, identification of a key point of contact, genetic testing, and financial concerns. The model of delivery instituted by the U.K. National Cancer Survivorship Initiative stands out because of its unique approach that initiates care planning at diagnosis and stratifies patients into a follow-up program based on self-management capacities. Summary: There is considerable variation in the approach to delivery and the extent to which scps follow the original recommendations from the iom. We discuss the implications of this review for future care-planning programs and prospective research. A holistic approach to care that goes beyond the iom recommendations and that incorporates care planning from the point of diagnosis to beyond completion of treatment might improve people’s experience of cancer care. Full article

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Open AccessArticle

Health Care Costs for Prostate Cancer Patients Receiving Androgen Deprivation Therapy: Treatment and Adverse Events

by M.D. Krahn, K.E. Bremner, J. Luo and S.M.H. Alibhai

Curr. Oncol. 2014, 21(3), 457-465; https://doi.org/10.3747/co.21.1865 - 01 Jun 2014

Cited by 33 | Viewed by 3213

Abstract

Background: Serious adverse events have been associated with androgen deprivation therapy (ADT) for prostate cancer (PCa), but few studies address the costs of those events. Methods: All PCa patients (ICD-9-CM 185) in Ontario who started 90 days or [...] Read more.

Background: Serious adverse events have been associated with androgen deprivation therapy (ADT) for prostate cancer (PCa), but few studies address the costs of those events. Methods: All PCa patients (ICD-9-CM 185) in Ontario who started 90 days or more of ADT or had orchiectomy at the age of 66 or older during 1995–2005 (n = 26,809) were identified using the Ontario Cancer Registry and drug and hospital data. Diagnosis dates of adverse events—myocardial infarction, acute coronary syndrome, congestive heart failure, stroke, deep vein thrombosis or pulmonary embolism, any diabetes, and fracture or osteoporosis—before and after ADT initiation were determined from administrative data. We excluded patients with the same diagnosis before and after ADT, and we allocated each patient’s time from ADT initiation to death or December 31, 2007, into health states: ADT (no adverse event), ADT-AE (specified single adverse event), Multiple (>1 event), and Final (≤180 days before death). We used methods for Canadian health administrative data to estimate annual total health care costs during each state, and we examined monthly trends. Results: Approximately 50% of 21,811 patients with no preADT adverse event developed 1 or more events after ADT. The costliest adverse event state was stroke ($26,432/year). Multiple was the most frequent (n = 2,336) and the second most costly health state ($24,374/year). Costs were highest in the first month after diagnosis (from $1,714 for diabetes to $14,068 for myocardial infarction). Costs declined within 18 months, ranging from $784 per 30 days (diabetes) to $1,852 per 30 days (stroke). Adverse events increased the costs of ADT by 100% to 265%. Conclusions: The economic burden of adverse events is relevant to programs and policies from clinic to government, and that burden merits consideration in the risks and benefits of ADT. Full article

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Open AccessArticle

One Compared with Two Cycles of Mitomycin C in Chemoradiotherapy for Anal Cancer: Analysis of Outcomes and Toxicity

by R. Yeung, Y. McConnell, G. Roxin, R. Banerjee, G.B. Roldán Urgoiti, A.R. MacLean, W.D. Buie, K.E. Mulder, M.M. Vickers, K.J. Joseph and C.M. Doll

Curr. Oncol. 2014, 21(3), 449-456; https://doi.org/10.3747/co.21.1903 - 01 Jun 2014

Cited by 21 | Viewed by 610

Abstract

(1) Background: Concurrent chemoradiation with fluorouracil (5fu) and mitomycin C (mmc) is standard treatment for anal canal carcinoma (acc). The current protocol in Alberta is administration of 5fu and mmc during weeks 1 and 5 [...] Read more.

(1) Background: Concurrent chemoradiation with fluorouracil (5fu) and mitomycin C (mmc) is standard treatment for anal canal carcinoma (acc). The current protocol in Alberta is administration of 5fu and mmc during weeks 1 and 5 of radiation. However, administration of the second bolus of mmc has been based largely on centre preference. Given limited published data on outcomes with different mmc regimens, our objective was to compare the efficacy and toxicity of 1 compared with 2 cycles of mmc in acc treatment. (2) Methods: Our retrospective study evaluated 169 acc patients treated with radical chemoradiotherapy between 2000 and 2010 at two tertiary cancer centres. All patients were treated with 2 cycles of 5fu and with 1 cycle (mmc1) or 2 cycles (mmc2) of mmc. Acute toxicities, disease-free (dfs) and overall survival (os) were analyzed. (3) Results: Baseline demographics, performance status, and stage were similar in the groups of patients who received mmc1 (52%) and mmc2 (48%). Before treatment, median hematologic parameters were comparable, except for white blood cell count, which was higher in the mmc2 group, but within normal range. The 5-year os and dfs were similar (75.1% and 54.2% for mmc1 vs. 70.7% and 44.2% for mmc2, p = 0.98 and p = 0.63 respectively). On multivariate analysis, mmc2 was the factor most strongly associated with specific acute toxicities: grade 3+ leukopenia (hazard ratio: 4.82; p < 0.01), grade 3+ skin toxicity (hazard ratio: 4.76; p < 0.001), and hospitalizations secondary to febrile neutropenia (hazard ratio: 9.91; p = 0.001). (4) Conclusions: In definitive chemoradiotherapy for acc, 1 cycle of mmc appears to offer outcomes similar to those achieved with 2 cycles, with significantly less acute toxicity. Full article

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Open AccessArticle

Use of Screening Tests, Diagnosis Wait Times, and Wait-Related Satisfaction in Breast and Prostate Cancer

by M. Mathews, D. Ryan, V. Gadag and R. West

Curr. Oncol. 2014, 21(3), 441-448; https://doi.org/10.3747/co.21.1843 - 01 Jun 2014

Cited by 4 | Viewed by 463

Abstract

Background: Understanding factors relating to the perception of wait time by patients is key to improving the patient experience. Methods: We surveyed 122 breast and 90 prostate cancer patients presenting at clinics or listed on the cancer registry in Newfoundland and Labrador and [...] Read more.

Background: Understanding factors relating to the perception of wait time by patients is key to improving the patient experience. Methods: We surveyed 122 breast and 90 prostate cancer patients presenting at clinics or listed on the cancer registry in Newfoundland and Labrador and reviewed their charts. We compared the wait time (first visit to diagnosis) and the wait-related satisfaction for breast and prostate cancer patients who received regular screening tests and whose cancer was screening test–detected (“screen/screen”); who received regular screening tests and whose cancer was symptomatic (“screen/symptomatic”); who did not receive regular screening tests and whose cancer was screen test–detected (“no screen/screen”); and who did not receive regular screening tests and whose cancer was symptomatic (“no screen/symptomatic”). Results: Although there were no group differences with respect to having a long wait (greater than the median of 47.5 days) for breast cancer patients (47.8% screen/ screen, 54.7% screen/symptomatic, 50.0% no screen/ screen, 40.0% no screen/symptomatic; p = 0.814), a smaller proportion of the screen/symptomatic patients were satisfied with their wait (72.5% screen/ screen, 56.4% screen/symptomatic, 100% no screen/ screen, 90.9% no screen/symptomatic; p = 0.048). A larger proportion of screen/symptomatic prostate cancer patients had long waits (>104.5 days: 41.3% screen/screen, 92.0% screen/symptomatic, 46.0% no screen/screen, 40.0% no screen/symptomatic; p = 0.011) and a smaller proportion of screen/ symptomatic patients were satisfied with their wait (71.2% screen/screen, 30.8% screen/symptomatic, 76.9% no screen/screen, 90.9% no screen/symptomatic; p = 0.008). Full article

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Open AccessArticle

Non-Myeloablative Allogeneic Hematopoietic Transplantation for Patients with Hematologic Malignancies: 9-Year Single-Centre Experience

by N.I. AlJohani, K. Thompson, W. Hasegawa, D. White, A. Kew and S. Couban

Curr. Oncol. 2014, 21(3), 434-440; https://doi.org/10.3747/co.21.1846 - 01 Jun 2014

Cited by 1 | Viewed by 548

Abstract

Matched related and unrelated allogeneic nonmyeloablative hematopoietic transplantation (NMT) is increasingly being used in patients with hematologic malignancies. Conditioning regimens and indications for NMT vary considerably from centre to centre. Our institution uses intravenous fludarabine and cyclophosphamide, plus graft-versus-host disease ( [...] Read more.

Matched related and unrelated allogeneic nonmyeloablative hematopoietic transplantation (NMT) is increasingly being used in patients with hematologic malignancies. Conditioning regimens and indications for NMT vary considerably from centre to centre. Our institution uses intravenous fludarabine and cyclophosphamide, plus graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. We retrospectively analyzed 89 consecutive patients who underwent NMT (65 related, 24 unrelated) at our institution from October 2002 to September 2011. The most frequent indications for NMT were acute myelocytic leukemia (high-risk in first complete or subsequent remission: n = 20, 22.5%) and relapsed follicular lymphoma (n = 18, 20.2%). The cumulative incidence of acute GVHD (grades 2–4) was 28.1% (n = 25), and rates were similar for related (n = 18, 28%) and unrelated (n = 7, 29%) NMT. At a median follow-up of 22.6 months, the cumulative incidence of chronic GVHD (limited and extensive) was 68% (n = 61): 68.5% (n = 44) for related and 71% (n = 17) for unrelated NMT. The 100-day transplant-related mortality rate was 2.2%: 1.5% for related and 4.2% for unrelated NMT. Of the 89 patients, 30 (33.7%) have relapsed: 41.5% after related and 12.5% after unrelated NMT. Relapse rates were similar in patients with myeloid and lymphoid malignancies (36.4% vs. 33.3%). The 3-year overall and progression-free survival rates were 50.0% and 43.4% respectively, with multivariate analysis showing that neither rate was affected by age, disease group, status at transplantation, or related compared with unrelated NMT. Our findings indicate that, despite its limitations, including the incidence of chronic GVHD, NMT is an important treatment modality for a selected subgroup of patients with hematologic malignancies. Full article

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Open AccessArticle

Access to Personalized Medicine: Factors Influencing the Use and Value of Gene Expression Profiling in Breast Cancer Treatment

by Y. Bombard, L. Rozmovits, M. Trudeau, N.B. Leighl, K. Deal and D.A. Marshall

Curr. Oncol. 2014, 21(3), 426-433; https://doi.org/10.3747/co.21.1782 - 01 Jun 2014

Cited by 22 | Viewed by 803

Abstract

Genomic information is increasingly being used to personalize health care. One example is gene expression profiling (gep) tests, which estimate recurrence risk to inform chemotherapy decisions in breast cancer. Recently, gep tests were publicly funded in Ontario. We explored the perceived [...] Read more.

Genomic information is increasingly being used to personalize health care. One example is gene expression profiling (gep) tests, which estimate recurrence risk to inform chemotherapy decisions in breast cancer. Recently, gep tests were publicly funded in Ontario. We explored the perceived utility of gep tests, focusing on the factors influencing their use and value in treatment decision-making by patients and oncologists. Methods: We conducted interviews with oncologists (n = 14) and interviews and a focus group with early-stage breast cancer patients (n = 28) who underwent gep testing. Both groups were recruited through oncology clinics in Ontario. Data were analyzed using the content analysis and constant comparison techniques. Results: Narratives from patients and oncologists provided insights into various factors facilitating and restricting access to gep. First, oncologists are positioned as gatekeepers of gep, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor–patient relationship. Second, media attention facilitated patient awareness of gep, but also complicated gatekeeping. Third, the dedicated administration attached to gep was burdensome and led to long waits for results and also to increased patient anxiety and delayed treatment. Collectively, because of barriers to access, those factors inadvertently heightened the perceived value of gep for patients relative to other prognostic indicators. Conclusions: Our study delineates the factors facilitating and restricting access to gep, and highlights the roles of media and organization of services in the perceived value and utilization of gep. The results identify a need for administrative changes and practice guidelines to support streamlined and standardized use of gep tests. Full article

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Open AccessArticle

Factors Associated with Breast Cancer Mortality after Local Recurrence

by R. Dent, A. Valentini, W. Hanna, E. Rawlinson, E. Rakovitch, P. Sun and S.A. Narod

Curr. Oncol. 2014, 21(3), 418-425; https://doi.org/10.3747/co.21.1563 - 01 Jun 2014

Cited by 35 | Viewed by 809

Abstract

Purpose: We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery. Experimental Design: Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women’s College Hospital [...] Read more.

Purpose: We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery. Experimental Design: Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women’s College Hospital from 1987 to 1997 and who later developed local recurrence. Clinical information and tumour receptor status were abstracted from medical records and pathology reports. Patients were followed from the date of local recurrence until death or last follow-up. Survival analysis used a Cox proportional hazards model. Results: Among the 267 women with a local recurrence, 97 (36.3%) died of breast cancer within 10 years (on average 2.6 years after the local recurrence). The actuarial risk of death was 46.1% at 10 years from recurrence. In a multivariable model, predictors of death included short time from diagnosis to recurrence [hazard ratio (hr) for <5 years compared with ≥10 years: 3.40; 95% confidence interval (ci): 1.04 to 11.1; p = 0.04], progesterone receptor positivity (hr: 0.35; 95% ci: 0.23 to 0.54; p < 0.001), lymph node positivity (hr: 2.1; 95% ci: 1.4 to 3.3; p = 0.001), and age at local recurrence (hr for age >45 compared with age ≤45 years: 0.61; 95% ci: 0.38 to 0.95; p = 0.03). Conclusions: The risk of death after local recurrence varies widely. Risk factors for death after local recurrence include node positivity, progesterone receptor negativity, young age at recurrence, and short time from diagnosis to recurrence. Full article

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Open AccessArticle

Concurrent Chemoradiotherapy Followed by Adjuvant Chemotherapy Compared with Concurrent Chemoradiotherapy Alone for the Treatment of Locally Advanced Nasopharyngeal Carcinoma: A Retrospective Controlled Study

by Z. Liang, X. Zhu, L. Li, S. Qu, X. Liang, Z. Liang, F. Su, Y. Li and W. Zhao

Curr. Oncol. 2014, 21(3), 408-417; https://doi.org/10.3747/co.21.1777 - 01 Jun 2014

Cited by 18 | Viewed by 740

Abstract

Objective: We evaluated the survival benefit of providing concurrent chemoradiotherapy (ccrt) plus adjuvant chemotherapy compared with ccrt alone to patients with locally advanced nasopharyngeal carcinoma. Methods: This retrospective study included 130 patients with nasopharyngeal carcinoma treated with ccrt plus [...] Read more.

Objective: We evaluated the survival benefit of providing concurrent chemoradiotherapy (ccrt) plus adjuvant chemotherapy compared with ccrt alone to patients with locally advanced nasopharyngeal carcinoma. Methods: This retrospective study included 130 patients with nasopharyngeal carcinoma treated with ccrt plus adjuvant chemotherapy from June 2005 to December 2010. Another 130 patients treated with ccrt alone during the same period were matched on age, sex, World Health Organization histology, T stage, N stage, and technology used for radiotherapy. The endpoints included overall survival, locoregional failure-free survival, distant metastasis failure-free survival, and failure-free survival. Results: At a mean follow-up of 42.1 months (range: 8–85 months), the observed hazard ratios for the group receiving ccrt plus adjuvant chemotherapy compared with the group receiving ccrt alone were: for overall survival, 0.77 [95% confidence interval (ci): 0.37 to 1.57]; for locoregional failure-free survival, 1.00 (95% ci: 0.37 to 2.71); for distant metastasis failure-free survival, 1.15 (95% ci: 0.56 to 2.37); and for failure-free survival, 1.26 (95% ci: 0.69 to 2.28). There were no significant differences in survival between the groups. After stratification by disease stage, ccrt plus adjuvant chemotherapy provided a borderline significant benefit for patients with N2–3 disease (hazard ratio: 0.35; 95% ci: 0.11 to 1.06; p = 0.052). Multivariate analyses indicated that only tumour stage was a prognostic factor for overall survival. Conclusions: Patients with locally advanced nasopharyngeal carcinoma received no significant survival benefit from the addition of adjuvant chemotherapy to ccrt. However, patients with N2–3 disease might benefit from the addition of adjuvant chemotherapy to ccrt. Full article

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Open AccessArticle

Treatment Outcomes for Male Breast Cancer: A Single-Centre Retrospective Case–Control Study

by M. Rushton, A. Kwong, H. Visram, N. Graham, W. Petrcich and S. Dent

Curr. Oncol. 2014, 21(3), 400-407; https://doi.org/10.3747/co.21.1730 - 01 Jun 2014

Cited by 13 | Viewed by 514

Abstract

Background: Male breast cancer (bc) is a rare disease, and the availability of information on treatment outcomes is limited compared with that for female bc. The objective of the present study was to compare disease-free (dfs) and [...] Read more.

Background: Male breast cancer (bc) is a rare disease, and the availability of information on treatment outcomes is limited compared with that for female bc. The objective of the present study was to compare disease-free (dfs) and overall survival (os) for men compared with women having early-stage bc. Methods: This retrospective case–control study compared men and women treated for stage 0–iiib bc at a single institution between 1981 and 2009. Matching was based on age at diagnosis, year of diagnosis, and stage. Treatment, recurrence, and survival data were collected. Kaplan–Meier analysis was used to calculate os and dfs. Results: For the 144 eligible patients (72 men, 72 women), median age at diagnosis was 66.5 years. Treatments included mastectomy (72 men, 38 women), radiation (29 men, 44 women), chemotherapy (23 men, 20 women), and endocrine therapy (57 men, 57 women). Mean dfs was 127 months for women compared with 93 months for men (p = 0.62). Mean os was 117 months for women compared with 124 months for men (p = 0.35). In multivariate analysis, the only parameter that affected both dfs and os was stage at diagnosis. Conclusions: This case–control study is one of the largest to report treatment outcomes in early-stage male bc patients treated in a non-trial setting. Male patients received systemic therapy that was comparable to that received by their female counterparts, and they had similar os and dfs. These results add to current evidence from population studies that male sex is not a poor prognostic factor in early-stage breast cancer. Full article

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Open AccessArticle

Clinical Manifestations in Patients with Alpha-Fetoprotein–Producing Gastric Cancer

by H.J. Lin, Y.H. Hsieh, W.L. Fang, K.H. Huang and A.F.Y. Li

Curr. Oncol. 2014, 21(3), 394-399; https://doi.org/10.3747/co.21.1768 - 01 Jun 2014

Cited by 34 | Viewed by 562

Abstract

Backgroud: Patients with alpha-fetoprotein (afp)–producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients. Methods: Our study enrolled patients who, before surgery, had gastric cancer with [...] Read more.

Backgroud: Patients with alpha-fetoprotein (afp)–producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients. Methods: Our study enrolled patients who, before surgery, had gastric cancer with serum afp exceeding 20 ng/mL [afp>20 (n = 58)] and with serum afp 20 ng/mL or less [afp≤20 (n = 1236)]. Clinical manifestations were compared between the groups. Results: Early gastric cancer was more frequent (30.1% vs. 4%) and advanced gastric cancer was less frequent (69.9% vs. 96%) in the afp≤20 group than the afp>20 group (p < 0.001). Liver and lymph node metastasis occurred less frequently in the afp≤20 group (4.4% vs. 27.6%, p < 0.001, and 60.7% vs. 91.4%, p < 0.001, respectively). The 1-, 3-, 5-, and 10-year survival rates of afp≤20 patients were 75.2%, 53.4%, 45.8%, and 34.6% respectively. The 1-, 3-, 5-, and 10-year survival rates of patients with afp greater than 20 ng/mL, but 300 ng/mL or less, were 46.7%, 28.9%, 17.8%, and 13.3% respectively. The 1-, 3-, and 5-year survival rates of patients with serum afp greater than 300 ng/mL were 15.4%, 7.7%, and 0% respectively. The independent predictors for survival time were afp concentration, age, peritoneal seeding, liver metastasis, lymph node metastasis, vascular invasion, TNM stage, curative surgery, serosal invasion, and Lauren classification. Conclusions: Patients with high serum afp had a high frequency of liver and lymph node metastasis and very poor prognosis. More aggressive management with multimodal therapy (for example, chemotherapy, radiotherapy) might be needed when treating such patients. Full article

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Open AccessEditorial

Ottawa Cardiac Oncology Program Wins 2013 Cancer Quality Council of Ontario Innovation Award

by J. Sulpher, C. Johnson, M. Turek, A. Law, E. Stadnick, S. Hopkins, N. Graham and S.F. Dent

Curr. Oncol. 2014, 21(3), 150; https://doi.org/10.3747/co.21.1913 - 01 Jun 2014

Cited by 1 | Viewed by 465

Abstract

The Ottawa Cardiac Oncology Program (ocop) has won the 2013 Innovation award from the Cancer Quality Council of Ontario [...] Full article

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Open AccessPerspective

How Has Acute Oncology Improved Care for Patients?

by V. Navani

Curr. Oncol. 2014, 21(3), 147-149; https://doi.org/10.3747/co.21.1904 - 01 Jun 2014

Cited by 14 | Viewed by 626

Abstract

A United Kingdom–wide appreciation of the systemic failings of emergency cancer care led to the creation of a new subspecialty, acute oncology. It was meant to bridge the gap between admitting teams, oncology, and palliative care, providing support to manage the symptoms of [...] Read more.

A United Kingdom–wide appreciation of the systemic failings of emergency cancer care led to the creation of a new subspecialty, acute oncology. It was meant to bridge the gap between admitting teams, oncology, and palliative care, providing support to manage the symptoms of cancer, the side effects of cancer treatment, and people presenting with cancer of unknown primary origin. This article identifies the reasons for the creation of acute oncology and explores various models for this aspect of cancer care worldwide. With health care budgets static and demand increasing, the article also identifies ways in which acute oncology can contribute to an efficient and caring health system. Full article

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Open AccessEditorial

Two Indicators of Hospital Resource Efficiency in Cancer Care

by R. Rahal, J. Xu, S. Fung and H. Bryant

Curr. Oncol. 2014, 21(3), 144-146; https://doi.org/10.3747/co.21.2022 - 01 Jun 2014

Cited by 1 | Viewed by 392

Abstract

Acute inpatient hospital stays represent a major portion of cancer care costs. [...] Full article

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Open AccessReview

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

by E. Donnellan, B. Kevane, B.R. Healey Bird and F. Ni Ainle

Curr. Oncol. 2014, 21(3), 134-143; https://doi.org/10.3747/co.21.1864 - 01 Jun 2014

Cited by 56 | Viewed by 793

Abstract

Venous thromboembolism (VTE) represents a major challenge in the management of patients with cancer. The malignant phenotype is associated with derangements in the coagulation cascade that can manifest as thrombosis, hemorrhage, or disseminated intravascular coagulation. The risk of VTE is increased [...] Read more.

Venous thromboembolism (VTE) represents a major challenge in the management of patients with cancer. The malignant phenotype is associated with derangements in the coagulation cascade that can manifest as thrombosis, hemorrhage, or disseminated intravascular coagulation. The risk of VTE is increased by a factor of approximately 6 in patients with cancer compared with non-cancer patients, and cancer patients account for approximately 20% of all newly diagnosed cases of VTE. Postmortem studies have demonstrated rates of VTE in patients with cancer to be as high as 50%. Despite that prevalence, VTE prophylaxis is underused in hospitalized patients with cancer. Studies have demonstrated that hospitalized patients with cancer are less likely than their non-cancer counterparts to receive VTE prophylaxis. Consensus guidelines address the aforementioned issues and emerging concepts in the area, including the use of risk-assessment models, biomarkers to identify patients at highest risk of VTE, and use of anticoagulants as anticancer therapy. Despite those guidelines, a gulf exists between current recommendations and clinical practice; greater efforts are thus required to ensure effective implementation of strategies to reduce the incidence of VTE in patients with cancer. Full article

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Open AccessArticle

Effect of Preoperative Chemoradiotherapy on Outcome of Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma—A Pilot Study

by M. Orditura, G. Galizia, N. Di Martino, E. Ancona, C. Castoro, R. Pacelli, F. Morgillo, S. Rossetti, V. Gambardella, A. Farella, M.M. Laterza, A. Ruol, A. Fabozzi, V. Napolitano, F. Iovino, E. Lieto, L. Fei, G. Conzo, F. Ciardiello and F. De Vita

Curr. Oncol. 2014, 21(3), 125-133; https://doi.org/10.3747/co.21.1570 - 01 Jun 2014

Cited by 12 | Viewed by 516

Abstract

Background: To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby [...] Read more.

Background: To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results. Methods: We studied 41 patients affected by locally advanced Siewert type i and ii gej adenocarcinoma who were treated with a neoadjuvant crt regimen [folfox4 (leucovorin–5-fluorouracil–oxaliplatin) for 4 cycles, and concurrent computed tomography–based threedimensional conformal radiotherapy delivered using 5 daily fractions of 1.8 Gy per week for a total dose of 45 Gy], followed by surgery. Completeness of tumour resection (performed approximately 6 weeks after completion of crt), clinical and pathologic response rates, and safety and outcome of the treatment were the main endpoints of the study. Results: All 41 patients completed preoperative treatment. Combined therapy was well tolerated, with no treatment-related deaths. Dose reduction was necessary in 8 patients (19.5%). After crt, 78% of the patients showed a partial clinical response, 17% were stable, and 5% experienced disease progression. Pathology examination of surgical specimens demonstrated a 10% complete response rate. The median and mean survival times were 26 and 36 months respectively (95% confidence interval: 14 to 37 months and 30 to 41 months respectively). On multivariate analysis, TNM staging and clinical response were demonstrated to be the only independent variables related to long-term survival. Conclusions: In our experience, preoperative chemoradiotherapy with folfox4 is feasible in locally advanced gej adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response. Full article

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Open AccessArticle

A Comparison of the Risks of In-Breast Recurrence after a Diagnosis of Dcis or Early Invasive Breast Cancer

by S.A. Narod and E. Rakovitch

Curr. Oncol. 2014, 21(3), 119-124; https://doi.org/10.3747/co.21.1892 - 01 Jun 2014

Cited by 6 | Viewed by 493

Abstract

(1) Background: It is controversial whether ductal carcinoma in situ (dcis) is a preinvasive marker of breast cancer or if it is part of a spectrum of small cancers with malignant potential. Comparing clinical outcomes in women with invasive and [...] Read more.

(1) Background: It is controversial whether ductal carcinoma in situ (dcis) is a preinvasive marker of breast cancer or if it is part of a spectrum of small cancers with malignant potential. Comparing clinical outcomes in women with invasive and noninvasive breast lesions might help to resolve the issue. (2) Methods: From a database of 2641 patients with breast cancer, we selected women who had been treated with breast-conserving surgery for a cancer that was 2.0 cm or less in size, node-negative, and nonpalpable. No subject received chemotherapy. Cancers were categorized as noninvasive (stage 0, n = 172) or invasive (stage 1, n = 401) based on a review of the pathology records. We compared the actuarial risks of in-breast recurrence after invasive and noninvasive breast lesions before and after adjusting for tamoxifen and radiotherapy. (3) Results: The 18-year cumulative risk of in-breast recurrence was 35.2% for patients with dcis and 12.8% for patients with small invasive cancers (hazard ratio: 2.4; 95% confidence interval: 1.5 to 3.8; p < 0.0003). After adjustment for radiotherapy and tamoxifen treatment, the difference was small and nonsignificant (hazard ratio: 1.4; 95% confidence interval: 0.9 to 2.4; p = 0.22). (4) Conclusions: For women with small, nonpalpable, node-negative breast cancers, the likelihood of experiencing an in-breast recurrence was associated with radiotherapy and with tamoxifen, but not with the presence of cancer cells invading beyond the basement membrane. Full article

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Open AccessEditorial

Utilization of Stereotactic Ablative Radiotherapy in the Management of Oligometastatic Disease

by J.A. Broomfield, J.N. Greenspoon and A. Swaminath

Curr. Oncol. 2014, 21(3), 115-117; https://doi.org/10.3747/co.21.1988 - 01 Jun 2014

Cited by 9 | Viewed by 371

Abstract

In 2008, cancer overtook cardiovascular disease as the leading cause of death in Canada. [...] Full article

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Curr. Oncol., Volume 21, Issue 3 (June 2014) – 24 articles

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