Role of Radiotherapy-Induced Malignancies in Patients with Both Breast and Lung Cancer Diagnoses

Background:Breast and lung cancer are two of the most commonly diagnosed cancers in North America. While patients are living longer with advances in treatment and supportive care, some patients are being diagnosed with a second malignancy. The primary objective in this study was to assess the correlation between the development of an ipsilateral lung cancer or breast cancer, and prior radiation therapy. In addition, we sought to report the survival outcomes of patients in these clinical scenarios. Methods: We conducted a single institution (the Ottawa Hospital Cancer Centre) retrospective review of patients with the diagnoses of both breast and lung cancer treated between 1995 and 2013. Patients were included if they received radiation for a breast primary, and subsequently developed an ipsilateral lung primary, or vice-versa. Data included patient demographics, lifestyle factors, tumor location and subtype, cancer stages, treatment modalities, and survival outcomes. Results: Of 252 patients included in the study, 217 patients developed a breast primary first, with 35 patients developing a lung primary first. Median disease-free survival from the second primary diagnosis was 36 months in breast primary first patients, and 59 months in the lung primary first cohort. There was no significant correlation between the laterality of radiation treatment and side of second primary based on Fisher’s exact test. Conclusions: Our data reveal no association between side of radiation treatment and subsequent cancer development. The benefits of radiotherapy outweigh the risk of radiation-induced primaries. Longer term studies with matched patient cohorts are required to further assess treatment and lifestyle factors that may contribute towards the development of second malignancies.

Assessing Patient Outcomes after Palliative Radiotherapy Using IG-IMRT

Purpose: To assess clinical outcomes after using IG-IMRT for palliation among patients with advanced cancers. Methods: Patients with advanced and/or metastatic cancers were treated on our Tomo-PAL (Tomotherapy?-Planning and Administration Linked) protocol using helical TomoTherapy? and evaluated to assess clinical efficacy of treatment as well as to assess side effects. Results: A total of 40 patients were treated to 40 sites from Feb 2007 to May 2009. There were 25 men and 15 women with a median age of 70 years (range 16 - 94). Pain and bleeding were the most common symptoms being palliated (80% and 12.5% respectively). The dose prescribed ranged from 5 - 25 Gy in 1 - 5 fractions. A qualitative improvement in symptoms was documented in 82% of patients (75% partial relief and 7% complete relief) and major side effects were not encountered. Conclusions: IG-IMRT can be used for palliation and produces response rates that compare favourably with those reported in the published literature.

对症状复发或残留卵巢癌进行有效的姑息性放疗

Objective.:To evaluate the efficacy of radiotherapy (RT) for symptomatic recurrent or residual ovarian cancer. Methods.:A review was conducted on patients (pts) treated with palliative RT for symptomatic ovarian cancer at The Ottawa Hospital Regional Cancer Centre between 1990 and 2003. Patient demographics,tumor factors,treatment variables,and clinical outcome were entered into a database. Symptom response was defined as complete (CR),partial (PR),or none. Results.:62 courses of RT were delivered to 53 pts. The symptoms treated were:bleeding (40%),pain (37%),and ‘others’(23%). The most common dose fractionation scheme was 30 Gy in 10 fractions (f) (range:5 Gy/1 f to 52.5 Gy/20 f). The overall response rate was 100%,with 68%achieving a CR. The CR rates were 88,65,and 36%for the symp- toms of bleeding,pain,and ‘others’,respectively (P = 0.003). The median duration of response was 4.8 months (range:1-71 months). In multivariate analysis,the only factors that were found to be significant positive predictors of symptom control were:the symptom bleeding (P = 0.015) and stage III/IV disease at presentation (P = 0.01). The most commonly reported toxicities were grades 1 and 2 nausea/vomiting and diarrhea. There were no grade 3/4 toxicities reported. Conclusions.:Radiotherapy is highly effective in palliating symptomatic ovarian cancer. Excellent results are achieved for patients presenting with bleeding or pain. Symptomatic patients should be strongly considered for palliative radiotherapy. Higher doses of radiotherapy should be considered for those with symptoms other than bleeding or pain and those with longer life expectancies.

复发卵巢颗粒细胞瘤的姑息放疗:报道3例患者的放射学反应证据

Background:The role of radiotherapy for recurrent or residual granulosa cell tumor of the ovary (GCTO) is controversial. One reason for this controversy may be that most published studies on this topic have not utilized sectional imaging to assess response to radiotherapy. We report on three cases of recurrent or residual GCTO that were treated with radiotherapy for which pre-and post-treatment CT scans were available to assess response. Case reports:Case #1:A 77-year-old woman with a 7 ×10 cm pelvic mass post-surgery was treated with radiotherapy to a dose of 45 Gy in 25 fractions followed by a boost of 10 Gy in 5 fractions. Post-treatment scans revealed a decrease in tumor size to 4 ×2.5 cm. The reduction in tumor volume was 86%,and the duration of response was 13 months. Case #2:A 73-year-old woman with multiple abdominal recurrences was treated with radiotherapy to a dose of 30Gy in 20 fractions. The dominant mass shrank from 13 ×17 cm to 5.1 ×6.6 cm. The reduction in volume was 85%,and the duration of response has been 5 months. Her symptom of abdominal bloating and early satiety abated. Case #3:An 83-year-old woman with a 20 ×20 ×15-cm mass in the left abdomen was treated with radiotherapy to a dose of 45 Gy in 25 fractions. The mass decreased in size to 3.7 ×2.5 cm post-treatment. The duration of response has been 21 months. Her symptom of left leg swelling disappeared after therapy. Conclusion:Radiotherapy is highly effective in treating recurrent or residual GCTO. In these three cases,the tumor volume decreased by 85 to 90%,and the duration of response has,up to now,been 5 to 21 months.

The role of systemic therapy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma(PDAC)remains a deadly disease,even in patients whose cancer is localized and non-metastatic.Surgical resection provides the only option for cure,but long-term survival rates remain dismal.For patients with borderline resectable(BR)disease who undergo upfront resection,many patients are either too unwell for subsequent adjuvant systemic therapy,develop recurrence soon after,or are found to have unresectable disease intra-operatively.There is increasing evidence for a neoadjuvant approach,using more conventional multi-agent chemotherapy regimens,which have demonstrated higher activity in the metastatic setting compared to single agents.For patients with locally advanced(LA)disease,which is unresectable by current definitions,there is mounting evidence that effective neoadjuvant systemic therapy is able to convert some patients’disease to a resectable state,offering the potential for long-term survival and cure.Herein we present a review of key trials focusing on prospective,randomized studies to provide high-level evidence supporting a neoadjuvant approach to both BR and LA PDAC.However,many knowledge gaps exist,such as the optimal neoadjuvant multi-agent chemotherapy regimen,the role of radiotherapy,and the safety and efficacy of adding immunotherapy to chemo/radiation therapy.Future challenges in determining the optimal approach to patients with BR or LA PDAC include not only overcoming the inherent difficulties in conducting complex,multidisciplinary,multicentre randomized trials in patients with a high-morbidity and mortality disease,but also trying to standardize disease definitions,treatment regimens,and outcome measures.