Differences in Treatment and Outcome of Pancreatic Adenocarcinoma Stage I and II in the EURECCA Pancreas Consortium.

BACKGROUND: The EUropean REgistration of Cancer CAre (EURECCA) consortium aims to investigate differences in treatment and to improve cancer care through Europe. The purpose of this study was to compare neo- and adjuvant chemotherapy (ACT) and outcome after tumor resection for pancreatic adenocarcinoma stage I and II in the EURECCA Pancreas consortium. METHODS: The eight, collaborating national, regional, and single-center partners shared their anonymized dataset. Patients diagnosed in 2012-2013 who underwent tumor resection for pancreatic adenocarcinoma stage I and II were investigated with respect to treatment and survival and compared using uni- and multivariable logistic and Cox regression analyses. All comparisons were performed separately per registry type: national, regional, and single-center registries. RESULTS: In total, 2052 patients were included. Stage II was present in the majority of patients. The use of neo-ACT was limited in most registries (range 2.8-15.5%) and was only different between Belgium and The Netherlands after adjustment for potential confounders. The use of ACT was different between the registries (range 40.5-70.0%), even after adjustment for potential confounders. Ninety-day mortality was also different between the registries (range 0.9-13.6%). In multivariable analyses for overall survival, differences were observed between the national and regional registries. Furthermore, patients in ascending age groups and patients with stage II showed a significant worse overall survival. CONCLUSIONS: This study provides a clear insight in clinical practice in the EURECCA Pancreas consortium. The differences observed in (neo-)ACT and outcome give us the chance to further investigate the best practices and improve outcome of pancreatic adenocarcinoma.

Cancer burden of breast and gynecological cancers in Bulgaria: epidemiology and clinical aspects.

PURPOSE: In Bulgaria, there are over 3700 cases diagnosed with breast cancer annually and over 3300 with gynecological cancers. The purpose of this study was to estimate the burden of breast and gynecological cancers in Bulgaria, analyzing trends of incidence, mortality and survival for the past two decades. METHODS: Data from the Bulgarian National Cancer Registry for women diagnosed with cancer of breast (C50, ICD10), cervix uteri (C53), corpus uteri (C54) and ovary (C56) during 1993 - 2009 were analyzed. Age-standardized incidence and mortality rates (ASR) per 100,000 persons were calculated using the world standard population. Average annual percent changes (AAPC) for 1993-2009 were estimated by Joinpoint regression. The observed survival was analyzed with the Life Table method for two periods: 1993-1997 and 2005-2009. RESULTS: Incidence rates of the most frequent cancers among Bulgarian women are increasing - from 1.7% to 2.6% annually. Mortality rates are decreasing significantly for breast (-0.8% annually) and increasing for corpus uteri cancers (4.9% annually). Survival for all sites increased from 3 to 8% over the study period. We observed greater proportion of cases diagnosed in stage I in 2009 than in 1993, for the 4 sites. CONCLUSION: These results indicate some differences in trends in incidence and mortality of the reviewed sites compared with other European countries, highlighting the need for more strict adherence to integrated treatment standards and the necessity of introduction of population screening programs.

Hodgkin's disease incidence and survival in European children and adolescents (1978-1997): report from the Automated Cancer Information System project.

This paper reports the geographical patterns and time trends of incidence and survival of Hodgkin's disease (HD) in children and adolescents in Europe over the period 1978-1997. Data on 4230 HD cases were gathered from 62 paediatric or general cancer registries in 19 European countries by the Automated Cancer Information System (ACCIS). European annual incidence rates in 1988-1997 were estimated at 5.8 per million in children (world age-standardised) and at 29.7 per million in adolescents, with higher rates in the East and South. Incidence rates increased steeply with age, while the male predominance, marked for the youngest children, vanished in the highest age groups. Over the period 1978-1997 incidence rates increased in age groups 10-14 years (+1% per year) and 15-19 years (+3.5% per year), mainly due to the nodular sclerosis subtype. Age and sex distribution of cases remained unchanged with time. The overall 5-year survival rate was higher in children (93%, 95% confidence interval (CI) 92-94) than in adolescents (89% (95% CI 87-91)) for the period 1988-1997. Five-year survival increased significantly in all regions from 87% to 93% in children and from 80% to 88% in adolescents between 1978-1982 and 1993-1997. In future, detailed documentation of cases in the cancer registries with respect to standardised diagnostic subtypes, stage of extension, and treatments, will help to refine interpretation of international and temporal variations in incidence and survival.

Cancer incidence and survival in European adolescents (1978-1997). Report from the Automated Childhood Cancer Information System project.

Data on 15,399 adolescents diagnosed with cancer at age 15-19 years during 1978-1997 in Europe were extracted from the database of the Automated Childhood Cancer Information System (ACCIS). Total incidence in Europe as a whole was 186 per million in 1988-1997. Incidence among males was 1.2 times that among females. Lymphomas had the highest incidence of any diagnostic group, 46 per million, followed by epithelial tumours, 41 per million; central nervous system (CNS) tumours, 24; germ cell and gonadal tumours, 23; leukaemias, 23; bone tumours, 14; and soft tissue sarcomas, 13 per million. Total incidence varied widely between regions, from 169 per million in the East to 210 per million in the North, but lymphomas were the most frequent diagnostic group in all regions. Cancer incidence among adolescents increased significantly at a rate of 2% per year during 1978-1997. Five-year survival for all cancers combined in 1988-1997 was 73% in Europe as a whole. Survival was highest in the North, 78%, and lowest in the East, 57%. Five-year survival was generally comparable with that in the Surveillance, Epidemiology, and End Results (SEER) registries of the United States of America (USA), but for Ewing's sarcoma it was below 45% in all European regions compared with 56% in the USA. Survival increased significantly during 1978-1997 for all cancers combined and for all diagnostic groups with sufficient registrations for analysis.

Common variables in European pancreatic cancer registries: The introduction of the EURECCA pancreatic cancer project.

BACKGROUND: Quality assurance of cancer care is of utmost importance to detect and avoid under and over treatment. Most cancer data are collected by different procedures in different countries, and are poorly comparable at an international level. EURECCA, acronym for European Registration of Cancer Care, is a platform aiming to harmonize cancer data collection and improve cancer care by feedback. After the prior launch of the projects on colorectal, breast and upper GI cancer, EURECCA's newest project is collecting data on pancreatic cancer in several European countries. METHODS: National cancer registries, as well as specific pancreatic cancer audits/registries, were invited to participate in EURECCA Pancreas. Participating countries were requested to share an overview of their collected data items. Of the received datasets, a shared items list was made which creates insight in similarities between different national registries and will enable data comparison on a larger scale. Additionally, first data was requested from the participating countries. RESULTS: Over 24 countries have been approached and 11 confirmed participation: Austria, Belgium, Bulgaria, Denmark, Germany, The Netherlands, Slovenia, Spain, Sweden, Ukraine and United Kingdom. The number of collected data items varied between 16 and 285. This led to a shared items list of 25 variables divided into five categories: patient characteristics, preoperative diagnostics, treatment, staging and survival. Eight countries shared their first data. CONCLUSIONS: A list of 25 shared items on pancreatic cancer coming from eleven participating registries was created, providing a basis for future prospective data collection in pancreatic cancer treatment internationally.

Trends in incidence of various cancers in Bulgaria, 1981-1990.

BACKGROUND: Bulgaria has undergone considerable social changes in the last 40 years, including a transition from a 75% rural to a 75% urban population. These changes might be expected to be reflected in disease rates. The Bulgarian cancer registry has computerized data on cancer incidence throughout the country from 1981 onwards. METHODS: Incidence rates in Bulgaria from 1981 to 1990 of cancers of the lung, stomach, large bowel, prostate and bladder in males and of cancers of the breast, lung, stomach, large bowel, cervix and corpus uteri in females were analysed with particular attention to time trends, age-specific changes in rates and urban/rural differences. Poisson regression was used for statistical analysis. RESULTS: Male rates of cancers of the lung, large bowel, prostate and bladder increased significantly over the period, with average annual increases of 0.4%, 2.9%, 1.3% and 2.3% respectively. In females, rates of cancers of the breast, cervix and corpus uteri increased significantly, with average annual increases of 1.3%, 1.9%, and 2.9%. In both sexes, stomach cancer incidence declined significantly, by 3.0% per year for males and 3.6% per year for females. Rural rates were lower than urban rates for most cancers, particularly in the higher age groups. The decline in male stomach cancer rates was confined to rural areas. The increases in rates of lung cancer and prostate cancer in males and of colorectal cancer and breast cancer in females were most rapid in urban areas. CONCLUSIONS: Substantial changes in rates of various cancers have taken place from 1981 to 1990, in particular increases in rates of breast cancer and large bowel cancer in women resident in urban areas. It is suggested that dietary changes may be responsible for some of these changes.

Clinical stages of cutaneous malignant melanoma in Bulgaria.

The aim of the study was to investigate the distribution of the newly diagnosed cases with cutaneous malignant melanoma by clinical stages in Bulgaria over the period 1993-1995 as a reason for improving both mclanoma prevention and control. Over the period 827 new cases with cutaneous malignant melanoma are registered in the country. A representative sample of 671 cases has been taken. The cases with a localized melanoma (Stage I and II) were prevalent - 509 (75.8% of all studied cases). The thick melanomas (Stage IIB) were most frequently encountered among the primary lesions. They were 207 cases (30.8%). The thin melanomas (Stage IA) were only 41 (6.1%). The proportion of the cases with nodal and in-transit metastases (Stage III) -122 (18.2%) and the proportion of the cases with distant metastases (Stage IV) -40 (6.0%) were quite high. The analysis of the results shows that the cases with cutaneous malignant melanoma in Bulgaria are detected quite late. The cases with early-diagnosed melanoma are prevalent among women, young persons and urban population, and the cases with advanced melanoma are more frequent among men, persons older than 50 and rural population.

Control of acute emesis in repeated courses of moderately emetogenic chemotherapy.

PURPOSE: Cyclophosphamide (CY)-containing chemotherapy is usually characterized as moderately emetogenic. The aim of this study was to evaluate the efficacy of different antiemetics in the control of acute emesis in repeated cycles of moderately emetogenic chemotherapy. PATIENTS AND METHODS: A total of 101 patients with breast cancer (41, 40.6%), Hodgkin's disease (46, 45.5%) and non-Hodgkin's lymphoma (14, 13.9%) were studied. These patients received standard protocols of CY-based (>/=750 mg/m(2)) moderately emetogenic chemotherapy. Intravenous (i.v.) bolus metoclopramide (MCL), ondansetron (OND) and their combinations with corticosteroids (CS) were administered to the patients. The MCL-alone group of patients was used as control group. Emesis was evaluated during the first 3 courses of chemotherapy according to the internationally accepted criteria. All calculations were performed using the SPSS-5.0 statistical computing package. RESULTS: During the first course of chemotherapy no differences in the efficacy between the control group and the other groups were noted (p >0.05). On the contrary, during the next 2 courses the efficacy of MCL progressively decreased and OND, OND plus CS and MCL plus CS showed significantly higher efficacy compared with MCL alone (p <0.05). Excluding MCL alone, the other antiemetics showed similar efficacy in the 2nd and 3rd course of chemotherapy (p >0.05). Patients aged over 35 years had more severe emesis. CONCLUSION: The combination of MCL plus CS showed similar efficacy compared with OND and OND plus CS, and is cost-effective. The control of acute emesis in the first course and the patients' age are significant factors, influencing the efficacy of the antiemetic therapy in repeated courses of moderately emetogenic chemotherapy.

Different chemotherapy schedules in metastatic colorectal cancer: a response and survival analysis.

PURPOSE: To evaluate the response rate and overall survival (OS) of chemotherapy-naïve patients with metastatic colorectal adenocarcinoma treated with 4 different chemotherapy regimens. PATIENTS AND METHODS: One hundred fifty-eight patients with metastatic colorectal cancer (CRC) were included in this prospective study. The treatment regimens were as follows: a) Intraarterial (i.a.) chemotherapy: 5-fluorouracil (5-FU) 600 mg/m(2)/day by 120 hour-infusion, mitomycin C 8 mg/m(2) day 1, and epirubicin 80 mg/m(2) day 5, every 3 weeks, b) Intravenous (i.v.) chronochemotherapy: 5-FU 800 mg/m(2) i.v. infusion during 18.00 h-06.00h, leucovorin (LV) 100 mg/m(2) i.v. infusion during 18.00h-06.00h; and cisplatin 20mg/m(2) i.v. infusion, during 10.00h-18.00 h, all given on days 1-5, every 3 weeks, c) Scheme: 5-FU 500 mg/m(2) i.v. bolus, days 1-5, vincristine 1.2 mg/m(2) i.v. bolus, day 1, CCNU 120 mg/m(2) per so (p.o.), day 5, every 3 weeks. Scheme I was used as control group, d) Scheme II: 5-FU 425 mg/m(2) i.v. bolus, days 1-5, and LV 50 mg/m(2) i.v. bolus, days 1-5, every 3 weeks. The patients received 3-26 cycles of chemotherapy. The results taken were compared using the Kaplan-Meier life-table method, logrank test, Cox proportional hazard model, and Cox model with time-dependent covariates. RESULTS: Nine (26%) out of 34 patients with i.a. chemotherapy achieved complete response (CR), 8 (24%) partial response (PR), and 11 (32%) stable disease (SD). In the group of 42 patients with chronochemotherapy 4 (10%) achieved CR, 15 (36%) PR and 12 (28%) SD. In the group of 61 patients with conventional treatment with 5-FU and LV (scheme II) no CR was achieved with 11 (18%) patients responding partially. In the control group of treatment (scheme I) with 21 patients PR was observed in 2 (10%) patients. Patients with i.a. chemotherapy and chronochemotherapy achieved a similar OS, which was better than OS of scheme II. The survival was worst with scheme I. CONCLUSION: I.a. chemotherapy and chronochemotherapy showed an almost equivalent efficacy in terms of response rates, which were clearly superior to those achieved by schemes I and II. Also, OS was significantly better in the patients treated with i.a. chemotherapy and chronochemotherapy compared to patients treated with scheme II. The worst survival was seen in scheme I patients.

Cancer consequences of the Chernobyl accident in Europe outside the former USSR: a review.

The accident which occurred during the night of April 25-26, 1986 in reactor 4 of the Chernobyl nuclear power plant in the Ukraine released considerable amounts of radioactive substances into the environment. Outside the former USSR, the highest levels of contamination were recorded in Bulgaria, Austria, Greece and Romania, followed by other countries of Central, Southeast and Northern Europe. Studies of the health consequences of the accident have been carried out in these countries, as well as in other countries in Europe. This report presents the results of a critical review of cancer studies of the exposed population in Europe, carried out on the occasion of the 10th anniversary of the Chernobyl accident. Overall, three is no evidence to date of a major public health impact of the Chernobyl accident in the field of cancer in countries of Europe outside the former USSR.