Assessment of Quality of Life and Safety in Postmenopausal Breast Cancer Patients Receiving Letrozole as an Early Adjuvant Treatment / 한국유방암학회지

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.

A Comparative Analysis of the Preoperative Chemoradiation Versus Radiation only for Mid and Lower Rectal Cancer

This study was designed to evaluate the worth of preoperative chemoradiation therapy in the management of locally advanced rectal cancer. Between march 1993 and January 1997, 64 patients with adenocarcinoma of the rectum were treated with preoperative irradiation followed by operation by one surgeon at department of surgery, Chungnam national university hospital. Cancers were treated with high-dose radiation (45 to 54 Gy) with (group 2) or without (group 1) chemotherapy Preoperatively 64 Patients were analysed prospectively, of these, 15 cases were preoperative radiotherapy alone arm and 49 cases were preoperative radiotherapy plus chemotherapy arm. The average age of the patients were 56 years (range 38~67) in group 1 and 57 years (range 27~80) in group 2. Male to female ratio was 8 : 7 in group 1 and 30 : 19 in group 2. Most clinical stage of the primary tumor mass were 73 (80% in Group 1,96% in group 2), being palpated slightly fixed (40% in group 1, 43% in group 2) or fixed (13.3% in group 1, 24.5% in group 2). As to distance of tumor from anal verge, most patients ranged from 4 to 8 cm (53% in group 1, 63.3% in Group 2). Chemotherapy consisted of 2 cycles of 5-fluorouracil (500 mg/m2/day for S days) delivered as a continuous infusion or bolus therapy and low-dose leukovorin (20 mg/m2/day for 5 days). After six weeks resting period of radiation, definitive surgical approach was performed. Overall treatment related toxicity rate was similar in both group except erythema on perineal skin, which was more frequent in group 2 than in group 1. Most frequent postoperative complication was intestinal obstruction (7.8%) followed by wound infection (6.3%), but there was no significant difference between two groups. There was one case of postoperative mortality in group 2 patients at 44 days after operation due to pneumonia and sepsis combined with liver cirrhosis. Tumor depth was downstaged in 38.5% of group 1 and 70% of group 2 patients on preoperative CT staging, and nodal downstaging was more effective on the respect of postoperative pathological report. Overall recurrence rate was 38.5% in group 1 and 20.5% in group 2. Of these, failure occured first as a distant metastasis more frequently than as a local recurrence in both group. These data do suggest that the preoperative chemotherapy and radiotherapy used are as safe as preoperative radiotherapy alone. Futhermore, tumor and lymph node downstaging are more effective in combined arm. Preoperative chemotherapy will more promising in prevention of distant metastasis when treated in the period of least metastatic tumor burden. Whether combined arm will have greater or lesser survival awaits the completion of this relevant study.