Prophylactic Versus Reactive Megestrol Acetate Use for Critical Body Weight Loss in Patients with Pharyngeal and Laryngeal Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy.

This study compared the effects of megestrol acetate (MA) prophylactic (p-MA) versus reactive (r-MA) use for critical body-weight loss (>5% from baseline) during concurrent chemoradiotherapy (CCRT) in patients with advanced pharyngolaryngeal squamous cell carcinoma (PLSCC).Patients receiving CCRT alone in two phase-II trials were included for analyses. Both the p-MA and r-MA cohorts received the same treatment protocol at the same institution, and the critical body-weight loss, survival, and adverse event profiles were compared.The mean (SD) weight loss was 5.1% (4.7%) in the p-MA cohort (n = 54) vs. 8.1% (4.6%) in the r-MA cohort (n = 50) (p = .001). The percentage of subjects with body-weight loss >5% was 42.6% in the p-MA cohort vs. 68.0% in the r-MA cohort (p = .011). Tube feeding was needed in 22.2% of p-MA vs. 62.0% of r-MA patients (p < .001). Less neutropenia (26.0% vs. 70.0% [p < .001]) and a shorter duration of grade 3-4 mucositis (2.4 ± 1.4 vs. 3.6 ± 2.0 wk [p = .009]) were observed with p-MA treatment. Disease-specific survival, locoregional control, or distant metastasis-free survival did not differ. Less competing mortality from secondary primary cancer resulted in a better overall survival trend in the p-MA cohort.p-MA may reduce body-weight loss and improve adverse event profiles during CCRT for patients with PLSCC.

Baseline multicentric tumors, distant recurrences and leptomeningeal dissemination predict poor survival in patients with recurrent glioblastomas receiving bevacizumab.

PURPOSE: There are no widely accepted MRI markers that predict treatment outcomes of bevacizumab among patients with recurrent glioblastoma (GB). We aimed to determine if conventional MRI features of recurrent GB predict survival of patients receiving bevacizumab. METHODS: Patients with recurrent GB were retrospectively included if they received bevacizumab monotherapy between 2008 and 2017 after failure of standard treatment. Their MRI studies obtained at baseline and tumor recurrence, prior to bevacizumab treatment, were evaluated for multiple MRI features including measurable tumor, baseline multicentric tumors, distant recurrence, non-contrast-enhancing tumor, deep white matter invasion, multiple parenchymal tumors, bilateral cerebral involvement, ependymal extension and leptomeningeal dissemination. Predictive values of MRI features and patient characteristics on patient survival were statistically analyzed. RESULTS: A total of 103 patients were included. Baseline multicentric tumors (OR = 4.07; P = 0.042) and distant recurrence (OR = 28.5; P < 0.001) were two significant predictors of 3-month progression-free survival (PFS) rate. Distant recurrence (HR = 3.94; P < 0.001) was the only independent predictor of PFS. Baseline multicentric tumors (HR = 1.97; P = 0.028), distant recurrence (HR = 4.73; P < 0.001) and leptomeningeal dissemination (HR = 2.28; P = 0.044) were three independent predictors of overall survival. CONCLUSIONS: Baseline multicentric tumors, distant recurrence and leptomeningeal dissemination predicted poor survival among patients receiving bevacizumab for recurrent GB. Conventional MRI may help selecting patients with recurrent GB for bevacizumab treatment.

Impact of palliative care consultative service on disease awareness for patients with terminal cancer.

PURPOSE: Awareness of the status of disease among terminally ill cancer patients is an important part of the end-of-life care. We have evaluated how palliative care consultative service (PCCS) affects patient disease awareness and determined who may benefit from such services in Taiwan. METHODS: In total, 2,887 terminally ill cancer patients consecutively received PCCS between January 2006 and December 2010 at a single medical center in Taiwan, after which they were evaluated for disease awareness. At the beginning of PCCS, 31 % of patients (n = 895) were unaware of their disease status. The characteristics of these 895 patients were analyzed retrospectively to determine variables pertinent to patient disease awareness after PCCS. RESULTS: In total, 485 (50 %) of the 895 patients became aware of their disease at the end of PCCS. Factors significantly associated with higher disease awareness included a longer interval between the date of hospital admission and that of PCCS referral (>4 weeks versus ≤2 weeks), a longer duration of PCCS (>14 days versus ≤7 days), the male gender, divorced marital status (versus married), and family awareness (versus lack of family awareness). Lower disease awareness was associated with older age (age > 75 years versus age = 18-65 years), referral from non-oncology departments, and primary cancer localization (lung, colon-rectum, or urological versus liver). CONCLUSIONS: Disease awareness is affected by multiple factors related to the patients, their families, and the clinicians. The promotion of PCCS increased disease awareness among terminally ill cancer patients in Taiwan.

Maintenance tegafur-plus-uracil after adjuvant concurrent chemoradiotherapy may improve outcome for resected oral cavity squamous cell carcinoma with extranodal extension.

Objectives: To evaluate whether tegafur-uracil maintenance (UFTm) following postoperation adjuvant cisplatin-based concurrent chemoradiotherapy (CCRT) may reduce distant metastasis in patients with resected oral cavity squamous cell carcinoma (OSCC) with pathologic extranodal extension (pENE+). Methods: A retrospective comparison was conducted between two cohorts of patients with resected pENE+ OSCC who completed adjuvant CCRT between March 2015 and December 2017, including one cohort of a phase II trial using UFTm and a trial-eligible but off-protocol cohort without using UFTm (non-UFTm) after their adjuvant CCRT. The UFTm trial enrolled patients without relapse within 2 months after the end of adjuvant CCRT and administered UFT 400 mg/day for 1 year. Kaplan-Meier methods estimated the actuarial rate of distant metastasis-free (DMF), locoregional control (LRC), event-free survival (EFS), and overall survival (OS). Results: A total of 103 patients were included in this study, 64 patients in UFTm and 39 patients in non-UFTm. Severe adverse events in UFTm included grade 3 anemia (n = 1, 1.6%) and grade 3 mucositis (n = 1, 1.6%). A total of 40 (62.5%) patients completed the full course of UFTm, while the remaining terminated UFTm earlier due to disease relapse (n = 14, 21.8%), poor compliance (n = 9, 14.1%), and adverse event (n = 1, 1.6%). The median (range) follow-up time of surviving patients was 43 (22-65) months. The outcomes compared between UFTm and non-UFTm were OS (hazard ratio [HR] 0.31 [95% CI: 0.17-0.57], p < 0·001), EFS (0.45 [0.25-0.82], 0.009), LRC (0.45 [0.19-1.05], 0.067), and DMF (0.47 [0.24-0.95], 0.035). Multivariable analysis, adjusted for UFTm, Charlson comorbidity index score 1-3, site of tongue, and number of ENE+ LN ≧4, confirmed better OS (0.29 [0.16-0.54], <0.001) and EFS (0.47 [0.26-0.85], 0.012) in favor of UFTm over non-UFTm. The 2-year DM rate was 25.8% in UFTm and 44.2% in non-UFTm. For relapsed patients in UFTm vs. non-UFTm, the rate of metastasectomy for oligometastasis was 53% vs. 6%, and the OS was 21.0 (95% CI: 17.8-24.1) months vs. 11.0 (9.1-12.8) months (p < 0.001), respectively. Conclusions: UFTm may improve the dismal outcomes of the resected pENE+ OSCC. Further investigations are needed to confirm our observations.

Adjuvant Chemoradiotherapy Associated with Improved Overall Survival in Resected Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiotherapy in Intensity-Modulated Radiotherapy Era.

BACKGROUND: The prognosis of patients with resected esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy is particularly poor in those who were staged as ypT3/T4 and/or ypN+. This study investigated whether adjuvant chemoradiotherapy was associated with improved clinical outcomes in these patients. METHODS: we identified patients with esophageal squamous cell carcinoma who were staged as ypT3/T4 and/or ypN+ after being treated with neoadjuvant chemoradiotherapy followed by esophagectomy between the years 2013 and 2019. Patients were divided into two groups based on whether they received adjuvant chemoradiotherapy. The Kaplan-Meier method and Cox regression modeling were performed for survival analyses and multivariable analysis, respectively. RESULTS: 76 eligible patients were included in the analyses. The median follow-up for the study cohort was 43.4 months. On Kaplan-Meier analyses of the overall population, adjuvant chemoradiotherapy was associated with significantly improved median overall survival (31.7 months vs. 16.3 months, p = 0.036). On Kaplan-Meier analyses of the 35 matched pairs generated by propensity score matching, adjuvant chemoradiotherapy was associated with significantly longer median overall survival (31.7 months vs. 14.3 months; p = 0.004) and median recurrence-free survival (18.9 months vs. 11.7 months; p = 0.020). In multivariable analysis, adjuvant chemoradiotherapy was independently associated with a 60% reduction in mortality (p = 0.003) and a 48% reduction in risk of recurrence (p = 0.035) after adjusting for putative confounders. In addition, microscopic positive resection margin and Mandard tumor regression grade 3-4 were independently associated with increased mortality and risk of recurrence. While a greater number of lymph nodes dissected was independently associated with significantly improved overall survival, the number of positive lymph nodes was independently associated with significantly worse overall survival and a trend (p = 0.058) towards worse recurrence-free survival. CONCLUSIONS: This study demonstrated that adjuvant CRT was independently associated with a significantly improved survival and lower risk of recurrence than observation in esophageal squamous cell carcinoma patients staged as ypT3 and/or ypN+ after receiving neoadjuvant chemoradiotherapy and radical surgery. The results of this study have implications for the design of future clinical trials and may improve treatment outcomes of patients in this setting who cannot afford or are without access to adjuvant nivolumab.

Outcome of central nervous system germinoma treatment by chemoradiation.

Central nervous system germinoma historically has been treated with radiotherapy alone. Although this regimen provides good tumor control, there are risks of long-term complications; this study used a combination of chemotherapy and low-dose radiotherapy to reduce these risks. Between January 2002 and June 2009, 16 patients (14 male, 2 female) with a median age of 14.7 years (9.2 to 19.6 y), were treated. Thirteen of the tumors had a single focus and 3 were multifocal: 8 were located in the pineal, 8 were suprasellar, and 3 were in the basal ganglion or other periventricular areas. All patients had negative spinal magnetic resonance imaging findings. Treatment consisted of cisplatin-based and etoposide-based chemotherapy, and 2340 cGy of radiotherapy delivered to the whole brain/ventricle. The median time of follow-up was 45 months. None of the patients suffered from treatment failure. Tumors larger than 2.5 cm regressed less completely after upfront chemotherapy than smaller tumors, but overall treatment outcome was not affected by tumor size. One patient developed a new complication (hypopituitarism) 8 months after treatment, and 1 patient developed a second malignancy 3 years after diagnosis. The results confirm that short courses of chemotherapy combined with low-dose whole-brain or whole-ventricular radiotherapy have favorable outcomes.

Simple Stepwise Approach to Differentiate Cyst-Like Soft-Tissue Masses by Using Time-Resolved Magnetic Resonance Angiography.

This retrospective study aimed to differentiate cyst-like musculoskeletal soft-tissue masses by using time-resolved magnetic resonance angiography (MRA). During May 2015 to November 2019, patients with cyst-like soft-tissue masses examined through contrast-enhanced MRI followed by histologic diagnosis were included. The masses were classified into vascular lesions, solid lesions, and true cysts. Size, T1 hyperintensity, T2 composition, perilesional edema, time-resolved MRA, and static internal enhancement were assessed. The time-resolved MRA manifestations were classified into vascular pooling, solid stain, and occult lesion. Imaging predictors for each type of mass were identified through logistic regression and were used to develop a diagnostic flowchart. A total of 80 patients (47 men; median age, 42 years) were included, with 22 vascular lesions, 38 solid lesions, and 20 true cysts. The T2 composition, time-resolved MRA, and static internal enhancement were significantly different among the masses. Vascular pooling on time-resolved MRA was the sole predictor of vascular lesions (odds ratio = 722.0, p < 0.001). Solid stain on time-resolved MRA was the sole predictor of solid lesions (odds ratio = 73.6, p < 0.001). Occult lesion on time-resolved MRA (odds ratio = 7.4, p = 0.001) and absence of static internal enhancement (odds ratio = 80.0, p < 0.001) both predicted true cysts, while the latter was the sole predictor of true cysts after multivariate analysis. A diagnostic flowchart based on time-resolved MRA correctly classified 89% of the masses. In conclusion, time-resolved MRA accurately differentiates cyst-like soft-tissue masses and provides guidance for management.

Review of emerging biomarkers in head and neck squamous cell carcinoma in the era of immunotherapy and targeted therapy.

BACKGROUND: Biomarkers in head and neck squamous cell carcinoma (HNSCC) emerge rapidly in recent years, especially for new targeted therapies and immunotherapies. METHODS: Recent, relevant peer-reviewed evidence were critically reviewed and summarized. RESULTS: This review article briefly introduces essential biomarker concepts, including purposes and classifications (predictive, prognostic, and diagnostic markers), and the phases of biomarker development. We summarize current biomarkers in order of clinical utility; p16 and human papillomavirus status remain the most important and validated biomarkers in HNSCC. The rationale for biomarker study design continues to evolve with technological advances, especially whole-exome or whole-genomic sequencing. Noninvasive body fluid and liquid biopsy biomarkers appear to hold strong potential for development as tools for early cancer detection, cancer diagnosis, monitoring of disease recurrence, and outcome prediction. In light of discrepancies among different technologies, standardized approaches are needed. CONCLUSION: Biomarkers from cancer tissue or blood in HNSCC could direct new anticancer therapies.

Female sex, good performance status, and bevacizumab-induced hypertension associated with survival benefit in Asian patients with recurrent glioblastoma treated with bevacizumab.

AIM: The goals of this study were to assess the activity and safety profile of bevacizumab in Taiwan Chinese patients with recurrent glioblastoma, to determine whether their response differed from that reported in other clinical trials, and to examine potential prognostic factors for survival. METHODS: We retrospectively assessed patients who received bevacizumab for recurrent glioblastoma between 2012 and 2015. Twelve predefined variables and the outcomes of our cohort were analyzed. RESULTS: In total, 76 patients with recurrent glioblastoma were analyzed. The overall response rate was 59.2%, including 19 patients (25.0%) with complete response and 26 patients (34.2%) with partial response. The median progression-free survival and overall survival were 5.2 months (95% confidence interval [CI], 4.6-5.8 months) and 7.8 months (95% CI, 5.8-9.8 months), respectively. Multivariate analysis identified sex and grade 3 posttreatment hypertension (systolic ≥ 160 mmHg or diastolic ≥ 100 mmHg) as the only independent predictive factors for progression-free survival and overall survival. Eastern Cooperative Oncology Group performance status was also found to be independently predictive of improved overall survival. CONCLUSION: We showed good responses using bevacizumab and the progression-free survival and overall survival were comparable with those previously reported. The adverse events of bevacizumab in our study were generally acceptable and manageable. Female sex, good performance status, and grade 3 posttreatment hypertension were suggested to be associated with survival benefits.

Hand-foot skin reaction predicts treatment outcome of pazopanib in patients with metastatic soft tissue sarcoma: A multicenter study in the Asian population.

AIM: Pazopanib is a multitargeted tyrosine kinase inhibitor used as a standard treatment for chemotherapy-refractory recurrent or metastatic soft tissue sarcoma. This study aimed to evaluate the efficacy and safety of pazopanib for treatment of metastatic soft tissue sarcoma in the Asian population. METHODS: Fifty patients with chemotherapy-refractory recurrent or metastatic soft tissue sarcoma, who had received pazopanib treatment between 2015 and 2016 were enrolled. We reviewed patients' clinical characteristics and studied survival outcomes following pazopanib treatment. RESULTS: Median follow-up was 5.7 months. Seven patients were still on pazopanib by the end of this study and the disease had progressed in the other 43 patients, leading to 23 deaths. We found that despite treatment more than half the patients experienced disease progression (56% vs 14% partial response and 30% stable disease). The median progression-free survival and overall survival was 3.1 and 11.0 months, respectively. Multivariate analysis identified good Eastern Cooperative Oncology Group performance status (0 or 1) and occurrence of hand-foot skin reaction as independent factors associated with better outcome. Hand-foot skin reaction was 32% in our cohort and the median onset time was 4 (1.00-8.29) weeks. It had dose-dependent effect by clinical observation. CONCLUSIONS: Our study showed that the incidence rate of hand-foot skin reaction in Taiwan is higher than western population, and it is an independent predictive factor for better treatment outcomes.

Giant Cell Tumors of the Bone With Pulmonary Metastasis.

Giant cell tumors of the bone are benign but locally aggressive, and they rarely metastasize to the lungs. The purpose of this study was to retrospectively review the clinical presentation, long-term outcomes, and treatment of pulmonary metastasis of these tumors. Between 1991 and 2004, a total of 168 patients with giant cell tumors of the bone were treated at the authors' institution, 7 of whom developed lung metastasis. Four of the 7 patients were men, and mean age of these patients at initial surgery was 40 years (range, 19-56 years). All patients underwent wide excision and reconstruction or curettage and bone grafting for the bony lesions. Lung metastases were detected at a mean of 44 months after the treatment of bone lesions. Five patients had multiple metastases, and 2 had solitary pulmonary metastases. Six of these patients underwent delayed treatment, locally aggressive, or multiple recurrent and surgical procedures. All of the aforementioned procedures had similar risk factors to those previously reported in the literature. One patient had multiple giant cell tumors of the bone. At last follow-up, 2 patients had died due to complications from the pulmonary metastases or chemotherapy. One patient underwent a metastasectomy 4 years after treatment due to the progression of pulmonary metastasis. The remaining 4 patients were alive and healthy after chemotherapy or conservative treatment. Therefore, early detection, adequate treatment of the primary bone lesion, conservative treatment of lung metastases, and regular long-term follow-up are recommended.

Renal metastasis from papillary thyroid microcarcinoma.

Papillary or follicular microcarcinoma of the thyroid comprises 10-20% of all thyroid malignancies. Most of these diseases exhibit slow progression and have a favorable prognosis. Distant metastasis caused by thyroid microcarcinoma is uncommon, and is usually found in the lung or bone. Thyroid microcarcinoma with metastasis to the kidney has not previously been reported. Clinically detectable well-differentiated metastatic thyroid carcinoma to the kidney is rare, and only 16 cases have been reported. Herein we describe a case of metastatic papillary thyroid microcarcinoma to the kidney in a patient with a pelvic fracture and pulmonary metastasis. The patient underwent a total thyroidectomy, radiotherapy, ablation treatment with 131I and thyroxine suppressive therapy. In conclusion, microcarcinoma cannot be ignored. Although uncommon, metastases may arise.

Clinical Outcomes of Patients with Resected Oral Cavity Cancer and Simultaneous Second Primary Malignancies.

OBJECTIVES: Simultaneous second primary tumors (SSPT) are not uncommon in patients with oral cavity squamous cell carcinoma (OSCC) living in areas where the habit of betel quid chewing is widespread. We sought to identify the main prognostic factors in OSCC patients with SSPT and incorporate them into a risk stratification scheme. METHODS: A total of 1822 consecutive patients with primary OSCC treated between January 1996 and February 2014 were analyzed for the presence of SSPT. The 18-month and 5-year overall survival (OS) rates served as the main outcome measures. RESULTS: Of the 1822 patients, 77 (4%) were found to have SSPT (i.e, two malignancies identified within one month of each other). The 18-month and 5-year OS rates in patients without SSPT and with SSPT were 82% and 69%, and 72% and 53%, respectively (p = 0.0063). Patients with SSPT were further divided into patients with either esophageal cancer or hepatocellular carcinoma (eso-HCC subgroup, n = 8) and other tumors (NO eso-HCC subgroup, n = 69). After multivariate analysis, neck nodal extracapsular spread (ECS, n = 18) and the presence of eso-HCC were identified as independent adverse prognostic factors. The 18-month OS rates of SSPT patients with both eso-HCC and ECS (n = 5) vs. the remaining patients (n = 72) were 0% and 78%, respectively (p < 0.0001). CONCLUSION: OSCC patients with neck nodal ECS and esophageal cancer or hepatocellular carcinoma as SSPT have a dismal short-term prognosis.

Chemotherapy using 5-fluorouracil, mitoxantrone, and cisplatin for patients with advanced hepatocellular carcinoma: an analysis of 63 cases.

BACKGROUND: We evaluated the anti-tumor efficacy and toxicity of 5-fluorouracil (5-FU), mitoxantrone, and cisplatin (FMP) in patients with advanced hepatocellular carcinoma (HCC), and conducted an analysis of the prognostic factors for response to such therapy and patient survival. METHODS: Sixty-three patients suffering from unresectable and non-embolizable HCC and who had objectively measurable tumors, adequate liver and renal function, and adequate bone-marrow reserve were enrolled in this study. The therapeutic regimen consisted of cisplatin 80 mg/m(2) and mitoxantrone 6 mg/m(2) intravenously on day 1, and 5-FU 450 mg/m(2) per day continuous infusion for a period of 5 days. Univariate and multivariate analyses of patient and disease characteristics were used to identify factors predicting patient response and survival. RESULTS: The objective response was 23.8% (95% confidence interval [CI], 13.0-34.6%). The median survival for all 63 patients was 4.9 months (95% CI, 3.2-6.6 months). The median time to progression was 2.5 months (95% CI, 1.7-3.3 months). Multivariate analysis identified only performance status ( P = 0.050) and liver tumor size ( P = 0.012) as being significantly related to patient objective response. Independent variables associated with a better patient survival included: the absence of ascites ( P = 0.003), a lower total bilirubin level ( P = 0.026), and the patient being a positive chemotherapy responder ( P = 0.009). CONCLUSIONS: The response rate to an FMP regimen was still unsatisfactory, although a specific subgroup of patients (good performance status, smaller liver tumor mass, good liver reserve, and distant metastasis) may benefit from this regimen.We evaluated the anti-tumor efficacy and toxicity of 5-fluorouracil (5-FU), mitoxantrone, and cisplatin (FMP) in patients with advanced hepatocellular carcinoma (HCC), and conducted an analysis of the prognostic factors for response to such therapy and patient survival.

Reduced maintenance of complete protection from emesis for women during chemotherapy cycles.

Women have a significantly higher rate of chemotherapy-induced emesis. We observed that gender was the important predict factor for reducing the maintenance of complete protection from emesis during chemotherapy cycles. Four hundred patients were enrolled in one of two arms in a crossover fashion. Arm A: three 8-mg doses of ondansetron were given intravenously at 4-hour intervals plus dexamethasone 20 mg intravenously from the start of chemotherapy, followed by dexamethasone 5 mg intravenously every 12 hours. Arm B: as in arm A but with three 8-mg doses of ondansetron intravenously given at 24-hour intervals substituted for ondansetron intravenously given at 4-hour intervals. Rates for complete protection from vomiting/nausea through days 1 to 6 were 69.7%/58.4% for Arm A, and 71.2%/60.9% for Arm B, and 69.0%/60.0% for the first chemotherapy cycle. Risk factors for vomiting and nausea included gender and cisplatin dosage. Complete control of vomiting/nausea for patients without emesis during previous cycle(s) was maintained at 91.4%/86.6%, 91.1%/85.2%, 93.9%/89.9%, 94.7%/92.6%, and 94.9%/94.9% during the second through sixth cycles of chemotherapy, respectively. Complete protection from vomiting and nausea was significantly reduced for female patients (p = 0.048 and p = 0.0004, during the second cycle, and p = 0.0006 and p = 0.0008, during the third through sixth cycles, respectively). The results suggest that women had less maintenance for complete protection from both vomiting and nausea during chemotherapy cycles.

Primary adenocarcinoma arising in esophageal colon interposition: report of a case.

Colon interposition has become a favored technique for esophageal reconstruction. We report a 79-year-old man with primary adenocarcinoma arising in the interposed colon 30 years after esophageal reconstruction for esophageal cancer. The occurrence of a carcinoma in a colon removed from its natural location and serving a different function suggests this rise in incidence may result from the action of carcinogens on colonic cells over an increasing period.

Modified biweekly oxaliplatin and capecitabine for advanced gastric cancer: a retrospective analysis from a medical center.

BACKGROUND: We modified 3-week XELOX regimen with oxaliplatin to 85 mg/m 2 on Day 1 and capecitabine 1000 mg/m 2 BID for 10 days every 14 days to be more practical in clinical practice for advanced gastric cancer. The aim of this retrospective analysis is to evaluate the safety profile and efficacy of the modified oxaliplatin plus capecitabine (XELOX) regimen as the first-line treatment for patients with advanced gastric cancer in a medical center in Taiwan. METHODS: From March 2009 to December 2010, among the 614 patients diagnosed with gastric cancer in a medical center, 49 patients with unresectable advanced or metastatic gastric adenocarcinoma were treated with oxaliplatin (85 mg/m 2 ) on Day 1 and capecitabine (1000 mg/m 2 BID) for 10 days every 2 weeks (mXELOX). CT scan was performed for tumor response evaluation. Clinical outcome and adverse events after mXELOX treatment were analyzed retrospectively. RESULTS: A total of 354 mXELOX sessions (median: 6) were administered in 49 patients. The overall tumor response rate was 39.1% among 46 evaluated patients: three complete response (6.5%) and 15 partial response (32.6%). Seven patients had stable disease (15.2%) and 21 (45.7%) patients had progressive disease. The median progression-free survival and median overall survival were 4.37 months and 12.26 months, respectively. The most common grade III/IV hematologic toxicity was anemia (10.2%), and non-hematologic toxicity effects were numbness (8.2%), hand-foot syndrome (10.2%), diarrhea (6.1%), thrombocytopenia (6.1%), and abdominal pain (6.1%). CONCLUSION: This modified biweekly oxaliplatin and capecitabine combination chemotherapy is practical and effective for unresectable advanced or metastatic gastric cancer in our daily practice.

Predictive factors for do-not-resuscitate designation among terminally ill cancer patients receiving care from a palliative care consultation service.

CONTEXT: Since the development of palliative care in the 1980s, "do not resuscitate" (DNR) has been promoted worldwide to avoid unnecessary resuscitation in terminally ill cancer patients. OBJECTIVES: This study aimed to evaluate the effect of a palliative care consultation service (PCCS) on DNR designation and to identify a subgroup of patients who would potentially benefit from care by the PCCS with respect to DNR designation. METHODS: In total, 2995 terminally ill cancer patients (with a predicted life expectancy of less than six months by clinician estimate) who received care by the PCCS between January 2006 and December 2010 at a single medical center in Taiwan were selected. Among these, the characteristics of 2020 (67.4%) patients who were not designated as DNR at the beginning of care by the PCCS were retrospectively analyzed to identify variables pertinent to DNR designation. RESULTS: A total of 1301 (64%) of 2020 patients were designated as DNR at the end of care by the PCCS. Male gender and primary liver cancer were characteristics more predominantly found among DNR-designated patients who also had worse performance status, higher prevalence of physical distress, and shorter intervals from palliative care referral to death than did patients without DNR designation. On univariate analysis, a higher probability of DNR designation was associated with male gender, duration of care by the PCCS of more than 14 days, patients' prognostic awareness, family's diagnostic and prognostic awareness, and high Palliative Prognostic Index (PPI) scores. On multivariate analysis, duration of care by the PCCS, patients' prognostic awareness, family's diagnostic and prognostic awareness, and a high PPI score constituted independent variables predicting DNR-designated patients at the end of care by the PCCS. CONCLUSION: DNR designation was late in terminally ill cancer patients. DNR-designated cancer patient indicators were high PPI scores, patients' prognostic awareness, family's diagnostic and prognostic awareness, and longer durations of care by the PCCS.

Efficacy of postoperative oxaliplatin- or irinotecan-based chemotherapy after curative resection of synchronous liver metastases from colorectal cancer.

BACKGROUND: Postoperative 5-fluorouracil (5-FU)-based chemotherapy improves survival after resection of synchronous liver metastases from colorectal cancer (CRLM). We retrospectively assessed the efficacy of postoperative chemotherapy with a modern regimen containing of oxaliplatin or irinotecan after curative resection of synchronous CRLM. PATIENTS AND METHODS: Seventy-two patients who received postoperative chemotherapy following curative resection of synchronous CRLM were analyzed. Patients were categorized into fluorouracil plus leucovorin (5-FU/LV, n=25), irinotecan-based regimen (FOLFIRI/IFL, n=21) and oxaliplatin-based regimen (FOLFOX, n=26) groups, according to the postoperative chemotherapy regimen. The clinicopathological parameters of patients were analyzed to evaluate clinical outcome. RESULTS: Median relapse-free survival (RFS) was 14.4 months in the 5-FU/LV group vs. 20.8 months in the FOLFIRI/IFL group (p=0.032) and 18.8 months in the FOLFOX regimen (p=0.123). Median overall survival (OS) was >60 months in the FOLFOX and FOLFIRI/IFL groups vs. 38.5 months in the 5-FU/LV group (p=0.002 and p=0.019, respectively). In multivariate analysis, administrations of FOLFIRI/IFL or FOLFOX regimens were independent predictive factors for favorable RFS. Administration of the FOLFIRI/IFL regimen was the only independent predictive factor for favorable OS. CONCLUSION: Postoperative FOLFIRI/IFL and FOLFOX chemotherapy lead to more favorable RFS than 5-FU/LV following curative resection of synchronous CRLM.

Characteristics of patients with hematologic malignancies who received palliative care consultation services in a medical center.

This study aimed to compare the characteristics of patients with hematologic malignancies and solid cancers who received palliative care. A total of 124 patients with hematologic malignancy and 3032 patients with solid cancer, who received palliative care consultation services between 2006 and 2010 in a medical center in Taiwan, were retrospectively analyzed. Higher prevalence of oral stomatitis, diarrhea, and hematologic symptoms including infection, fever, severe anemia, and bleeding, and lower prevalence of constipation, abdominal distension, and pain were observed in patients with hematologic malignancies compared to that in patients with solid cancer. The interval from hospital admission to palliative care referral was longer for patients with hematologic malignancy than that for patients with solid cancer. Hematologists should refer patients earlier, and palliative care specialists should understand the specific needs of patients with hematologic malignancy.