Treatment and outcomes in adult patients with primary cardiac sarcoma: the British Columbia Cancer Agency experience.

BACKGROUND: To evaluate treatment and survival in a cohort of patients referred to a Canadian institution with newly diagnosed primary cardiac sarcoma. METHODS: Between 1990 and 2006, 16 patients were referred to the British Columbia Cancer Agency with pathologically confirmed sarcoma of cardiac origin. Retrospective chart review was performed to document patient, tumor, and treatment characteristics. Disease-free survival and overall survival (OS) were calculated by Kaplan-Meier methods and compared in different subgroups by log rank statistics. RESULTS: The cohort comprised 10 female and 6 male patients. The mean age was 51 years (range, 27-81 years). The most common histologic subtype was angiosarcoma. Surgical resection, alone or in combination with chemotherapy or radiotherapy, was undertaken in 10 of 12 patients with localized and 3 of 4 patients with metastatic disease. At a median follow-up of 8 months, all patients had died of disease. In the entire cohort, mean disease-free survival and OS were 6 months and 14 months, respectively. Patients with localized disease had significantly longer survival compared to metastatic disease (mean OS 18 months vs. 2 months, P = 0.001). Patients treated with complete resection had improved OS compared to incompletely resected disease (25 months vs. 6 months, P = 0.042). Age, sex, tumor grade, location, and subtype were not associated with statistically significant survival differences. CONCLUSIONS: Patients with nonmetastatic cardiac sarcoma amenable to complete resection experienced improved survival. However, the high overall rates of disease progression and mortality highlight the need for more effective local and systemic treatments that may be used in conjunction with surgery to improve patient outcomes.

The impact of comorbidities on the benefits of prolonged androgen ablation in patients with T3-4 prostate cancer treated with external beam radiation therapy.

PURPOSE: To determine whether the survival benefit associated with prolonged androgen deprivation therapy (ADT) and radiotherapy (EBRT) varies with baseline estimates of overall survival in cT3-4 prostate cancer patients (PCa). METHODS AND MATERIALS: In 1997, the BC Cancer Agency adopted as standard a policy of prolonged ADT (>18months) with EBRT for locally advanced PCa. Two cohorts of cT3-T4 PCa treated with EBRT were selected: 1993-1995 (early: N=725) and 1999-2001 (late: N=584). Duration of ADT and baseline prognostic factors (age, clinical stage, grade, presenting PSA, and Charlson index (CCI)) were abstracted from charts. Estimates of 10-year (E10) survival using an age-adjusted CCI were calculated and patients were grouped into low (<60%), medium (60-90%) and high (>90%) E10. In each E10 group, actual overall survivals were compared by era using log rank test. RESULTS: There were 318 low, 544 medium, and 447 high E10 patients with median follow-up of 11.1years. Gleason grade and T stage were not statistically different between E10 groups. As expected, median age and baseline CCI were higher in lower E10 groups (p<0.0001). Overall survival was higher in the late era, but varied with E10 group: low (43% vs. 49%, p=0.54), medium (55% vs. 64%, p=0.02) and high (66% vs. 77%, p=0.01). CONCLUSION: The policy of prolonged ADT with EBRT provides a survival benefit that varies with baseline risk of death from other causes. Absolute benefit from ADT is largest in those with medium or high E10.

Population-based validation of a policy change to use long-term androgen deprivation therapy for cT3-4 prostate cancer: impact of the EORTC22863 and RTOG 85-31 and 92-02 trials.

PURPOSE: After publication of EORTC-22863 trial, prolonged androgen deprivation therapy (ADT) combined with radiation therapy (RT) became standard policy for high-risk prostate cancer patients in British Columbia (BC) in 1997. We evaluated whether population-based survival improved after this policy change. PATIENTS AND METHODS: Two cohorts comprising all patients with T3-T4 prostate cancer treated with curative-intent RT in BC were reviewed. The Early cohort (n=730) was all patients treated between 1993 and 1995, and the Late cohort (n=584) was all patients treated between 1999 and 2001. The BC Cancer Registry, which collects data on survival, was linked to RT and pharmacy databases. Duration of ADT, age, stage, grade, presenting PSA, and Charlson comorbidity index (CCI; none=0, minor=1, major=2+), were abstracted from charts. RESULTS: Usage of ≥6 months and ≥18 months of neoadjuvant and adjuvant ADT increased from 14% and 1% to 97% and 59% (p<0.0001). Baseline characteristics were similar, except for lower Gleason score (G2-6: 45% vs. 20%, G7: 35% vs. 48%, G8-10: 19% vs. 32%; p<0.0001), higher T-stage (T4: 9% vs. 5%, p=0.004) and higher comorbidity (CCI 0: 62% vs. 71%, CCI 1: 26% vs. 20%, CCI 2+: 11% vs. 9%, p=0.002) in the Early cohort. Disease-specific survival adjusted for competing risks from other causes mortality was improved (90% vs. 86%, p=0.042). On multivariate analysis, the Late cohort was independently associated with improved 8-year overall survival (76% vs. 64%, p=0.0002). CONCLUSIONS: This population-based study demonstrated improved overall survival following a policy change to use of prolonged ADT with curative RT for patients with T3-T4 prostate cancer.

Primary sarcoma of the mediastinum: a report of 16 cases referred to the British Columbia Cancer Agency.

BACKGROUND: Sarcoma arising in the mediastinum is a rare entity. This study evaluates treatment and survival in a cohort of patients with primary mediastinal sarcoma. METHODS: Between 1990 and 2006, 16 patients were referred to the British Columbia Cancer Agency with histologically confirmed sarcoma of mediastinal origin. Outcomes examined were disease-free survival (DFS) and overall survival (OS). RESULTS: There were nine male and seven female patients. The median age at diagnosis was 56 years (range 21-70 years). Thirteen (81%) patients had localized disease, and three (19%) patients had distant metastasis at diagnosis. Surgical resection was performed in 8 of 13 patients with localized disease. At a median follow-up of 18 months, 12 patients have died of disease, three were alive with disease, and one was alive with no evidence of disease. In the entire cohort, median DFS was 12 months (range 0-107 months), and median OS was 18 months (range 1-193 months). Patients who underwent surgery experienced improved DFS (p = 0.054) and OS (p = 0.034). Eastern Cooperative Oncology Group performance status 0 to 1 was associated with improved DFS (p = 0.038) and OS (p = 0.007). The histologic subtype with the longest survival was well-differentiated liposarcoma. Age, gender, tumor location, T and N stage, tumor size, location, and grade were not associated with significant survival differences. CONCLUSION: Surgical resection was associated with more favorable survival in patients with mediastinal sarcoma. However, the high rates of progression and mortality underscore the need for more effective adjuvant treatments.