Outcomes of small cell lung cancer patients treated with cisplatin-etoposide versus carboplatin-etoposide.

PURPOSE: This descriptive study compares overall survival (OS) and locoregional control (LRC) rates between cisplatin-etoposide (EP) and carboplatin-etoposide (EC) at a population level in patients with limited disease (LD) and extensive disease (ED) small cell lung cancer (SCLC). MATERIALS AND METHODS: All patients diagnosed with SCLC from January 2004 to December 2008 were identified. Patients with LD SCLC treated with EP or EC and concurrent or sequential radiotherapy and those with ED SCLC treated with EP or EC were included for analysis. A retrospective review examining prognostic features and outcomes was performed. OS and LRC curves were calculated using the Kaplan-Meier method and compared with the log-rank test. RESULTS: A total of 249 patients with LD SCLC and 287 patients with ED SCLC were identified. Patients treated with EC were significantly older for both LD (median 62 vs. 72, P<0.001) and ED (median 62 vs. 73, P<0.001). Median follow-up times were 37 and 22 months for LD and ED SCLC, respectively. Median OS for EP and EC in LD SCLC patients were 23 and 18 months (P=0.10). LRC rates at 12 months were 81% for the EP group and 68% for the EC group (P=0.97). Median OS for the EP and EC patients with ED SCLC was 10 and 11 months, respectively, (P=0.24). CONCLUSION: Despite the preferential use of EC in an older population, median OS and LRC rates were not significantly different for patients treated with EP for both LD and ED SCLC.

Biochemical control with radiotherapy improves overall survival in intermediate and high-risk prostate cancer patients who have an estimated 10-year overall survival of >90%.

PURPOSE: To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled. METHODS AND MATERIALS: A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival. RESULTS: Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p < 0.001) were statistically significant. CONCLUSION: Biochemical control translates into improved overall survival in patients with high or intermediate risk disease and an estimated 10-year overall survival of >90%.

The use of radiotherapy for the treatment of localized orbital amyloidosis.

OBJECTIVE: To describe two patients with localized orbital amyloidosis and the response of their condition to surgical debulking followed by external beam radiotherapy. DESIGN: Retrospective noncomparative interventional case series. OUTCOME MEASURES: Stabilization or regression of orbital signs after treatment. METHODS: Patients with biopsy-proven diagnosis of localized progressive orbital amyloidosis received 34 and 30 Gy fractionated external beam radiotherapy. The clinical case notes and histopathology for the two patients were reviewed. RESULTS: A 69-year-old man with orbital amyloid deposition in association with localized MALT lymphoma had a marked improvement in orbital signs following surgical debulking and radiotherapy, with no recurrence over two years. A 59-year-old woman with localized orbital amyloidosis showed regression of disease after surgical debulking and radiotherapy, with no evidence of recurrence after six years of follow-up. CONCLUSION: External beam radiotherapy following surgical debulking appears to halt the progression of localized orbital amyloidosis. Radiotherapy may be used in conjunction with surgical debulking of disease.