Tumor-related leukocytosis is associated with poor radiation response and clinical outcome in uterine cervical cancer patients.

BACKGROUND: To evaluate response to radiation and clinical outcome of uterine cervical cancer patients with tumor-related leukocytosis (TRL) at initial diagnosis and during definitive radiotherapy. PATIENTS AND METHODS: We retrospectively analyzed 2456 patients with stage IA-IVA uterine cervical cancer who received definitive radiotherapy with (37.4%) or without (62.6%) platinum-based chemotherapy between 1986 and 2012. TRL was defined as two or more occurrences of leukocytosis over 9000/µl at the time of diagnosis and during the course of treatment. Locoregional failure-free survival (LFFS) and overall survival (OS) were compared between patients with or without TRL. RESULTS: The median age of all patients was 55 years, and the median follow-up time was 65.1 months. TRL was observed in 398 patients (16%) at initial diagnosis; TRL (+) patients were younger and had larger tumors, advanced stage, and more frequent lymph node metastases (all P < 0.05). TRL (+) patients showed a significantly lower rate of complete remission than TRL (-) patients (89.9% versus 96.3%, respectively, P = 0.042). Ten-year LFFS and OS for all patients were 84% and 78%, respectively. LFFS and OS were significantly lower in TRL (+) patients than TRL (-) patients (10-year LFFS: 69% versus 87% respectively, P < 0.001; 10-year OS: 63% versus 81% respectively P < 0.001). After propensity score matching, LFFS and OS rates in TRL (+) patients remained significantly lower than for TRL (-) patients; this significant difference was also observed on multivariate analysis. Twenty-six percent of patients with locoregional failure (n = 345) were TRL (+) and had significantly poorer median OS (6 versus 12 months, P = 0.001). CONCLUSION: This study reveals the aggressive nature of cervical cancer with TRL and its poor response to radiation therapy. Given the unfavorable prognosis and higher probability of treatment failure, optimal diagnostic and therapeutic approaches and careful monitoring for early detection of recurrence should be considered for these patients.

Urgencias oncológicas / Oncology urgency

Las urgencias oncológicas son un capítulo importante dentro de la oncología pediátrica y de especial interés, tanto para los médicos generales como pediatras, ya que éstas son causa de morbimortalidad en pacientes con cáncer y pueden estar presentes desde el momento del diagnóstico. Aunque existe una gran variedad de ellas, en este capítulo sólo abordaremos las de mayor frecuencia como son la lisis tumoral, muchas veces presente al momento del diagnóstico y que puede conducir a una insuficiencia renal; la hiperleucocitosis, que es capaz de producir enfermedad por lisis tumoral o por un síndrome de hiperviscosidad, que se manifiesta por complicaciones pulmonares y neurológicas, siendo la más grave de ellas la hemorragia intracraneala; finalmente revisaremos la urgencia oncológica más frecuente que es la neutropenia febril que es secundaria a la toxicidad por quimioterapia y que puede causar la muerte en estos pacientes.

The role of splenic irradiation in chronic lymphocytic leukemia.

Fourteen patients with chronic lymphocytic leukemia (CCL) who received a total of 23 courses of splenic irradiation (SI)for various combinations of painful splenomegaly, progressive leukocytosis, lymphocytosis, thrombocytopenia, and anemia are reviewed. Splenic midplane doses ranged from 200-1750 rads (3-14 days), while the most typicalregimen was 300-450 rads in two to three fractions of 150 rads given over 3-8 days. Response to SI was rated according to a scoring system which evaluated the splenic and hematologic response, as well as the response of disease-related symptons. According to this scoring system, most patients demonstrated a significant relief of painful splenomegaly, along with improvement of hemogram and bone marrow parameters. While those patients judged as failures to prior chemotherapy or total body irradiation showed improvement following SI, those who had received minimal therapy prior to SI showed a superior response. SI, in those showing a satisfactory response, was repeated successfully in several patients (up to six times in one instance). The onset and duration of response to SI, dose-reponse data, survival, clinical and hemotologic responses, and the possible mechanism of action of SI are discussed with reference to the available literature.