Management of anaemia in prostate cancer.

Anaemia is a frequent complication of prostate cancer and of its treatments. In Europe prostate cancer accounts for the 10.8% of all malignant neoplasms. Iatrogenic hypogonadism and age-related physiologic changes along with nutritional deficits contribute to increase prevalence of prostate cancer related anaemia. The reason of the present review is to provide clinicians with all aspects of a frequent and multifactorial co-morbidity, whose effects are often underestimated. Erythropoiesis pathology and causes of anaemia in prostate cancer are reviewed. Critical issues of clinical management of anaemia in prostate cancer are discussed.

Pre-treatment carcinoembryonic antigen and outcome of patients with rectal cancer receiving neo-adjuvant chemo-radiation and surgical resection: a systematic review and meta-analysis.

Neo-adjuvant chemo-radiation is the standard of care for patients with locally advanced rectal carcinoma. The aim of the present paper is to evaluate the relationship of the baseline serologic concentration of the carcinoembryonic antigen with the outcome. Data sources included MEDLINE and Web of Science databases. A systematic search of the databases by a predefined criterion has been conducted. Chemo-radiation followed by surgical resection of rectal tumors was the intervention of interest. From selected studies, the relationships between carcinoembryonic antigen and pathologic complete response, disease-free survival and overall survival were assessed. Carcinoembryonic antigen correlated significantly and inversely with the rate of pathologic complete responses (OR 2.00). Similar to this relationship, a low baseline carcinoembryonic antigen concentration was associated with a better disease-free survival (OR 1.88) and a better overall survival (OR 1.85). Heterogeneity of studies and publication bias were considerable in evaluating the relationship of baseline carcinoembryonic antigen and pathologic complete response. Baseline carcinoembryonic antigen should be regarded as a predictor of outcome of patients undergoing neo-adjuvant chemo-radiation. A calibration of the cutoff value from 5 to 3 ng/ml appears more appropriate to this patient population and should be evaluated in prospective trials.

Trial Level Analysis of Prostate-Specific Antigen-Related Versus Unrelated Endpoints in Phase III Trials of First-Line and Second-Line Medical Treatments of Patients With Metastatic Castration-Resistant Prostate Cancer.

BACKGROUND: No endpoint (EP) has yet been recognized as a surrogate of overall survival (OS) after systemic treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of the present report was to suggest, using a trial-level analysis, what might be the most appropriate EPs for trials of new drugs for patients with mCRPC. MATERIALS AND METHODS: A literature search of randomized trials of medical treatments in patients with mCRPC was undertaken. The response-related and time-to-event EPs were evaluated. For each trial, the differences in OS and the examined EPs between the experimental and control arms and a correlation coefficient for every relationship were calculated. An additional regression analysis was performed to determine the proportion of variability explained (R2trial) on OS for the most frequently reported EPs in the selected trials. RESULTS: A total of 28 studies were included in the present analysis. Correlation analyses documented a significant relationship between the prostate-specific antigen (PSA)-related response rate and OS. Although not significant, a strong correlation coefficient was found for the relationship of radiologic progression-free survival (PFS) and OS and of PSA-related PFS and OS. The strength of the relationships with OS for all 3 EPs was greater among the trials published from 2005 to 2014. CONCLUSION: The PSA response rate and radiologic PFS reported greater rates of correlation with OS among trials of medical treatments of mCRPC, in particular, in studies published in the past 10 years. Both PSA and PFS should be evaluated for surrogacy at an individual level in large prospective trials of medical treatments for patients with mCRPC.

Impact of dose and volume on radiation-induced mucositis.

There is a relationship between a given radiation dose and the resulting biological effect in the management of head and neck cancer. Radiation mucositis represents a frequent complication in cancer chemoradiation. Its prevention and treatment are major goals in radiation therapy schedules. Critical tissues can be spared using high conformal radiation therapy (3DCRT) based on consensus guidelines for target volume. Current approaches to radiation mucositis with respect to the dose and volume impact are illustrated. The monitoring system of late toxicity used by the authors is presented.