|
1
|
Uçar G, Sekmek S, Karahan İ, Ergün Y, İsak ÖA, Tunç S, Doğan M, Gürler F, Bayram D, Açıkgöz Y, Esen SA, Civelek B, Köş FT, Bal Ö, Algın E, Eren T, İmamoğlu Gİ, Urakçı Z, Yazıcı O, Özdemir N, Uncu D. The Comparison of FLOT and DCF Regimens as Perioperative Treatment for Gastric Cancer. Oncology 2024; 103:128-133. [PMID: 39079501 DOI: 10.1159/000540517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Locoregional gastric cancer is a still serious problem and perioperative treatments may improve the success of management. Different regimens were examined. The present study purposed to compare the efficacy of fluorouracil-leucovorin-oxaliplatin-docetaxel (FLOT) and docetaxel-cisplatin-fluorouracil (DCF) regimens. METHODS A retrospective multicenter study assessed the patients with locoregional gastric cancer. There are 240 patients (137 DCF, 103 FLOT). Survival rates were compared. RESULTS Demographic features were similar between the two groups, but the time period was different. The FLOT group had 7.8% pathological complete response, while the DCF group did not. Disease-free survival was longer in the FLOT than in the DCF group (median not reached - 13.94 months, respectively). Median overall survival was similar (30.9 vs. 37.8 months), but median follow-up affected the analysis. Survival for 36 months was 63% for the FLOT group and 40% for the DCF group (log-rank; p = 0.015). CONCLUSION FLOT regimen was superior to DCF regimen for response and survival rates. DCF is a historical approach. Long-term follow-up period is needed for FLOT treatment.
Collapse
Affiliation(s)
- Gökhan Uçar
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Serhat Sekmek
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - İrfan Karahan
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yakup Ergün
- Department of Medical Oncology, Antalya City Hospital, Ankara, Turkey
| | - Özlem Aydın İsak
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Sezai Tunç
- Department of Medicak Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mutlu Doğan
- Department of Medical Oncology, Ankara Dr. AY Oncology Training and Research Hospital, Ankara, Turkey
| | - Fatih Gürler
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Doğan Bayram
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yusuf Açıkgöz
- Medical Oncology, Kastamonu Education and Research Hospital, Kastamonu, Turkey
| | - Selin Aktürk Esen
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Burak Civelek
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fahriye Tuğba Köş
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Öznur Bal
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Efnan Algın
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Tülay Eren
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | | | - Zuhat Urakçı
- Department of Medicak Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nuriye Özdemir
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Doğan Uncu
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| |
Collapse
|
|
2
|
Alkan A, Mızrak D, Yaşar A, Karcı E, Köksoy EB, Ürün M, Özyurt N, Kuştaş AA, Kütük T, Ürün Y, Şenler FÇ, Akyürek S, Utkan G, Demirkazık A, Gökçe ŞÇ, Akbulut H. Adjuvant Concurrent Chemoradiotherapy (CRT) plus Docetaxel-Cisplatin-Fluorouracil (DCF) versus CRT plus Fluorouracil-Folinic Acid (FUFA) in Stage III Gastric Cancer. J Cancer Res Ther 2024; 20:913-917. [PMID: 39023597 DOI: 10.4103/jcrt.jcrt_1009_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2022] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Adjuvant chemoradiotherapy (CRT) is the optimal management strategy in resectable gastric cancer. There is a debate about the efficacy of more aggressive CRT plus chemotherapy regimens in adjuvant setting. This study aimed to compare the efficacy of adjuvant CRT plus docetaxel-cisplatin-fluorouracil (DCF) versus CRT plus fluorouracil-folinic acid (FUFA) in stage III gastric cancer. METHODS Patients with a diagnosis of stage III gastric cancer treated with adjuvant therapy after curative resection were analyzed. Patients' disease characteristics and impacts of the regimens on median disease-free survival (DFS) and median overall survival (OS) were analyzed retrospectively. RESULTS One hundred sixty-one patients (102 in FUFA arm and 59 in DCF arm) with a median age of 56.0 (29-79) were evaluated. In the DCF arm, there were more renal toxicities (31.6% vs 6.4% P < 0.001), emergency department admissions (64.9% vs 23.7%, P < 0.001), and dose reductions/treatment modifications in the DCF arm (51.6% vs 37.2, P < 0.001). The median follow-up was 23 months (1-124) in the FUFA arm and 26.0 months (1-77) in the DCF arm. The median DFS was 25.0 months (%95 CI, 12.7-37.2) in the DCF arm and 17.0 months (%95 CI, 2.6-31.3) in the FUFA arm, P = 0.66. The median OS was 28.0 months (%95 CI, 17.0-38.9) in the DCF arm and 25.0 months (%95 CI, 11.9-36.0) in the FUFA arm, P = 0.70. CONCLUSION In conclusion, when compared with FUFA regimen, more aggressive therapy with DCF was more toxic and did not improve OS in adjuvant setting of stage III gastric cancer.
Collapse
Affiliation(s)
- Ali Alkan
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
- Department of Medical Oncology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Dilşa Mızrak
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Arzu Yaşar
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ebru Karcı
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Elif Berna Köksoy
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Muslih Ürün
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Neslihan Özyurt
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ali Aytuğ Kuştaş
- Department of Internal Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Tuğçe Kütük
- Department of Radiation Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Filiz Çay Şenler
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Serap Akyürek
- Department of Radiation Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ahmet Demirkazık
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Şaban Çakır Gökçe
- Department of Radiation Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, School of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
|
3
|
Fu P, Shi Y, Chen G, Fan Y, Gu Y, Gao Z. Prognostic Factors in Patients With Osteosarcoma With the Surveillance, Epidemiology, and End Results Database. Technol Cancer Res Treat 2020; 19:1533033820947701. [PMID: 32787692 PMCID: PMC7427153 DOI: 10.1177/1533033820947701] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Osteosarcoma is a rare type of bone tumor, and this study aimed to assess the clinicopathologic features and prognoses of osteosarcoma patients. Methods: Clinicopathologic and survival data of 1025 patients between 2010 and 2016, 230 between 2008 and 2009 were downloaded and analyzed from the SEER database. Patients’ survival was analyzed using the Kaplan-Meier analysis; prognostic factors were assessed using the Cox regression hazards model. The 1-, 3-, and 5-year survival rates were estimated with nomogram. Competitive risk models were used to identify prognostic risk factors related to endpoint events of osteosarcoma patients. Results: Overall, 722 samples were obtained from the extremities, 134 from the axial bones, and 119 from the cranial and mandible in SEER (2010-2016 cohort). After the preliminary diagnosis, the median survival time of patients with osteosarcoma was 39 months, and the 1-, 3-, and 5-year survival rates were 87.3%, 67.2%, and 58.0%, respectively (P < 0.001). The competitive risk model revealed no competitive risks of the endpoint event. Conclusion: Our study found out the prognostic factors in patients with Osteosarcoma by Cox regression hazards model, after that, nomogram was established to predict the 1-, 3-, and 5-year survival rates, which may help oncologists to understand the highly malignant tumor.
Collapse
Affiliation(s)
- Peng Fu
- Department of Orthopedic, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yu Shi
- Department of Radiotherapy, 74567Affiliated Hospital of Nantong University, Nantong, China
| | - Gang Chen
- Department of Orthopedic, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yaohua Fan
- Department of Clinical Oncology, 569220The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yanhong Gu
- Department of Clinical Oncology, 74734The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenzhen Gao
- Department of Clinical Oncology, 569220The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| |
Collapse
|
|
4
|
Phase I Trial of Intensity-Modulated Hyperfractionated Radiotherapy Boost with Concurrent Chemotherapy Immediately Following Standard Chemoradiotherapy in Patients Primarily with Advanced Intra-thoracic/Cervical Esophageal Squamous Cell Carcinomas. Int J Radiat Oncol Biol Phys 2020; 106:340-348. [PMID: 31655197 DOI: 10.1016/j.ijrobp.2019.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Local persistence and relapse of disease in the gross tumor volume (GTV) account for the majority of treatment failures after standard chemoradiation therapy. The primary objective of this phase 1 trial was to define the maximum tolerated dose (MTD) of a hyperfractionated radiation therapy (HFRT) boost to the GTV with concurrent weekly paclitaxel and carboplatin after standard-dose chemoradiation therapy, using image guided intensity modulated radiation therapy techniques. METHODS AND MATERIALS Eligible patients were given weekly doses of paclitaxel (45 mg/m2) and carboplatin (area under the curve 1.5) for 5 weeks with concurrent radiation therapy (50 Gy), immediately followed by an HFRT boost to the GTV with the same chemotherapy regimen. The boost doses were escalated in increments of 7.2 Gy delivered in 6 twice-daily fractions of 1.2 Gy using a modified Fibonacci design. Once the MTD was established, additional patients were treated at that dose to determine the safety. RESULTS Thirty-one patients fulfilled the inclusion criteria. The incidence of dose-limiting toxicity was 0 of 3, 0 of 3, 0 of 3, 1 of 6 (grade 4 esophagitis), 0 of 3, and 2 of 3 (1 case each of grade 5 esophageal fistula and grade 3 pneumotitis) at 7.2, 14.4, 21.6, 28.8, 36, and 43.2 Gy, respectively, indicating an MTD of 36 Gy. Ten patients treated with this MTD showed no dose-limiting toxicities. The most common acute grade 3 or greater toxicities were esophagitis (26%) and neutropenia (19%). Late toxicity of grade 2 esophageal stricture occurred in 4 patients. The overall response rate was 84% (95% confidence interval, 42%-93%) in the entire cohort. The 1-year local control rate was 100% among those receiving a cumulative dose of the MTD or greater. CONCLUSIONS The MTD of the HFRT boost after standard chemoradiation therapy in the setting of concurrent chemotherapy was 36 Gy, resulting in the cumulative tumor dose of 86 Gy in patients primarily with advanced intrathoracic/cervical esophageal squamous cell carcinomas and not adenocarcinomas of the gastroesophageal junction. A phase 2 study to further evaluate this regimen is underway.
Collapse
|
|
5
|
Agolli L, Nicosia L. Between evidence and new perspectives on the current state of the multimodal approach to gastric cancer: Is there still a role for radiation therapy? World J Gastrointest Oncol 2018; 10:271-281. [PMID: 30254722 PMCID: PMC6147768 DOI: 10.4251/wjgo.v10.i9.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
In patients affected by gastric cancer (GC), especially those in advanced stage, the multidisciplinary approach of treatment is fundamental to obtain a good disease control and quality of life. Although many chemotherapeutics in combination to radiotherapy are adopted in the peri- or postoperative setting, the most optimal timing, regimens and doses remains controversial. In the era of radical surgery performed with D2-lymphadenectomy, the role of radiation therapy remains to be better defined. Categories of patients, who could benefit more from an intensified local treatment rather than more toxic systemic therapy, are still under investigation. Evidence and recent updates of the randomized trials, meta-analysis and prospective trials show that the postoperative radiotherapy plays a fundamental role in reducing the loco-regional recurrence and in turn the disease-free survival in operable advanced GC patients, also after a well performed D2 surgery. Therapeutic decisions should be taken considering the individual patients, but the multimodal approach is necessary to guarantee a longer survival and a good quality of life. Ongoing randomized trials could better define the timing and the combination of radiotherapy and systemic therapy.
Collapse
Affiliation(s)
- Linda Agolli
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01037, Germany
| | - Luca Nicosia
- Department of Radiation Oncology, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy
| |
Collapse
|