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Objective Despite the lack of definitive data on the impact of Comprehensive Geriatric Assessment (CGA) in the geriatric oncology setting, the broad use of any form of CGA is strongly recommended before any treatment decision in elderly cancer patients (ECP); currently there is no consensus about the best format for this geriatric assessment. The aim of this study was to firstly test the Multidimensional Prognostic Index (MPI) in ECP with locally advanced or metastatic disease. Materials and Methods Patients aged ≥ 70 years with inoperable or metastatic solid cancer consecutively admitted to our Program of Geriatric Oncology were assessed by a multidisciplinary team and received a basal CGA to calculate the MPI score. Results A hundred and sixty patients entered the study. In the Cox's regression model, MPI, CIRS-SI, BSA, GDS, MMSE, chemotherapy and a diagnosis of primary lung cancer were associated with mortality at 6 and 12 months. The ROC curves confirmed the prognostic value of MPI, with the best discriminatory power for mortality at both 6 and 12 months. Conclusion The present study is the first to indicate that the MPI retains its prognostic value even in elderly cancer patients with advanced stage of disease. The CIRS-SI and the GDS may potentiate the prognostic value of MPI.

The aim of the study was to evaluate the differences in terms of toxicity and feasibility of neoadjuvant 5-fluorouracil (5FU) continuous infusion (c.i.) or bolus in combination with pelvic radiotherapy (RT) in locally advanced rectal cancer "fit" or "vulnerable" elderly patients. A secondary endpoint was to identify any specific comorbidity that affected either effectiveness or morbidity of treatment.From June 2000 to June 2005, 36 patients over 70 years of age out of a total of 88 consecutive elderly cases were retrospectively examined. Variables considered were age, gender, modality of 5FU administration and comorbidities (evaluated according to Cumulative Illness Rating Scale-Geriatric, CIRS-G).Median age was 74 years (range, 70-82) years and the male:female ratio, 22:14. Fourteen % of the patients healthy and 25% with slight comorbidities were considered "fit" and 61% "vulnerable". All the patients received the full course of RT. The mean number of chemotherapy weeks was 5.34 (range, 2-6); "vulnerable" patients did not experience higher toxicity compared to "fit" patients (p = 0.69). Eighty-nine % of the patients were operated without relevant postoperative complications. Thirteen out of 20 "vulnerable" and 10 out of 12 "fit" patients had a pathological downstaging of disease (p = 0.24).Selected elderly "vulnerable" patients with rectal cancer can receive the same neoadjuvant 5FU-based chemoradiotherapy (either bolus or c.i.) and undergo surgery as well as "fit" elderly patients, since tolerability and response rate seem to be similar in both categories of patients.

Purpose To compare the efficacy and safety of fludarabine phosphate with cyclophosphamide, vincristine, and prednisone (CVP) in 381 previously untreated, advanced-stage, low-grade (lg) non-Hodgkin's lymphoma (NHL) patients in a phase III, multicenter study. Patients and Methods Between 1993 and 1997, patients were randomly assigned to treatment with either fludarabine (25 mg/m2 intravenously [IV] daily for 5 days every 4 weeks) or CVP (cyclophosphamide 750 mg/m2 IV on day 1; vincristine, 1.4 mg/m2 IV on day 1; and prednisone, 40 mg/m2 orally on days 1 through 5 every 4 weeks). Results Overall response (OR) rates were significantly improved in the fludarabine arm versus the CVP arm, both for the intent-to-treat (ITT) population and assessable patients (P < .001). Complete response (CR) rates in the ITT population were also higher after fludarabine treatment. The CR rate was 38.6% for fludarabine compared with 15.0% for CVP. There were no statistically significant differences in time to progression (TTP), time to treatment failure (TTF), and overall survival (OS) between treatment groups. WHO grades 3 and 4 hematologic adverse events were more common in the fludarabine arm. However, concerning the higher incidence of granulocytopenia, this did not translate to more infections in fludarabine-treated patients. Conclusion Newly diagnosed lgNHL patients who received fludarabine achieved higher OR and CR rates compared with CVP-treated patients. No differences in TTP, TTF, and OS were noted. Fludarabine is a highly active single agent in lgNHL. Combination therapies incorporating fludarabine are now being further evaluated as first-line therapy in follicular NHL.

Objectives: To investigate the efficacy of temozolomide (TMZ) in relationship to progression free survival at 6 months (PFS-6), median time to progression (TTP), response rate and toxicity, a phase II study was conducted in patients with recurrent glioblastoma multiforme (GBM) following surgery plus radiotherapy and a first-line regimen based on nitrosourea, procarbazine and vincristine. Methods: Forty-two patients with GBM were administered TMZ at the dose of 150 mg/m2/daily for 5 days every 4 weeks. Results: The PFS-6 and at 12 months (PFS-12) was 24% (95% Confidence Interval [CI] = 14–42%) and 8% (CI = 2–27%), respectively, with a median TTP of 11.7 weeks (CI = 9–22 weeks). The response was assessed in all 42 patients; we observed 2 complete responses (CR) (4.7%), 6 partial responses (PR) (14.3%), and 9 stable disease (SD) (21.4%), with CR+PR = 19% (CI = 7–31%). Conclusion: TMZ as a second line regimen is a valid option in patients with heavily pretreated GBM.

Twenty-two patients with advanced testicular cancer received iproplatin at a dose of 180–240 mg/m 2 every 4 weeks. All the patients progressed or recurred after chemotherapy including cisplatin. The most severe toxicity was thrombocytopenia with two toxic deaths after a first cycle of 240 and 180 mg/m 2 respectively. Nausea and vomiting were almost universal but mild in intensity. One renal failure occurred 6 weeks after the first cycle while the tumor was progressing. No antitumor activity was observed in this heavily pretreated population of patients.

RUDOLF A. JOSS,* SILVIO MONFARDINI,t MOGENS HANSEN,; PER DOMBERNOWSKY,§ JOSETTE RENARDfl and HERBERT M. PINED07 for the EORTC Early Clinical Trials Group** *Institute for Medical Onzology, lJniversi@ of Bern, Inselspital, Bern, Switzerland, TCentro di Rifcrimtnto Oncologico, Aviano, Itab, $Bispebjerg Hospital, Copenhagen, Denmark, § lJniversi& Hospital, Herlev, Denmark, [(EORTC Data Center, Brussels, Belgium and TDepartment of Oncolo~, Free University Hospital, Amsterdam, The Netherlands

The natural history of 292 consecutive cases of reticulum cell sarcoma and lymphosarcoma of Waldeyer's ring and the survival rate after radiotherapy are reported. In our institute since 1928 from 30 to 35% of pharyngeal neoplasms have been lymphomas, and of these 55% have been reticulum cell sarcomas, 21% lymphosarcomas, and 1% Hodgkin's disease. This high incidence may probably be ascribed to the fact that in all malignant lymphomas, irrespective of the clinical presentation, a systematic biopsy of the whole Waldeyer's ring was carried out. Pharyngeal lymphomas were confined to Waldeyer's ring in 19.6% of cases, with initial spread to contiguous cervical nodes in 43.8%, to distant nodes in 24.2%, and to extranodal tissues in 12.4%. Lymphography showed abnormal retroperitoneal lymph nodes in 38.3% of cases. There was gastrointestinal involvement either initially or later in 17.6% of cases. High-energy radiation therapy to both sides of the neck was the treatment of choice for local and regional disease. It achieved a five-year survival rate of 41.9% in the group of 97 patients treated during the past decade. The incidence of relapse (recurrence and new manifestations) was highest in the first year after treatment.

Introduction : Patients (pts) with gastrointestinal cancers suffer from many symptoms during their disese (1-25). Pain is the most prevalent symptom in cancer pts. Its occur in 70-90% of pts with advanced disease and its often undertreated in elderly (>70years) pts. Fatigue is the most frequently reported symptom in cancer pts undergoing chemotherapy. Aim : The aim of this study was to compare the symptom prevalence and its severity in cht naive pts before versus after chemotherapy protocols were applied. We also compared symptoms in younger versus elderly pts. Results : 132 pts were inrolled into the study ; 48 females and 74 males with mean age of 64, 2 years. Elderly group consisted of 32 pts (24, 2%) ; 20 females and 12 males with mean age of 73, 8 years. There was 86 (65, 1%) pts with metastatic or locally advanced disease. The most common cancer site was gastric and pancreatic cancer. In follow-up period 264 cycles were applicated. Symptoms severity levels (mild, moderate, severe) had been evaluated in all pts at the start, after 1st and 2nd cycle of CPF (cisplatin, 5-fluorouracil and leucovorin) cht protocol. The most common symptoms reported in cht naive pts were pain in multiple sites (69, 7%), anorexia (53%), sleeping disorders (53%) and fatigue (47%): After 2nd cycle of cht fatigue in 85%, depression in 58%, anorexia in 51% and pain in 17% were the most reported symptoms in younger pts. In elderly group fatigue in 87, 5%, pain in 56, 3%, anorexia in 43, 7% and sleeping disorders in 40, 6% of pts were the most common symptoms. Conclusions : With good analgetic therapy during cht, pain become good controlled symptom in younger pts ; its still remain serious problem in elderly pts. Fatigue experience during cht is a serious problem for both groups. Although CPF is middle toxic protocol, significant number of pts developed severe fatigue, supporting the need for better fatigue management.

Introduction: Patients (pts) with gastrointestinal (GIT) cancers suffer from many symptom during their disease (1-25). Pain is the most prevalent symptom and occur in 70-90% of pts with advanced cancer. Aim: the aim of this study was to compare the pain prevalence in elderly cancer pts versus younger cancer pts. Results: During 5 years period we examined 946 pts with cancer of GIT site in our hospital. 676 of them (71, 46%) expressed pain. 120 females and 172 males (292) were elderly with mean age of 77, 4± ; 3, 2 years. In this group the most common pain was moderate (128 pts-43, 84%). 384 younger pts had mean age of 63, 2± ; 4, 1 years and also mostly expressed moderate pain.. In elderly group 165 (56, 51%) of pts respected prescribed pain therapy versus 291 (75, 78%) in younger group. Elderly prefered transdermal opioid system for pain relief. Conclusions: there was no difference in pain expression according to age, gender and tumor site. Younger pts respected more pain therapy than elderly. Elderly prefered transdermal opioid system for pain therapy.