Search

Background: The National Cancer Plan (NCP) provided the incentives needed to establish a technical infrastructure adequate to meet the medical needs of radiotherapy in cancer care. The goal of this study is to evaluate the development of radiotherapy in South-Eastern Norway Regional Health Authority (S-E NRHA) and to compare it with the aims of NCP., Material and Methods: The material includes the 86,000 courses of radiotherapy performed in S-E NRHA in the period 1985-2008. The data were extracted from existing patient registries and include cancer diagnosis and patient demographic information. The number of treatment series is coupled with cancer incidence of each county and that in S-E NRHA., Results: During the latter half of the 1980s, radiotherapy was only offered to 50 % (range 30-60 % in the various counties) of those who needed it. The situation had improved in 2007, when this figure was close to 80 %, but there was still a significant discrepancy between counties (67-91 %). With respect to the medical needs, 10 000 additional courses of radiotherapy should have been performed in S-E NRHA in the period 2003-2007., Interpretation: The demonstrated insufficient use of radiotherapy and the geographical differences between counties are not acceptable. A prerequisite for optimal use of radiotherapy in cancer treatment is that the medical professions strengthen their oncological competence.

In a cross-sectional observational study to explore long-term satisfaction with treatment among men who had undergone radical prostatectomy (RP) or definitive pelvic radiotherapy (RT) for prostate cancer (PCa). After mean 7 years from therapy (range: 6–8), 431 PCa-survivors (RP: n = 313, RT: n = 118) completed a mailed questionnaire assessing persistent treatment-related adverse effects (AEs) (Expanded Prostate cancer Index Composite [EPIC-26]) and seven Quality indicators describing satisfaction with the health care service following a most often general practitioner (GP)-led follow-up plan. A logistic regression model evaluated the associations between long-term satisfaction and treatment modality, age, the seven satisfaction-related Quality indicators, and persistent AEs. The significance level was set at p<.05. Four of five (81%) PCa-survivors reported long-term satisfaction with their treatment. In a multivariable model, satisfaction was positively associated with sufficient information about treatment and AEs, patient-perceived sufficient cooperation between the hospital and the GP and sufficient follow-up of AEs (ref.: insufficient). Age ≥70 years (ref.: <70) and a rising summary score within the EPIC-26 sexual domain additionally increased long-term satisfaction. The treatment modality itself (RP versus RT) did not significantly impact on satisfaction. The majority of curatively treated PCa-survivors are satisfied with their treatment more than 5 years after primary therapy. Sufficient information, improved cooperation between the hospital specialists and the responsible GP and optimized follow-up of AEs may further increase long-term satisfaction among prostatectomized and irradiated PCa-survivors. [ABSTRACT FROM AUTHOR]

Abstract Background We previously observed that a radiotherapy-induced biochemical response in plasma was associated with favourable outcome in head and neck squamous carcinoma cancer (HNSCC) patients. The aim of the present study was to compare stress associated blood cell gene expression between two sub-groups of HNSCC patients with different biochemical responses to radiotherapy. Methods Out of 87 patients (histologically verified), 10 biochemical ‘responders’ having a high relative increase in plasma oxidative damage and a concomitant decrease in plasma antioxidants during radiotherapy and 10 ‘poor-responders’ were selected for gene-expression analysis and compared using gene set enrichment analysis. Results There was a significant induction of stress-relevant gene-sets in the responders following radiotherapy compared to the poor-responders. The relevance of the involvement of similar stress associated gene expression for HNSCC cancer and radioresistance was verified using two publicly available data sets of 42 HNSCC cases and 14 controls (GEO GSE6791), and radiation resistant and radiation sensitive HNSCC xenografts (E-GEOD-9716). Conclusions Radiotherapy induces a systemic stress response, as revealed by induction of stress relevant gene expression in blood cells, which is associated to favourable outcome in a cohort of 87 HNSCC patients. Whether these changes in gene expression reflects a systemic effect or are biomarkers of the tumour micro-environmental status needs further study. Trial registration Raw data are available at ArrayExpress under accession number E-MEXP-2460.

Few longitudinal studies have compared patient-reported long-term adverse effects after radical prostatectomy (RP) alone and RP followed by radiotherapy (RAD), also analyzing the effect of the development of post-treatment dysfunctions/problems (Symptom Burden) on Health-Related Quality of Life (HRQoL). After median seven years since RP and six years since post-RP RAD, development of EPIC-26 Domain Summary Scores (DSS Changes) and HRQoL scores (SF-12) since the pre-RP situation were evaluated in respectively 317 prostatectomized men without and in 63 patients with additional post-RP RAD. Post-treatment inter-group differences of the prevalent Symptom Burden and of the DSS Changes were calculated. Multivariable logistic regressions evaluated the associations between DSS Changes and post-treatment impaired HRQoL. Compared to RP alone, post-RP RAD increased the post-treatment Symptom Burden, with least inter-group differences within the urinary irritative/obstructive and bowel domain. No significant inter-group difference emerged for the proportions of men with impaired HRQoL. The odds of impaired HRQoL increased significantly with rising DSS Changes (worsening) within the vitality/hormonal domain. Worsening within urinary incontinence and bowel domains significantly increased the odds of impaired physical QoL. High HRQoL scores before RP reduced the odds of post-treatment impaired HRQoL. Living without a partner and use of androgen deprivation therapy increased this odds. Post-RP radiotherapy increases post-treatment Symptom Burden with negative, though limited impact on the patient's HRQoL. Counceling before post-RP radiotherapy should cover this possible development, taking into account the patient's social situation. [ABSTRACT FROM AUTHOR]

PURPOSE: To our knowledge, we conducted the first prospective oncologic clinical trial in Nepal aimed at providing state-of-the-art chemotherapy to patients with Ewing sarcoma. The efficacy of external-beam radiotherapy (RT) as the sole local treatment modality was explored and deemed justified as a result of the lack of available advanced tumor-orthopedic services in Nepal. PATIENTS AND METHODS: Twenty patients, 11 female and 9 male patients between the ages of 6 and 37 years, with newly diagnosed Ewing sarcoma were enrolled. Neoadjuvant combination chemotherapy, comprising well-established drug combinations, was administered in five courses before external-beam RT, during which one course of etoposide and ifosfamide was given. After RT, six additional chemotherapy courses were scheduled. RESULTS: RT was tolerated well, providing rapid symptom relief and local tumor control, with no pathologic fractures observed among the 15 patients who received such treatment. Eleven patients completed the entire treatment protocol; seven patients were under continued follow-up, with no evidence of disease in six patients at a median follow-up time of 2.3 years (range, 1.3 to 3.1 years) and one patient alive but with a regional recurrence. Four patients experienced metastatic relapse and died as a result of their disease. Three treatment-related deaths linked to toxicity from chemotherapy occurred. Four of the six patients who refused to complete the treatment protocol and were lost to follow-up experienced progressive disease and were assumed dead. CONCLUSION: This study was feasible with RT as the sole local treatment modality in combination with chemotherapy. As a result of the high number of patients lost to follow-up, no firm conclusions can be drawn, but the majority of the patients who completed treatment obtained durable long-term remissions. [ABSTRACT FROM AUTHOR]

: PurposeTo explore the efficacy of adjuvant 89Sr applied with external beam radiotherapy (EBRT) to treat bone metastases.: Methods and materialsNinety-five patients were randomized to 89Sr (Arm A) or saline (Arm B) on Day 1 of EBRT to demonstrate a reduction in 3-month physician-assessed subjective progression from 70% to 45%.: ResultsAt 3 and 6 months, no difference between treatment arms was observed in the progression rate. At 3 months, the physician-assessed response rate for all patients was 25%, with 46% of the patients progressing. The pretreatment use of opiates was independently associated with short progression-free survival. On the basis of the quality-of-life assessments, pain relief occurred in 50% of patients and 32% experienced improvement in global quality of life, without impact from 89Sr. Differences were observed between the physician evaluation of radiotherapy efficacy and the patient assessment. In Arm A, serum alkaline phosphatase, but not serum prostate-specific antigen, decreased during the first 3 months after treatment.: Conclusion89Sr, adjuvant to ERBT, does not seem to reduce the number of patients with subjective progression at 3 months. Patients should be referred for palliative RT before their bone pain requires high doses of opiates. In radiotherapy trials, the evaluation of pain and pain relief remains problematic because of the confounding use of analgesics. [Copyright &y& Elsevier]

The aim of our study was to compare plasma carotenoids (i.e., biomarkers of fruits and vegetables intake) and tocopherols in 29 head and neck squamous cell carcinoma (HNSCC) patients with 51 healthy controls and to explore the possibility whether these plasma antioxidants could be related to outcome among patients. The patients' blood samples were taken at the end of radiotherapy. We observed that plasma lutein, zeaxanthin, α-carotene, β-carotene, lycopene, and total carotenoids were significantly lower in HNSCC patients than controls. Among the patients, 18 died and 11 were still alive during median follow-up of 55 mo for survivors. We found a significant positive association between postradiotherapy plasma carotenoids (lutein, α-carotene, and β-carotene) and progression-free survival in these patients. This study indicates that increasing postradiotherapy plasma carotenoid concentration may reduce risk of premature death or recurrence of tumor in HNSCC patients. Increasing plasma carotenoid concentration should be done by increasing intake of carotenoid-rich fruits and vegetables, as other studies have shown either no or negative effects due to use of carotenoid supplements. [ABSTRACT FROM AUTHOR]

Abstract: We have studied the role of systemic oxidative stress for survival of patients with head and neck squamous cell carcinomas (HNSCC). Patients with lowest plasma total GSH levels had the lowest 36 months survival. In patients with post-radiotherapy concentrations of plasma total GSH less than median value, about 73% died during the 36 months follow-up compared to about 21% of patients with GSH values above median. Systemic oxidative stress as assessed by low GSH in post-radiotherapy plasma is associated to outcome in HNSCC patients. [Copyright &y& Elsevier]

Abstract: Background: Most previous studies of prostate cancer (CaP) patients have focused on functional side effects. In the decision about treatment, the patients' subjective experience of function (bother) should also be considered. In this prospective study of CaP patients, we used both categorical and dimensional methods to examine changes of sexual, urinary, and bowel bother after robot-assisted prostatectomy (RALP), after high dose radiotherapy alone (RAD), or with adjuvant androgen deprivation therapy (RAD + ADT). We also studied the associations between psychosocial factors and post-treatment bother and the correlations between bother and function at the follow-up time points. Methods: A total of 462 patients (n = 150 RALP, n = 104 RAD, and n = 208 RAD + ADT) completed questionnaires at all time points (baseline, 3, 6, 12, and 24 months post-treatment). Our outcome measures were the proportion of patients who regained their baseline bother core (PBS-100) and the mean group scores on sexual, urinary, and bowel bother based on the UCLA-PCI questionnaire. Generalized estimating equation (GEE) identified the time points at which various variables were significantly associated with bother at 2 years. The time points at which the proportions of bothered patients became stable were defined. Results: The different treatment modalities provided distinctive patterns over time regarding urinary, sexual, and bowel bothers. RALP gave sexual and urinary bother, RAD + ADT patients reported bowel and sexual bother, while RAD patient suffered mainly from bowel bother. According to GEE, the bother scores at 3 or 6 months were significantly associated with the bother scores at 24 months for all groups. PBS-100 and stability of the recovered bother domains was reached at 3 to 6 months. Strong correlations were observed between function and bother for the urinary and bowel domains but not for the sexual domain. The associations between psychosocial factors and bother were weak. Conclusions: Two years after treatment, RALP patients mainly reported sexual and urinary bother, while irradiated patients were bothered by bowel dysfunction. Sexual, urinary, and bowel bother reached stable proportions at 3 to 6 months post-treatment. Based on GEE, bother at 6 months was in general significantly associated with bother at 24 months. [Copyright &y& Elsevier]