<b><i>Introduction:</i></b> Human epidermal growth factor receptor 2 (HER-2) targeted therapy regimens can improve tumor response in HER-2-positive metastatic breast cancer (MBC), with overall survival benefits. <b><i>Objective:</i></b> We evaluated the efficacy of dual HER-2 blockade combined with chemotherapy for HER-2-positive MBC patients as a first-line therapy in our patient population. <b><i>Patients and Methods:</i></b> We identified 75 patients at King Faisal Specialist Hospital and Research Center that received trastuzumab, pertuzumab, and docetaxel as a first-line therapy in HER-2 positive MBC in 2013–2016. <b><i>Results:</i></b> Median age at diagnosis was 45 years; 54.7% were estrogen receptor (ER)-positive. 10% of patients presented with only bone metastasis. The median follow-up time was 36 months with an objective response rate of 74.7% (complete response [CR] 18.7%; partial response [PR] 56%). The 5-year progression-free survival (PFS) and overall survival (OS) were 21% and 71.9% respectively, with a median PFS of 36 months (95% confidence interval [CI] 23.6–48.4). The 5-year OS for ER-negative and ER-positive patients was 93.9% and 59.4% respectively (<i>p</i> = 0.189); 23 patients experienced grade 1/2 toxicity and 2 patients had grade 3/4 toxicity. In terms of OS and PFS, the site of metastasis did not make any significant difference. <b><i>Conclusions:</i></b> First line pertuzumab, trastuzumab, and docetaxel for HER-2-positive MBC patients was found to be an effective and safe therapy in the Saudi population. This finding was consistent with the results seen in the CLEOPATRA trials.
Dose escalation with SIB-VMAT as NACRT for rectal cancer is feasible. Moreover, it can increase the rate of pathological complete response with a favorable toxicity profile. Clinical benefit of this approach needs to be validated in a larger cohort of patients with longer follow-up.
e23581 Background: Sarcomas are aggressive malignancy,30-40% of them originate from retroperitoneal space. which makes adequate free surgical margin after surgical debulking mostly not achievable. The addition of Hyperthermic intraperitoneal chemotherapy (HIPEC)+/- Intraoperative radiation therapy (IORT) may overcome local failure with an overall survival benefit. we studied the outcome of cytoreductive surgery (CRS)+ HIPEC +/- IORT on patients with peritoneal sarcomatosis,at our institute. Methods: Patients with peritoneal sarcomatosis treated with CRS+ HIPEC +/- IORT, in the period between 2011-2016 were included. Results: 24 patients identified;15(62.5%) were males. Median age was 58(31-77). Liposarcoma was the most frequent diagnosis in 50% of them. Neoadjuvant chemotherapy was received in 5 patients, while neoadjuvant radiation therapy was received in 3 patients. Cytoreduction completeness score (CC-0/1) was achieved in 19(79.17%), with median peritoneal cancer index (PCI) of 11 (3–28). Melphalan was the most commonly used agent for HIPEC chemotherapy, it was used in 16(66.67%) patients. IORT was given in 16(66.67%) patients. 8 patients developed grade III-IV Clavien-Dindo (CD) complications, with one died 5 days post operatively due to pulmonary embolism. Adjuvant chemotherapy was received in 9 patients. After a median follow up of 21 months, the mean, 2 years and estimated 4 years progression free survival was 19.6 months, 30.6% and 15.3% respectively, 13(54.2%) patients developed systemic progression, lung was the most affected site at time of progression in 8/13(61.5%) patients. Local progression occurred in two patients, while both systemic and local progression occurred in one patient. The 3 cases progressed locally underwent redo CRS and HIPEC with average 18 months between the first and redo surgery. The mean, 2 years and estimated 4 years overall survival was 21.2 months, 75.7% and 75.7% respective. In univariate analysis only CC score correlate with PFS, the mean PFS for those patients with CC (0-1) vs (2-3) was 13.7 vs 11.5 months ( p = 0.036). Conclusions: Addition of HIPEC+IORT to surgical debulking in the management of peritoneal sarcomatosis; seems to be safe and may improve local control rate with a questionable survival benefit, a larger cohort with a multicentric study is needed for further evaluation.
Background: Ependymoma of the fourth ventricle is a challenging disease. Brain stem tolerance dose usually hinders the delivery of adequate radiation dose to target volumes. Aim: To present the treatment outcome of pediatric ependymoma of the fourth ventricle using combined CyberKnife and volumetric modulated arc therapy (VMAT) and compare it to VMAT plans. Methods: The medical charts of 15 patients were retrospectively reviewed. All patients underwent surgery and received radiotherapy in 2 phases using combined plans of VMAT and CyberKnife boost aiming for a total prescription dose of 59.4 Gy in 33 fractions. These plans were compared to a cone-down two-phase VMAT plans. At least 95% of the target volume was required to be encompassed by the 95% isodose level of prescription dose. Results: It was not feasible to achieve adequate target coverage using VMAT without exceeding the brain stem tolerance doses in all but one case. Brain stem maximum point dose, V59 Gy, V55.8 Gy and mean doses were 60.46 ± 0.3 Gy, 1.62 ± 0.42 cc, 37.49 ± 5.78% and 54.79 ± 0.64 Gy in VMAT plans compared to 59.67 ± 0.21 Gy, 0.55 ± 0.22 cc, 25.49 ± 3.84% and 52.86 ± 0.88 Gy in combined technique plans (p = 0.002, 0.001, 0.001 and 0.001; respectively). The estimated 5-year progression-free and overall survival rates were 53.3% and 63.6%. Performance status and extent of surgery significantly influenced overall survival. None of the patients had serious toxicities. Conclusion: On the contrary to VMAT cone-down plans, it was possible to achieve adequate target coverage without violating brain stem constraints using the combination of VMAT and CyberKnife techniques in pediatric ependymoma of the fourth ventricle. The treatment protocol was well tolerated with no reported serious radiation toxicities.
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