To our knowledge, this is the largest phase III trial comparing SLC plus BSC with BSC alone in AGC. In pretreated patients, SLC is tolerated and significantly improves OS when added to BSC.

BACKGROUND AND PURPOSE:Methylation of the MGMT gene promoter is associated with a favorable prognosis in adult patients with GBM treated with TMZ. We determined the incidence of pseudoprogression according to the MGMT methylation status and the potential value of DSC perfusion MR images for predicting pseudoprogression.

BACKGROUND The objective of this prospective cohort study was to determine the efficacy of stereotactic radiosurgery (SRS) as a salvage treatment in patients with recurrent malignant gliomas. METHODS Between January 2000 and December 2006, 114 consecutive patients were treated with SRS as a salvage treatment for recurrent malignant gliomas at a single institution. Clinical outcome and its prognostic factors were analyzed and compared with the historical control group who were treated at the same institution between 1995 and 1999. RESULTS The median overall survival from the time of diagnosis was 37.5 months (95% confidence interval [95% CI], 11.7–63.2 months) for patients with grade 3 gliomas (according to World Health Organization criteria) and was 23months (95% CI, 16.2–29.3 months) for patients with glioblastomas. The median progression‐free survival after SRS was 8.6 months (95% CI, 1.1–16.2 months) for patients with grade 3 gliomas and 4.6 months for patients with glioblastomas (95% CI, 4.0–5.2 months). With regard to treatment‐related complications, radiation‐induced necrosis was observed in 22 of 114 patients (24.4%). Compared with this historic control group, SRS significantly prolonged survival as a salvage treatment in patients with recurrent glioblastomas (23 months vs 12 months; P < .0001), but it was not found to provide a significant surgical benefit in patients with recurrent grade 3 gliomas (37.5 months vs 26 months; P = .789). On univariate analysis of prognostic factors, tumor volume (<10 mL) and low histologic grade were found to significantly influence better survival (P = .009 and P = .041, respectively). CONCLUSIONS SRS is a safe and effective modality in selected patients with recurrent small‐sized glioblastomas. However, the efficacy of SRS for recurrent grade 3 gliomas needs to be further evaluated in well‐designed clinical studies. Cancer 2008. © 2008 American Cancer Society.

No abstract

Although erlotinib has become an important therapeutic option in addition to gemcitabine, the high frequency of KRAS mutations in pancreatic cancer probably limits the benefits. We retrospectively studied 136 pancreatic cancer patients with available formalin-fixed paraffin-embedded tumor blocks from 2003 to 2009 to understand the clinical significance of KRAS mutations in pancreatic cancer patients treated with gemcitabine-based chemotherapy. KRAS mutations were analyzed by sequencing codons 12, 13, and 61. In this study, 71 (52.2%) of the 136 pancreatic adenocarcinomas examined harbored a point mutation in codons 12 (n ¼ 70) and 61 (n ¼ 1) of KRAS. KRAS mutation was not associated with clinicopathologic parameters. Patients with KRAS mutations showed a worse response (11.3%) than those with wild-type KRAS (26.2%) and poor survival (mutant KRAS, 5.8 months vs. wild-type KRAS, 8.0 months; P ¼ 0.001). Multivariate analysis revealed good prognostic factors for overall survival as well to moderately differentiated histology (P < 0.001; HR ¼ 0.437, 95% CI: 0.301-0.634), locally advanced disease (P < 0.001; HR ¼ 0.417, 95% CI: 0.255-0.681), response to first-line chemotherapy (P ¼ 0.003; HR ¼ 0.482, 95% CI: 0.297-0.780), and wild-type KRAS (P ¼ 0.001; HR ¼ 0.523, 95% CI: 0.355-0.770). However, the observed survival advantage is derived from the subgroup of patients treated with gemcitabine/erlotinib (9.7 vs. 5.2 months; P ¼ 0.002), whereas no survival difference based on KRAS mutation status is obvious in the other subgroup of patients treated without erlotinib (7.0 vs. 7.0 months; P ¼ 0.121). These results need to be further explored in upcoming prospective studies to provide a rationale for personalized medicine in pancreatic cancer.

Because the biologic behaviors of GISTs differ according to the location of the tumor, a more stratified strategy is required for managing EGISTs including incorporation of molecular features.

The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed. Gastric cancer is the most common cancer in Korea (Shin et al, 2002). Complete tumour removal with sufficient resection margin plus extended lymph node dissection is considered to be the most important factor in terms of reduced locoregional recurrence and improved survival. Although the incidence of early gastric cancer is increasing, most patients still present with an advanced stage, and, even after complete resection, 38 -94% of patients developed locoregional recurrence (McNeer et al, 1951;Gunderson and Sosin, 1982;Wisbeck et al, 1986;Landry et al, 1990), which translates into 33 -69% of all recurrences (Gunderson and Sosin, 1982;Landry et al, 1990;Maehara et al, 2000;Yoo et al, 2000). However, high recurrence rates may be reduced by adjuvant treatment, so postoperative adjuvant radiotherapy and/or chemotherapy is generally performed.There were several studies (GITSG, 1982;Moertel et al, 1984;Allum et al, 1989;Regine and Mohiuddin, 1992) showing positive effects of radiotherapy and/or chemotherapy in patients with locally advanced or unresectable gastric adenocarcinoma, but the benefit of adjuvant treatment after curative resection remains controversial. Intergroup trial (MacDonald et al, 2001) showed that adjuvant chemoradiotherapy reduced recurrences and increased survival of patients with gastric adenocarcinoma. However, after extended lymph node dissection with R0 gastrectomy, there are no data regarding whether adjuvant radiotherapy could reduce locoregional recurrence and increase survival.The purpose of this study was to analyse the patterns of failure in patients with gastric adenocarcinoma after gastrectomy with D2 lymph node dissection plus postoperative chemoradiotherapy, and to evaluate any effect of adjuvant radiotherapy on locoregional recurrence reduction and su...

We investigated the value of Epstein-Barr virus (EBV) DNA load in unfractionated whole blood for the diagnosis and prognosis of EBV-associated lymphoma. From July 2004 to July 2007, we compared EBV DNA loads in 101 patients with lymphoma and 105 control individuals. The median copy number of EBV was higher in patients with EBV-positive lymphoma (p<0.001). In patients with natural killer (NK)/T-cell lymphomas, the median EBV DNA load at presentation was significantly related to the stage (p = 0.011) and response (p = 0.026). The newly proposed classification model for NK/T cell lymphoma showed EBV DNA load differed significantly between patients with upper and extra-upper aerodigestive tracts (p = 0.017). In 16 patients with NK/T-cell lymphoma monitored serially, EBV DNA load correlated well with the treatment response and clinical course. Further prospective studies are required to evaluate the diagnosing and monitoring role of whole blood EBV DNA for uniformly treated patients.