436 Background: The FOLFIRINOX chemotherapy regimen has been shown to improve overall survival in patients with metastatic pancreatic cancer, however, toxicity is increased. The aim of this analysis was to assess the tolerability and outcomes of this regimen in clinical practice. Methods: A retrospective analysis of patients treated with FOLFIRINOX chemotherapy in a tertiary referral centre between January 2013 and May 2014 was conducted. Toxicity was graded as per CTCAE version 4.0. Overall survival and tumour response were analysed. Results: A total of 80 patients were identified with locally advanced or metastatic disease in 47 and 33 cases respectively. The median patient age was 63 (range 30 –79) and the median number of cycles delivered was 6 (range 1-12). G3/4 neutropenia was recorded in 12.5% of patients, with a febrile neutropenia rate of 9.9%. G3/4 nausea and vomiting was reported in 17.5% and G3/4 diarrhoea in 15% of cases. G3/4 electrolyte disturbance occurred in 5%. Response rates assessed after 3-6 cycles showed PR 26%, SD 31% and PD 25%. Median duration of follow up for survivors is 8.7 months (range 3.6 – 20.8). Median OS is 11.4 months (95% CI 10.1 – 12.7). Median OS was reported as 11.4 months, 10.9 months and 2.3 months according to baseline PS 0, 1 and 2 respectively (log rank p <0.001). Conclusions: FOLFIRINOX can be safely delivered out with a trial cohort. Outcomes are strongly influenced by patient PS and careful patient selection is critical.
444 Background: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related mortality worldwide. Lymph node involvement and resection margin status play important roles in predicting relapse. Resectable disease occurs in only 15–20% of total patients who present with PDAC. Unfortunately, margin involvement (R1) occurs in 70–80% of these patients. Emerging evidence has shown that the use of neoadjuvant chemotherapy and localised radiotherapy to downsize the tumours and increase the margin clearance (R0) rate may improve the overall survival of PDAC patients.We report a neoadjuvant therapy approach in the non-clinical trial setting of our large, tertiary cancer centre. Methods: We prospectively collected the outcome data and toxicity of 53 patients diagnosed with borderline resectable or initially non-resectable PDAC between 2012 and 2014. These patients received either FOLFIRINOX (FFX) or Gemcitabine/Capecitabine (GemCap) combination chemotherapies. Following restaging by computed tomography (CT), the patients proceeded to preo-operative 5-FU-based chemo-radiotherapy, immediate resection or subsequent palliativetherapies. Results: The median age was 65 (range 30 – 79) at PDAC diagnosis. Sixty-one percent (n=32) were male with the commonest anatomical location being the head of the pancreas (58%, n=31). The median follow up for survivors is 13.7 months (range: 5.3–24.4). The median overall survival was 18.3 months (95%, CI: 12.0–24.5). There was no statistical difference between overall survival in patients receiving FFX and GemCap chemotherapies. The margin clearance rate (R0) was 36% (4/11) in patients who proceeded to resection after neoadjuvant chemotherapy alone. The rate was 100% (4/4) in patients who received additional chemoradiation prior to surgery. Conclusions: This case series reveals that neoadjuvant therapy improved survival of patients with PDAC. In addition, we showed an increase in the R0 resection rate in patients who underwent chemoradiation prior to surgery. Further work is ongoing but based on historical data we believe that this neoadjuvant approach may lead to a long term survival benefit.
Radiation Therapy and You is written for you-someone who is about to get or is now getting radiation therapy for cancer. People who are close to you may also find this book helpful. This book is a guide that you can refer to throughout radiation therapy. It has facts about radiation therapy and side effects and describes how you can care for yourself during and after treatment.
Boron neutron capture therapy (BNCT) is high-LET radiotherapy, where boron-10 is first targeted to tumors using a carrier compound, often L-boronophenylalanine (L-BPA), followed by low energy external neutron beam irradiation. A high target dose from BNCT is predictive for tumor response and favorable survival in patients with head and neck (H&N) squamous cell carcinoma. Constant tumor-tothe whole blood boron concentration ratios are often assumed in dose calculation, but tumor-to-normal tissue (T/N) ratios obtained from tumor imaging with PET using 18F-BPA as the tracer might also be useful in dose calculations. We investigated the association between the T/N ratios obtained from 18F-BPA PET and efficacy of BNCT in patients with H&N cancer. Materials/Methods: 117 patients with inoperable, locally recurred H&N cancer were treated with L-BPA-mediated BNCT at the FiR 1 research reactor facility, Espoo, Finland, in February, 2003 to January, 2012. To estimate tumor BPA accumulation, 33 patients underwent 18 F-BPA PET prior to BNCT. The T/N ratios were evaluated from static emission scans. Blood boron concentration was monitored with inductively coupled plasma atomic emission spectrometry during neutron irradiation. Normal tissue boron concentration was assumed to equal to that of the whole blood. Tumor response to BNCT was assessed with conventional imaging using the RECISTv.1.0 criteria. Results: Thirty-three patients (male, 55%) participated in the study. Most (25, 76%) had squamous cell carcinoma, 4 (12%) sarcoma, and 4 adenocystic carcinoma. The median minimum radiation dose to the gross tumor, calculated with the measured blood boron concentrations and the T/N ratios from PET, was 14 Gy (RBE) (range, 7 to 78 Gy [RBE]), and when a constant tumor-to-blood ratio of 3.5 was assumed, 19 Gy (RBE) (range, 10 to 29 Gy [RBE]). Two patients were unevaluable for response to BNCT (died early). Nineteen (61%) of the 31 evaluable responded (had a CR or a PR). The median overall survival (OS) time estimate was 22.8 months; 2year OS was 42%. The 18 F-BPA PET-derived T/N values ranged from 1 to 18 (median, 2.7). The median OS for the patients who had a T/N ratio >2.7 was 12.3 months as compared to 27.7 months among those with a smaller ratio (log-rank p Z 0.036). A higher than the median T/N ratio did not predict for tumor response to BNCT (p Z 0.24). Conclusion: A high tumor T/N ratio derived from 18 F-BPA-PET is associated with unfavorable survival after BNCT. Cancers with high 18 F-BPA uptake in PET may often be biologically aggressive, which hypothesis requires further study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.