Maintaining appropriate dose intensity is important not only in the curative setting but also in treatment with palliative intent. We evaluated the outcome of advanced non small cell lung cancer treated with doublet platinum based chemotherapy. Outcome was compared between patients treated by medical oncologists at a tertiary cancer center and those treated by non medical oncologists in the community. The dose intensity, overall response rate and overall survival was significantly better when patients were treated by trained qualified and experienced medical oncologists. Hence, even in the palliative setting, cancer directed systemic therapy will yield maximum benefit for the patients when treated by medical oncologists.
Introduction The essential goal of neoadjuvant chemotherapy (NACT) is to downstage the primary tumor making it amenable for breast conservation surgery (BCS). However, since the safety of this surgery is paramount, post-NACT breast conservation rates remain low. As per the recommendation of the 2018 Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) overview of long-term post-NACT follow-up, we have devised a protocol for imaging, localization, rad-path analysis, and documentation of radiotherapy techniques to ensure the safety of post-NACT breast conservation. Methods This is a retrospective cohort of 180 breast cancer patients who received NACT and were operated on by a single surgical oncologist from 2015 to 2020. After selection based on published guidelines, patients were treated with neoadjuvant systemic (chemo or hormone) therapy. In cases where primary tumors responded and reduced to 1–2 cm in size mid-NACT, the residual tumors were localized by clips under ultrasound guidance and calcification was wire localized. All patients were treated using appropriate surgical and oncoplastic techniques where indicated. Negative margins were ensured by intra-operative rad-path analysis. Adjuvant chemotherapy and radiotherapy were given as per protocol. Results In 81 cases that required mastectomy at presentation, we were able to achieve a 72.8% post-NACT BCS rate with the help of oncoplasty. Overall, 142 of 180 (80%) patients were treated with breast conserving surgery of which 80% (121 of 142) were oncoplasty. Margins were assessed on intra-operative frozen and re-excised in the same setting. No positive margins were reported in final histopath of 142 breast conservation procedures. Post-operative complication rates after breast conservation in the first year were at 17% (24 of 142 including two major complications). Patient reported outcomes were satisfactory with increased satisfaction for breast conservation compared with immediate breast reconstruction. Discussion Employing oncoplastic breast surgery (OBS) techniques following stringent protocols for accurate localization of the residual tumor, intra-operative rad-path analysis, and adjuvant treatments, we show successful breast conservation in 72.8% of our mastectomy-qualified patients after downstaging by NACT. We also report satisfactory outcomes for post-NACT surgery, patient-reported satisfaction, and survival.
6710 Background: Imatinib mesylate is a novel tyrosine kinase inhibitor. It has been found to be effective in CML and c-kit positive tumors. Methods: We conducted a prospective non-randomized single arm study of imatinib mesylate monotherapy in CML. 174 patients (122 males, 52 females) with Philadelphia positive CML (Chronic phase- 97, Accelerated phase- 47and Blast crisis-30) from May 2001 to September 2003 received imatinib mesylate as monotherapy in recommended doses. Results: Thrombocytopenia, neutropenia and dermatitis were dose-limiting toxicities. 121 patients (69.5%) had lightening of skin color. Nine patients developed photosensitivity, 1 had phototoxicity. Imatinib may have interaction with the endocrine system. Edema, weight gain improvement are known estrogenic actions. Some patients with generalized lightening of skin had hyperpigmentation over the malar area, similar to chloasma of pregnancy. Thirty-five patients had dermatitis of which 31 were males and 4 females (88.6% Vs 11.4%, p=0.007). Conclusions: Imatinib mesylate is effective in all phases of chronic myeloid leukemia. The endocrine and dermatological aspects mandate further studies. No significant financial relationships to disclose.
Advances in the management of ovarian cancer by use of aggressive surgery and effective platinum-based chemotherapy have prolonged survival; this may have resulted in an alteration of the metastatic pattern of the disease and spread to unusual sites (e.g., CNS) has become more common. Also, with the availability of more sensitive imaging techniques, these tumors are being diagnosed with increasing frequency. Intramedullary spinal cord metastasis is rare. We report one such case treated successfully with chemotherapy and radiotherapy with long-term survival.
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