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Quality of life changes during adjuvant chemotherapy in patients with colon cancer

Seo Hee LEE ; Taek Gu LEE ; Moo Jun BAEK ; Jang Jin KIM ; Sung Su PARK ; Sang Jeon LEE

Korean Journal of Clinical Oncology.2016;12(1):60-66. doi:10.14216/kjco.16010

PURPOSE: The survival of advanced colon cancer patients has increased due to the development of surgical techniques and adjuvant chemotherapy. The administration of adjuvant chemotherapy after curative resection is generally accepted as a standard of care. The primary endpoint of chemotherapy should include not only tumor response and survival, but also impact on the quality of life (QoL). We evaluated changes in QoL during adjuvant chemotherapy in patients with colon cancer.METHODS: Between October 2009 and February 2012, 56 patients with stage II and III colon cancer received the combination adjuvant chemotherapy 5-flurouracil/folinic acid with oxaliplatin (FOLFOX). Patients were asked to complete the QoL questionnaire QLQ-C30 version 3 before and after 6 cycles of adjuvant chemotherapy.RESULTS: There was no significant difference in the QoL between the start of chemotherapy and after the completion of 6 cycles. After completion of 6 cycles, global QoL was worse in patients >70 years of age. The functional scale score was low in patients with chemotherapy schedules delayed more than 2 times due to adverse events. Patients with body weight increases greater than 5% scored lower on symptom scales. Interestingly, patients with peripheral neuropathy scored higher on symptom scales.CONCLUSION: QoL changes during adjuvant chemotherapy did not show significant differences. After the sixth chemotherapy, QoL was affected by age, body weight gain, delay of the scheduled chemotherapy, and peripheral neuropathy. Therefore, the proper attitude of physicians focused on reassurance and education of patients is very important during chemotherapy.
Appointments and Schedules ; Body Weight ; Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Drug Therapy ; Humans ; Patient Education as Topic ; Peripheral Nervous System Diseases ; Quality of Life ; Standard of Care ; Weights and Measures

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Predictive factor for excessive myelosuppression in patients receiving chemotherapy for breast cancer

Jung Suk LEE ; Hye Yoon LEE ; Nak Song SUNG ; Ki Won CHEON ; Ju Ik MOON ; Sang Eok LEE ; In Seok CHOI ; Won Jun CHOI ; Dae Sung YOON

Korean Journal of Clinical Oncology.2016;12(1):55-59. doi:10.14216/kjco.16009

PURPOSE: Myelosuppression, particularly neutropenia, is one of the most frequent and serious toxicity seen in patients with breast cancer undergoing systemic chemotherapy. However, the predictive factors for development of severe neutropenia in chemotherapy remain unknown. We therefore evaluated predictive factors for excessive myelosuppression.METHODS: We retrospectively analyzed 341 patients with breast cancer treated with chemotherapy from 2000 to 2012. Clinicopathological characteristics, number of using of granulocyte colony-stimulating factor (G-CSF), and pretreatment hematologic values were extracted from the electronic medical record system. Patients were sorted 2 groups by number of using G-CSF in each chemotherapeutic regimens; group 1 is more G-CSF (within high 20 percentile) and 2 less G-CSF using group (within lower 20 percentile).RESULTS: Number of using G-CSF was ranged 0–83 (mean 10.76). One hundred one patients were in group 1 and 65 patients were in group 2. Mean of number of G-CSF using was 0.21 in group 1 and 28.02 in group 2. Pretreatment white blood cell, hemoglobin and platelet count were lower in group 2 than in group 1 (6.88×10³/µL vs. 5.97×10³/µL, 12.63 g/dL vs. 11.90 g/dL, and 275.95×10⁴ µL vs. 227.37×10⁴ µL). There were no statistically differences in other clinicopathologic characteristics such as age, body mass index or comorbidities, hormonal receptor, stage, and other pretreatment hematologic values.CONCLUSION: Pretreatment white blood cell count, hemoglobin and platelet count can be used to identify patients at increased risk of significant myelosuppression undergoing chemotherapy with breast cancer. This information can be used to target high-risk patients for prophylactic treatment.
Body Mass Index ; Breast Neoplasms ; Breast ; Comorbidity ; Drug Therapy ; Electronic Health Records ; Granulocyte Colony-Stimulating Factor ; Humans ; Leukocyte Count ; Leukocytes ; Neutropenia ; Platelet Count ; Retrospective Studies

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Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction

Se Hui OH ; Nak Jun CHOI ; Sang Hyuk SEO ; Min Sung AN ; Kwang Hee KIM ; Ki Beom BAE ; Jin Won HWANG ; Sang Heon LEE ; Ji Hyun KIM ; Sam Ryong JEE ; Mi Seon KANG ; Kwan Hee HONG

Korean Journal of Clinical Oncology.2016;12(1):48-54. doi:10.14216/kjco.16008

PURPOSE: Colorectal obstruction develops most frequently by carcinoma, and 7%–30% of these colorectal carcinomas are acute cases. The oncologic safety of self-expanding metal stent (SEMS) insertion as a bridge to surgery has not yet been established. Thus, we investigated the oncologic safety of SEMS insertion as a bridge to surgery in patients with obstructive colorectal cancer.METHODS: This retrospective had 56 patients enrolled requiring emergency management for obstructive colorectal cancer at stage II or III, who had undergone curative surgery between July 2008 and June 2011. These subjects were divided into two groups: patients who had undergone emergency surgery without SEMS insertion (non-stent group) and those who had undergone elective surgery after preoperative decompression with SEMS insertion (stent group). The two groups were compared for clinicopathologic characteristics, postoperative complications, and survival rate.RESULTS: Enterostomy was performed in 25 patients (100.0%) in the non-stent group and 1 patient (3.2%) in the stent group; laparoscopic surgery was carried out in 7 patients (28.0%) in the non-stent group and 19 patients (61.29%) in the stent group, each showing statistically significant differences. There was no statistically significant difference in postoperative complications and 5-year disease-free survival rate (72% vs. 74.19%, P=0.87, respectively).CONCLUSION: In treatment of malignant colorectal obstruction, elective operation after stent insertion had similar oncologic outcomes compared with emergency operation. Preoperative stent insertion not only lowers the incidence of enterostomy but also makes laparoscopic surgery possible, thereby enhancing patients' quality of life. Therefore, preoperative stent insertion is a useful method that may replace emergency surgery in treatment of malignant colorectal obstruction.
Colorectal Neoplasms ; Decompression ; Disease-Free Survival ; Emergencies ; Enterostomy ; Humans ; Incidence ; Intestinal Obstruction ; Laparoscopy ; Methods ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stents ; Survival Rate

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Oncologic outcomes of squamous cell carcinoma of the anal canal after chemoradiation therapy

Dae Ro LIM ; Hyuk HUR ; Byung Soh MIN ; Seung Hyuk BAIK ; Kang Young LEE ; Nam Kyu KIM

Korean Journal of Clinical Oncology.2016;12(1):41-47. doi:10.14216/kjco.16007

PURPOSE: The aim of this study is to analyze the oncological outcomes of squamous cell carcinoma (SCC) of the anal canal after chemoradiation therapy (CRT) in a single institution.METHODS: Fifty-one patients with anal SCC who had been treated with CRT between January 2000 and December 2010 were analyze data single center in Korea.RESULTS: Forty-eight patients exhibited clinical complete response. After a median follow-up of 42.1 months, 13 patients (25.5%) showed recurrence. The disease-free survival (DFS) rate was 63.4% at 5 and 10 years. The overall survival (OS) rates were 83.6% (5 years) and 75.2% (10 years). Stage I: DFS, 100%; OS, 100%; stage II: DFS, 85.7%; OS, 100%; stage IIIA: DFS, 68.6%; OS, 87.5%; stage IIIB: DFS, 34.7%; OS, 48.4%; and stage IV: DFS and OS, 0%. The local recurrence patterns were as follows: pelvic node (n=4, 7.8%), inguinal node (n=1, 2.0%), and inguinal and pelvic node (n=1, 2.0%). The systemic recurrence patterns were as follows: lung (n=2, 3.9%), para-aortic node (n=1, 2.0%), and extrapelvic site (n=2, 3.9%). N-stage represented a single independent prognostic factor for recurrence (P<0.05).CONCLUSION: CRT for SCC of the anal canal is effective for oncological outcomes and sphincter preservation. The initial nodal status may affect the oncological outcome.
Anal Canal ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Disease-Free Survival ; Epithelial Cells ; Follow-Up Studies ; Humans ; Korea ; Lung ; Recurrence

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Metronomic capecitabine versus doxorubicin in advanced hepatocellular carcinoma

Gehan Abd Elatti KHEDR ; Sherif Farouk ELZAWAWY ; Ahmad Gaber GOWIL ; Amany Saleh ELYAMANY ; Mohamed ESHAFEI

Korean Journal of Clinical Oncology.2016;12(1):32-40. doi:10.14216/kjco.16006

PURPOSE: We evaluated oral metronomic capecitabine (MC) compared to intravenous doxorubicin in patients with advanced or metastatic hepatocellular carcinoma (HCC).METHODS: From January 2013 to December 2015, patients with Child-Pugh class A or early B were randomized either to MC group (500 mg twice daily continuously) or doxorubicin group (60 mg/m² every 21 days).RESULTS: Forty patients were included in each group. The baseline clinical characteristics of the enrolled patients were well balanced between the two groups. No complete response (CR) was reported in either group. In MC group, 2 patients (5%) had partial response (PR), 25 patients (62.5%) stable disease (SD) and 27 patients (67.5%) had disease control. In doxorubicin group, 4 patients (10%) achieved PR, 24 patients (60%) SD and 28 patients (70%) had disease control. The 6 months overall survival (OS) was 77.5% for MC and 75% for doxorubicin. The one year OS was 47.5% for MC and 42.5% for doxorubicin (P=0.521). The median OS survival was 10.2 months for MC and 9.6 months for doxorubicin (95% confidence interval, 3.2–6.5). The 6 month progression-free survival (PFS) was 45% for MC and 50% for doxorubicin. The one year PFS was 12.5% for MC and 7.5% for doxorubicin (P=0.289). The median time to progression was 3.4 months for MC and 3.1 months for doxorubicin. On multivariate analysis no significant impact for tumor stage, previous transhepatic arterial chemoembolization, portal vein thrombosis or median baseline alpha fetoprotein on OS.CONCLUSION: MC showed response rate and survival outcome comparable to doxorubicin in advanced HCC but with a more favorable toxicity profile.
alpha-Fetoproteins ; Capecitabine ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Doxorubicin ; Humans ; Multivariate Analysis ; Venous Thrombosis

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Laparoscopic surgery for left-sided colon cancer: Clinical and long-term oncologic outcomes

Min Kyung CHO ; Tae Hyung KIM ; Chang Nam KIM ; Je Ho JANG ; Jaehag JUNG ; Moon Soo LEE ; Byung Sun CHO ; Yoon Jung KANG ; Joo Seung PARK

Korean Journal of Clinical Oncology.2016;12(1):25-31. doi:10.14216/kjco.16005

PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.
Colon ; Colonic Neoplasms ; Colorectal Surgery ; Disease-Free Survival ; Follow-Up Studies ; Hand-Assisted Laparoscopy ; Humans ; Laparoscopy ; Male ; Neoplasm Metastasis ; Survival Rate

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In which group of gastric cancer patients is the preoperative neutrophil-to-lymphocyte ratio a significant prognostic factor?

Hee Soon CHANG ; Dong Seok HAN ; Ho Yoon BANG ; Pyeong Su KIM ; Kyung Yung LEE

Korean Journal of Clinical Oncology.2016;12(1):19-24. doi:10.14216/kjco.16004

PURPOSE: Several recent studies have reported on the clinical importance and prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in gastric cancer. The objective of this study was to identify the subgroups of patients with gastric cancer for which the preoperative NLR was prognostically significant.METHODS: Data from 870 patients who were among those who had undergone surgery for gastric cancer between August 2005 and December 2013 were evaluated. Receiver operating characteristic curve analysis was used to determine the cut-off value for NLR. The patients were classified into high-NLR (NLR≥1.7) and low-NLR (NLR<1.7) groups, and survival analysis of subgroups of gastric cancer patients was performed.RESULTS: Univariate analysis identified age, gender, tumor location, tumor histology, tumor, node, metastasis (TNM) stage, and NLR as significant prognostic factors. Multivariate analysis identified age, TNM stage, and NLR as significant prognostic factors. In subgroup analysis, NLR was a significant prognostic factor except group of TNM stage I, II with age younger than 70 years.CONCLUSION: Except group of TNM stage I, II with age younger than 70 years, careful postoperative follow-up is warranted for those patients with elevated NLR.
Follow-Up Studies ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; ROC Curve ; Stomach Neoplasms

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Comparison of long-term oncologic outcomes between radiofrequency ablation and surgical resection for metachronous isolated hepatic metastases from colorectal cancer

Hyun Gu LEE ; Byoung Chul LEE ; In Ja PARK ; So Yeon KIM ; Ki Hun KIM ; Tae Yong HA ; Jae Hoon LEE ; Chan Wook KIM ; Jong Lyul LEE ; Yong Sik YOON ; Seok Byung LIM ; Chang Sik YU ; Jin Cheon KIM

Korean Journal of Clinical Oncology.2016;12(1):13-18. doi:10.14216/kjco.16003

PURPOSE: We compared oncologic outcomes between surgery and radiofrequency ablation (RFA) in patients with metachronous isolated hepatic metastases from colorectal cancer.METHODS: We retrospectively analyzed 123 patients treated with hepatic resection and 82 patients treated with RFA for metachronous hepatic metastases between April 2000 and October 2011. Re-recurrence pattern and 3-year re-recurrence free survival (RFS) rate compared between groups. Factors associated with RFS were evaluated.RESULTS: The patients in the two groups were similar in age, gender, location of primary tumor, disease-free interval to hepatic metastasis, pathological stage of primary disease, number of metastatic lesions. The mean diameter of the biggest hepatic metastatic lesion was significantly larger in the resection group than in the RFA group. The RFS rate after hepatic metastasis treatment was significantly higher in the resection group than in the RFA group (48.6% vs. 33.7%, respectively; P=0.015). Marginal recurrence at the RFA site was observed in 14 of the 82 patients (17.1%). The size and number of metastatic lesions, stage of primary disease, disease-free interval to hepatic metastasis, and modality of treatment were confirmed as re-recurrence-associated factors after hepatic metastasis treatment. Among patients with solitary metastases of ≤3 cm, the RFS rate was not different between the resection and RFA groups (52.4% vs. 53.4%, respectively; P=0.491).CONCLUSION: Surgical resection for metachronous hepatic metastases achieved higher RFS and lower local recurrence rates. However, the RFS rate in patients with a solitary hepatic metastasis of ≤3 cm was similar between the resection and RFA groups.
Catheter Ablation ; Colorectal Neoplasms ; Hepatectomy ; Humans ; Liver ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies

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Gastric biomarker study using proteomic method

Sang Ho JEONG ; Young Joon LEE ; Soon Chan SOON-CHAN ; Woo Song HA

Korean Journal of Clinical Oncology.2016;12(1):7-12. doi:10.14216/kjco.16002

Biomarker is defined as biological variables that correlate with biologic outcome. This review will discuss investigations into gastric cancer (GC) biomarkers by proteomic analysis. Proteomic analysis consists of 3 steps. The first step is the digestion and separation process using 2-dimensional electrophoresis gel or liquid chromatography. The second step is mass analysis using mass spectrometry. The third step is protein identification using databases. Clinical validation of proteins identified can help estimate expressions of cancer tissue and cancer cell line using Western blot and immunohistochemistry. Researchers can validate the association between protein expression and clinical data (tumor stage, cell type, survival, and recurrence), which helps identify the possibility of biomarkers for GC. After clinical validation, the next step is functional analysis in vitro and in vivo. This step is commonly performed by knock-in and knock-out studies on the proliferation, migration, and invasion using the cancer cell line. Animal studies also provide indirect evidence for the role of the proteins in tumor growth and metastasis in vivo. In conclusion, the proteomic analysis is one of the useful methods for detecting biomarkers for GC. Multidisciplinary approaches to protein, DNA, RNA, and epigenetics are crucial to the investigation for molecular biomarkers for GC.
Animals ; Biomarkers ; Blotting, Western ; Cell Line ; Chromatography, Liquid ; Digestion ; DNA ; Electrophoresis ; Epigenomics ; Immunohistochemistry ; In Vitro Techniques ; Mass Spectrometry ; Methods ; Neoplasm Metastasis ; Proteomics ; RNA ; Stomach Neoplasms ; Tissue Array Analysis

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Actual duration of patient-reported mucositis: Far longer than 2 to 4 weeks and may be avoidable altogether

Ricky Wayne MCCULLOUGH

Korean Journal of Clinical Oncology.2016;12(1):1-6. doi:10.14216/kjco.16001

The impression that oral mucositis is a brief 14–28 day-consequence of chemoradiation is misguided. Clinically significant patient-reported oral mucositis may last 46 to 102 days depending on the treatment schedule and the modality used. The process of mucositis can occur in the epithelium throughout the entire GI tract and may possibly be avoided with the prescribed use of high potency polymerized cross-linked sucralfate (HPPCLS). Literature review of patient-reported mucositis occuring in the three common schedules of cancer treatment administration: daily radiation therapy, induction-based hematopoietic stem cell transplantation (HSCT), and multi-cycle chemo/immunotherapy (CT-IT). Review articles published in last 15 years focused on treatment-induced oral mucositis. The author reviewed 56 articles published in 15 years from 1999–2014 that focused primarily on treatment-induced oral mucositis. Only 6 were found to meet the criteria of providing patient-reported data from the beginning, throughout and following cancer treatment. For HSCT, radiation therapy, and CT-IT, despite active anti-mucositis treatment, patient-reported oral mucositis lasted 46–60 days, 70–84 days, and 68–102 days, respectively. Mucositis caused by cancer treatment, regardless of modality, lasts far longer than the oft quoted 2–4 weeks (range, 14–28 days). Patient reported mucositis persists from 46 to 102 days. This patient-based experience is the primary cause of treatment interruptions, delays or cancellations. It may be avoidable with HPPCLS that both prevents and rapidly reverses mucositis anywhere it occurs within the gastrointestinal tract.
Appointments and Schedules ; Drug Therapy ; Epithelium ; Gastrointestinal Tract ; Hematopoietic Stem Cell Transplantation ; Humans ; Mucositis ; Polymerization ; Polymers ; Stomatitis ; Sucralfate

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