Adolescent body mass index and risk of colon and rectal cancer in a cohort of 1.79 million Israeli men and women: A population-based study

BACKGROUND

This study examined the association between the body mass index (BMI) in late adolescence and the risk of colon and rectal cancer.

METHODS

This study analyzed a cohort of 1,087,358 Jewish men and 707,212 Jewish women who underwent health examinations at the ages of 16 to 19 years between 1967 and 2002 and were followed by linkage to the national cancer registry up to 2012. Cox regression was used to estimate hazard ratios (HRs) for cancer according to age- and sex-adjusted BMI percentiles from the US Centers for Disease Control and Prevention (overweight, 85th percentile to <95th percentile; obesity, ≥95th percentile).

RESULTS

Over a median follow-up of 23 years, 2967 incidence cases of colorectal cancer, including 1977 among men (1403 in the colon and 574 in the rectum) and 990 among women (764 in the colon and 226 in the rectum), were identified. Overweight and obesity were associated with the risk for colon cancer among both men (HR for overweight, 1.53; 95% confidence interval [CI], 1.28-1.84; HR for obesity, 1.54; 95% CI, 1.15-2.06; statistically significant from a BMI of 23.4 kg/m² [spline analysis]) and women (HR for overweight, 1.54; 95% CI, 1.22-1.93; HR for obesity, 1.51; 95% CI, 0.89-2.57; significant from a BMI of 23.6 kg/m²). Obesity, but not overweight, was associated with a risk for rectal cancer among men (HR, 1.71; 95% CI, 1.11-2.65; significant from a BMI of 29.6 kg/m²) and women (HR, 2.03; 95% CI, 0.90-4.58; significant from a BMI of 30.6 kg/m²).

CONCLUSIONS

Being overweight or obese in adolescence was associated with an increased risk of subsequent colon cancers in men and women, whereas obesity was associated with rectal cancer. Cancer 2017. © 2017 American Cancer Society.

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Multicenter randomized double-blind, placebo-controlled trial GORTEC 2009-01 evaluating the effect of the regenerating agent RGTA on radiodermatitis of head and neck cancer patients

Publication date: Available online 22 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yungan Tao, Anne Auperin, Christian Sire, Michel Martin, Marie-Gabrielle Saliou, Etienne Bardet, Xu Shan Sun, Thierry Chatellier, Clotilde Morand, Alexandre Cornely, Moussa Angokai, Alessia Di Rito, Ketty Kichenin, Pierre Blanchard, Ida D'Onofrio, Jean Bourhis
BackgroundConcomitant cetuximab and radiotherapy could induce severe radiodermatitis in patients with head and neck cancer (HNC). The OTD70DERM®, a Regenerating Agent (RGTA) is structural and functional analogue of glycosaminoglycans. Pre-clinical studies showed that topical RGTA could markedly reduce radiation-induced mucosal and cutaneous toxicities without tumor protection. This study aimed to transfer this observation in patients to evaluate the effect of topical RGTA on radiodermatitis in a clinical situation for which radio-induced skin reactions are frequent and/or severe i.e. in patients with HNC receiving radiotherapy and cetuximab. The primary endpoint was the incidence of grade ≥2 radiodermatitis.Patients and MethodsA multicenter, randomized, double-blind, placebo-controlled trial was performed on newly diagnosed HNC patients receiving conventionally fractionated RT (70 Gy/ 35 fractions) and weekly cetuximab. Patients were randomized 1:1 to receive topical OTD70DERM® or placebo on irradiated skin once daily. The criteria NCI-CTCAE 3.0 was used for radiodermatitis (photography of radiation zone); and the Dermatology Life Quality Index (DLQI) score was evaluated. All the skin reactions obtained from photographs were scored independently of investigators by two experts.ResultsIn 76 randomized patients (38 in each arm), 72 patients were available for final radiodermatitis evaluation (37 in RGTA arm and 35 in placebo arm). No significant difference was observed concerning the incidence or duration of grade ≥2 radiodermatitis between the two arms (81% for RGTA versus 80% placebo, p = 0.9); no significant difference between two arms regarding grade ≥2 radiodermatitis evaluated by experts regarding the photographs analyzed for 68 patients (76% vs 74%, p = 0.78); and no significant difference of DLQI score was observed (score > 10: 15% vs 20%, p = 0.45).ConclusionDespite a good pre-clinical rationale, RGTA did not reduce the incidence and severity of radiodermatitis in patients with HNC..

Teaser

Pre-clinical studies showed that topical OTD70DERM®, a Regenerating Agent functional analogue of glycosaminoglycans could markedly reduce radiation-induced mucosal and cutaneous toxicities. This hypothesis was tested in a randomized, placebo-controlled trial performed in 76 HNC patients receiving radiotherapy plus cetuximab. No significant difference was observed concerning the incidence or duration of grade ≥2 radiodermatitis between the arms. Despite a good pre-clinical rationale, OTD70DERM® did not reduce the incidence and severity of radiodermatitis.


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Conventional versus hypofractionated radiotherapy in localized or locally advanced prostate cancer: A systematic review and meta-analysis along with therapeutic implications

Publication date: Available online 22 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Niloy R. Datta, Emanuel Stutz, Susanne Rogers, Stephan Bodis
PurposeA systematic review and meta-analysis was conducted to evaluate the therapeutic outcomes of conventional (CRT) and hypofractionated radiotherapy (HRT) in localized or locally advanced prostate cancers (LLPCa).Material and methods599 abstracts were extracted from five databases and screened as per the PRISMA guidelines. Only phase III trials randomized between CRT and HRT in LLPCa with a minimum of 5-year follow-up were considered. The evaluated endpoints were - biochemical failure (BF), biochemical and/or clinical failure (BCF), overall mortality (OM), prostate cancer-specific mortality (PCaSM), both acute and late gastrointestinal (GI) and genitourinary (GU) (grade >2) toxicities.ResultsTen trials from nine publications, totaling 8,146 patients (CRT: 3,520; HRT: 4,626; one study compared two HRT schedules with a common CRT regime) were included in the evaluation. There were no significant differences in patient characteristics between the two arms. However, the radiotherapy treatment parameters differed significantly between CRT and HRT (all p<0.001). Use of androgen deprivation therapy (ADT) varied from 0-100% in both groups, (mean + SD: 43.3% + 43.6; CRT vs. HRT: p:ns). The odds ratio (OR), risk ratio (RR) and risk difference (RD) between CRT and HRT for BF, BCF, OM, PCaSM, acute GU, late GU and GI toxicities were all nonsignificant. Nevertheless, acute GI toxicities were 9.1% less with CRT (RD=0.091, OR=1.687, RR=1.470, all p<0.001). On subgroup analysis, patient groups with < vs.>66.8% ADT (RD: 0.052 vs. 0.136; p=0.008) and < vs.>76% full seminal vesicles in clinical target volume (RD: 0.034 vs. 0.108; p<0.001) were found to significantly influence the acute GI toxicity with HRT.ConclusionsHRT provides similar therapeutic outcomes to CRT in LLPCa except for a significantly higher risk of acute GI toxicity. HRT enables a reduction in overall treatment time and offers patient convenience. However variables contributing to an increased acute GI toxicity need careful consideration.



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Radiation therapy for optic pathway and hypothalamic low-grade gliomas in children

Publication date: Available online 23 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Derek S. Tsang, Erin S. Murphy, Thomas E. Merchant
BackgroundThe long-term survival of pediatric patients with optic pathway or hypothalamic low-grade glioma (LGG) who receive radiation therapy (RT) has not been previously assessed.MethodsA retrospective study was performed of all patients with optic-hypothalamic pediatric LGG treated with RT at a single institution. Eligible patients were aged 21 years or younger at the time of RT and had localized LGG diagnosed by neuroimaging or histology. The median RT dose was 54 Gy, delivered in 30 fractions. Event-free survival (EFS) was defined as survival without progression or secondary high-grade glioma. Days were counted from the first day of RT.ResultsEighty-nine patients were included in the study, with a median follow-up of 12.5 years. Fourteen of the patients had neurofibromatosis type 1 (NF-1). The 10-year EFS was 61.9% (95% CI 31.2–82.1) for patients with NF-1 and 67.5% (95% CI 54.8–77.3) for those without NF-1. The 10-year overall survival (OS) was 92.3% (95% CI 56.6–98.9) for patients with NF-1 and 98.4% (95% CI 89.1–99.8) for those without NF-1. Pre-RT chemotherapy (which was more commonly given to younger patients) was associated with reduced EFS, whereas younger age was associated with reduced OS. Eight patients, including four with NF-1, developed possible radiation-induced neoplasms. The 10-year cumulative incidence of clinically-significant vasculopathy was 7.1% (95% CI 2.9–13.9); no child older than 10 years at the commencement of RT developed vasculopathy.Conclusion(s)Radiation is an effective treatment for optic-hypothalamic LGG. Older children without NF-1 have a low risk of late toxicity. RT can be considered for selected younger patients or individuals with NF-1 as a salvage treatment after progression.

Teaser

Radiation therapy for pediatric optic pathway or hypothalamic low-grade glioma establishes long-term disease control in most patients, with 10-year event-free survival (EFS) of greater than 60% and 10-year overall survival (OS) of greater than 90%. The presence of NF-1 did not affect EFS or OS. No child older than 10 years developed vasculopathy after receiving RT. Radiation is thus an effective treatment for optic-hypothalamic LGG, and older children without NF-1 have a low risk of late toxicity.


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Recent time trends and predictors of heart dose from breast radiotherapy in a large quality consortium of radiation oncology practices

Publication date: Available online 22 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lori J. Pierce, Mary Feng, Kent A. Griffith, Reshma Jagsi, Thomas Boike, Daniel Dryden, Gregory S. Gustafson, Lisa Benedetti, Martha M. Matuszak, Teamour S. Nurushev, Joe Haywood, Jeffrey D. Radawski, Corey Speers, Eleanor M. Walker, James A. Hayman, Jean M. Moran
IntroductionLimited data exist regarding the range of heart doses received in routine practice following radiotherapy (RT) for breast cancer (BC) in the United States today and the potential impact of continual assessment of cardiac dose on practice patterns.Methods and MaterialsFrom 2012-2015, 4688 patients with BC treated with whole breast RT at 20 sites participating in a state-wide consortium were enrolled into a registry. The importance of limiting cardiac dose has been emphasized in the consortium since 2012 and mean heart dose (MHD) has been reported to each institution since 2014. Effects on MHD were estimated for both conventional fractionation (CF) and accelerated fractionation (AF) using regression models with technique (intensity modulated RT, IMRT vs. three-dimensional conformal RT, 3DCRT), deep-inspiration breath hold (DIBH) use, position (supine vs. prone), nodal RT (if delivered) and boost (yes/no) as covariates.ResultsFor left-sided BC treated with CF, median MHD in 2012 was 2.19 Gy compared to 1.65 Gy in 2015 (p<0.001). Factors which significantly increased MHD for CF were increasing separation relative to 22 cm (1.5%/cm) ; supra-/infraclavicular node RT (17.1%); internal mammary node RT (40.7%); use of boost (20.9%); treatment per year prior to 2015 (7.7%); and IMRT (20.8%). For left-sided BC treated with AF, the median MHD in 2012 was 1.70 Gy versus 1.22 Gy in 2015 (p<0.001). Factors that significantly increased MHD following AF were separation (1.7% /cm); use of boost (20.0%); year prior to 2015 (8.5%); and IMRT (19.2%). Factors for both CF and AF that significantly reduced MHD were use of DIBH and prone positioning.ConclusionsMHD for left-sided cancers has decreased over a recent 4-year period coincident with increased focus on cardiac sparing in the radiation oncology community in general and within a state-wide consortium specifically. These data suggest a positive impact of systematically monitoring heart dose delivered.

Teaser

With recent focus on minimizing radiation dose to the heart following adjuvant therapy for breast cancer, it is important to understand the current state of cardiac sparing and predictors of heart dose. In a large U.S. state-wide registry, we evaluated recent time trends in mean heart dose, adjusting for planned target dose and treatment technique. Our findings indicate mean heart dose decreased significantly for left-sided breast cancers over a 4-year period using ongoing monitoring of cardiac dose by institution.


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The accuracy of treatment planning system dose modelling in the presence of brass mesh bolus

Publication date: September–October 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 5
Author(s): Neil Richmond
AimThis work assesses the dosimetric accuracy of three commercial treatment planning system (TPS) photon dose calculation algorithms in the presence of brass mesh used as a bolus.BackgroundBolus material is used in radiotherapy to provide dose build-up where superficial tissues require irradiation. They are generally water equivalent but high density materials can also be used.Materials and methodsDose calculations were performed on Monaco and Masterplan TPS (Elekta AB, Sweden) using phantoms defined by the three DICOM CT image sets of water equivalent blocks (no bolus, 1 layer and 2 layers of brass mesh) exported from the CT scanner. The effect of the mesh on monitor units, build-up dose, phantom exit dose and beam penumbra were compared to measured data.ResultsDose calculations for 6 and 15MV photon beams on plain water equivalent phantoms were seen to agree well with measurement validating the basic planning system algorithms and models. Dose in the build-up region, phantom exit dose and beam penumbra were poorly modelled in the presence of the brass mesh. The beam attenuation created by the bolus material was overestimated by all three calculation algorithms, at both photon energies, e.g. 1.6% for one layer and up to 3.1% for two layers at 6MV. The poor modelling of the physical situation in the build-up region is in part a consequence of the high HU artefact caused by the mesh in the CT image.ConclusionsCT imaging is not recommended with the brass mesh bolus in situ due to the poor accuracy of the subsequent TPS modelling.



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Intensity-modulated radiation therapy for small cell carcinoma of the prostate: A case report

Publication date: September–October 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 5
Author(s): Yaichiro Hashimoto, Yuka Ishii, Sawa Kono, Sachiko Izumi, Junpei Iizuka, Atsuko Hiroi, Kumiko Karasawa
Small cell carcinomas (SCC) make up only 1% of malignancies of the prostate. Reports of several case series have described outcomes of surgery and chemotherapy for SCC of the prostate, but few reports address radiotherapy. We treated a case of SCC of the prostate with intensity-modulated radiation therapy (IMRT) consisting of 70Gy administered in 35 fractions followed by hormonal therapy using only luteinizing hormone-releasing hormone (LH-RH) agonist. The tumor volume decreased remarkably by 4 months after IMRT. The rapid decrease in tumor size of this SCC of the prostate seemed to suggest a similar high radiosensitivity to that of SCC of the lung, but the tumor increased rapidly thereafter within the radiation fields, and pelvic lymph node metastases had developed by 24 months after IMRT. By 28 months after IMRT, multiple lung metastases developed, and the patient died of SCC of the prostate 31 months after initial diagnosis.



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Hematopoietic Stem Cell Transplantation in Pakistan - Country Report

Publication date: Available online 22 July 2017
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Parvez Ahmed, Tahir Sultan Shamsi, Salman Naseem Adil, Tariq Mahmood Satti, Qamar un Nisa Chaudhry, Syed Kamran Mahmood, Kamran Rashid, Saqib Ansari, Natasha Ali, Tariq Ghafoor




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