Radiation Therapy For Early-Stage Hodgkin’s.

Study Finds Survival Benefit To Radiation Therapy For Early-Stage Hodgkin’s. Medscape reports that a study presented at the American Society for Radiation Oncology (ASTRO) 56th Annual Meeting found “a significant survival benefit in patients with early-stage Hodgkin’s lymphoma who received consolidation radiation added onto chemotherapy.” The article predicts the study will “fuel the ongoing debate about whether the use of any radiation at all in early-stage Hodgkin’s disease is worth the potential long-term risks.” Some argue that radiation should only be used with the about 12% of patients whose early-stage disease is resistant to chemotherapy.

breast radiation short v longer time

Long-term data support hypofractionated radiotherapy after primary surgery for early breast cancer. Despite the convenience and potential cost-savings of shorter courses of adjuvant breast cancer radiation, concerns about this approach have focused on long-term local control and cosmesis. Prior trials have allayed these fears to some degree, but most U.S. clinicians have been cautious about adopting shorter radiation courses, citing inadequate long-term follow-up as the primary concern. Now, U.K. investigators report long-term results of the randomized, controlled, Standardisation of Breast Radiotherapy trials (START-A and START-B), which evaluated various doses and schedules of postoperative breast radiation in women with completely excised invasive breast cancer. In START-A, 2236 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus either 41.6 Gy or 39 Gy in 13 fractions over 5 weeks. At a median follow-up of 9.3 years, 10-year rates of local-regional relapse did not differ significantly between the 41.6 Gy and 50 Gy groups or between the 39-Gy and 50-Gy groups. Moderate or marked breast induration, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 39-Gy group than in the 50-Gy group. Normal tissue effects were similar in the 41.6-Gy and 50-Gy groups. In START-B, 2215 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus 40 Gy in 15 fractions over 3 weeks. At median follow-up of 9.9 years, 10-year rates of local-regional relapse were similar in both groups. Breast shrinkage, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 40-Gy group than in the 50-Gy group. Haviland JS et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013 Oct; 14:1086. - See more at: http://www.jwatch.org/na32352/2013/09/27/breast-radiation-shorter-good-longer?query=etoc_jwonchem#sthash.JE8RgOCP.dpuf

pancreatic cancer new chemo regime

Patients with metastatic cancer of the pancreas showed better overall survival on a regimen of gemcitabine plus albumin-bound paclitaxel than with gemcitabine alone, according to a New England Journal of Medicine study. In a phase 3, international study conducted by the drug maker, some 850 patients were randomized to treatment cycles of either gemcitabine plus nab-paclitaxel or gemcitabine alone. Cycles continued until disease progression. Median overall survival, the study's primary endpoint, favored the combination (8.5 months vs. 6.7 with gemcitabine alone); 1- and 2-year survival rates were significantly higher as well. Neutropenia, fatigue, and neuropathy were all more frequent with the combination, however. "represents a new care standard, and offers an alternative to the [four-drug] combination known as FOLFIRINOX." ref

FDA Advisers Recommend Drug for Preoperative Treatment of Early Breast Cancer

An advisory panel to the FDA has recommended approval of the first drug to treat early stage breast cancer prior to surgery, the Associated Press reports. Pertuzumab (marketed as Perjeta), a monoclonal antibody, is currently approved for HER2-positive metastatic breast cancer. An industry trial indicated that women with preoperative breast cancer whose regimens contained pertuzumab were up to 18% more likely to be free of cancer at 12 weeks than women who were given other drugs. ref

Taller = higher cancer risk

Taller postmenopausal women face higher risks for 10 types of cancer, according to a study in Cancer Epidemiology, Biomarkers and Prevention. Researchers examined the association between height and cancer risk among some 145,000 Women's Health Initiative participants. During roughly 12 years of follow-up, 14% received diagnoses of invasive cancer. After multivariable adjustment, the risk for all cancers increased significantly, by 13%, with each 10-cm (4-inch) increase in height. In particular, risks for the following types of cancer were increased: breast, colon, colorectal, endometrial, melanoma, multiple melanoma, ovarian, rectal, renal, and thyroid. Additional adjustment for cancer screening did not alter the results. The researchers say height should be considered "a marker for one or more exposures that influence cancer risk rather than a risk factor itself." ref

Conflict-of-Interest Seen in Some Prescribing Radiotherapy for Prostate Cancer

The number of self-referrals for intensity-modulated radiation therapy (IMRT) of prostate cancer has increased in the U.S. in recent years, while use of this treatment has actually declined among non-self-referring groups, according to a Government Accountability Office report. The number of self-referred claims for IMRT among Medicare recipients increased from 80,000 to 366,000 from 2006 to 2010. Non-self-referring claims dropped from 490,000 to 466,000 over the same period. The GAO says its analyses "suggest that financial incentives for self-referring providers — specifically those in limited specialty groups — were likely a major factor driving the increase." The report recommends that providers be required to disclose their financial interests to their patients and that Medicare "should identify and monitor self-referral of IMRT services." ref

NEJM cartoon regarding radium and prostate cancer