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Curr. Oncol., Volume 27, Issue 3 (June 2020) – 27 articles

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Erratum
Erratum: Therapeutic Landscape of Metastatic Non-Small-Cell Lung Cancer in Canada in 2020
by
Curr. Oncol. 2020, 27(3), 349; https://doi.org/10.3747/co.27.6577 - 01 Jun 2020
Viewed by 206
Abstract
In Table i in the initially published manuscript, several column headings are incorrectly presented.[...] Full article
Letter
Re: Renal Medullary Carcinoma and Its Association with Sickle Cell Trait: A Case Report and Literature Review
Curr. Oncol. 2020, 27(3), 348; https://doi.org/10.3747/co.27.6783 - 01 Jun 2020
Viewed by 153
Abstract
We read with great interest the article by Holland et al. [...]
Full article
Letter
At a Loss
Curr. Oncol. 2020, 27(3), 347; https://doi.org/10.3747/co.27.6069 - 01 Jun 2020
Viewed by 165
Abstract
He had thyroid cancer, we were told, and he would have to have the whole gland taken out [...]
Full article
Article
Validation in Alberta of an Administrative Data Algorithm to Identify Cancer Recurrence
Curr. Oncol. 2020, 27(3), 343-346; https://doi.org/10.3747/co.27.5861 - 01 Jun 2020
Cited by 1 | Viewed by 241
Abstract
Background: Readily available population-based data about cancer recurrence would improve surveillance and research for women of reproductive age. Methods: We randomly selected 200 women from the Alberta Cancer Registry who had received a cancer diagnosis and who ever had a pregnancy between 2003 [...] Read more.
Background: Readily available population-based data about cancer recurrence would improve surveillance and research for women of reproductive age. Methods: We randomly selected 200 women from the Alberta Cancer Registry who had received a cancer diagnosis and who ever had a pregnancy between 2003 and 2012. Administrative data were obtained and linked. Several definitions of recurrence were assessed using various minimum lengths of time between the initial diagnosis date and subsequent diagnoses or treatments, or both. Chart review was used as a “gold standard” definition of recurrence. Results: Chart review identified recurrences in 26 women. The definition that best captured “recurrence” was 2 or more cancer diagnosis codes 10 or more months from the diagnosis date [sensitivity: 80.8%; 95% confidence interval (ci): 60.7% to 93.5%; specificity: 81.0%; 95% ci: 74.4% to 86.6%; positive predictive value: 38.9%; 95% ci: 25.9% to 53.1%; negative predictive value: 96.6%; 95% ci: 92.2% to 98.9%; kappa = 0.42; 95% ci: 0.28 to 0.57]. Conclusions: Recurrence in reproductive-aged women can be captured with moderate validity using administrative data, but should be interpreted with caution. Full article
Article
Women’s Views about Breast Cancer Prevention at Mammography Screening Units and Well Women’s Clinics
Curr. Oncol. 2020, 27(3), 336-342; https://doi.org/10.3747/co.27.5755 - 01 Jun 2020
Cited by 1 | Viewed by 306
Abstract
Background: Women attending mammography screening units (msus) and well women’s clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. Methods: We used a feasibility questionnaire distributed [...] Read more.
Background: Women attending mammography screening units (msus) and well women’s clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. Methods: We used a feasibility questionnaire distributed to women (40–49 or 50–74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine (1) women’s views about bca primary prevention and sources of health care information, (2) prevalence of lifestyle-related bca risk factors, and, (3) predictors of prior mammography encounters within provincial screening guidelines. Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Results: Of the 244 responses obtained during 1.5 months from women aged 40–49 years (n = 75) and 50–74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40–49 years of age; no independent predictors were observed in the older age group. Conclusions: Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women’s views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the “mammogram point of care” to engage motivated women in bca primary prevention strategies. Full article
Article
Management of Chronic Lymphocytic Leukemia in Canada during the Coronavirus Pandemic
Curr. Oncol. 2020, 27(3), 332-335; https://doi.org/10.3747/co.27.6769 - 01 Jun 2020
Cited by 4 | Viewed by 348
Abstract
The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided [...] Read more.
The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided a series of recommendations for the treatment of patients with cll during the pandemic, covering a range of topics, including testing for covid-19, cll treatment initiation and selection, use of immunoglobulin therapy, in-person monitoring, and treatment of patients with cll and covid-19. We summarize the ash recommendations and discuss their applicability as guidelines for the treatment of cll during the covid-19 pandemic in Canada. Full article
Article
Consensus Statement on Tumour Bed Localization for Radiation after Oncoplastic Breast Surgery
Curr. Oncol. 2020, 27(3), 326-331; https://doi.org/10.3747/co.27.5977 - 01 Jun 2020
Cited by 3 | Viewed by 235
Abstract
Background: Oncoplastic surgery (ops) is becoming the new standard of care for breast-conserving surgery, leading to some challenges with adjuvant radiation, particularly when accurate tumour bed (tbd) delineation is needed for focused radiation (that is, accelerated partial breast [...] Read more.
Background: Oncoplastic surgery (ops) is becoming the new standard of care for breast-conserving surgery, leading to some challenges with adjuvant radiation, particularly when accurate tumour bed (tbd) delineation is needed for focused radiation (that is, accelerated partial breast irradiation or boost radiation). Currently, no guidelines have been published concerning tbd localization for adjuvant targeted radiation after ops. Methods: A modified Delphi method was used to establish consensus by a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus Group and in a subsequent online member survey. Results: These are the main recommendations: (1) Surgical clips are necessary and should, at a minimum, be placed along the 4 side walls of the cavity, plus 1–4 clips at the posterior margin if necessary. (2) Operative reports should include pertinent information to help guide the radiation oncologists. (3) Breast surgeons and radiation oncologists should have a basic understanding of ops techniques and work on “speaking a common language.” (4) Careful consideration is needed when determining the value of targeted radiation, such as boost, in higher-level ops procedures with extensive tissue rearrangement. Conclusions: The panel developed a total of 6 recommendations on tbd delineation for more focused radiation therapy after ops, with more than 80% agreement on each statement. All are summarized, together with the corresponding evidence or expert opinion. Full article
Article
Locoregional Management of in-Transit Metastasis in Melanoma: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline
Curr. Oncol. 2020, 27(3), 318-325; https://doi.org/10.3747/co.27.6523 - 01 Jun 2020
Cited by 4 | Viewed by 274
Abstract
Objective: The purpose of this guideline is to provide guidance on appropriate management of satellite and in-transit metastasis (itm) from melanoma. Methods: The guideline was developed by the Program in Evidence-Based Care (pebc) of Ontario Health (Cancer Care Ontario) [...] Read more.
Objective: The purpose of this guideline is to provide guidance on appropriate management of satellite and in-transit metastasis (itm) from melanoma. Methods: The guideline was developed by the Program in Evidence-Based Care (pebc) of Ontario Health (Cancer Care Ontario) and the Melanoma Disease Site Group. Recommendations were drafted by a Working Group based on a systematic review of publications in the medline and embase databases. The document underwent patient- and caregiver-specific consultation and was circulated to the Melanoma Disease Site Group and the pebc Report Approval Panel for internal review; the revised document underwent external review. Recommendations: “Minimal itm” is defined as lesions in a location with limited spread (generally 1–4 lesions); the lesions are generally superficial, often clustered together, and surgically resectable. “Moderate itm” is defined as more than 5 lesions covering a wider area, or the rapid development (within weeks) of new in-transit lesions. “Maximal itm” is defined as large-volume disease with multiple (>15–20) 2–3 cm nodules or subcutaneous or deeper lesions over a wide area. (1) In patients presenting with minimal itm, complete surgical excision with negative pathologic margins is recommended. In addition to complete surgical resection, adjuvant treatment may be considered. (2) In patients presenting with moderate unresectable itm, consider using this approach for localized treatment: intralesional interleukin 2 or talimogene laherparepvec as 1st choice, topical diphenylcyclopropenone as 2nd choice, or radiation therapy as 3rd choice. Evidence is insufficient to recommend intralesional bacille Calmette– Guérin or CO2 laser ablation outside of a research setting. (3) In patients presenting with maximal itm confined to an extremity, isolated limb perfusion, isolated limb infusion, or systemic therapy may be considered. In extremely select cases, amputation could be considered as a final option in patients without systemic disease after discussion at a multidisciplinary case conference. (4) In cases in which local, regional, or surgical treatments for itm might be ineffective or unable to be performed, or if a patient has systemic metastases at the same time, systemic therapy may be considered. Full article
Article
Consensus Statement: Summary of the Quebec Lung Cancer Network Recommendations for Prioritizing Patients with Thoracic Cancers in the Context of the COVID-19 Pandemic
Curr. Oncol. 2020, 27(3), 313-317; https://doi.org/10.3747/co.27.6685 - 01 Jun 2020
Cited by 5 | Viewed by 361
Abstract
Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non–covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services [...] Read more.
Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non–covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them. Full article
Article
Barriers to Conducting Cancer Trials in CanadA: An Analysis of Key Informant Interviews
Curr. Oncol. 2020, 27(3), 307-312; https://doi.org/10.3747/co.27.5707 - 01 Jun 2020
Cited by 2 | Viewed by 213
Abstract
Background: In Canada, there is growing evidence that oncology clinical trials units (ctus) and programs face serious financial challenges. Investment in cancer research in Canada has declined almost 20% in the 5 years since its peak in 2011, and the [...] Read more.
Background: In Canada, there is growing evidence that oncology clinical trials units (ctus) and programs face serious financial challenges. Investment in cancer research in Canada has declined almost 20% in the 5 years since its peak in 2011, and the costs of conducting leading-edge trials are rising. Clinical trials units must therefore be strategic about which studies they open. We interviewed Canadian health care professionals responsible for running cancer trials programs to identify the barriers to sustainability that they face. Methods: One-on-one telephone interviews were conducted with clinicians and clinical research professionals at oncology ctus in Canada. We asked for their perspectives about the barriers to conducting trials at their institutions, in their provinces, and nationwide. Interviews were digitally recorded, transcribed, anonymized, and coded in the NVivo software application (version 11: QSR International, Melbourne, Australia). The initial coding structure was informed by the interview script, with new concepts drawn out and coded during analysis, using a constant comparative approach. Results: Between June 2017 and November 2018, 25 interviews were conducted. Key barriers that participants identified were (1) insufficient stable funding to support trials infrastructure and retain staff; (2) the need to adopt strict cost-recovery policies, leading to fewer academic trials in portfolios; and (3) an overreliance on industry to fund clinical research in Canada. Conclusions: Funding uncertainties have led ctus to increasingly rely on industry sponsorship and more stringent feasibility thresholds to remain solvent. Retaining skilled trials staff can create efficiencies in opening and running studies, with spillover effects of more trials being open to patients. More academic studies are needed to curb industry’s influence. Full article
Article
Investigating Epidemiologic Trends and the Geographic Distribution of Patients with Anal Squamous Cell Carcinoma throughout Canada
Curr. Oncol. 2020, 27(3), 294-306; https://doi.org/10.3747/co.27.6061 - 01 Jun 2020
Cited by 2 | Viewed by 216
Abstract
Background: Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in [...] Read more.
Background: Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in recent decades, and various risk factors pertaining to the pathogenesis of the disease have been identified, including infection with the human papillomavirus, tobacco use, and immunosuppression. The epidemiology and distribution of anal scc throughout Canada remain poorly understood, however. Methods: Using 3 population-based cancer registries, a retrospective analysis of demographic data across Canada for 1992–2010 was performed. The incidence and mortality for anal scc was examined at the levels of provinces, cities, and the forward sortation area (FSA) component (first 3 characters) of postal codes. Results: During 1992–2010, 3720 individuals were diagnosed with anal scc in Canada; 64% were women. The overall national incidence rate was 6.3 cases per million population per year, with an average age at diagnosis of 60.4 years. The incidence increased over time, with significantly higher incidence rates documented in British Columbia and Nova Scotia (9.3 cases per million population each). Closer examination revealed clustering of cases in various urban centres and self-identified lgbtq communities in Toronto, Montreal, and Vancouver. Discussion: This study provides, for the first time, a comprehensive analysis of the burden of anal scc in Canada, identifying susceptible populations and shedding light onto novel avenues of research to lower the incidence of anal cancer throughout the country. Full article
Article
Postoperative Radiotherapy Option Based on Mediastinal Lymph Node Reclassification for Patients with pN2 Non-small-Cell Lung Cancer
Curr. Oncol. 2020, 27(3), 283-293; https://doi.org/10.3747/co.27.5899 - 01 Jun 2020
Cited by 1 | Viewed by 207
Abstract
Background: In this research, we used the mediastinal lymph node reclassification proposed by the International Association for the Study of Lung Cancer (iaslc) to screen for patients with pathologic N2 (pN2) non-small-cell lung cancer (nsclc) who might benefit from [...] Read more.
Background: In this research, we used the mediastinal lymph node reclassification proposed by the International Association for the Study of Lung Cancer (iaslc) to screen for patients with pathologic N2 (pN2) non-small-cell lung cancer (nsclc) who might benefit from postoperative radiotherapy (port). Methods: The study enrolled 440 patients with pN2 nsclc who received complete surgical resection and allocated them to one of three groups: N2a1 (single-station skip mediastinal lymph node metastasis), N2a2 (single-station non-skip mediastinal lymph node metastasis), and N2b (multi-station mediastinal lymph node metastasis). Rates of local recurrence at first recurrence in patients receiving and not receiving port were compared using the chi-square test. Overall (os) and disease-free survival (dfs) were then compared using Kaplan–Meier survival analysis with log-rank test. In addition, the factors potentially influencing os and dfs were analyzed using univariate and multivariate Cox regression. Results: The rate of local recurrence for the N2a2 and N2b groups was significantly lower in patients receiving port (p = 0.044 and p = 0.043 respectively). The log-rank test revealed that, for the N2a1 group, differences in os and dfs were not statistically significant between the patients who did and did not receive port (p = 0.304 and p = 0.197 respectively). For the N2a2 group, os and dfs were markedly superior in patients who received port compared with those who did not (p = 0.001 and p = 0.014 respectively). For the N2b group, os was evidently better in patients who received port compared with those who did not (p = 0.025), but no statistically significant difference in dfs was observed (p = 0.134). Multivariate regression analysis revealed that, in the N2a1 group, port was significantly associated with poor os [hazard ratio (hr): 2.618; 95% confidence interval (ci): 1.185 to 5.785; p = 0.017]; in the N2a2 group, port was associated with improved os (hr: 0.481; 95% ci: 0.314 to 0.736; p = 0.001) and dfs (hr: 0.685; 95% ci: 0.479 to 0.980; p = 0.039). Conclusions: For patients with pN2 nsclc who receive complete resection, port might be beneficial only for patients with single-station non-skip metastasis (N2a2). Patients with single-station skip metastasis (N2a1) and multi-station metastasis (N2b) might not currently benefit from port. Full article
Article
Tyrosine Kinase Inhibitors Significantly Improved Survival Outcomes in Patients with Metastatic Gastrointestinal Stromal Tumour: A Multi-Institutional Cohort Study
Curr. Oncol. 2020, 27(3), 276-282; https://doi.org/10.3747/co.27.5869 - 01 Jun 2020
Viewed by 213
Abstract
Background: The real-world impact of tyrosine kinase inhibitors (tkis) in clinical practice for gastrointestinal stromal tumour (gist) has not been extensively reported. We sought to assess how outcomes have changed over the eras and to evaluate the effect of [...] Read more.
Background: The real-world impact of tyrosine kinase inhibitors (tkis) in clinical practice for gastrointestinal stromal tumour (gist) has not been extensively reported. We sought to assess how outcomes have changed over the eras and to evaluate the effect of access to imatinib and sunitinib on survival in patients with unresectable or metastatic gist in British Columbia. Methods: Patients with metastatic or unresectable gist were allocated to one of three eras: pre-2002, 2002–2007, and post-2007 based on treatment availability (pre-imatinib, post-imatinib, and post-sunitinib). Overall survival (os) and progression-free survival (pfs) were compared between eras. Univariate and multivariate analyses were performed to determine the effects of tumour, patient, and treatment characteristics on survival outcomes. Results: Of 657 patients diagnosed with gist throughout British Columbia during 1996–2016, 196 had metastatic disease: 23 in the pre-imatinib era, 67 in the post-imatinib era, and 106 in the post-sunitinib era. A significant increase in os, by 53.6 months (p = 0.0007), and pfs, by 29.1 months (p = 0.044), was observed after the introduction of imatinib. The introduction of sunitinib did not significantly affect os or pfs. Conclusions: Implementation of tkis has drastically improved survival outcomes for patients with metastatic gist by up to 4.55 years in the real-world setting. Our study demonstrates that implementation of tkis in clinical practice has outperformed their benefit predicted in clinical trials. Full article
Article
Access to Cancer Care in Northwestern Ontario—A Population-Based Study Using Administrative Data
Curr. Oncol. 2020, 27(3), 271-275; https://doi.org/10.3747/co.27.5717 - 01 Jun 2020
Viewed by 274
Abstract
Background: Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer [...] Read more.
Background: Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and that little information is available about cancer statistics specific to northwestern Ontario, the purpose of the present study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods: This population-based retrospective study used administrative data obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates, starting with the primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results: Within the 6-year study period (2010–2016), 2583 index cases were identified. Most (n = 2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age [p < 0.0001; odds ratio (or): 0.29; 95% confidence interval (ci): 0.19 to 0.44] and rural residence (p < 0.0001; or: 0.48; 95% ci: 0.48 to 0.72). Factors associated with receiving a specialist consultation included a longer timeline (p < 0.0001; or: 1.32; 95% ci: 1.19 to 1.46), a diagnosis of breast cancer (p < 0.0001; or: 2.51; 95% ci: 1.43 to 4.42), and a diagnosis of lung cancer (p < 0.0001; or: 1.77; 95% ci: 1.38 to 2.26). Conclusions: This study is the first to look at care access in northwestern Ontario. The complexity and multidisciplinary nature of cancer care makes the provision of appropriate care a challenge; a one-size-fits-all disease prevention and treatment strategy might not be appropriate. Full article
Article
Does the Time from Diagnostic Biopsy to Neoadjuvant Chemotherapy Affect the Rate of Pathologic Complete Response in Stages I–III Breast Cancer?
Curr. Oncol. 2020, 27(3), 265-270; https://doi.org/10.3747/co.27.5907 - 01 Jun 2020
Viewed by 202
Abstract
Background: Studies in the adjuvant setting suggest that the timing of breast cancer diagnosis, surgery, and chemotherapy might affect outcomes. In the neoadjuvant setting, data exploring whether expeditious neoadjuvant chemotherapy (nac) after diagnosis improves the rate of pathologic complete response ( [...] Read more.
Background: Studies in the adjuvant setting suggest that the timing of breast cancer diagnosis, surgery, and chemotherapy might affect outcomes. In the neoadjuvant setting, data exploring whether expeditious neoadjuvant chemotherapy (nac) after diagnosis improves the rate of pathologic complete response (pcr) in breast cancer are limited. Methods: Patients who received nac and completed treatment between May 2012 and December 2018 were identified from a prospectively collected database at BC Cancer. Time from diagnosis to start of nac was calculated. Patients were grouped into those who did and did not experience a pcr, and those who started nac within 28 days or after 28 days [time to nac (ttn)]. The association between pcr and ttn was tested using logistic regression. Results: In the time period studied, 482 patients who received nac were identified. After exclusions, 421 patients met the eligibility criteria. Median time from biopsy to chemotherapy was 33 days (range: 7–140 days). In 149 patients (35.4%), nac was received within 28 days of diagnosis (range: 7–28 days); in 272 patients (64.6%), it was received after more than 28 days (range: 29–140 days). The overall pcr rate was 31.8%. A trend toward a higher pcr rate, although not statistically significant, was observed in the group that initiated chemotherapy within 28 days (34.2% vs. 30.5%, p = 0.43). In the logistic regression model, rates of pcr were associated with receptor status, but not age, stage, or ttn. Conclusions: In the neoadjuvant setting, we observed no difference in the rate of pcr in patients who started nac within 28 days or after 28 days. Full article
Article
Prognosis and Clinicopathologic Features in Patients with Gastric Stump Cancer after Curative Surgery
Curr. Oncol. 2020, 27(3), 259-264; https://doi.org/10.3747/co.27.6017 - 01 Jun 2020
Cited by 3 | Viewed by 228
Abstract
Background: Gastric stump (“remnant”) cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial. Methods: From January 1988 to December 2012 at a single medical centre [...] Read more.
Background: Gastric stump (“remnant”) cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial. Methods: From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival (os). Results: The 5-year os rates for patients with gastric stump cancer and with primary gastric cancer were 51.2% and 54.5% respectively (p = 0.035). Analysis of clinicopathologic characteristics indicated that, compared with patients having primary gastric cancer, those with gastric stump cancer had more lymph node metastasis (p < 0.001) and had been diagnosed at a more advanced stage (p = 0.047). Multivariate analysis with os as an endpoint showed that age [p = 0.015; hazard ratio (hr): 2.300; 95% confidence interval (ci): 1.173 to 4.509], tumour size (p = 0.037; hr: 1.700; 95% ci: 1.031 to 2.801), stromal reaction (p = 0.021; hr: 1.802; 95% ci: 1.094 to 2.969), and pathologic N category (p = 0.001; hr: 1.449; 95% ci: 1.161 to 1.807) were independent predictors in gastric stump cancer. The os rates for patients with gastric stump cancer who previously had gastric cancer or peptic ulcer disease were 72.9% and 50.0% respectively (p = 0.019). The Borrmann classification was more superficial (p = 0.005), lymph node metastases were fewer (p = 0.004), and staging was less advanced (p = 0.025) in patients with gastric stump cancer who previously had gastric cancer than in their counterparts who previously had peptic ulcer disease. Conclusions: Survival is poorer in patients with gastric stump cancer who previously had peptic ulcer disease than in those who previously had primary gastric cancer. Patients with gastric stump cancer who previously had gastric cancer and could receive curative gastrectomy tended to have a better prognosis because of a more superficial Borrmann classification. Regular follow-up in patients who have undergone gastric surgery is recommended for the early detection of gastric stump cancer. Full article
Article
Real-World Impact of Laparoscopic Surgery for Rectal Cancer: A Population-Based Analysis
Curr. Oncol. 2020, 27(3), 251-258; https://doi.org/10.3747/co.27.5829 - 01 Jun 2020
Cited by 1 | Viewed by 184
Abstract
Background: Randomized trials have demonstrated equivalent oncologic outcomes and decreased morbidity in patients with rectal cancer who undergo laparoscopic surgery (LapSx) compared with open surgery (OpenSx). The objective of the present study was [...] Read more.
Background: Randomized trials have demonstrated equivalent oncologic outcomes and decreased morbidity in patients with rectal cancer who undergo laparoscopic surgery (LapSx) compared with open surgery (OpenSx). The objective of the present study was to compare short-term outcomes after LapSx and OpenSx in a real-world setting. Methods: A national discharge abstract database was used to identify all patients who underwent rectal cancer resection in Canada (excluding Quebec) from April 2004 through March 2015. Short-term outcomes examined included same-admission mortality and length of stay (los). Results: Of 28,455 patients, 82.4% underwent OpenSx, and 17.6%, LapSx. The use of LapSx increased to 34% in 2014 from 5.9% in 2004 (p < 0.0001). Same-admission mortality was lower among patients undergoing LapSx than among those undergoing OpenSx (1.08% and 1.95% respectively, p < 0.0001). On multivariable analysis, the odds of same-admission mortality with LapSx was 36% lower than that with OpenSx (odds ratio: 0.64; p = 0.003). Median los was shorter after LapSx than after OpenSx (5 days and 8 days respectively, p = 0.0001). The strong association of LapSx with shorter los was maintained on multivariable analysis controlling for patient, surgeon, and hospital factors. Conclusions: For patients with rectal cancer, shorter los and decreased same-admission mortality are associated with the use of LapSx compared with OpenSx. Full article
Article
Evaluation of a Routine Screening Program with Tuberculin Skin Testing on Rates of Detection of Latent Tuberculosis Infection and Prevention of Active Tuberculosis in Patients with Multiple Myeloma at a Canadian Cancer Centre
Curr. Oncol. 2020, 27(3), 246-250; https://doi.org/10.3747/co.27.5577 - 01 Jun 2020
Viewed by 210
Abstract
Background: Chemotherapy-induced T cell dysfunction, resulting from treatment of multiple myeloma (MM), enhances the risk for reactivation of latent tuberculous infection (LTBI). However, routine screening for LTBI has its limitations. The objective of the present study was to assess [...] Read more.
Background: Chemotherapy-induced T cell dysfunction, resulting from treatment of multiple myeloma (MM), enhances the risk for reactivation of latent tuberculous infection (LTBI). However, routine screening for LTBI has its limitations. The objective of the present study was to assess the number of patients treated for LTBI both before and after the introduction of a consistent tuberculin skin test (TST) screening program for patients with MM at our cancer centre. Methods: This retrospective observational study analyzed adult patients with MM treated with autologous hematopoietic stem-cell transplantation from 1 January 2013 to 31 December 2014, for whom TST was consistently performed at our cancer facility. Baseline demographic characteristics of patients who received TST testing and LTBI therapy were compared with those of a pre-intervention cohort of patients (1 January 2008 to 31 December 2009) who were not tested. Results: During the post-intervention period, 170 patients with MM had a TST. In 14 patients (8.2%) results were positive, and 11 of the 14 received LTBI therapy. Of another 12 patients with radiographic imaging changes consistent with prior granulomatous disease and negative TST results, 2 were treated. No cases of tuberculosis (TB) reactivation were noted in individuals who completed LTBI therapy. One case of active TB was diagnosed in a patient with a negative TST. In contrast, in the pre-intervention matched cohort of 170 patients, no TSTs were performed, and no cases of active TB were documented. Conclusions: Patients with MM could benefit from a consistent TST testing policy coupled with subsequent LTBI therapy. However, universal testing might not be required. A targeted program combining evaluation of host risk factors, imaging findings, and screening tests might optimize LTBI diagnosis and management, and thus be effective in preventing the development of active TB in at-risk patients with MM. Full article
Case Report
PD-1 Inhibition in Malignant Melanoma and Lack of Clinical Response in Chronic Lymphocytic Leukemia in the Same Patients: A Case Series
Curr. Oncol. 2020, 27(3), 169-172; https://doi.org/10.3747/co.27.5371 - 01 Jun 2020
Cited by 1 | Viewed by 194
Abstract
Chronic lymphocytic leukemia (cll) is the most common adult leukemia in the Western world. Unfortunately, affected patients are often immunosuppressed and at increased risk of infection and secondary malignancy. Previous meta-analysis has found that patients with cll have a risk of [...] Read more.
Chronic lymphocytic leukemia (cll) is the most common adult leukemia in the Western world. Unfortunately, affected patients are often immunosuppressed and at increased risk of infection and secondary malignancy. Previous meta-analysis has found that patients with cll have a risk of melanoma that is increased by a factor of 4 compared with the general population. Recent advances in the understanding of the PD receptor pathway have led to immunotherapies that target cancer cells. The use of PD-1 inhibitors is now considered first-line treatment for BRAF wild-type metastatic melanoma. Interestingly, early preclinical data suggest that inhibition of that pathway could also be used in the treatment of cll; however, recent clinical data did not support the effectiveness of that approach. In this case series, we highlight 2 cases in which patients with cll and concurrent malignant melanoma underwent treatment with PD-1 inhibitors and were found to experience reductions in their white blood cell counts without improvement in their hemoglobin. Those cases further illustrate that treatment of cll with PD-1 inhibitors is ineffective. Full article
Commentary
Preparing for the Renaissance: Treating Breast Cancer during the COVID-19 Pandemic and Planning for a Safe Re-Emergence to Routine Surgical Care within a Universal Health Care System
Curr. Oncol. 2020, 27(3), 163-168; https://doi.org/10.3747/co.27.6699 - 01 Jun 2020
Cited by 4 | Viewed by 291
Abstract
The evolving covid-19 pandemic is placing tremendous pressure on health systems. [...]
Full article
Commentary
Impact of the COVID-19 Outbreak on Adjuvant Chemotherapy for Patients with Stage II or III Colon Cancer: Experiences from a Multicentre Clinical Trial in China
Curr. Oncol. 2020, 27(3), 159-162; https://doi.org/10.3747/co.27.6529 - 01 Jun 2020
Cited by 8 | Viewed by 274
Abstract
Since January 2020, the outbreak of the novel coronavirus disease designated covid-19 by the World Health Organization, a human-to-human contagious viral pneumonia that began in 2019, has been extensively influencing daily life in China[...] Full article
Article
Tumour Response 3 Months after Neoadjuvant Single-Fraction Radiotherapy for Low-Risk Breast Cancer
Curr. Oncol. 2020, 27(3), 155-158; https://doi.org/10.3747/co.27.6059 - 01 Jun 2020
Cited by 1 | Viewed by 208
Abstract
Introduction: Standard treatment for early-stage invasive breast cancer (bca) consists of breast-conserving surgery and several weeks of adjuvant radiotherapy (rt). Neoadjuvant single-fraction rt is a novel approach for early-stage bca. We sought to investigate the effect [...] Read more.
Introduction: Standard treatment for early-stage invasive breast cancer (bca) consists of breast-conserving surgery and several weeks of adjuvant radiotherapy (rt). Neoadjuvant single-fraction rt is a novel approach for early-stage bca. We sought to investigate the effect of delaying surgery after neoadjuvant rt with respect to the rate of pathologic response (pr). Methods: Women 65 years of age or older with a new diagnosis of stage i luminal A bca were eligible for inclusion. A single 20 Gy dose to the primary breast tumour was given, followed by breast-conserving surgery 3 months later. The primary endpoint was the pr rate assessed by microscopic evaluation using the Miller–Payne system. Results: To date, 10 patients have been successfully treated. Median age of the patients was 72 years (range: 65–84 years). In 8 patients, neoadjuvant rt resulted in a tumour pr with median residual cellularity of 3%. No immediate rt complications other than mild dermatitis were noted. Conclusions: This study demonstrates a method for delivering single-fraction rt that can lead to a high level of pr in most patients. Continued accrual to this study and subsequent trials are needed to determine the feasibility, safety, and role of this novel technique in the management of early-stage bca. Full article
Article
Indications for Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery: A Clinical Practice Guideline
Curr. Oncol. 2020, 27(3), 146-154; https://doi.org/10.3747/co.27.6033 - 01 Jun 2020
Cited by 7 | Viewed by 430
Abstract
Objective: The purpose of the present review was to provide evidence-based guidance about the provision of cytoreductive surgery (crs) with hyperthermic intraperitoneal chemotherapy (hipec) in the treatment of peritoneal cancers. Methods: The guideline was developed by the Program in [...] Read more.
Objective: The purpose of the present review was to provide evidence-based guidance about the provision of cytoreductive surgery (crs) with hyperthermic intraperitoneal chemotherapy (hipec) in the treatment of peritoneal cancers. Methods: The guideline was developed by the Program in Evidence-Based Care together with the Surgical Oncology Program at Ontario Health (Cancer Care Ontario) through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Results: Recommendation 1a: For patients with newly diagnosed stage iii primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, hipec should be considered for those with at least stable disease after neoadjuvant chemotherapy at the time that interval crs (if complete) or optimal cytoreduction is achieved. Recommendation 1b: There is insufficient evidence to recommend the addition of hipec when primary crs is performed for patients with newly diagnosed advanced primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, outside of a clinical trial. Recommendation 2: There is insufficient evidence to recommend hipec with crs in patients with recurrent ovarian cancer outside the context of a clinical trial. Recommendation 3: There is insufficient evidence to recommend hipec with crs in patients with peritoneal colorectal carcinomatosis outside the context of a clinical trial. Recommendation 4: There is insufficient evidence to recommend hipec with crs for the prevention of peritoneal carcinomatosis in colorectal cancer outside the context of a clinical trial; however, hipec using oxaliplatin is not recommended. Recommendation 5: There is insufficient evidence to recommend hipec with crs for the treatment of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 6: There is insufficient evidence to recommend hipec with crs for the prevention of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 7: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with malignant peritoneal mesothelioma; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol. Recommendation 8: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with disseminated mucinous neoplasm in the appendix; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol. Full article
Article
Management of Dyspnea in Palliative Care
Curr. Oncol. 2020, 27(3), 142-145; https://doi.org/10.3747/co.27.6413 - 01 Jun 2020
Cited by 2 | Viewed by 666
Abstract
Dyspnea is a symptom commonly experienced by cancer patients that causes significant suffering, worsens throughout a patient’s disease trajectory, and can be more difficult to manage than other symptoms. Assessment of dyspnea is best accomplished by a subjective description; physiologic measures are only [...] Read more.
Dyspnea is a symptom commonly experienced by cancer patients that causes significant suffering, worsens throughout a patient’s disease trajectory, and can be more difficult to manage than other symptoms. Assessment of dyspnea is best accomplished by a subjective description; physiologic measures are only weakly correlated with the patient’s experience. It is important to consider a wide range of possible malignant and nonmalignant causes of dyspnea in cancer patients and to correct underlying causes where possible. For patients with refractory dyspnea, opioids are a safe and effective treatment. Benzodiazepines can be considered, but the evidence for their use is weak. Supplemental oxygen is beneficial if patients are hypoxemic, or if they have concurrent chronic obstructive pulmonary disease. Nonpharmacologic strategies such as fan therapy, exercise programs, and pulmonary rehabilitation can also be beneficial. One important diagnosis to consider in all cancer patients is venous thromboembolism. Prompt evaluation and treatment are vital to improving symptoms and outcomes for patients. Although dyspnea is common and potentially debilitating in cancer patients, it can be effectively managed with a structured approach to rule out reversible causes while concurrently treating the patient using appropriate therapeutic strategies. Full article
Article
Inflammatory Markers as Prognostic Factors of Recurrence in Advanced-Stage Squamous Cell Carcinoma of the Head and Neck
Curr. Oncol. 2020, 27(3), 135-141; https://doi.org/10.3747/co.27.5731 - 01 Jun 2020
Cited by 2 | Viewed by 361
Abstract
Background: Multiple immunologic parameters have provided useful prognostic and assessment significance in various cancers, including head-and-neck squamous cell carcinoma (scc). We sought to identify whether pretreatment inflammatory markers could prognosticate recurrence in patients with advanced (stage III or IV) head-and-neck [...] Read more.
Background: Multiple immunologic parameters have provided useful prognostic and assessment significance in various cancers, including head-and-neck squamous cell carcinoma (scc). We sought to identify whether pretreatment inflammatory markers could prognosticate recurrence in patients with advanced (stage III or IV) head-and-neck scc who underwent therapy with curative intent in a tertiary care centre between January 2010 and December 2012. Methods: In a chart review, we recorded demographics; primary tumour characteristics; p16 status; pretreatment inflammatory markers, including body mass index (bmi), neutrophil-to-lymphocyte ratio (nlr), C-reactive protein (crp), and serum albumin; therapy received; and date of relapse, death, or last follow-up. The main outcome was relapse-free survival (rfs). Overall survival (os) was a secondary outcome. Results: From among 235 charts reviewed, 118 cases were included: 86 oropharyngeal (50 p16-positive, 18 p16-negative, 17 p16 unavailable, 1 p16 indeterminate), and 32 non-oropharyngeal (7 p16-positive, 19 p16-negative, 6 p16 unavailable). Median follow-up was 2.45 years (25%–75% interquartile range: 1.65–3.3 years). In univariate analysis, p16 status, bmi, modified Glasgow prognostic score, and crp were significant for rfs, but in multivariate analysis, only p16 status, bmi, and crp remained significant. For os, only crp and nlr were significant in both the univariate and multivariate analyses. After adjustment for p16 status, nlr did not remain significant. After adjustment for p16 status, crp remained significant for both rfs and os. Conclusions: In patients with head-and-neck scc, a stronger prognostic value is associated with human papillomavirus status than with nlr and many other factors, including bmi and albumin. However, even though few of our patients had high crp, serum crp remained significant despite p16-positive status. Full article
Article
Willingness of Women with Early Estrogen Receptor–Positive Breast Cancer to Take Adjuvant CDK4/6 Inhibitors
Curr. Oncol. 2020, 27(3), 127-134; https://doi.org/10.3747/co.27.6131 - 01 Jun 2020
Cited by 1 | Viewed by 202
Abstract
Background: The steady decline in breast cancer (bca) mortality has come at the cost of increasingly toxic and expensive adjuvant therapies. Trials evaluating the addition of 2 or 3 years of cyclin-dependent kinase 4/6 (cdk4/6) inhibitors to adjuvant [...] Read more.
Background: The steady decline in breast cancer (bca) mortality has come at the cost of increasingly toxic and expensive adjuvant therapies. Trials evaluating the addition of 2 or 3 years of cyclin-dependent kinase 4/6 (cdk4/6) inhibitors to adjuvant endocrine therapy (et) are ongoing, but the willingness of patients to take such additional therapy is unknown. Methods: We surveyed 100 consecutive postmenopausal women with nonmetastatic estrogen receptor–positive bca who had initiated adjuvant et within the preceding 2 years. Participants were asked about perceived recurrence risk, bca worry, and overall health. They were then asked about their willingness to accept 2 years of treatment with an additional oral drug that would reduce recurrence by 40% for a range of baseline recurrence risks in 2 hypothetical scenarios. Results: Mean age of the 99 evaluable participants was 61.7 years. In the scenario with no drug toxicity, 85% of respondents were likely to accept the new drug for a reduction in recurrence to 30% from 50%, but only 49% would take the drug if risk was reduced to 3% from 5%. In a scenario with drug-induced fatigue, the corresponding drug acceptance rates were 55% and 39% respectively. For the second scenario, bca worry was correlated with increased willingness to take the drug, even for only a 2% absolute reduction in recurrence risk. Conclusions: The willingness of patients with estrogen receptor–positive bca to take an adjuvant cdk4/6 inhibitor will greatly depend on the expected benefit and toxicities described to them as well as on worry about bca recurrence. Full article
Editorial
The Challenge of Creating Evidence-Based Clinical Practice Guidelines for the Use of Hyperthermic Intraperitoneal Chemotherapy in the Management of Peritoneal Malignancies
Curr. Oncol. 2020, 27(3), 125-126; https://doi.org/10.3747/co.27.6679 - 01 Jun 2020
Viewed by 164
Abstract
The management of primary and secondary malignancies of the peritoneum continues to pose a challenge to modern, multidisciplinary cancer care.[...] Full article
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