Claire Phillips

Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma.

Background Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a period of 6 weeks). In elderly patients, more convenient shorter courses of radiotherapy are commonly used, but the benefit of adding temozolomide to a shorter course of radiotherapy is unknown. Methods We conducted a trial involving patients 65 years of age or older with newly diagnosed glioblastoma. Patients were randomly assigned to receive either radiotherapy alone (40 Gy in 15 fractions) or radiotherapy with concomitant and adjuvant temozolomide. Results A total of 562 patients underwent randomization, 281 to each group. The median age was 73 years (range, 65 to 90). The median overall survival was longer with radiotherapy plus temozolomide than with radiotherapy alone (9.3 months vs. 7.6 months; hazard ratio for death, 0.67; 95% confidence interval [CI], 0.56 to 0.80; P<0.001), as was the median progression‐free survival (5.3 months vs. 3.9 months; hazard ratio for disease progression or death, 0.50; 95% CI, 0.41 to 0.60; P<0.001). Among 165 patients with methylated O6‐methylguanine–DNA methyltransferase (MGMT) status, the median overall survival was 13.5 months with radiotherapy plus temozolomide and 7.7 months with radiotherapy alone (hazard ratio for death, 0.53; 95% CI, 0.38 to 0.73; P<0.001). Among 189 patients with unmethylated MGMT status, the median overall survival was 10.0 months with radiotherapy plus temozolomide and 7.9 months with radiotherapy alone (hazard ratio for death, 0.75; 95% CI, 0.56 to 1.01; P=0.055; P=0.08 for interaction). Quality of life was similar in the two trial groups. Conclusions In elderly patients with glioblastoma, the addition of temozolomide to short‐course radiotherapy resulted in longer survival than short‐course radiotherapy alone. (Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials.gov number, NCT00482677.)

A randomized trial comparing 35 Gy in ten fractions with 60 Gy in 30 fractions of cerebral irradiation for glioblastoma multiforme and older patients with anaplastic astrocytoma

A randomized prospective clinical trial was conducted to compare conventional high dose radiotherapy with hypofractionated, short course radiotherapy in poor prognosis patients with high grade glioma. The primary endpoint was overall survival.

Management of breast cancer brain metastases: a practical review

Brain metastases are a common, and frequently challenging, clinical problem in the contemporary management of metastatic breast cancer. While the management of extracranial metastatic breast cancer is now strongly defined by tumour phenotype, this approach is not so well defined for brain metastases. We review available evidence regarding management of brain metastases, including the limited breast-cancer-specific data. A framework for management according to breast cancer phenotype is proposed.

Solitary pituitary metastasis from HER2-positive breast cancer.

The introduction of anti‐HER2 therapy with trastuzumab has seen an increase in frequency of central nervous system metastasis as the site of first recurrence. Here, we present a rare case of a 63‐year‐old woman who presented with an isolated breast carcinoma pituitary metastasis 5 years following treatment for a high‐risk breast cancer. This report underscores the changing nature of HER2‐positive disease in the post‐trastuzumab era.

Novel 3D conformal technique for treatment of choroidal melanoma with external beam photon radiotherapy.

To report a 3D conformal radiotherapy (3D‐CRT) technique that utilises a specific eye immobilisation and treatment set‐up method as an alternative to stereotactic radiotherapy (SRT), for treatment of juxtapapillary choroidal melanoma (CM) and report early treatment outcomes of this technique.

Uptake of adjuvant breast cancer treatments recommended by multi‐disciplinary meetings

Adjuvant therapy for breast cancer is routinely discussed and recommended in multi‐disciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines; however, it does not explore whether treatment is concordant with MDMs. This study provides an Australian perspective on the uptake of MDM recommendations and reasons for non‐concordance.

Reply to Dr Altundag from the authors of ‘Management of breast cancer brain metastases; a practical review’

We thank Dr Altundag for his interest in our review of the management of breast cancer brain metastases [1] and for drawing attention to the large case series from MD Anderson Cancer Centre (MDACC) of patients with breast brain metastases [2]. In this series, Dr Altundag and colleagues observed some patients to have long survival after development of BM and found phenotype and age to be significant predictors of prognosis, in keeping with the RTOG disease-specific Graded Prognostic Assessment [3]. The MDACC review also found a solitary BM to portend a better prognosis than more than 1BM. We agree with Dr Altundag that the prognostic significance of BM number in breast cancer remains controversial [4]. The patient population in Dr Altundags series was treated for brain metastases between 1994 and 2004. This mostly pre-dates the era of HER2-targeted therapy and certainly predates the newer agents for hormone-positive tumours. With modern systemic therapy, the potential for prolonged survival after a diagnosis of BM from the HER2 and hormone positive phenotypes

Transient Hyperesthesia and Radicular Pain: An Unrecognised Complication of Thoracic Radiotherapy

Radiotherapy may be associated with both permanent and transient neurological adverse effects. We report seven cases of previously undocumented type of transient hyperesthesia and radicular pain occurring after radiotherapy for thoracic malignancies and describe the potential mechanisms. This is different to Lhermittes sign in its character, location, and duration of symptoms. Knowledge of such adverse effects will prevent inappropriate investigations and anxiety for patients.