Pei-Hung Chang

Pretreatment performance status and nutrition are associated with early mortality of locally advanced head and neck cancer patients undergoing concurrent chemoradiation

Unexpected fatal events in patients with head and neck cancers undergoing concurrent chemoradiation therapy are a clinical concern. Malnutrition, which is reported frequently in head and neck cancer patients, are associated with immunity derangement. The purpose of this study was to identify risk factors for early death of patients undergoing chemoradiation. We retrospectively analyzed the records of 194 stage III, IVA, and IVB head and neck cancer patients who were treated with chemoradiation between 2007 and 2009. We defined early death as death while receiving chemoradiation or within 60xa0days of treatment completion. Risk factors for early death were tested using univariate and multivariate analyses. Fourteen patients (7.2xa0%) experienced early death, 78.6xa0% of whom died of infection. Univariate analysis revealed significant correlations between early death and several pretreatment variables, including Eastern Cooperative Oncology Group performance status (PS) >1, hemoglobin <10xa0g/dL, albumin <3xa0g/dL, body mass index (BMI) <19xa0kg/m2, and peripheral blood total lymphocyte count <700/μL. Multivariate analysis showed that PS >1, BMI <19xa0kg/m2, and peripheral blood total lymphocyte count <700/μL were independent variables associated with early death. Poor performance status and malnutrition before chemoradiation independently predict early death in locally advanced head and neck cancer patients undergoing chemoradiation. Cautious management of head and neck cancer patients with these risk factors is required throughout chemoradiation period.

Omega-3 fatty acid-, micronutrient-, and probiotic-enriched nutrition helps body weight stabilization in head and neck cancer cachexia

OBJECTIVEnTo evaluate whether an oral nutritional supplement enriched with omega-3 fatty acids, micronutrients, and probiotics affected body weight (BW) changes, serum albumin and prealbumin levels in patients with head and neck cancer (HNC) cachexia.nnnSTUDY DESIGNnSixty-eight HNC patients were randomly assigned to receive either an Ethanwell/Ethanzyme (EE) regimen enriched with omega-3 fatty acids, micronutrients, and probiotics, or control (Isocal) for a 3-month period. Analysis of covariance was used to examine the association between BW change and variables.nnnRESULTSnPatients with body mass index (BMI) <19 and those receiving the EE regimen consumed fewer daily calories but showed significantly increased BW and maintained higher serum albumin and prealbumin levels than other patients (P<.05). Their BW changes were significantly associated with changes in serum albumin and prealbumin levels.nnnCONCLUSIONSnEE regimen improved BW as well as serum albumin and prealbumin levels in HNC patients with BMI <19.

The Prognostic Value of HER2-Positive Circulating Tumor Cells in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Introduction A meta‐analysis was conducted to determine the prognostic value of HER2‐positive circulating tumor cells (CTCs) in patients with breast cancer. Materials and Methods MedLine, Central, and Embase databases were searched. Inclusion criteria were: (1) randomized controlled trials, 2‐arm prospective studies, and retrospective studies; (2) patients with breast cancer; (3) HER2‐positive CTCs were examined; and (4) hazard ratio (HR) of survival between patients with HER2‐positive and HER2‐negative CTCs was reported. Results Four studies with a total of 550 patients with stage I to IV breast cancer were included. HER2‐positive CTCs were not associated with worse overall survival (OS; HR, 1.489, 95% confidence interval [CI], 0.873‐2.540, P = .144) or progression‐free survival (PFS; HR, 1.543; 95% CI, 0.636‐3.744; P = .338). In patients without metastasis, HER2‐positive CTCs were associated with worse OS (HR, 2.273; 95% CI, 1.340‐3.853; P = .002) and worse PFS (HR, 2.870; 95% CI, 1.298‐6.343; P = .009). There was no significant relationship between HER2‐positive CTCs and survival in subgroups of patients with metastasis. Conclusion HER2‐positive CTCs have prognostic value in patients with breast cancer and without distant metastasis. Micro‐Abstract A meta‐analysis was conducted to determine the prognostic value of HER2‐positive circulating tumor cells (CTCs) in patients with breast cancer. MedLine, Central, and Embase databases were searched. HER2‐positive CTCs were associated with worse overall survival, but not worse progression‐free survival. HER2‐positive CTCs have prognostic value in patients with breast cancer.

Intravenous glutamine appears to reduce the severity of symptomatic platinum-induced neuropathy: a prospective randomized study.

Abstract The purpose of this study is to evaluate the efficacy of intravenous (IV) glutamine or calcium/magnesium (Ca/Mg) infusion against platinum-induced neuropathy. Patients undergoing platinum-based (oxaliplatin or cisplatin) therapy were randomized to receive IV glutamine or Ca/Mg infusion during four cycles of chemotherapy, from the fifth cycle of therapy to the eighth cycle. The total neuropathy score (TNS) was evaluated at the end of the fourth course of chemotherapy (as baseline) and at the end of the eighth cycle (as end-of treatment). The intent-to-treat analysis of the end point included 29 patients in the glutamine arm and 26 patients in the Ca/Mg arm. The mean TNS of both cohorts increased significantly. The baseline and end-of-treatment TNSs between the two groups were not statistically different. Patients with symptoms at baseline (Nu2009=u200929) had significantly lower scores at the end of the study in the glutamine group (Pu2009=u20090.045). Besides, glutamine group patients who initially had only sensory symptoms (Nu2009=u200923) also had significantly lower scores at the studys end (Pu2009=u20090.035). Neither IV glutamine nor Ca/Mg infusion prevented further worsening of platinum-induced neuropathy. However, IV glutamine apparently reduced the severity of symptomatic platinum-induced neuropathy.

Chemoradiotherapy in elderly patients with advanced head and neck cancer under intensive nutritional support.

To evaluate treatment tolerance, toxicities and survival in elderly patients with advanced head and neck cancer who received inpatient‐based intensive nutritional support with concurrent chemoradiotherapy in comparison with younger patients undergoing the same treatment.

Glasgow prognostic score after concurrent chemoradiotherapy is a prognostic factor in advanced head and neck cancer

Objective This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT). Methods We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre- and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival. Results The GPS changed in 72 (51.8%) patients, with worse scores observed post-CCRT in 65 (90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage. Conclusions After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.

Analysis of First Year Mortality in Stage III Esophageal Cancer Patients Treated with Concurrent Chemoradiotherapy

Medical practitioners currently have several management options to treat locally advanced esophageal cancer, including surgery, radiation therapy, and chemotherapy. However, most patients had multidisciplinary treatment. In Taiwan, the one-year survival rate of esophageal cancer was less than 50%. This phenomenon may be due to patient mortality before therapy, during therapy, or early after the completion of therapy. Because of this elevated mortality rate, it is important to illustrate the cause of mortality in the first year. We analyzed 47 locally advanced stage III esophageal cancer patients who had received concurrent chemoradiotherapy (CCRT) in our hospital. Eighteen of them died in the first year after diagnosis. Ten patients (56%) had tumor progression (primarily distant metastasis), 13 patients (72%) died directly from infection, 1 patient (6%) died from main artery esophageal fistula, 1 patient (6%) died from esophageal mediastinal fistula, 1 patient (6%) died solely from disease progression, 1 patient (6%) died from some kind of social event, and 1 patient (6%) died from ischemic stroke. Timely research to analyze the complications and mortality early after CCRT is relevant to improving treatment outcomes.

Bilateral Reactive Pleural Effusion as a Complication of Picibanil Pleurodesis

OK-432 (picibanil) is a potent immunostimulant which has demonstrated benefit in the treatment of several types of malignancies, malignant ascites, and pleural effusion. We report a female patient with premenopausal breast cancer presenting with refractory malignant right pleural effusion. Shortly after OK-432 pleurodesis, bilateral reactive pleural effusion developed, soon followed by dyspnea. The pleural effusion was improved by bilateral pigtail catheter replacement, and no more massive pleural effusion was noted in the following 4 months. This complication was possibly related to immune response, but further experience and investigation is needed to prove it.