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501Radiotherapy or single agent carboplatin as adjuvant in stage I seminoma — preliminary results
S128 499
498
ASSESSMENT OF FUNCTIONAL STATUS IN PATIENTS (pts) W I T H L O C A L I Z E D BLADDER C A N C E R (BC)
THE OBSOLESCENCE OF CLINICAL STAGING IN CARCINOMA OF THE PROSTATE TREATED BY EXTERNAL BEAM RADIATION THERAPY
C. Kamby, L. Sengelov Department of Oncology, Copenhagen University Hospital in Herlev, Denmark.
D.G. McGowan, Cross Cancer Institute, Edmonton, Canada
In August 1987, Prostatic Specific Antigen (PSA) estimations were introduced at the Cross Cancer Institute. Between then and the end of 1991, a total of 462 patients received radical radiation therapy for their prostatic carcinoma. All had a diagnosis of adenocarcinoma of the prostate and all had the pretreatment PSA available. Of these, 268 were treated with external beam radiation therapy and form the basis for this report. Analysis of this group of patients was conducted by PSA failure free survival (PSAFF), clinical disease free survival (DFS), disease specific survival (DSS) and overall survival (OVS). Using PSAFF survival, three major prognostic factors were identified, which in order of significance am pretreatment PSA (p < 1 x 10"28), local extent of disease (p < 1 x 10-7), and histological grade (p < 1 x 10"6). The corresponding p-values on a DFS basis are < 1 x 10-12,< 1 x 10-6 and < 0.0002. When multivariant analysis was performed using PSAFF, pretreatment PSA became the single most important prognostic factor (p < 1 x 10"12), while histological grade became of borderline significance (p = 0.03). Local extent of disease was of no prognostic significance (p < 0.12). The corresponding p-values on a DFS basis are < 1 x 10-5, < 0.09 and < 0.12.
Performance status (PS) score is an important prognostic factor for response and survival of pts with cancer. It is important to evaluate the functional status when conducting retrospective studies on prognostic factors. Ahn : To evaluate reliability and validity of retrospective assessment of PS based on information from the records. Material and methods: The records of 149 pts with Iocoregional BC referred for curative radiotherapy were blindly scored according to the WHO PS scale, twice by two investigators. The results were analyzed in a Cox model together with other potential prognostic factors for survival. Results : The median time of observation was 126 months (range 5220). The median survival was 12,9 months: 12 pts were alive at follow-up. The intra- and interobserver Kappa coefficients of PS were 56-78% and 44-61%. The four assessments were all significantly related to survival, Multivariate analyses showed that sex. platelet count, and each of the four PS scores were independent prognostic factors. C o n c l u s i o n : Retrospective scoring of performance status is a reproducible and reliable tool, which has additive prognostic in[ormation. Retrospective evaluation of prognostic factors in pts with BC should include an assessment of PS.
These results suggest that the current clinical staging system is irrelevant. A new clinical staging system which takes account of the pretreatment PSA requites development.
501
500 FOLLOWING CARCINOMA
PATTERN OF F A I L U R E S U R G I C A L R E S E C T I O N OF RENAL C E L L
I. Aref, D. Salhani Ottawa Regional
Cancer
Centre,
G. Bociek,
Ottawa,
Canada
Radiotherapy or single agent carboplafin as adjuvant in' stage I semlnoma- preliminary results T. Wiegel1, U. Steiner2, S. Weinknecht3, K.P. Diekmann4, W. HinkelbeinI - Dept. of RadiotherapyI and Dept. of Urology2, UniversityHospital Benjamin Franklin, Dept. of Urology3, KH am Urban, Berlin and Dept. of Urology4, Albertinen-KH, Hamburg, FRG Ah~lra( I
Background: The v a l u e of p o s t - n e p h r e c t o m y r a d i o t h e r a p y for renal cell c a r c i n o m a is controversial, and c o n f l i c t i n g results have been reported. The b e n e f i t of r a d i o t h e r a p y as an a d j u v a n t m o d a l i t y is limited, if the p a t t e r n of failure is m a i n l y by d i s t a n t metastases. Purpose: To i d e n t i f y the p a t t e r n of failure in p a t i e n t s w i t h r e s e c t e d renal cell c a r c i n o m a (RCC). M a t e r i a l & Methods: The r e c o r d s of 116 patients w i t h u n i l a t e r a l n o n - m e t a s t a t i c RCC, who w e r e t r e a t e d w i t h d e f i n i t i v e surgery and r e f e r r e d to the O t t a w a R e g i o n a l Cancer Centre b e t w e e n 1977 and 1988 w e r e reviewed. Distribution by stage included: T1 = 3 patients, T2 = 42 patients, T3 = 71 patients. The m e d i a n f o l l o w - u p was 44 months, w i t h a range of 4-267 months. Results: L o c o - r e g i o n a l failure (LRF) d e v e l o p ed in 8 patients, y i e l d i n g a 7-year a c t u a r i a l i n c i d e n c e of 8% for LRF, as first event. Nine p a t i e n t s d e v e l o p e d local or regional r e c u r r e n c e + d i s t a n t failure, and 58 p a t i e n t s had d i s t a n t m e t a s t a s e s only. S e v e n - y e a r a c t u a r i a l incidence of d i s t a n t failure was 55%. The o v e r a l l 7-year a c t u a r i a l survival rate was 40%, and c a u s e - s p e c i f i c s u r v i v a l was 45%. Conclusion: LRF was rare f o l l o w i n g n e p h r e c t omy. This d a t a does not support the role of a d j u v a n t r a d i a t i o n t h e r a p y in this disease.
Background: In the last years the use of carboplatin as a single agent adjuvant treatment (one or two coupeS) in stage I seminoma became more interesting. Our aim was to compare this form of treatment with adiuvant radiotherapy. Material and Methods: From 1991-1993 58 patients with stage I seminoma received either single agent platinum (31 patients)(group l) or radiotherapy (27 patients)(group If) as adjuvant following orchiedemy. Patients treated with single agent platinum received one course of 400 mgJm2 Carboplatin. All patients had B-HCG-negative tumors. The median age in group I was38 years and in group |1 42 years. All patients of group II had Tl-tumors, similar to group I with 29 patients TI-, one with a T2- and one with a T3-tumor. Results: All patients were scored prospectively. With a median follow up of 35 months in group I and 30 months in group [I (range: 19-42 months) no progression of disease was seen neither in group I or group [[. No late complications were seen until yet. Acute side effects were milde and consisted of nausea in 30% of group l] and 25% in group I.White plateletts-side effects WHO-grade H were seen in 5 patients of group I. Condusior~.. The results of both treatment forms seems to be comparable, because most failures in the treatent of stage I seminoma accure within the first two years after treatment. However, late results of radiotherapy in seminoma patients are well known, but not for patients treated with carboplatin. Long term results and randomized prospective clinical trials are necessary to confirm these preliminary results.
498
ASSESSMENT OF FUNCTIONAL STATUS IN PATIENTS (pts) W I T H L O C A L I Z E D BLADDER C A N C E R (BC)
THE OBSOLESCENCE OF CLINICAL STAGING IN CARCINOMA OF THE PROSTATE TREATED BY EXTERNAL BEAM RADIATION THERAPY
C. Kamby, L. Sengelov Department of Oncology, Copenhagen University Hospital in Herlev, Denmark.
D.G. McGowan, Cross Cancer Institute, Edmonton, Canada
In August 1987, Prostatic Specific Antigen (PSA) estimations were introduced at the Cross Cancer Institute. Between then and the end of 1991, a total of 462 patients received radical radiation therapy for their prostatic carcinoma. All had a diagnosis of adenocarcinoma of the prostate and all had the pretreatment PSA available. Of these, 268 were treated with external beam radiation therapy and form the basis for this report. Analysis of this group of patients was conducted by PSA failure free survival (PSAFF), clinical disease free survival (DFS), disease specific survival (DSS) and overall survival (OVS). Using PSAFF survival, three major prognostic factors were identified, which in order of significance am pretreatment PSA (p < 1 x 10"28), local extent of disease (p < 1 x 10-7), and histological grade (p < 1 x 10"6). The corresponding p-values on a DFS basis are < 1 x 10-12,< 1 x 10-6 and < 0.0002. When multivariant analysis was performed using PSAFF, pretreatment PSA became the single most important prognostic factor (p < 1 x 10"12), while histological grade became of borderline significance (p = 0.03). Local extent of disease was of no prognostic significance (p < 0.12). The corresponding p-values on a DFS basis are < 1 x 10-5, < 0.09 and < 0.12.
Performance status (PS) score is an important prognostic factor for response and survival of pts with cancer. It is important to evaluate the functional status when conducting retrospective studies on prognostic factors. Ahn : To evaluate reliability and validity of retrospective assessment of PS based on information from the records. Material and methods: The records of 149 pts with Iocoregional BC referred for curative radiotherapy were blindly scored according to the WHO PS scale, twice by two investigators. The results were analyzed in a Cox model together with other potential prognostic factors for survival. Results : The median time of observation was 126 months (range 5220). The median survival was 12,9 months: 12 pts were alive at follow-up. The intra- and interobserver Kappa coefficients of PS were 56-78% and 44-61%. The four assessments were all significantly related to survival, Multivariate analyses showed that sex. platelet count, and each of the four PS scores were independent prognostic factors. C o n c l u s i o n : Retrospective scoring of performance status is a reproducible and reliable tool, which has additive prognostic in[ormation. Retrospective evaluation of prognostic factors in pts with BC should include an assessment of PS.
These results suggest that the current clinical staging system is irrelevant. A new clinical staging system which takes account of the pretreatment PSA requites development.
501
500 FOLLOWING CARCINOMA
PATTERN OF F A I L U R E S U R G I C A L R E S E C T I O N OF RENAL C E L L
I. Aref, D. Salhani Ottawa Regional
Cancer
Centre,
G. Bociek,
Ottawa,
Canada
Radiotherapy or single agent carboplafin as adjuvant in' stage I semlnoma- preliminary results T. Wiegel1, U. Steiner2, S. Weinknecht3, K.P. Diekmann4, W. HinkelbeinI - Dept. of RadiotherapyI and Dept. of Urology2, UniversityHospital Benjamin Franklin, Dept. of Urology3, KH am Urban, Berlin and Dept. of Urology4, Albertinen-KH, Hamburg, FRG Ah~lra( I
Background: The v a l u e of p o s t - n e p h r e c t o m y r a d i o t h e r a p y for renal cell c a r c i n o m a is controversial, and c o n f l i c t i n g results have been reported. The b e n e f i t of r a d i o t h e r a p y as an a d j u v a n t m o d a l i t y is limited, if the p a t t e r n of failure is m a i n l y by d i s t a n t metastases. Purpose: To i d e n t i f y the p a t t e r n of failure in p a t i e n t s w i t h r e s e c t e d renal cell c a r c i n o m a (RCC). M a t e r i a l & Methods: The r e c o r d s of 116 patients w i t h u n i l a t e r a l n o n - m e t a s t a t i c RCC, who w e r e t r e a t e d w i t h d e f i n i t i v e surgery and r e f e r r e d to the O t t a w a R e g i o n a l Cancer Centre b e t w e e n 1977 and 1988 w e r e reviewed. Distribution by stage included: T1 = 3 patients, T2 = 42 patients, T3 = 71 patients. The m e d i a n f o l l o w - u p was 44 months, w i t h a range of 4-267 months. Results: L o c o - r e g i o n a l failure (LRF) d e v e l o p ed in 8 patients, y i e l d i n g a 7-year a c t u a r i a l i n c i d e n c e of 8% for LRF, as first event. Nine p a t i e n t s d e v e l o p e d local or regional r e c u r r e n c e + d i s t a n t failure, and 58 p a t i e n t s had d i s t a n t m e t a s t a s e s only. S e v e n - y e a r a c t u a r i a l incidence of d i s t a n t failure was 55%. The o v e r a l l 7-year a c t u a r i a l survival rate was 40%, and c a u s e - s p e c i f i c s u r v i v a l was 45%. Conclusion: LRF was rare f o l l o w i n g n e p h r e c t omy. This d a t a does not support the role of a d j u v a n t r a d i a t i o n t h e r a p y in this disease.
Background: In the last years the use of carboplatin as a single agent adjuvant treatment (one or two coupeS) in stage I seminoma became more interesting. Our aim was to compare this form of treatment with adiuvant radiotherapy. Material and Methods: From 1991-1993 58 patients with stage I seminoma received either single agent platinum (31 patients)(group l) or radiotherapy (27 patients)(group If) as adjuvant following orchiedemy. Patients treated with single agent platinum received one course of 400 mgJm2 Carboplatin. All patients had B-HCG-negative tumors. The median age in group I was38 years and in group |1 42 years. All patients of group II had Tl-tumors, similar to group I with 29 patients TI-, one with a T2- and one with a T3-tumor. Results: All patients were scored prospectively. With a median follow up of 35 months in group I and 30 months in group [I (range: 19-42 months) no progression of disease was seen neither in group I or group [[. No late complications were seen until yet. Acute side effects were milde and consisted of nausea in 30% of group l] and 25% in group I.White plateletts-side effects WHO-grade H were seen in 5 patients of group I. Condusior~.. The results of both treatment forms seems to be comparable, because most failures in the treatent of stage I seminoma accure within the first two years after treatment. However, late results of radiotherapy in seminoma patients are well known, but not for patients treated with carboplatin. Long term results and randomized prospective clinical trials are necessary to confirm these preliminary results.