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P44 Tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer in aged patients
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Critical Reviews in Oncology/Hematology 72S1 (2009)
health, participants were asked to recommend chemotherapy in addition to endocrine therapy for each patient based on clinicopathologic data without and with knowledge of the Oncotype DX RS. Changes in participants’ recommendations following inclusion of RS data were compared based on the patient’s age group. Results: Given results that patients with low risk disease and possibly intermediate risk disease are not likely to benefit from chemotherapy, the concordance of therapeutic recommendations for chemotherapy based on clinicopathologic findings with and without the Oncotype DX RS was 52.79% (38.8%-62.0%) for patients <65 and 55.3% (39.4%-72.7%) for patients 65 (p = 0.9434). Overestimation of treatment with chemotherapy was determined for 33.79% (15.7%-47.1%) of patients <65 and 31.44% (18.2%-45.4%) of patients 65 (p = 0.8584). Underestimation of treatment with chemotherapy was found for 13.41% (7.4%-22.3%) of patients <65 and 13.29% (6.1%-24.3%) of patients 65 (p = 0.9925). Further, no statistically significant differences were found between surgeons and medical oncologists in therapeutic recommendations for either age group. Conclusions: The Oncotype DX assay may be a valid tool in risk assessment of distant relapse due to breast cancer. The RS also correlates with the groups that would derive the least and the greatest benefits from chemotherapy. Results from this study indicated that the Oncotype DX RS affects therapeutic decision-making independent of age for patients with early stage hormone receptor positive breast cancer. P43 Breast cancer in the elderly population S. Gaskell1 *, A. Farooq1 , R.A. Audisio2 . 1 Southport and Ormskirk District General Hospital NHS Trust, Southport, United Kingdom, 2 St. Helens & Knowsley Teaching Hospitals NHS Trust, Whiston, United Kingdom Introduction: The treatment of breast cancer in the elderly is a topic of debate and is becoming increasingly important with the expanding elderly population. Clinicians are often guilty of under-treating elderly patients. As a result, patients can develop unnecessary complications and thus experience worse outcomes than they deserve. Case report: We report on the oldest radiotherapy-induced case of angiosarcoma affecting a 99 year old patient. The patient presented initially at age 87 with invasive ductal carcinoma of the right breast which was treated with wide local excision and radiotherapy to the breast and axilla. No axillary dissection was performed and the patient was not staged. Two years later, aged 89, the patient developed recurrent disease in the axilla which was treated with a surgical dissection of the axillary nodes (level I-II). After ten years of unremarkable surveillance the patient, who is now 99 years of age, re-presented with a pigmented lesion in the axilla. Investigation of this proved it to be an angiosarcoma. The lesion was excised under local anaesthetic; margins were clear but there was evidence of microvascular invasion. The angiosarcoma promptly re-presented only 4 months after removal. The patient is now receiving radiotherapy to control the local growth which is beyond surgical management. Discussion: Breast cancer is the most common cancer affecting older women. There are no guidelines on how to treat breast cancer in older patients, however, a consensus has been put forward by the SIOG breast task force (1). The number of older females not receiving standard treatment remains high and staging is often inadequate and/or inaccurate. As a result, these elderly patients are under-staged, under-treated and under-represented in clinical trials. Substandard treatment has significant drawbacks. Furthermore, assessment of the wide ranging needs of elderly patients is not done enough despite evidence supporting the use of screening tools such as PACE (2). It is hoped that the available data and emerging evidence which currently suggests that treatment outcomes for fit, elderly cancer patients can be similar to those of younger patients, will pave the way for formal treatment guidelines based upon solid scientific evidence. Reference(s) [1] Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M; International Society of Geriatric Oncology. Lancet Oncol. 2007 Dec;8(12):1101−15. [2] PACE participants, Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Bozzetti F, Colledan M, Wildiers H, Stotter A, Capewell A, Marshall E. Crit Rev Oncol Hematol. 2008 Feb;65(2):156−63.
Biology P44 Tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer in aged patients A.K. Zacharof *, D. Dimitrakis, D. Poulikakos, A. Margaritis, A. Kioumourtzis. 2nd Department of Internal Medicine, Hellenic Red Cross Hospital, Athens, Greece Purpose of the study: To evaluate the presence of tumor markers during hospitalization for the diagnosis of cancer in aged patients with idiopathic deep venous thrombosis. Method(s): The retrospective study includes 96 aged patients (>65 yrs old) hospitalized during the last 10 years in our Department with documented Deep Venous Thrombosis (DVT) who lacked a predisposing cause to DVT. We determined in serum: carcinoembryonic antigen, alpha fetoprotein, CA 19−9, CA 125, beta-2-microglobulin, PSA (prostate-specific antigen) in the males and CA15−3 in the women. The patients were evaluated for cancer during hospitalization. Result(s): A positive tumor marker at least was detected in 46 patients (48%). Cancer was diagnosed in 16 patients (16%), 8 in the group with elevated tumor markers and 8 in the group with normal tumor markers. We don’t find significant differences in cancer incidence between both groups. However, of the 8 cases of cancer diagnosed in the group with elevated markers only 2 was considered true positive since in the others 6 cases the elevate tumor marker was not appropriated with the cancer diagnosed. According to these results was obtained a sensitivity of 12%, a specificity of 52%, a positive predictive value of 5% and a negative predictive value of 75%. Conclusion(s): The cancer incidence is similar to previous series. We have found a poor sensitivity, specificity and positive predictive value. However, the negative predictive value was of 75%, and the elderly patients, who were normal for results of all tumor markers, were asymptomatic during admission and they hadn’t a subsequent cancer diagnosis.
Colorectal cancer P45 Clinical impact and QoL in older colon cancer patients after chemotherapy N. Pilnik *, M. Ibero, D. Carri. Hospital Transito, Hospital Frances, Cordoba University, Argentina Purpose of the study: About 60% of all colorectal cancers occur after the age of 50. This tumor is the second most common cause of cancer and the death by neoplasm. Beside, aging may affect several aspects of pharmacology due to progressive reserve deteriorations and the comorbidities presence; which may influence the tolerance to treatment. Method(s): 90 colorectal cancer pts, aged 65−78 years, who underwent surgery and Ch/Rt were included. Pts were divided in two groups: I: 70 and II >70 years. Patient selection was conducted using General Geriatric Assessment. All pts had adequate cardiac, hepatic, renal and bone marrow functions. Comorbidities studied were: hypertension, diabetes, COPD, arrhythmia, coronary disease, and gastrointestinal disease. Toxicities were studied following the WHO criteria and correlated according to age, Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), PS, WL comorbidities, and the use of more than 3 drugs (Polypharmacy), in addition to Ch/Rxt. QoL was studied through the evaluation of ADL, IADL, and PS evolution. Statistical Methods: Pearson’s Chi-Square test, Kaplan Meier’s Survival curves.
Critical Reviews in Oncology/Hematology 72S1 (2009)
health, participants were asked to recommend chemotherapy in addition to endocrine therapy for each patient based on clinicopathologic data without and with knowledge of the Oncotype DX RS. Changes in participants’ recommendations following inclusion of RS data were compared based on the patient’s age group. Results: Given results that patients with low risk disease and possibly intermediate risk disease are not likely to benefit from chemotherapy, the concordance of therapeutic recommendations for chemotherapy based on clinicopathologic findings with and without the Oncotype DX RS was 52.79% (38.8%-62.0%) for patients <65 and 55.3% (39.4%-72.7%) for patients 65 (p = 0.9434). Overestimation of treatment with chemotherapy was determined for 33.79% (15.7%-47.1%) of patients <65 and 31.44% (18.2%-45.4%) of patients 65 (p = 0.8584). Underestimation of treatment with chemotherapy was found for 13.41% (7.4%-22.3%) of patients <65 and 13.29% (6.1%-24.3%) of patients 65 (p = 0.9925). Further, no statistically significant differences were found between surgeons and medical oncologists in therapeutic recommendations for either age group. Conclusions: The Oncotype DX assay may be a valid tool in risk assessment of distant relapse due to breast cancer. The RS also correlates with the groups that would derive the least and the greatest benefits from chemotherapy. Results from this study indicated that the Oncotype DX RS affects therapeutic decision-making independent of age for patients with early stage hormone receptor positive breast cancer. P43 Breast cancer in the elderly population S. Gaskell1 *, A. Farooq1 , R.A. Audisio2 . 1 Southport and Ormskirk District General Hospital NHS Trust, Southport, United Kingdom, 2 St. Helens & Knowsley Teaching Hospitals NHS Trust, Whiston, United Kingdom Introduction: The treatment of breast cancer in the elderly is a topic of debate and is becoming increasingly important with the expanding elderly population. Clinicians are often guilty of under-treating elderly patients. As a result, patients can develop unnecessary complications and thus experience worse outcomes than they deserve. Case report: We report on the oldest radiotherapy-induced case of angiosarcoma affecting a 99 year old patient. The patient presented initially at age 87 with invasive ductal carcinoma of the right breast which was treated with wide local excision and radiotherapy to the breast and axilla. No axillary dissection was performed and the patient was not staged. Two years later, aged 89, the patient developed recurrent disease in the axilla which was treated with a surgical dissection of the axillary nodes (level I-II). After ten years of unremarkable surveillance the patient, who is now 99 years of age, re-presented with a pigmented lesion in the axilla. Investigation of this proved it to be an angiosarcoma. The lesion was excised under local anaesthetic; margins were clear but there was evidence of microvascular invasion. The angiosarcoma promptly re-presented only 4 months after removal. The patient is now receiving radiotherapy to control the local growth which is beyond surgical management. Discussion: Breast cancer is the most common cancer affecting older women. There are no guidelines on how to treat breast cancer in older patients, however, a consensus has been put forward by the SIOG breast task force (1). The number of older females not receiving standard treatment remains high and staging is often inadequate and/or inaccurate. As a result, these elderly patients are under-staged, under-treated and under-represented in clinical trials. Substandard treatment has significant drawbacks. Furthermore, assessment of the wide ranging needs of elderly patients is not done enough despite evidence supporting the use of screening tools such as PACE (2). It is hoped that the available data and emerging evidence which currently suggests that treatment outcomes for fit, elderly cancer patients can be similar to those of younger patients, will pave the way for formal treatment guidelines based upon solid scientific evidence. Reference(s) [1] Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M; International Society of Geriatric Oncology. Lancet Oncol. 2007 Dec;8(12):1101−15. [2] PACE participants, Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Bozzetti F, Colledan M, Wildiers H, Stotter A, Capewell A, Marshall E. Crit Rev Oncol Hematol. 2008 Feb;65(2):156−63.
Biology P44 Tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer in aged patients A.K. Zacharof *, D. Dimitrakis, D. Poulikakos, A. Margaritis, A. Kioumourtzis. 2nd Department of Internal Medicine, Hellenic Red Cross Hospital, Athens, Greece Purpose of the study: To evaluate the presence of tumor markers during hospitalization for the diagnosis of cancer in aged patients with idiopathic deep venous thrombosis. Method(s): The retrospective study includes 96 aged patients (>65 yrs old) hospitalized during the last 10 years in our Department with documented Deep Venous Thrombosis (DVT) who lacked a predisposing cause to DVT. We determined in serum: carcinoembryonic antigen, alpha fetoprotein, CA 19−9, CA 125, beta-2-microglobulin, PSA (prostate-specific antigen) in the males and CA15−3 in the women. The patients were evaluated for cancer during hospitalization. Result(s): A positive tumor marker at least was detected in 46 patients (48%). Cancer was diagnosed in 16 patients (16%), 8 in the group with elevated tumor markers and 8 in the group with normal tumor markers. We don’t find significant differences in cancer incidence between both groups. However, of the 8 cases of cancer diagnosed in the group with elevated markers only 2 was considered true positive since in the others 6 cases the elevate tumor marker was not appropriated with the cancer diagnosed. According to these results was obtained a sensitivity of 12%, a specificity of 52%, a positive predictive value of 5% and a negative predictive value of 75%. Conclusion(s): The cancer incidence is similar to previous series. We have found a poor sensitivity, specificity and positive predictive value. However, the negative predictive value was of 75%, and the elderly patients, who were normal for results of all tumor markers, were asymptomatic during admission and they hadn’t a subsequent cancer diagnosis.
Colorectal cancer P45 Clinical impact and QoL in older colon cancer patients after chemotherapy N. Pilnik *, M. Ibero, D. Carri. Hospital Transito, Hospital Frances, Cordoba University, Argentina Purpose of the study: About 60% of all colorectal cancers occur after the age of 50. This tumor is the second most common cause of cancer and the death by neoplasm. Beside, aging may affect several aspects of pharmacology due to progressive reserve deteriorations and the comorbidities presence; which may influence the tolerance to treatment. Method(s): 90 colorectal cancer pts, aged 65−78 years, who underwent surgery and Ch/Rt were included. Pts were divided in two groups: I: 70 and II >70 years. Patient selection was conducted using General Geriatric Assessment. All pts had adequate cardiac, hepatic, renal and bone marrow functions. Comorbidities studied were: hypertension, diabetes, COPD, arrhythmia, coronary disease, and gastrointestinal disease. Toxicities were studied following the WHO criteria and correlated according to age, Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), PS, WL comorbidities, and the use of more than 3 drugs (Polypharmacy), in addition to Ch/Rxt. QoL was studied through the evaluation of ADL, IADL, and PS evolution. Statistical Methods: Pearson’s Chi-Square test, Kaplan Meier’s Survival curves.