Acta Oncologica最新文献

Purpose: This study aims to identify and summarize evidence on the effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, health-related quality of life (HRQoL), feasibility of the interventions, in patients with malignant lymphoma undergoing chemotherapy.

Methods: A systematic search was conducted in six electronic databases and trials registers on November 15, 2023. Peer-reviewed randomized controlled trials (RCTs) comparing exercise intervention with controls/usual care in adults (≥18 years) diagnosed with Hodgkin's lymphoma and non-Hodgkin's lymphoma undergoing chemotherapy were considered for inclusion. All study authors were contacted to obtain unpublished subgroup data. Two reviewers independently screened and extracted data and assessed the quality of evidence using the revised Cochrane risk-of-bias tool for randomized trials.

Results: Six RCTs published between 2009 and 2021, with 838 participants, were included. Due to clinical heterogeneity, a meta-analysis was not feasible, therefore the results were synthesized narratively. Exercise interventions during treatment were found to be feasible with few adverse events reported. The included studies indicate positive effects of exercise during chemotherapy on muscle mass, muscle strength, functional performance, aerobic capacity, and HRQoL compared to usual care.

Interpretation: Despite extensive search criteria, a limited number of heterogenous studies were eligible, which may explain the very low certainty of evidence for all outcomes. Nonetheless, exercise-based interventions conducted during treatment were feasible, safe and potentially effective. Further studies are needed to guide future exercise recommendations for these patients.

Background and purpose: Coronavirus disease 2019 (COVID-19) caused a need for reorganization in the healthcare systems. First, we aimed to determine the impact of the COVID-19 pandemic on time to treatment in head and neck cancer (HNC) patients. Second, we aimed to determine the impact of COVID-19 on tumor stage and changes in treatment regimens used.

Material and methods: A systematic search in PubMed and Embase was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were: (1) Studies including patients with head and neck squamous cell carcinomas; (2) Studies containing a comparison of time to treatment; (3) Studies containing a well-defined time interval with restrictions on health care due to COVID-19 and a well-defined time interval without restrictions.

Results: A total of 19 studies were included comprising 24,898 patients treated for HNC cancer. Six studies (10.1% of the patients) reported an increase in waiting time within at least one interval, while seven studies reported a decrease (83.2% of the patients), and six studies found no significant effect. No changes in treatment modalities were observed. Seven of 15 studies (12.7% of the patients) observed an increase in either overall stage, size, or tumor node and metastasis classification during the COVID-19 pandemic. Among these, two studies reported increased waiting times as well.

Interpretation: The impact of the COIVD-19 pandemic on time to treatment was heterogenous and subject to considerable intercountry and interregional variations. A tendency toward a higher T-classification was observed. In conclusion, otorhinolaryngology departments demonstrated resilience, as the pandemic led to only slight alterations in time to treatment.

Background and purpose: In the late 1990s, the Nordic countries, with Norway at the top, were among the countries with the highest prostate cancer mortality in the world. We present updated mortality rates from the Nordic countries and discuss possible interpretations of changes in trends.

Material and methods: Age-standardized rates for prostate-specific mortality in 1985-2022, estimated lifetime risk of death (0-84 years) and annual changes in mortality were obtained from the NORDCAN database. Joinpoint regression was used to evaluate trend changes for the period 1985-2022. For comparison, rates from other European countries from 2022 were retrieved from the GLOBOCAN database.

Results: Between 1995-99 and 2018-22, mortality in men aged 40-84 years decreased from 38% in Denmark to 59% in Norway. By 2022 Norway had the second lowest mortality among the Nordic countries overall, and the lowest under 85 years. The life-time risk of dying from prostate cancer declined from 5.6-7.1% in 1995-99 to 3.1-4.2% in the last 5-year period. During the last years mortality has decreased most rapidly in Sweden (4.5% annually from 2016) and Norway (4.3% annually from 2014). The Nordic countries are no longer among the countries with the highest mortality in Europe.

Interpretation: Mortality from prostate cancer has decreased significantly in the Nordic countries over the last decades. Possible explanatory factors are likely to include improvements in prostate cancer management strategies and treatment.

Introduction: Organ preservation (OP) strategies are gaining interest in improving the quality of life in the management of rectal cancer, particularly for tumors located in the distal or middle rectum. The optimal OP protocol is still not standardized and relies on randomized trials. This review summarizes past and ongoing studies on OP protocols for adenocarcinoma of the distal and middle rectum.

Method: We searched for articles and abstracts on randomized clinical trials investigating OP approaches for rectal cancer, including data presented at the LUCARRE Congress held in Nice on November 25, 2023, covering ongoing and recently published trials on rectal preservation.

Results: Our review's findings are presented in four tables: the first evaluates key trials with overall survival (OS) as the primary endpoint; the second provides an overview of past Phase III trials; the third reviews Phase II/III trials that specifically focus on local excisions (LE); and finally, the fourth summarizes ongoing trials. Each table is accompanied by detailed comments elucidating the significance and implications of the presented data, alongside a review of current guidelines.

Interpretation: We highlight the growing interest in OP strategies for rectal cancer management to enhance patients' quality of life. Despite the lack of international consensus on the optimal OP protocol, past and ongoing randomized trials provide valuable findings into the evolving management strategies of rectal cancer treatment. The presented data supports the role of randomized phase III trials to provide evidence for a change in clinical practice.

Introduction: To target psychological support to cancer patients most in need of support, screening for psychological distress has been advocated and, in some settings, also implemented. Still, no prior studies have examined the appropriate 'dosage' and whether screening for distress before cancer treatment may be sufficient or if further screenings during treatment are necessary. We examined the development in symptom trajectories for breast cancer patients with low distress before surgery and explored potential risk factors for developing burdensome symptoms at a later point in time.

Methods: In total, 299 patients newly diagnosed with breast cancer who scored < 7 on the distress thermometer were included between August 2017 and October 2019 at the Department of Breast Surgery, Rigshospitalet, Copenhagen. Patients were followed through electronic questionnaires at baseline before surgery and after 6, 12, and 18 months. We used latent class mixed models to identify sub-groups of patients with similar development in distress, anxiety, depression, breast cancer-specific health-related quality of life, self-efficacy, and fear of recurrence over time. Logistic and multinomial regression analyses were applied to examine clinical and sociodemographic factors associated with specific symptom trajectories.

Results: We did not identify any sub-groups of women with low distress at diagnosis who developed disabling psychological symptoms up to 18 months after diagnosis. However, we did identify a sub-group of 52% of the women who experienced persistent mild anxiety (Generalised Anxiety Disorder [GAD]-7 score 5-9). Adjusted for baseline treatment modalities and sociodemographic characteristics, women having low social support (odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.07-7.87) or living with a partner (OR: 3.18; 95% CI: 1.38-7.34) were more likely to experience persistent mild anxiety.

Interpretation: The results show that the majority of women with low distress at breast cancer diagnosis do not experience an increase in psychological symptoms over time. Screening for distress at cancer diagnosis may be an essential step to identify most breast cancer patients in need of professional support for psychological symptoms.

Background and purpose: Comprehensive data on factors affecting partnership satisfaction among adolescents and young adult (AYA) cancer survivors are limited. Our study examines partnership satisfaction, sexual satisfaction, and attachment insecurities, exploring how attachment-related anxiety and avoidance influence the relationship between sexual and partnership satisfaction across major tumor entities in this population.

Patients and methods: We utilized data from two measurement time points (t1 and t6) of the AYA-LE study, a prospective longitudinal investigation examining the temporal course and associated factors of life satisfaction and psychological distress among AYA cancer survivors. We examined the mediating effect of attachment insecurities (ECR-RD) on the relationship between sexual satisfaction (FLZ-Sex) and partnership satisfaction (PFB), while controlling for sociodemographic and clinical characteristics, in a sample of N = 275 participants.

Results: Higher sexual satisfaction was correlated with lower attachment-related anxiety (r = -0.51, p < 0.001) and lower attachment-related avoidance (r = -0.49, p < 0.001). Both lower attachment-related anxiety and attachment-related avoidance were correlated with higher partnership satisfaction (r = -0.64, p < 0.001 and r = -0.72, p < 0.001, respectively). Sexual satisfaction partially predicted partnership satisfaction of AYA cancer survivors through attachment-related anxiety and attachment-related avoidance while the mediating effect accounted for 75% of the total effect.

Interpretation: The associations between sexual satisfaction, partnership satisfaction, and attachment highlight the need to address emotional and relational aspects in supportive care for AYA cancer survivors. There is a clear need for more targeted studies on attachment patterns, sexual satisfaction, and partnership satisfaction in this specific population to further refine and validate these approaches.

Background and purpose: Lymphedema is a debilitating late effect of cancer treatments, yet its prevalence beyond breast cancer remains understudied. This study examined the prevalence of lymphedema symptoms across cancer diagnoses and their association with depression, pain interference, and health-related quality of life (HRQoL).

Patients/material and methods: This cross-sectional study was conducted at the Department of Oncology, Copenhagen University Hospital, from February to April 2021, as part of a broader investigation into cancer-related late effects. Here, we present data from patients in follow-up who received online lymphedema symptom assesments (swelling, heaviness, or tightness). Utilized questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the Major Depression Inventory, and the Brief Pain Inventory. Associations between lymphedema symptoms and depression, pain interference, and HRQoL were examined via multiple linear regression.

Results: Of 1,901 patients in follow-up who received the lymphedema symptom items, 1,296 responded. Most participants had breast cancer (48%), followed by testicular (17%), gynecological (16%), and head/neck cancer (11%). One-third (n = 397) reported lymphedema symptoms, with 38% (n = 152) reporting moderate/severe symptoms. The highest symptom prevalence was seen in gynecological cancer (59%), followed by head/neck (41%), breast (21%), and testicular cancer (19%). Participants with moderate/severe lymphedema symptoms were significantly more likely to report higher depression and pain interference scores and lower HRQoL scores compared to those with no/mild symptoms.

Interpretation: Lymphedema symptoms are highly prevalent among patients who have completed treatment for diverse cancers and associated with higher scores for depression and pain interference, and lower HRQoL.

Background: The prognosis of patients with advanced soft tissue sarcoma (STS) remains dismal. Trofosfamide (TRO) has been proposed as a well-tolerated oral maintenance therapy. This retrospective analysis aims to determine the value of this therapy.

Methods: Fifty-nine patients with advanced STS who received TRO maintenance therapy between 2016 and 2022 were reviewed and analysed regarding clinical parameters and outcomes.

Results: The median age was 48 years; the most common histological subtype was synovial sarcoma (n = 22, 37%), and 71% of patients (n = 42) presented with metastatic disease. No radiological evidence of disease (NED) before the start of maintenance was reported in 36% of patients (n = 21). The median follow-up was 38.2 months with a median maintenance duration of 9.0 months. The median event-free survival (EFS) and overall survival (OS) were 9.5 and 33.2 months, respectively. In metastatic patients achieving NED before the initiation of TRO, the median EFS was 29.4 months, while the median OS was not reached. In metastatic patients with anthracycline + ifosfamide (AI) as first-line induction therapy without prior metastasis-directed local therapy, the median EFS and OS from the start of AI were 13.9 and 26.8 months, respectively. Multivariate analysis of the overall cohort demonstrated that NED before the start of maintenance was significantly associated with a prolonged EFS (p = 0.024, hazard ratio [HR] = 0.26), and G2 histology correlated with longer OS (p = 0.030, HR = 0.16, reference: G3).

Interpretation: Oral maintenance therapy with TRO appears to improve outcomes in patients with advanced STS. Metastatic patients who achieve NED through prior metastasectomy may particularly benefit from TRO maintenance.

Background and purpose: To present the clinical outcomes of two series of patients treated with carbon-ion radiotherapy (CIRT) and definitive photon radiotherapy (RT) for adenoid cystic carcinoma of the head and neck (HN-ACC).

Material and methods: The first cohort of six patients was referred from Oslo University Hospital (OUS) to Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) for CIRT in 2014-2017. The second cohort included 18 patients treated with definitive photon RT at OUS in 2005-2017. The primary endpoint was an evaluation of osteoradionecrosis (ORN) in the two cohorts. The secondary endpoints were treatment efficacy by local control (LC), progression-free survival (PFS), and overall survival (OS).

Results: The tumor stage was T4 for all the patients in the CIRT group and 15 (84%) in the photon group. There were three (50%) patients with grade 3 ORN in the CIRT group compared to one (6%) with grade 3 ORN in the photon group (p = 0.05). The 5-year LC (95% CI), PFS, and OS rates in the CIRT group and the photon group were 33% (11-100) and 39% (19-76), 17% (9-100) and 23% (2-59), and 80% (52-100) and 50% (31-82), respectively.

Interpretation: Half of the patients in the CIRT cohort experienced ORN requiring surgical management during the follow-up. Patients with ACC referred for CIRT often have a worse prognosis and more advanced disease than patients treated with photons. When returning from the referring center, these patients need close follow-up often in collaboration with treating centers to manage toxicity that impacts quality of life.

Objective: This study aims to assess the long-term safety and efficacy of adding pazopanib to neo-adjuvant radiotherapy followed by surgery in patients with high-risk non-metastatic soft tissue sarcoma of the trunk and extremities treated in the PASART-1 and PASART-2 trials, as well as to compare the PASART cohorts to a control cohort receiving standard treatment during the same time period from the Netherlands Cancer Registry (IKNL) to investigate if adding pazopanib improves Overall Survival (OS).

Methods: Updated follow-up data on disease control, survival and long-term toxicities of the PASART-trials were extracted from electronic patient records. The effect of adding pazopanib to neo-adjuvant radiotherapy on OS was investigated by comparing the combined PASART cohorts to the IKNL cohort via direct comparison and exact matching analysis.

Results: PASART-trials included 34 patients, IKNL cohort included 487 patients. After a median follow-up of 75.4 months (range: 30-131 months) the 1-year, 2-year and 5-year OS in the PASART-trials were 97% (95% confidence interval [CI]: 91.5-100), 85.3% (95% CI: 74.2-98.1), 79.3% (95% CI: 66.8-94.2), respectively. Matching resulted in 23 PASART and 89 IKNL patients. Adding pazopanib did not significantly improve OS when compared to standard treatment (IKNL) in a direct comparison (hazard ratio [HR]: 0.58; 95% CI: 0.30-1.13) or matched analysis (HR: 0.70; 95% CI: 0.29-1.73). Long-term toxicities, mainly fibrosis (n = 6) and edema (n = 2), were observed in 11 PASART patients and comparable to historical controls.

Interpretation: The addition of pazopanib had tolerable long-term toxicity but did not improve OS when compared to a control cohort receiving standard treatment.