Current guidelines recommend Surgery (S) and/or radiation therapy (RT) for early stage (IB-IIA) cervical carcinoma (CC) based on the pivotal Landoni et al randomized study published twenty years ago. Currently, combined Chemotherapy (CT) and RT (RT) in the postoperative (PO) or the definitive (DEF) setting is considered standard of care in high-risk features tumors. Using the National Cancer Data Base (NCDB), our study aims to compare the outcomes of PO_CRT versus DEF_CRT in the CT era. Between 2004 and 2013, 13338 CC patients were diagnosed with early stage (IB-IIA) node negative disease. CRT formed 80% of 3839 patients receiving DEF RT while PORT and PO_CRT were respectively delivered in 10% and 23% of 4083 patients undergoing radical hysterectomy. Chi-square test assessed the distribution of demographic, tumor and treatment variables in PO_CRT (1063) versus DEF_CRT (3075) groups. Kaplan-Meier method estimated overall survival (OS) Proportional hazards model estimated OS hazard ratios for prognostic factors including age, comorbidity, race, tumor size, grade, lymph node status, and histology. With a median follow up period of 34 months, the cohort included 4138 patients with age at diagnosis ranging from 19 to 90 years (median 48 years). Larger tumor size, advanced age, higher grade and squamous histology were significantly more frequent in the DEF_CRT group. The 5-year OS was 80% vs. 68% (P<0.0001) favoring PO_CRT, which reduced mortality hazards ratio (HR) to 0.56 (95% confidence intervals (CI) 0.46-0.67) vs. DEF_CRT. On multivariate analysis, age older than 65 years (HR: 1.36; P = 0.03), high Charlson comorbidity score (HR: 1.32; P = 0.01) and high-grade (HR: 1.8; P = 0.01), were significant predictors of poor outcome. PO_CRT (HR: 0. 59; P = 0.005), and negative lymph nodes (HR: 0. 54; P = 0.003), significantly predicted better survival. Adjusted HR using propensity score matching did not alter the results. In spite of the retrospective nature of the study and the covariates’ imbalance, our analysis hints that adjuvant chemoradiation therapy leads to better survival in early stage cervical carcinoma compared to definitive chemoradiation therapy. Further studies are warranted to establish this paradigm in the chemotherapy era.

The current Gynecologic Oncology group (GOG) 0263 trial explores whether the addition of chemotherapy (CT) to adjuvant radiation therapy (RT) improves recurrence-free survival (RFS) and/or overall survival (OS) in stage IB-IIA cervical cancer (CC) patients with intermediate risk factors (in the absence of positive surgical margins (SM), lymph nodes (LN) involvement or parametrical extension (PE) after radical hysterectomy. Using the National Cancer Data Base (NCDB), our study aims to evaluate the OS benefit of these two adjuvant strategies in a similar patient population. Between 2004 and 2013, 702 patients underwent radical hysterectomy for stage IB-IIA CC, retrieving 4 cm or larger tumor without positive SM or positive LN. Adjuvant chemoradiation therapy (CRT) and adjuvant RT were delivered in 195 and 136 patients respectively. Chi-square test assessed the distribution of demographic, tumor and treatment variables in CRT versus RT groups. Kaplan-Meier method estimated overall survival (OS). Proportional hazards model estimated OS hazard ratios for prognostic factors including age, comorbidity, race, tumor size, grade and histology. With a median follow up period of 37 months, the cohort included 331 patients with a median age at diagnosis of 45 years (range, 22 - 89). All the covariates were well balanced between the 2 groups including stage, grade, tumor size and histology. The 5-year OS was 79% vs. 84% (P = 0.346) not significantly different in CRT vs. RT, respectively. None of the covariates were significant predictors of survival on univariate analysis. In spite of the limited nature of this retrospective analysis, no evidence suggests that adding chemotherapy to adjuvant radiation therapy improves survival in resected intermediate risk cervical cancer. GOG 0263 may provide more guidance in the management of this uncommon patient population.

Several studies illustrated inferior disease-free and overall survival (OS) precipitated by overall treatment time (OTT) prolongation during definitive chemoradiation therapy (CRT) of Cervical cancer (CC) a disease characterized by rapid cellular proliferation rate. In the adjuvant setting, data on the relative importance of treatment duration and/or CRT timing are scarce. Using the National Cancer Data Base (NCDB), we aim to evaluate the impact of these treatment variables on OS outcomes in the postoperative CRT setting. The analysis included non-metastatic CC patients who underwent hysterectomy followed by adjuvant CRT from 2004 to 2013. Time variables such as surgery to CRT start interval, OTT (from CRT start to end dates) and package time (from diagnosis date to CRT end date) were divided each into two groups using 6, 7 weeks and 12 weeks cut points, respectively. CRT timing variable was defined as optimum (same start date), 1 week, or more than 1 week if CT and RT start dates coincided, separated by 1 week or more than one week apart, respectively. Kaplan-Meier method estimated OS. Proportional hazards model estimated OS hazard ratios for other prognostic factors including age, comorbidity, race, stage, tumor size, grade and histology, lymph node status. The analysis comprised 8226 patients with age at diagnosis ranging from 18 to 90 years (median 46 years). High-Grade, squamous histology and tumor 4 cm or larger formed 53%, 69% and 35% of the cohort, while 26% and 36% had positive surgical margins and lymph nodes, respectively. At median follow up period of 46 months, the 5-year OS was 75% (95% confidence interval (CI): 74.2%-76.5%). On Univariate analysis (UVA), OTT (hazards ratio (HR): 1.36; P<0.001) and package time (HR: 1.23; P<0.001) respectively exceeding 7 and 12 weeks and/or radiation therapy (RT) and chemotherapy (CT) start dates more than 1 week apart (HR: 1.39; P<0.001) were associated with inferior survival HR. Interval from surgery to CRT was not significant on UVA. On multivariate analysis, high comorbidity score, large tumor, high grade, OTT more than 7 weeks, treatment package time exceeding 12 weeks and CT/RT start more than one week apart were significant predictor of inferior survival. Our analysis suggests that prolongation of the treatment time beyond 7 weeks is detrimental even in the adjuvant setting. Concurrent administration of CT and RT is essential for maximum radiosensitization that translates in better treatment outcomes.

Prostate cancer remains the most commonly diagnosed noncutaneous malignancy in American men. Currently, there are 3 standard treatment options available to men with early prostate cancer: expectant management, radiation therapy, and radical prostatectomy. Although a number of studies have evaluated survival after treatment for early prostate cancer, the optimal choice of therapy for any given patient remains a difficult decision and requires the consideration of a variety of patient and tumor factors. The final selection of therapy for early prostate cancer should be based on an informed discussion between the physician and patient. To accomplish this goal, patients must be made familiar with the pertinent factors that affect survival. We review the factors most relevant for patients to understand as they consider their treatment options for early prostate cancer and summarize the data for physicians who counsel them.

In an attempt to improve the care they provide for their patients with breast cancer, the authors' institution developed a multidisciplinary breast cancer clinic (MDBCC) to offer "one‐stop shopping" consultation and support for newly diagnosed breast cancer patients.