scholarly journals Taxane/gemcitabine-containing chemotherapy plus locoregional IMRT for patients with de novo metastatic nasopharyngeal carcinoma: the treatment outcomes and prognostic factors analysis

2022 ◽  
Author(s):  
Chengrun Du ◽  
Mengshan Ni ◽  
Jianyun Jiang ◽  
Fangfang Kong ◽  
Ruiping Zhai ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Nasopharyngeal Carcinoma ◽  
Treatment Outcomes ◽  
Distant Metastasis ◽  
Lymphocyte Count ◽  
De Novo ◽  
Free Survival ◽  
Metastatic Nasopharyngeal Carcinoma

Abstract Purpose To evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors. Methods A total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed. Results The median follow-up time for the whole group was 31.5 months (range 5–138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60 (50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61 (51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p < 0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p = 0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, p < 0.001) and OS (HR = 0.518, p = 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFS. Conclusion Taxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.

Taxane/gemcitabine-Containing Chemotherapy Plus Locoregional IMRT for Patients With De Novo Metastatic Nasopharyngeal Carcinoma: The Treatment Outcomes and Prognostic Factors Analysis

2021 ◽  
Author(s):  
Chengrun Du ◽  
Mengshan Ni ◽  
Jianyun Jiang ◽  
Fangfang Kong ◽  
Ruiping Zhai ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Nasopharyngeal Carcinoma ◽  
Treatment Outcomes ◽  
Distant Metastasis ◽  
Lymphocyte Count ◽  
De Novo ◽  
Free Survival ◽  
Metastatic Nasopharyngeal Carcinoma

Abstract Objectives: To evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors.Materials and Methods: A total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed. Results: The median follow-up time for the whole group was 31.5 months (range, 5-138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60(50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61(51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p<0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p=0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, P < 0.001) and OS (HR=0.518, p= 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFSConclusion: Taxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.

scholarly journals Clinical Outcome and Prognostic Factors of Intensity-Modulated Radiotherapy for T4 Stage Nasopharyngeal Carcinoma

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Yangkun Luo ◽  
Yang Gao ◽  
Guangquan Yang ◽  
Jinyi Lang
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Nasopharyngeal Carcinoma ◽  
Lymph Nodes ◽  
Distant Metastasis ◽  
Intensity Modulated Radiotherapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Intensity Modulated ◽  
T4 Stage

Objective. To analyze the clinical outcomes and prognostic factors of intensity-modulated radiotherapy (IMRT) for T4 stage nasopharyngeal carcinoma (NPC).Methods. Between March 2005 and March 2010, 110 patients with T4 stage NPC without distant metastases were treated. All patients received IMRT. Induction and/or concurrent chemotherapy were given. 47 (42.7%) patients received IMRT replanning.Results. The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 90.1%, 97.0%, 67.5%, 63.9%, and 64.5%, respectively. Eleven patients experienced local-regional failure and total distant metastasis occurred in 34 patients. 45 patients died and 26 patients died of distant metastasis alone. The 5-year LRFS rates were 97.7% and 83.8% for the patients that received and did not receive IMRT replanning, respectively (P=0.023). Metastasis to the retropharyngeal lymph nodes (RLN) was associated with inferior 5-year OS rate (61.0% versus 91.7%,P=0.034). The gross tumor volume of the right/left lymph nodes (GTVln) was an independent prognostic factor for DMFS (P=0.006) and PFS (P=0.018). GTVln was with marginal significance as the prognostic factor for OS (P=0.050).Conclusion. IMRT provides excellent local-regional control for T4 stage NPC. Benefit of IMRT replanning may be associated with improvement in local control. Incorporating GTVln into the N staging system may provide better prognostic information.

Comparison Of Treatment Outcomes with EPOCH-Rituximab Versus CHOP-Rituximab in Patients with De-novo Intermediate and High Risk International Prognostic Index(IPI)Diffuse Large B Cell Lymphoma(DLBCL): A Single Center Retrospective Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5115-5115
Author(s):  
Hasmukh Jain ◽  
Manju Sengar ◽  
Hari Menon ◽  
Uma Dangi ◽  
Bhausaheb Bagal ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Outcomes ◽  
Disease Progression ◽  
Retrospective Analysis ◽  
Poor Prognosis ◽  
De Novo ◽  
Performance Status ◽  
Progression Free Survival ◽  
Free Survival

Abstract Poor prognosis DLBCL, including intermediate and high risk disease according to IPI accounts for approximately 20% of new cases of DLBCL. The addition of rituximab to conventional chemotherapy (CHOP) has improved the outcomes in this subset, with a 2-year overall survival (OS) of about 50%. However, 40-50% of these patients still have either primary refractory disease or relapse after an initial response. Rituximab-EPOCH (R-EPOCH), an infusional regimen has a dynamic dose adjustment strategy based on the hematopoietic nadir in previous cycle to achieve an optimal drug concentration. Phase II studies with R-EPOCH in untreated DLBCL with intermediate and high risk IPI have reported improved outcomes, with an estimated 2-year OS of 75% which appears superior to that of R-CHOP. Hence we analysed the outcomes of patients with de-novo, poor prognosis (intermediate and high risk IPI) DLBCL who received R-EPOCH and compared it to the  historical cohort of patients who were treated with R CHOP at our centre. Methods Treatment-naïve patients of DLBCL with intermediate or high risk IPI, registered at our centre between November 2011 to June 2013, who received R-EPOCH regimen, were included for the analysis. Case records were reviewed for – demography, histology, stage, bulk of disease, extranodal sites,  performance status, IPI, LDH, albumin, details of chemotherapy, grade ¾ toxicities (CTCAE version 4) and need for hospitalization.  Responses were evaluated at mid and end of chemotherapy. Overall and progression free survival were calculated. Similar analysis was done for poor prognosis DLBCL patients treated with R-CHOP between Jan 2007 to December 2010. Results Baseline characteristics and treatment outcomes of  32 patients (males-24, females-8) treated with R-EPOCH were compared to 42 patients (males-28, females-14) who received R- CHOP. Median age in R- EPOCH group was 47 years (range-20-75 years) versus 55 years (23-72 years )in R- CHOP. Performance status≥ 2 was seen in 47% in R- EPOCH as compared to 28% in R-CHOP group. Significant proportion of patients in R-EPOCH had bulky disease(81% versus  16%) and stage III/IV disease (90% versus 81%) as compared to R-CHOP. Patients with IPI of two represented 8(25%), IPI of three, 11(34%), and IPI of four and five, 10(32%) on R- EPOCH compared to 21(50%), 19(45%) and 2(5%) on R-CHOP, respectively. Serum albumin<3.5 gm/dL was seen in 10(32%) on R-EPOCH and 14(33%) on R-CHOP. LDH was elevated in all but two patients on R-EPOCH compared to 37(88%) patients on R-CHOP. Complete response was seen in 60%, and disease progression in 18% patients on R-EPOCH, compared to 59%, and 20% on R-CHOP respectively. There were 5 deaths on R-EPOCH, 3 due to toxicity and 2 due to disease progression, and in comparison there were 4 deaths on R-CHOP, all of them due to disease progression.  With a median follow up of 6 months, the estimated OS at 1 year is 74% and progression free survival (PFS) is 62% for patients on R- EPOCH. For patients on R- CHOP, with a median follow up of 31 months, 1 year OS is 68% and PFS is 64%. Conclusion Our retrospective analysis indicates that treatment with R-EPOCH regimen resulted in similar results as with R-CHOP regimen. However patients treated with R-EPOCH had more adverse features in terms of disease bulk, poor performance status and high IPI score. A prospective randomized comparison is warranted between these two regimens. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Disease-free Survival of Patients with Differentiated Thyroid Cancer: A Study from a Tertiary Center in Oman

2021 ◽  
Vol 36 (2) ◽  
pp. e246-e246
Author(s):  
Fathimabeebi P. Kunjumohamed ◽  
Abdulhakeem Al Rawahi ◽  
Noor B. Al Busaidi ◽  
Hilal N. Al Musalhi
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Distant Metastasis ◽  
Differentiated Thyroid Cancer ◽  
Disease Free Survival ◽  
Lymph Node Status ◽  
Free Survival ◽  
Disease Free

Objectives: As with global trends, the prevalence of differentiated thyroid cancer (DTC) has increased in recent years in Oman. However, to the best of our knowledge, no local studies have yet been published evaluating the prognosis of DTC cases in Oman. This study aimed to assess disease-free survival (DFS) and prognostic factors related to DTC among Omani patients attending a tertiary care center. Methods: This retrospective, observational cohort study was conducted between January 2006 and May 2016 at the National Diabetes and Endocrine Center in Oman. Data related to DFS and prognostic factors were obtained from the electronic medical records of all ≥ 18-year-old patients diagnosed with DTC during the study period. Results: A total of 346 DTC cases were identified. Overall, 82.7% of patients were disease-free at their last follow-up appointment. Univariate analysis indicated that various tumor characteristics including histological subtype (i.e., papillary carcinoma, Hurthle cell cancer, and minimally invasive follicular thyroid carcinoma), lymph node status, number of lymph node metastases, distant metastasis status, and TNM status (primary tumor (T), regional lymph node (N), distant metastasis (M) stage) were strong prognostic factors for DFS (p < 0.050). According to multivariate regression analysis, lymph node status, extrathyroidal extension, and angiovascular invasion were independent predictors of DFS (p < 0.050). Conclusions: The overall prognosis of DTC among Omani patients was excellent. Treatment and follow-up strategies for patients with DTC should be tailored based on the individual’s risk factor profile.

Prognostic factors and therapeutic options for epithelioid hemangioendothelioma (EHE): A multicenter analysis of a series of fifty-seven cases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11062-11062
Author(s):  
Aurore Vozy ◽  
Audrey Simonaggio ◽  
Philippe Terrier ◽  
Valerie Paradis ◽  
Nicolas Penel ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Active Surveillance ◽  
Soft Tissues ◽  
Cox Model ◽  
Univariate Analysis ◽  
Poor Prognostic Factor ◽  
Free Survival ◽  
The Impact

11062 Background: EHE is a rare vascular mesenchymal tumor for which there is currently no standard for treatment particularly for metastatic disease. EHE often present metastatic evolution but metastases are not a poor prognostic factor. The aim of this study was to improve knowledge of outcome of EHE patients and see the impact of active surveillance on outcome for metastatic EHE patients. Methods: Patients with EHE treated at three centers in France were included in this retrospective cohort. Univariate analysis of prognostic factors was performed using the Cox model. Survival was estimated using the Kaplan-Meier method and long rank analysis. Results: Fifty-seven patients with EHE were collected in this analysis: 27 (47%) women and 30 (53%) men, with a median age at diagnosis of 39 years (range, 12-83). At diagnosis, 17 (29.8%) patients had a localized tumor, while 40 (70.2%) patients had synchronous metastases. The most commonly affected organs were liver (29.8%), bones (14.0%), skin, lungs and soft tissues (10.5% each). For the 17 patients with localized EHE, the median distant recurrence-free survival after resection of primary was 64.6 months, 95% CI [29.4, NA], (median follow-up of 62.7 months, range, 12.5-234.8). For the 40 patients with metastatic EHE, the median progression-free survival (PFS) was 59.0 months, 95% CI [21.3, NA], (median follow-up of 121.1 months, range, 1.0-202.0). No prognostic factor was identified for localized EHE. For metastatic EHE, age was associated with progression (p = 0.019), and presence of pleural/ascites/pericarditis effusion adversely affected overall survival (OS) (p = 0.002). An initial “wait and see” attitude was proposed to 23 patients (57.5%) while 17 patients (42.5%) were treated at diagnosis with local or systemic treatment (monotherapy or combination of chemotherapy with anthracyclin, taxane, cyclophosphamide). OS were similar in both groups of patients, 174months and 121months for chemotherapy treated patients and active surveillance patients respectively (p = 0.56). Conclusions: Presence of effusion was a significant poor prognostic factor in metastatic EHE patients. Active surveillance could be proposed for asymptomatic patients without effusion but this strategy need to be confirmed in largest or prospective randomized trials.

scholarly journals Clinical Outcomes and Prognostic Factors of 695 Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Weidong Wang ◽  
Mei Feng ◽  
Zixuan Fan ◽  
Jie Li ◽  
Jinyi Lang
Keyword(s):  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Clinical Outcomes ◽  
Distant Metastasis ◽  
Clinical Target Volume ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Target Volume ◽  
Free Survival ◽  
Intensity Modulated

Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated.Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy.Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively.Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.

scholarly journals Survival Outcomes in Oral Tongue Cancer: A Mono-Institutional Experience Focusing on Age

2021 ◽  
Vol 11 ◽  
Author(s):  
Mohssen Ansarin ◽  
Rita De Berardinis ◽  
Federica Corso ◽  
Gioacchino Giugliano ◽  
Roberto Bruschini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Tongue Cancer ◽  
Age Groups ◽  
Age At Diagnosis ◽  
Oral Tongue ◽  
Free Survival

ObjectiveThe prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups.MethodsWe performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age.ResultsThe median follow-up time was 5.01 years (range 0–18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III–IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33–3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03–3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III–V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T–N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors.ConclusionsYoung age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.

A prospective, multicentric clinical study of intensity modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC): A 4-year follow-up report.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16054-e16054
Author(s):  
Fang Wu ◽  
Ren-sheng Wang ◽  
Guosheng Feng ◽  
Guisheng Li ◽  
Meilian Liu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Distant Metastasis ◽  
Treatment Efficacy ◽  
Disease Free Survival ◽  
Regional Recurrence ◽  
Free Survival ◽  
Number Of Patients ◽  
N Stage ◽  
Grade 3

e16054 Background: To evaluate the treatment efficacy, toxicity and prognostic factors of patients with NPC treated with IMRT. Methods: Between January 2006 and August 2008, 300 patients with pathologically diagnosed NPC from 6 medical center received IMRT. The number of patients with stage I, II, III, IVa-b disease (UICC/AJCC 2002 staging system) was 6, 45,141, and 108, respectively. The prescription doses were as follows: 70~74Gy/30 fraction to GTVnx, 68~70Gy/30 fraction to GTVnd, 60~64Gy/30 fraction to CTV1,50~54Gy /30 fraction to CTV2. Patients with stage III, IVa-b disease also received cisplatin-based chemotherapy. Results: The median follow-up time was 47.1 months (range,11-68 months). There were 18,15 and 42 patients who had developed local, regional recurrence and distant metastasis, respectively. There were 45 patients died. 34 patients died of distant metastasis,6 died of local and regional recurrence, 2 died of re-treatment, one died of hemorrhage complications of nasopharynx,one died of second primary tumor, and the other one died of unknown cause.The 4-year rate of local control (LC), regional control(RC), metastasis-free survival(DMFS),disease-free survival(DFS) and overall survival(OS) was 94.0%, 95.5%, 87.4%, 80.8%, 86.1%, respectively. Multivariate analysis showed that N stage was the only prognostic factor for OS (x2=3.912, p=0.048, HR=14.565), DMFS (x2=5.195, p=0.023, HR=8.737)and DFS (x2=7.613,p=0.006, HR=7.628), in these patients. Mucositis was the most severe acute toxicity, with 18.1% grade 1, 48.6% grade 2, 33.3% grade 3 . No patient suffered from grade 4 mucositis. Xerostomia was the most common seen late toxicity, with 8% grade 0, 50.5% grade 1, 4.6% grade 2. No grade 3-4 xerostomia was observed. Conclusions: IMRT can improve the treatment efficacy of patients with NPC. The acute and late toxicities were tolerated. Distant metastasis becomes the main treatment failure. N stage is a significant prognostic factors.

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