Bleomycin: low-risk therapy for good-risk testicular cancer

2018 ◽  
Vol 1719 (1) ◽  
pp. 5-5
Keyword(s):  
Testicular Cancer ◽  
Low Risk ◽  
Good Risk

scholarly journals Testicular Abscess an Unusual Cause for Febrile Neutropenia

2008 ◽  
Vol 8 ◽  
pp. 953-955
Author(s):  
Tal Grenader
Keyword(s):  
Febrile Neutropenia ◽  
Testicular Cancer ◽  
Metastatic Disease ◽  
Surgical Complications ◽  
Related Factors ◽  
Platinum Based Chemotherapy ◽  
Testicular Abscess ◽  
Chemotherapy Dose ◽  
Good Risk

Patients with good-risk disseminated testicular cancer are effectively managed with platinum-based chemotherapy. Febrile neutropenia is a dose-limiting event for many chemotherapy regimens. The risk of developing febrile neutropenia is related both to the chemotherapy dose and schedule, and to patient-related factors. Among patients who require ongoing chemotherapy for metastatic disease, it is very unusual for surgical complications to delay the initiation of chemotherapy. We describe a patient who developed febrile neutropenia with testicular abscess when treated with BEP 2 weeks following inguinal orchiectomy.

scholarly journals Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Low Risk ◽  
Stage I ◽  
Decision Analysis Model ◽  
Risk Patients

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy burden for those children.Methods Using decision analysis model, we collected clinical utilities from literature and survey and compared chemotherapy exposure between risk-adapted treatment and surveillance.Results In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤ 0.10 and the relapse rate of high-risk group ≥ 0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to salvage chemotherapy.Conclusions Risk-adapted treatment might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.

Practical Applications of The Low-Risk Anomaly: How Much Is a Good Risk Estimate Worth?

2022 ◽  
pp. pa.2022.pa474
Author(s):  
Tony Barchetto ◽  
Razvan Pascalau ◽  
Ryan Poirier
Keyword(s):  
Low Risk ◽  
Risk Estimate ◽  
Practical Applications ◽  
Good Risk

The Low-Risk Anomaly: How Much Is a Good Risk Estimate Worth?

2020 ◽  
Vol 47 (1) ◽  
pp. 88-106
Author(s):  
Tony Barchetto ◽  
Razvan Pascalau ◽  
Ryan Poirier
Keyword(s):  
Low Risk ◽  
Risk Estimate ◽  
Good Risk

Long Term Overall Survival of Greater Than 98% in Childhood ALL Patients with Good Risk Features and Low Risk MRD:Â Results from a Large Multi-Center Randomized Controlled Trial, UKALL 2003

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 806-806 ◽  
Author(s):  
Jack Bartram ◽  
David O'Connor ◽  
Amir Enshaei ◽  
Anthony V Moorman ◽  
Christine Harrison ◽  
...  
Keyword(s):  
Overall Survival ◽  
Death Rate ◽  
Risk Group ◽  
Controlled Trial ◽  
Low Risk ◽  
Childhood All ◽  
Randomized Controlled ◽  
Risk Patients ◽  
Good Risk

Background: Overall survival (OS) for childhood ALL treated on contemporary protocols is now > 90%. For low risk patients the risk of treatment related mortality (TRM) is now similar to the risk of death due to disease relapse. The only way to improve TRM and morbidity in this group is to identify even lower risk patients and reduce therapy. We analysed outcomes for patients with low risk MRD at end of induction (EOI) therapy treated on UKALL 2003, to identify a very low risk group who could potentially benefit from protocols that further reduce TRM. Methods: UKALL 2003 trial recruited 3126 patients aged 1-25 years with Philadelphia-negative ALL between Oct 1, 2003, and June 30, 2011. Treatment was initially stratified based on NCI risk and cytogenetic results. Subsequent treatment was directed by MRD from bone marrow (BM) measured using EuroMRD approved real-time quantitative PCR method for immunoglobulin and T-cell receptor gene rearrangements at EOI therapy. Analysis was performed on the 2666 patients with available MRD results and focused on patients with low risk MRD combined with other patient characteristics - cytogenetic risk group, white cell count (WCC) and age to identify those subgroups with extremely good event free survival (EFS). Low risk MRD at EOI was defined a level <0.005%. Patients with MRD ≥ 0.005% were considered high risk. Good risk cytogenetics included the presence of ETV6-RUNX1 or high hyperdiploidy. Results: Overall 52% (n=1391) of patients had MRD < 0.005% with the remaining 48% (n=1275) of patients with MRD ≥ 0.005%. 5yr OS 97.6 (95% CI 96.6-98.3) vs. 89.1% (87.2-90.7, p<0.0001) and 5yr EFS 94.4 (93.1-95.6) vs. 83.6% (81.4-85.5, p<0.0001). 53% (n=1407) of the patients with MRD results available had good risk cytogenetics, of which 60% (n=843) had MRD<0.005%. This group (with low risk MRD and good risk cytogenetics) makes up 31.6% of the whole trial cohort and has 5yr EFS 96.0% (94.5-97.3) and 5yr OS 98.9% (97.9-99.4). The outcome was similar irrespective of NCI high risk features (i.e. WCC>50 / age>10yrs). Long term survival remained excellent with 10 year EFS 93.9% (OS 98.2%). There were 32 relapses in the low risk MRD/ good risk cytogenetics group (relapse sites: 11 BM, 7 combined BM and central nervous system (CNS), 3 BM + other site, 6 isolated CNS and 5 other site, non BM/CNS), giving an overall relapse rate of 3.8% with a salvage rate of 81%. The relapse death rate was 0.7% (n=6) with TRM of 0.8% (n=7). The low risk group can be further sub divided into a group of 442 patients (16.6% of whole trial) with undetectable MRD at EOI and good risk cytogenetics who have a 5yr EFS of 97.4% (5yr OS 99.5%). Conclusion: This excellent long term outcome for a third of all patients with childhood ALL, low risk MRD and good risk cytogenetics in a large multi-center randomized controlled trial supports exploration of further reduction of therapy in this group to reduce TRM. This strategy is further supported by the observation that the rate of TRM is now similar the relapse death rate in this group, coupled with the very high salvage rates for those patients who do relapse. The superior OS for patients with undetectable MRD and good risk cytogenetics further highlights the additive strength of MRD to accurately predict outcome in the low risk cytogenetic group. Disclosures No relevant conflicts of interest to declare.

Successful treatment of good-risk disseminated testicular cancer with cisplatin, bleomycin, and reduced-dose vinblastine

Cancer ◽  
1986 ◽  
Vol 57 (11) ◽  
pp. 2114-2118 ◽  
Author(s):  
Giorgio Pizzocaro ◽  
Roberto Salvioni ◽  
Fulvio Zanoni ◽  
Angelo Milani ◽  
Luigi Piva
Keyword(s):  
Testicular Cancer ◽  
Successful Treatment ◽  
Reduced Dose ◽  
Good Risk

scholarly journals Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

2019 ◽  
Author(s):  
Yunlin Ye ◽  
Hong-chao Li ◽  
Ji Zhang ◽  
Hai-tao Liang ◽  
Zike Qin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Low Risk ◽  
Stage I ◽  
Risk Patients

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. This study was to compare chemotherapy exposure between risk-adapted treatment and surveillance in CS1 pediatric testicular cancer.Methods We collected clinical utilities from literature and survey. Using decision analysis model, we compared chemotherapy exposure between risk-adapted treatment and surveillance and sensitivity analysis was performed.Results In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to salvage chemotherapy.Conclusion Decision analysis demonstrated that risk-adapted treatment was associated with lower exposure of chemotherapy for patients with CS1 pediatric testicular cancer. This might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.

“Good Risk”: low-risk patients with ductal carcinoma in situ (DCIS) benefit from whole breast radiotherapy after breast conservation surgery (BCS)–long-term follow-up.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12062-e12062
Author(s):  
Anna Niwinska ◽  
Jacek Galecki ◽  
Agnieszka Irena Jagiello-Gruszfeld ◽  
Wojciech Michalski
Keyword(s):  
Recurrence Rate ◽  
Breast Conservation ◽  
Low Risk ◽  
Competing Risk ◽  
Cancer Center ◽  
Risk Of Recurrence ◽  
Whole Breast Radiotherapy ◽  
Risk Patients ◽  
Good Risk

e12062 Background: Identification of patients group with low risk DCIS that do not require radiation therapy after BCS is still a challenge. We assessed recurrence rates in patients with „good risk” DCIS with and without radiotherapy after BCS, and subsequently compared our results with the long-term data from RTOG 9804 trial [1]. Methods: Out of 737 patients with DCIS managed between 1996-2011 at the Cancer Center Warsaw, Poland, 400 were treated conservatively. Out of those 133 were classified as „good risk” patients in accordance with RTOG 9804 trial criteria (DCIS < 2.5 cm, mammographically detected, NG1/G2 with margin = > 3 mm). 79 patients received only BCS and another 54 patients were treated with BCS and radiotherapy. Competing risk of recurrence, DFS and OS were calculated for both groups. The results were compared with the long-term observation results of RTOG 9804 trial. Results: The competing risk of recurrence after 10 years in the group treated with BCS and in patients receiving BCS with radiotherapy was 26% and 6% respectively (p = 0.013). 10-year DFS was 58% and 88% (p = 0.02) and OS was 94% and 97% (p = 0.3) respectively. Based on the ASTRO Conference 2018, 10-year recurrence risk without and with radiotherapy in RTOG 9804 trial were 9.1% and 1.7% [1]. In our study in comparison to RTOG 9804 trial results, more patients had DCIS sized 1.1-2.5 cm, excision margins of 3-9 mm and no patient received adjuvant tamoxifen. Conclusions: Similarly to the results of RTOG 9804 trial [1], radiotherapy reduced recurrence rate in “good risk” DCIS, however, in our study the recurrence rate was higher - probably due to difference in risk factors and no tamoxifen use. 1.McCormick B et al. Randomized trial evaluating radiation following surgical excision for “Good Risk” DCIS: 12year report from NRG/RTOG 9804. ASTRO October 21, 2018.

scholarly journals Identification of Genes Whose Expression Overlaps Age Boundaries and Correlates with Risk Groups in Paediatric and Adult Acute Myeloid Leukaemia

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2769
Author(s):  
Lindsay Davis ◽  
Ken I. Mills ◽  
Kim H. Orchard ◽  
Barbara-Ann Guinn
Keyword(s):  
Gene Expression ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Low Risk ◽  
The Cancer Genome Atlas ◽  
Sequencing Data ◽  
Expression Levels ◽  
Patient Subgroups ◽  
Good Risk ◽  
Acute Myeloid

Few studies have compared gene expression in paediatric and adult acute myeloid leukaemia (AML). In this study, we have analysed mRNA-sequencing data from two publicly accessible databases: (1) National Cancer Institute’s Therapeutically Applicable Research to Generate Effective Treatments (NCI-TARGET), examining paediatric patients, and (2) The Cancer Genome Atlas (TCGA), examining adult patients with AML. With a particular focus on 144 known tumour antigens, we identified STEAP1, SAGE1, MORC4, SLC34A2 and CEACAM3 as significantly different in their expression between standard and low risk paediatric AML patient subgroups, as well as between poor and good, and intermediate and good risk adult AML patient subgroups. We found significant differences in event-free survival (EFS) in paediatric AML patients, when comparing standard and low risk subgroups, and quartile expression levels of BIRC5, MAGEF1, MELTF, STEAP1 and VGLL4. We found significant differences in EFS in adult AML patients when comparing intermediate and good, and poor and good risk adult AML patient subgroups and quartile expression levels of MORC4 and SAGE1, respectively. When examining Kyoto Encyclopedia of Genes and Genomes (KEGG) (2016) pathway data, we found that genes altered in AML were involved in key processes such as the evasion of apoptosis (BIRC5, WNT1) or the control of cell proliferation (SSX2IP, AML1-ETO). For the first time we have compared gene expression in paediatric AML patients with that of adult AML patients. This study provides unique insights into the differences and similarities in the gene expression that underlies AML, the genes that are significantly differently expressed between risk subgroups, and provides new insights into the molecular pathways involved in AML pathogenesis.

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