Performance status versus anatomical recovery in metastatic disease: The role of palliative radiation treatment

126 Background: Palliative radiation treatment (pRT) is a common and effective treatment for patients with symptomatic bone metastases. However, patients receiving RT for bone metastases often may have a poor performance status and are more likely to experience toxicity during or after treatment. This study aims to investigate the number and type of toxicity event occurring during or after pRT for bone metastases. Methods: Patients treated with RT for bone metastases at Mayo Clinic from 2007 to 2016 were included in this study. Demographic, disease, treatment, and toxicity information were collected. Specifically, toxicity events were identified as emergency department (ED) visits and inpatient hospitalization (IH) within 90 days, breaks in treatment >4 days, and excessive 30 day financial toxicity defined as standardized Medicare costs >1 standard deviation above the mean. RT treatment was compared by dose and fractionation via descriptive statistics. Results: A total of 538 patients treated with pRT were identified, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Patients with breast and prostate cancer were most likely to be treated with 3Gy x10 and patients with GI and Lung cancer were most likely to be treated with 8Gy x1. A description of the patient characteristics and toxicities are shown in Table 1. For 8Gy x1, 4Gy x5, and 3Gy x10 breaks in treatment were rare (0%, 2%, and 3.3%), ED visits (15%, 24%, & 28%), IH (12%, 23%, & 19%), and financial toxicity (13%, 18%, & 21%) were common. A total of 22.6%, 27.5%, and 38.6% of patients were alive two years following pRT from each group. Conclusions: Toxicity during or shortly after pRT of bone metastases is common. This study confirms that additional steps should be taken to monitor and mitigate toxicity in this vulnerable patient group. [Table: see text]

Download Full-text

Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11030552 ◽

2021 ◽

Vol 11 (3) ◽

pp. 552

Author(s):

Salam Awenat ◽

Arnoldo Piccardo ◽

Patricia Carvoeiras ◽

Giovanni Signore ◽

Luca Giovanella ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Metastatic Disease ◽

Cancer Staging ◽

Relevant Information ◽

Cochrane Library ◽

Number Of Patients ◽

Pet Ct

Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.

Download Full-text

Palliative radiation treatment used for multiple purposes in a single irradiation field

BMJ Case Reports ◽

10.1136/bcr-2021-244172 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244172

Author(s):

Kosei Miura ◽

Hiromasa Kurosaki ◽

Nobuko Utsumi

Keyword(s):

Creatinine Level ◽

Radiation Treatment ◽

Peritoneal Dissemination ◽

Spine Metastasis ◽

Palliative Radiation ◽

Bilateral Hydronephrosis ◽

Gastrointestinal Obstruction ◽

Irradiation Therapy ◽

Irradiation Field ◽

Multiple Bone Metastases

In this case report, radiation therapy was performed for bilateral hydronephrosis developed during multiple bone metastases of breast cancer and ileus due to peritoneal dissemination. The patient’s preirradiation creatinine level was 8.2 mg/dL, which decreased by the fourth day after starting irradiation therapy. Creatinine level ultimately decreased to 0.6 mg/dL. Pain due to lumbar spine metastasis alleviated and ileus was resolved, allowing the patient to live at home for approximately 5 weeks. The effect of radiotherapy for bilateral hydronephrosis and gastrointestinal obstruction was rapid and good. Palliative radiation treatment can be used for multiple purposes, and in the present patient, we were able to prolong the vital prognosis.

Download Full-text

Ziv-aflibercept: A novel angiogenesis inhibitor for the treatment of metastatic colorectal cancer

American Journal of Health-System Pharmacy ◽

10.2146/ajhp130143 ◽

2013 ◽

Vol 70 (21) ◽

pp. 1887-1896 ◽

Cited By ~ 21

Author(s):

Clement Chung ◽

Nisha Pherwani

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Performance Status ◽

Angiogenesis Inhibitor ◽

Progression Free Survival ◽

Phase Iii ◽

Second Line ◽

Patient Response ◽

Line Setting

Abstract Purpose The pharmacology, pharmacokinetics, clinical efficacy, safety, and administration of ziv-aflibercept in combination therapy for metastatic colorectal cancer (mCRC) are reviewed. Summary Ziv-aflibercept (Zaltrap, Regeneron Pharmaceuticals and sanofi-aventis) is a novel recombinant fusion protein that targets the angiogenesis signaling pathway of tumor cells by blocking vascular endothelial growth factor (VEGF) receptors that play a key role in tumor growth and metastasis; it is a more potent VEGF blocker than bevacizumab. Ziv-aflibercept is approved by the Food and Drug Administration for use in combination with fluorouracil, irinotecan, and leucovorin (the FOLFIRI regimen) for second-line treatment of patients with mCRC who have disease progression during first-line oxaliplatin-based chemotherapy. A Phase III trial demonstrated that relative to FOLFIRI therapy alone, the use of ziv-aflibercept was associated with significantly improved patient response, overall survival, and progression-free survival in patients with good performance status at baseline, including some who had received prior bevacizumab therapy. The most common grade 3 or 4 adverse effects associated with ziv-aflibercept use in clinical studies were neutropenia, hypertension, and diarrhea; the U.S. product labeling warns of potential hemorrhage and other treatment-related risks. Conclusion Current clinical data are insufficient to directly compare ziv-aflibercept and bevacizumab when used with standard combination chemotherapy as first- or second-line regimens for mCRC. The role of ziv-aflibercept is currently limited to the second-line setting in combination with irinotecan-based regimens in mCRC patients who have not received irinotecan previously. The role of ziv-aflibercept in chemotherapy for other tumor types is yet to be determined.

Download Full-text

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽

10.1182/asheducation-2013.1.406 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 406-413 ◽

Cited By ~ 9

Author(s):

Michelle Fanale

Keyword(s):

B Cell ◽

Hodgkin Lymphoma ◽

Radiation Treatment ◽

Early Stage ◽

B Cell Lymphoma ◽

B Cell Lymphomas ◽

Early Stage Disease ◽

Stage Disease ◽

Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

Download Full-text

Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study

BJU International ◽

10.1111/j.1464-410x.2011.10479.x ◽

2011 ◽

Vol 109 (8) ◽

pp. 1155-1161 ◽

Cited By ~ 27

Author(s):

Juan Ignacio Martinez-Salamanca ◽

Shahrokh F. Shariat ◽

Joaquin Carballido Rodriguez ◽

Thomas F. Chromecki ◽

Vincenzo Ficarra ◽

...

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

Performance Status ◽

International Study ◽

Upper Urinary Tract ◽

Prognostic Role ◽

Ecog Performance Status

Download Full-text

Role of Runx2 phosphorylation in prostate cancer and association with metastatic disease

Oncogene ◽

10.1038/onc.2015.91 ◽

2015 ◽

Vol 35 (3) ◽

pp. 366-376 ◽

Cited By ~ 33

Author(s):

C Ge ◽

G Zhao ◽

Y Li ◽

H Li ◽

X Zhao ◽

...

Keyword(s):

Prostate Cancer ◽

Metastatic Disease

Download Full-text

Outcomes of Patients with Initially Locally Advanced Pancreatic Adenocarcinoma who did not Benefit from Resection: A Prospective Cohort Study

10.21203/rs.2.15620/v3 ◽

2020 ◽

Author(s):

Jonathan Garnier ◽

Jacques Ewald ◽

Ugo Marchese ◽

Marine Gilabert ◽

Simon Launay ◽

...

Keyword(s):

Confidence Interval ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Performance Status ◽

Locally Advanced ◽

Wilcoxon Test ◽

Stepwise Logistic Regression ◽

Short Term Treatment ◽

Locally Advanced Pancreatic Adenocarcinoma ◽

Advanced Pancreatic Adenocarcinoma

Abstract Background: The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods: Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results: FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR)=1.2, 95% confidence interval: 0.86–1.6, P =.03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR=1.38, 95% confidence interval: 1–1.9, P <.01) and limited short-term treatment-related toxicity. Conclusions: The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease.

Download Full-text