Does Neutrophil/Leukocyte Ratio Predict Distant Metastases or Only Local Progression?

PURPOSE A prospective, multiinstitutional trial was initiated in 1991 to examine the tolerance to and efficacy of a program of preoperative chemoradiotherapy (CTRT) and surgical resection for patients with localized adenocarcinoma of the pancreas. PATIENTS AND METHODS Fifty-three patients were assessable for analysis, with a median follow-up of 52 months for survivors. Radiation therapy (RT) totaling 5,040 cGy in 180 cGy fractions with mitomycin 10 mg/m2 day 2 and fluorouracil (5-FU) 1,000 mg/m2/d continuous infusion days 2 through 5 and 29 through 32 were given as preoperative adjuvant therapy. Twelve patients did not proceed to surgery (one death, one toxicity, three local progression, six distant metastases, one intercurrent illness), whereas 41 patients underwent surgery. Of these, 17 patients did not have resection (11, hepatic and/or peritoneal metastases and six local extension that precluded resection). Twenty-four patients had tumor resection (19 Whipple, four total pancreatectomy, one distal pancreatectomy). RESULTS Treatment toxicity was primarily hematologic, although a comparable number suffered biliary tract complications, either from obstruction or cholangitis as a result of an occluded stent or the primary tumor. There was one postoperative death. Median survival for the entire group and for the 24 patients with resection was 9.7 and 15.7 months. This survival rate reflected the advanced state of most resected cancers (positive peritoneal cytology, three patients; margins within 2 mm, 13 patients; involved lymph nodes, four patients; and need for superior mesenteric vein (SMV) resection, four patients). Tumor progression was most frequent at metastatic sites. CONCLUSION This preoperative CTRT protocol was feasible and safe in a cooperative group setting. Entry of patients with advanced tumors probably accounted for the suboptimal resectability and survival results.

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A Case of Definitive Therapy for Localised Prostate Cancer: Report of a Urological Nightmare

Advances in Urology ◽

10.1155/2012/632419 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Andreas Sommerhuber ◽

Verena Traxlmayr ◽

Wolfgang Loidl

Keyword(s):

External Beam Radiotherapy ◽

Treatment Options ◽

Neuroendocrine Differentiation ◽

Distant Metastases ◽

Clinical Staging ◽

Infravesical Obstruction ◽

Hormonal Manipulation ◽

Local Progression ◽

Definitive Therapy ◽

Adenocarcinoma Of The Prostate

Radical prostatectomy, external beam radiotherapy and permanent brachytherapy are the most common treatment options for nonmetastatic localised adenocarcinoma of the prostate (PCa). Accurate pretherapeutic clinical staging is difficult, the number of positive cores after biopsy does not imperatively represent the extension of the cancer. Furthermore postoperative upgrading in Gleason score is frequently observed. Even in a localised setting a certain amount of patients with organ-confined PCa will develop biochemical progression. In case of a rise in PSA level after radiation the majority of patients will receive androgen deprivation therapy what must be considered as palliative. If local or systemic progressive disease is associated with evolving neuroendocrine differentiation hormonal manipulation is increasingly ineffective; radiotherapy and systemic chemotherapy with a platinum agent and etoposide are recommended. In case of local progression complications such as pelvic pain, gross haematuria, infravesical obstruction and rectal invasion with obstruction and consecutive ileus can possibly occur. In this situation palliative radical surgery is a therapy option especially in the absence of distant metastases. A case with local and later systemic progression after permanent brachytherapy is presented here.

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Phase I/II trial of concurrent sunitinib (SU) and image-guided radiotherapy (IGRT) followed by maintenance systemic therapy for patients with oligometastases.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.306 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 306-306

Author(s):

J. Kao ◽

J. A. Cesaretti ◽

M. W. Sung ◽

R. Stock ◽

M. D. Galsky ◽

...

Keyword(s):

Systemic Therapy ◽

T Regulatory Cells ◽

Suppressor Cells ◽

Progression Free Survival ◽

Distant Metastases ◽

Liver Function Tests ◽

Primary Tumors ◽

Free Survival ◽

Image Guided Radiotherapy ◽

Local Progression

306 Background: Preclinical data suggest that SU enhances the efficacy of radiotherapy. We tested the combination of SU and hypofractionated IGRT in a cohort of patients with historically incurable distant metastases. Methods: Eligible patients had 1 to 5 sites of metastatic solid tumors measuring ≤ 6 cm. The most common tumor types treated were head and neck, liver, lung, kidney, and prostate cancers. Patients were treated with concurrent SU (25 to 50 qd d 1–28) and IGRT (40 to 50 Gy in 10 fractions d 8–19). Following IGRT, patients could either receive maintenance SU (50 mg daily, 4 weeks on/2 weeks off starting on d 43) or alternate forms of systemic therapy. Most patients were treated with the recommended phase II dose of SU 37.5 mg and IGRT 50 Gy. Maintenance SU was used in 40% of patients. Results: Between 2/07 and 6/08, 43 patients with 81 metastatic lesions were enrolled with a median follow up for surviving patients was 20.1 months (range, 5–37 months). The incidence of acute grade ≥ 3 toxicities was 33%, most commonly myelosuppression, bleeding and abnormal liver function tests. The 2-year estimates for local control and distant control were 74% and 43%, respectively. The 2-year estimates for progression- free survival and overall survival were 39% and 46%, respectively. To date, 15 (35%) patients were alive without evidence of disease, 6 (14%) were alive with distant metastases, 13 (30%) were dead from distant metastases, 1 (2%) was dead from local progression, 6 (14%) were dead from comorbid illness, and 2 (5%) were dead from treatment-related toxicities. Predictors of improved progression-free survival were genitourinary primary tumor (HR 0.18; p=0.04), IGRT dose > 40 Gy (HR 0.21; p=0.005), number of metastases (HR 2.22; p=0.006) and maintenance SU (HR 0.31; p=0.06). Flow cytometry demonstrates a significant reduction in immune suppressive myeloid derived suppressor cells and T regulatory cells in SU treated patients. Conclusions: Concurrent SU and IGRT achieves durable local and distant control in a significant subset of patients with oligometastases, particularly patients with genitourinary primary tumors with ≤ 2 distant metastases. [Table: see text]

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Radiotherapy in the Management of Pediatric and Adult Osteosarcomas: A Multi-Institutional Cohort Analysis

Cells ◽

10.3390/cells10020366 ◽

2021 ◽

Vol 10 (2) ◽

pp. 366

Author(s):

Mateusz Jacek Spałek ◽

Jan Poleszczuk ◽

Anna Małgorzata Czarnecka ◽

Monika Dudzisz-Śledź ◽

Aleksandra Napieralska ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Confidence Interval ◽

Systemic Treatment ◽

Cohort Analysis ◽

Distant Metastases ◽

Two Dimensional ◽

Factors Associated ◽

Local Progression ◽

Valuable Treatment

Background: Due to the rarity of osteosarcoma and limited indications for radiotherapy (RT), data on RT for this tumor are scarce. This study aimed to investigate the utilization of RT for osteosarcomas in the recent 20 years and to identify factors related to patients’ response to radiation. Methods: We performed a retrospective analysis of patients irradiated for osteosarcoma treatment. We planned to assess differences in the utilization of RT between the periods of 2000–2010 and 2011–2020, identify the risk factors associated with local progression (LP), determine whether RT-related parameters are associated with LP, and calculate patients’ survival. Results: A total of 126 patients with osteosarcoma who received 181 RT treatments were identified. We found a difference in RT techniques between RT performed in the years 2000–2010 and that performed in the years 2011–2020. LP was observed after 37 (20.4%) RT treatments. Intent of RT, distant metastases, and concomitant systemic treatment affected the risk of LP. Five-year overall survival was 33% (95% confidence interval (26%–43%)). Conclusions: RT for osteosarcoma treatment has evolved from simple two-dimensional palliative irradiation into more conformal RT applied for new indications including oligometastatic and oligoprogressive disease. RT may be a valuable treatment modality for selected patients with osteosarcoma.

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Diagnosis of local relapse after radical radiotherapy (RRTH) of prostate cancer by biochemical PSA kinetics and transrectal ultrasonography (TRUS) verified by prostate biopsy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14631 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14631-14631

Author(s):

K. E. Nietupski ◽

T. Demkow ◽

I. Skoneczna ◽

M. Pilichowska ◽

P. Peczkowski ◽

...

Keyword(s):

Bone Scan ◽

Invasive Procedure ◽

Distant Metastases ◽

Local Relapse ◽

Observation Time ◽

Radical Radiotherapy ◽

Positive Biopsy ◽

Local Progression ◽

Area Under Roc Curve ◽

Cancer Of The Prostate

14631 Background: Patients (pts) with the cancer of the prostate after radical radiotherapy (RRTH) are followed by clinical examination, periodical measurements of PSA level, bone scan, bone x-ray examinations, CT of abdomen and pelvis. The biochemical progression (according ASTRO Consensus Panel) is not always equal the clinical progression. The next step in all cases of rising PSA is to diagnose or to exclude the local progression, which has to be distinguished from systemic progression. Methods: Prospective evaluation of effectiveness of the biochemical indicators as predictors of local relapse after RRTH and probability of positive tru-cut biopsy outcome in case of positive TRUS result. 51 pts with prostatic adenocarcinoma after RRTH, who experienced biochemical (PSA) progression were included. All of them had a negative bone scan results, negative abdomen-pelvis CT scan or ultrasonography and no clinical evidence of distant metastases. All pts underwent a tru-cut biopsy guided by TRUS. Each of them were eligible to local salvage procedures. The TRUS-guided tru-cut biopsy were performed in all pts. Results: The median observation time (between RRTH and biopsy) was 34 mo (11–78). The median PSA level at the biopsy was 2.46 ng/ml (0,69–11,26). TRUS was positive in 20/51 pts. In 31 pts, there was no evidence of local progression in TRUS. TRUS specificity was 62.02% (95% CI 48.75–75.39%) and sensitivity 40.91% (95% CI 27.42%–54.40). The biopsy outcome was positive in 22/51 pts (43%). The biopsy was positive in 58% (25/26) in subgroup with PSA level lower than 2.46 ng/ml and 27% (7/25) in group with PSA upper to this value. There were no significant associations between positive biopsy outcome and PSA velocity. Conclusions: In pts with suspicion of local relapse we observed the low predictive value of PSA level at biopsy (area under ROC curve = 0.6113). There were no associations between positive biopsy outcome and PSADT (PSA doubling time) which could help in better selection for invasive procedure. No significant financial relationships to disclose.

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644: Cathepsin D is a Marker for Early Stage Renal Cell Cancer and Predicts the Presence of Distant Metastases

The Journal of Urology ◽

10.1016/s0022-5347(18)34884-5 ◽

2005 ◽

Vol 173 (4S) ◽

pp. 175-175

Author(s):

Axel S. Merseburger ◽

Joerg Hennenlotter ◽

Perikles Simon ◽

Marcus Horstmann ◽

Arnulf Stenzl ◽

...

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Cathepsin D ◽

Early Stage ◽

Cell Cancer ◽

Distant Metastases

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1777: Differences in Site of Distant Metastases by Renal Cell Carcinoma Subtype

The Journal of Urology ◽

10.1016/s0022-5347(18)38969-9 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 470-470

Author(s):

Michael D. Gillett ◽

John C. Cheville ◽

Christine M. Lohse ◽

Bradley C. Leibovich ◽

Horst Zincke ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Distant Metastases

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131I-MIBG as a treatment in medullary thyroid carcinoma with distant metastases.

Endocrine Abstracts ◽

10.1530/endoabs.56.p1176 ◽

2018 ◽

Author(s):

Nerea Utrilla Uriarte ◽

Pedro Gonzalez Fernandez ◽

Alba Esteban Figueruelo ◽

Marina Nevares Herrero ◽

Javier Santamaria Sandi

Keyword(s):

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Distant Metastases ◽

Medullary Thyroid ◽

131I Mibg

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A Case of Duodenal Neuroendocrine Carcinoma Treated with Amrubicin as Second-line Chemotherapy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.243.ino ◽

2015 ◽

Vol 24 (3) ◽

pp. 379-382

Author(s):

Tadahisa Inoue ◽

Hitoshi Sano ◽

Takashi Mizushima ◽

Hirotada Nishie ◽

Hiroyasu Iwasaki ◽

...

Keyword(s):

Neuroendocrine Carcinoma ◽

Distant Metastases ◽

Salvage Chemotherapy ◽

Second Line ◽

Effective Treatment Option ◽

Second Line Chemotherapy ◽

Best Response ◽

Long Term Effect ◽

Line Chemotherapy

We present the case of a Japanese man in his 60s with duodenal neuroendocrine carcinoma with distant metastases. Chemotherapy with irinotecan plus cisplatin was initiated as a first-line regimen. However, disease progression was observed after only two cycles. Therefore, amrubicin was administered as a second-line chemotherapy. The patient showed a long-term effect of amrubicin therapy, and the best response was a partial response after seven cycles. For duodenal neuroendocrine carcinoma, amrubicin therapy can be considered an effective treatment option as salvage chemotherapy.

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