Anterior Skull Base Sarcomas: Report of Characteristics and Outcomes at a Tertiary Care Cancer Center

2021 ◽  
Author(s):  
Sallie Long ◽  
Panagiotis Asimakopoulos ◽  
Marlena McGill ◽  
Marc A. Cohen ◽  
Snehal G. Patel ◽  
...  
Keyword(s):  
Skull Base ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Anterior Skull Base ◽  
Cancer Center ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
High Grade

Abstract Objective This study was aimed to describe our institutional experience on characteristics and treatment outcomes of sinonasal sarcomas invading the anterior skull base. Design Present study is a retrospective review. Setting The study was conducted at an academic cancer care center. Participants Thirty-one patients with skull base sarcomas treated with primary surgery from 1979 to 2015 were identified for this study from a preexisting database. Main Outcome Measures Survival and recurrence outcomes using the Kaplan–Meier method were the focus areas of the study. Results The median age was 44 years (range: 13–69 years). Twenty patients were male (64.5%). Twenty-nine patients underwent open craniofacial resection (93.5%) and two patients underwent endoscopic resection (6.5%). The majority of tumors were staged pT4 (77.4%). The most common pathologies were leiomyosarcoma (19.4%), osteosarcoma (16.1%), and chondrosarcoma (12.9%). Of those with known margin status, 10 patients had positive/close margins (32.2%) and 16 patients had negative margins (51.6%). Most tumors were high grade (74.2%). Twenty-three patients (74.2%) received adjuvant radiation and four patients (12.9%) received adjuvant chemotherapy. There were nine postoperative complications (29%) including one mortality and three cerebrospinal fluid leaks. There were 10 local, 2 regional, and 5 distant recurrences over a median follow-up of 74 months (range: 1–300 months). The 5-year disease-specific survival (DSS) was 69.8%. The 5-year locoregional recurrence-free probability (RFP) was 63.2% and the 10-year distant RFP was 71.7%. The 5-year DSS for high grade tumors was 64.2 and 85.7% for low grade tumors (p = 0.117). Conclusion This study contributes an updated analysis of anterior skull base sarcomas. Five-year DSS is approximately 70%. Analysis of survival outcomes based on grade, tumor size, and other factors is limited by small sample size and the rarity of these tumors.

scholarly journals Regional Recurrences and Hyams Grade in Esthesioneuroblastoma

2020 ◽  
Author(s):  
Hedyeh Ziai ◽  
Eugene Yu ◽  
Ilan Weinreb ◽  
Bayardo Perez-Ordonez ◽  
Christopher M. K. L. Yao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Oncologic Outcomes ◽  
Low Grade ◽  
High Grade ◽  
Grade Versus ◽  
Regional Failure ◽  
The Impact

Abstract Objective The aim of this study is to determine if Hyams grade may help predict which patients with esthesioneuroblastoma (ENB) tumors are likely to develop regional recurrences, and to determine the impact of tumor extent on regional failure in ENB patients without evidence of nodal disease at presentation. Design The study was designed as a retrospective review for ENB patients. Settings The study was prepared at tertiary care academic center for ENB patients. Participants Patients with ENB were included in the study. Main Outcome Measures  Oncologic outcomes (5-year regional and locoregional control (LRC) and overall survival) in patients with Hyams low grade versus high grade. Oncologic outcomes based on radiographic disease extent. Results A total of 43 patients were included. Total 25 patients (58%) had Hyams low-grade tumor, and 18 (42%) had high-grade tumor. Of the 34 patients without regional disease at presentation, 8 (24%) were treated with elective nodal radiation. There were no statistically significant differences in 5-year regional control in the Hyams low-grade versus high-grade groups (78 vs. 89%; p = 0.4). The 5-year LRC rates in patients with low grade versus high grade were 73 versus 89% (p = 0.6). The 5-year overall survival rates in patients with low-grade versus high-grade tumors were 86 versus 63% (p = 0.1). Radiographic extension of disease into the olfactory groove, olfactory nerve, dura, and periorbita were statistically associated with decreased 5-year overall survival (5-year OS 49 vs. 91% [p = 0.04], 49 vs. 91% [p = 0.04], 44 vs. 92% [p = 0.02], and 44 vs. 80% [p = 0.04], respectively). Conclusion ENBs are associated with a risk of regional failure. The current analysis suggests that Hyams low-grade and high-grade malignancies have comparable rates of early and delayed regional recurrences, although small sample size may limit our conclusions.

scholarly journals Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion

2017 ◽  
Vol 79 (05) ◽  
pp. 419-426 ◽  
Author(s):  
Hedyeh Ziai ◽  
Eugene Yu ◽  
Terence Fu ◽  
Nidal Muhanna ◽  
Eric Monteiro ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Tertiary Care ◽  
Small Sample ◽  
Anterior Skull Base ◽  
Preoperative Imaging ◽  
Sinonasal Malignancies ◽  
Control Versus ◽  
Margin Control ◽  
The Impact

Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging). Study Design Retrospective study. Setting Tertiary care academic center. Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion. Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047). Conclusion This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.

Tertiary Care Multidisciplinary Teams Associated with Improved Survival in Rectal Cancer Patients: A Comparative Study

2018 ◽  
Vol 84 (10) ◽  
pp. 1645-1649
Author(s):  
Beverly Tambe ◽  
Clara V. Wang ◽  
Erik Noren ◽  
M. Philip Duldulao ◽  
Afsaneh Barzi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Stage Ii ◽  
Multidisciplinary Teams

For stage II/III rectal cancer patients, comprehensive multidisciplinary care (MDC) affects outcomes. Randomized trials have shown the effectiveness of adjuvant and neoadjuvant therapy in treatment of these patients. However, the effectiveness of collaboration within MDC is undetermined. It is possible that regional variation in survival outcomes may be tied to treatment facility. We retrospectively reviewed a prospectively collected database of patients with stage II/III rectal cancer who received MDC at any location and underwent oncologic colorectal resection at a tertiary care center (TCC) between 2005 and 2011. Of the 571 rectal cancer patients, 391 had a stage II/III rectal cancer and received surgery at a TCC. After exclusion criteria, we observed that 120 patients received neoadjuvant therapy and 119 patients received adjuvant therapy. For neoadjuvant patients, no difference in overall survival was observed between treatment received at a TCC versus an outside facility. However, a significant improvement in survival was observed in patients who received adjuvant therapy at a TCC ( P = 0.01). Thus, the location of postoperative adjuvant therapy shows improvement in 10-year survival at a TCC versus elsewhere. Thus, standardization of care can impact outcomes for invasive rectal cancer patients. The limitations of this study are its retrospective nature and relatively small sample size.

scholarly journals Clinical manifestations and treatment outcomes of human brucellosis at a tertiary care center in Saudi Arabia

2021 ◽  
Vol 41 (2) ◽  
pp. 109-114
Author(s):  
Jameela Edathodu ◽  
Maha Alamri ◽  
Khadijah Ahmed Alshangiti ◽  
Noura S. Alfagyh ◽  
Ahmed S. Alnaghmush ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Sample Size ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Small Sample ◽  
Human Brucellosis ◽  
Tertiary Care Center ◽  
Positive Serology

BACKGROUND: Brucellosis, which has profound public health and economic consequences, is endemic to Saudi Arabia. Brucella is transmitted to humans by direct contact with infected animals or by consumption of unpasteurized dairy products. Manifestations of brucellosis are protean and require a combination of drugs to prevent the emergence of resistance. The WHO recommends the use of doxycycline with rifampicin or an aminoglycoside for brucellosis, but experts in Saudi Arabia prefer to avoid the use of rifampicin and aminoglycosides to lessen the possibility of emergence of drug-resistant tuberculosis. OBJECTIVES: Compare rifampicin and doxycycline in the treatment of human brucellosis versus various combinations of doxycycline, with either trimethoprim-sulfamethoxazole (co-trimoxazole), quinolones or aminoglycosides, and describe the clinical manifestations of brucellosis. DESIGN: Retrospective medical record review. SETTING: Single tertiary care center. PATIENTS AND METHODS: Diagnosis of brucellosis was based on positive serology by standard agglutination test (SAT), or isolation by culture of Brucella species from blood, body fluid or tissue. MAIN OUTCOME MEASURES: Cure rate with the use of doxycycline in combination with either co-trimoxazole, quinolone or aminoglyco-sides in comparison to doxycycline/rifampicin and the clinical features of brucellosis. SAMPLE SIZE: 123. RESULTS: In 118 (96%) patients, the median IgG/IgM antibody titers at diagnosis and at 6 and 12 months were 1:1280/1:1280, 1:640/1:640, and 1:320/1:160, respectively. There were no differences in outcome between treatment regimens, as evidenced by a significant decrease in SAT titers and symptom resolution within six months. Five (4%) patients relapsed from non-adherence to treatment, but responded well to a second course of treatment. Blood cultures were positive in 50 patients (41%) patients. Fever, arthralgia and back pain were the most common symptoms. Good serological and clinical responses were achieved in 96% of patients. Relapse in 4% (n=5) was due to self-reported non-adherence. LIMITATIONS: Retrospective, relatively small sample size. CONCLUSIONS: Doxycycline with co-trimoxazole is as efficacious as doxycycline/rifampicin in non-focal brucellosis and is preferred in countries with a high prevalence of tuberculosis. CONFLICT OF INTEREST: None.

scholarly journals Endoscopic Management of Anterior Skull Base Lesions: Experience of Tertiary Care Center in India

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
Preetam Chappity ◽  
Dilip Samal ◽  
Anjan Sahoo ◽  
Saurav Sarkar ◽  
Pradeep Pradhan ◽  
...  
Keyword(s):  
Skull Base ◽  
Care Center ◽  
Tertiary Care ◽  
Anterior Skull Base ◽  
Endoscopic Management ◽  
Tertiary Care Center ◽  
Skull Base Lesions

scholarly journals Malignant Tumors of the Anterolateral Skull Base

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 102-112 ◽  
Author(s):  
Stephen J. Hentschel ◽  
Yashil Vora ◽  
Dima Suki ◽  
Ehab Y. Hanna ◽  
Franco DeMonte
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Malignant Tumors ◽  
Treatment Protocol ◽  
Anterior Skull Base ◽  
Low Grade ◽  
High Grade ◽  
Cranial Nerve Palsies ◽  
The Mean

Abstract OBJECTIVE Malignancies of the anterolateral skull base are clinically and pathologically distinct from those of the central anterior skull base and the temporal bone. The purpose of this report is to describe the outcomes and complications after skull base surgery and multimodality therapy in a group of patients with anterolateral skull base malignancies. PATIENT DATA AND METHODS The mean duration of follow-up for living patients was 57.2 months (median, 56.8 months). The median age of the 52 patients who met the inclusion criteria for this study was 47 years (range, 1–81 years). The most common presenting feature was cranial nerve palsy (60%). Of these cranial nerve palsies, trigeminal neuropathies causing facial numbness were the most common, with V2 being affected in 35%, V3 affected in 33%, and V1 affected in 17%. Abducens neuropathy was present in 14% of patients. The most frequently occurring pathologies after the various sarcomas were squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC) in 23% and 14% of patients, respectively. Of the 30 sarcomas, 16 were classified as low grade and 14 were classified as high grade. RESULTS Complications of treatments were identified in 16 patients (31%). Ten patients had a single complication, whereas 6 patients experienced multiple complications. The most common complications were a new or worsened cranial nerve deficit (n = 4), pneumonia (n = 4), and flap necrosis (n = 3). Recurrence after the treatment associated with the index surgery occurred in 37 patients (71%). The recurrence was local in 30 patients (58%), both local and distant (metastatic) in 4 patients (8%), and only distant in 3 patients (12%). The median progression-free survival (PFS) was 2.1 years (range, 1.2–3.0 years). Median PFS times of 0.6 and 1.6 years were noted for patients with high-grade sarcoma (HGS) and low-grade sarcoma (LGS), respectively. The mean PFS (median not reached) for the patients with SCC was 4.6 years, whereas the median PFS for patients with ACC was 3.3 years. The overall 2- and 5-year survivals for all patients were 81% and 53% (median, 5.0 years; 95% confidence interval, 3.9–6.1 years), respectively. The median survival for patients with nonsarcomas was 6.9 years, the 2-year survival was 82%, and the 5-year survival was 55%. Patients with HGS survived the shortest time (median, 3.3 years; 2-year, 64%; 5-year, 27%), whereas those patients with LGS had an intermediate survival (median, 5.3 years; 2-year, 94%, 5-year, 72%). CONCLUSION It is our belief that anterolateral skull base malignancies comprise a distinct group of tumors. These lesions should be analyzed separately from central anterior skull base lesions and temporal bone malignancies. With a multimodality treatment protocol, acceptable survivals may be obtained that are comparable to results that have been reported for tumors involving less difficult areas of the skull base.

scholarly journals Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems – a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 575-581
Author(s):  
Martina Kreft ◽  
Roland Zimmermann ◽  
Nina Kimmich
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Low Grade ◽  
Singleton Pregnancy ◽  
Perineal Tear ◽  
Vertex Presentation

AbstractObjectivesBirth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.MethodsIn a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.ResultsA total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.ConclusionsThere were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

scholarly journals Maintaining an Adult Hematology/Oncology Service at a Tertiary Care Center during the SARS-CoV-2 Pandemic: An Eight-Week-Experience with a Newly Implemented Procedural Plan

2021 ◽  
pp. 1-6
Author(s):  
Philipp G. Hemmati ◽  
Dorothea Fischer ◽  
Frank Breywisch ◽  
Sabine Wohlfarth ◽  
Matthias Kramer ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Cancer Center ◽  
Staff Members ◽  
Oncology Service ◽  
Containment Measures ◽  
Vulnerable Patient ◽  
Set Up ◽  
Oncology Unit

Treatment of cancer patients has become challenging when large parts of hospital services need to be shut down as a consequence of a local COVID-19 outbreak that requires rapid containment measures, in conjunction with the shifting of priorities to vital services. Reports providing conceptual frameworks and first experiences on how to maintain a clinical hematology/oncology service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are scarce. Here, we report our first 8 weeks of experience after implementing a procedural plan at a hematology/oncology unit with its associated cancer center at a large academic teaching hospital in Germany. By strictly separating team workflows and implementing vigorous testing for SARS-CoV-2 infections for all patients and staff members irrespective of clinical symptoms, we were successful in maintaining a comprehensive hematology/oncology service to allow for the continuation of treatment for our patients. Notably, this was achieved without introducing or further transmitting SARS-CoV-2 infections within the unit and the entire center. Although challenging, our approach appears safe and feasible and may help others to set up or optimize their procedures for cancer treatment or for other exceedingly vulnerable patient cohorts.

The feasibility of same day pegfilgrastim-cbqv administration in breast cancer patients receiving myelosuppressive chemotherapy regimens at a northern Virginia cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18687-e18687
Author(s):  
Maya Leiva ◽  
Angela Pennisi ◽  
Kathleen Kiernan Harnden ◽  
Patricia Conrad Rizzo ◽  
Lauren Ann Mauro
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Small Sample Size ◽  
Standard Of Care ◽  
Secondary Prophylaxis ◽  
Small Sample ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Curative Intent ◽  
Myelosuppressive Chemotherapy

e18687 Background: The long-acting injectable G-CSF, pegfilgrastim and its biosimilars have historically been given to patients 24 hours following the administration of myelosuppressive chemotherapy for either primary or secondary prophylaxis of febrile neutropenia (FN). Previous literature has indicated that pegfilgrastim administration prior to 24 hours post chemotherapy, may result in a deepened and prolonged neutropenia due to the increase in circulating granulocytes exposed to chemotherapy. With the onset of the COVID-19 pandemic and to reduce potential SAR-CoV-2 exposure to cancer patients on therapy, we implemented same day administration of injectable pegfilgrastim-cbqv among select breast cancer patients receiving myelosuppressive chemotherapy regimens from March 2020 – February 2021. Methods: Utilizing retrospective EHR chart reviews, 55 patients among 4 medical oncologists in our breast cancer group were identified as meeting the criteria of same day pegfilgrastim-cbqv administration. Inclusion was based on completion of at least 2 consecutive cycles of same day pegfilgrastim-cbqv 6 mg subcutaneous injection for primary or secondary prophylaxis. The selected patient charts were reviewed for the incidence and severity of FN. Among the patients who had documented FN, further subgroup analyses were done regarding baseline characteristics, timing of neutropenia, regimens, regimen sequence, and reported ADRs associated with pegfilgrastim-cbqv. Results: 9 (16.4%) of the 55 patients experienced FN (Grades 3-4) and 6 (10.9%) patients were hospitalized. There were no Grade 5 events and none had therapy discontinued due to FN. 8 (88.9%) of the patients experienced FN between cycles 1 and 2. Of note, there were no cases of COVID-19 among the 9 patients who had an episode of FN. 52 (94.5%) of the 55 patients received treatment with curative intent and 3 (5.5%) had metastatic disease on a subsequent line of therapy. The median age was 49.1 years (range 29-71) and patients were 56.4% Caucasian, 18.1% Black or African American, 12.7% Asian, and 12.7% Hispanic/Latina. Conclusions: Based on the retrospective data analysis, same day pegfilgrastim-cbqv appears to be a safe and effective option in the primary and secondary prophylaxis of FN with myelosuppressive standard of care chemotherapy used in breast cancer treatment. Though our review was limited by a relatively small sample size and confined to younger (49.1 median age) breast cancer patients, this opens the door to further re-evaluation of same day pegfilgrastim-cbqv administration in other patient populations. In a post pandemic treatment world, this slight change in practice has the potential to reduce patient financial toxicity associated with multiple medical visits, provide an alternative to on-body injector formulations, and ensure treatment adherence.

scholarly journals High-grade glioma with anterior skull base erosion and intranasal extension: case report

2017 ◽  
Vol 126 (5) ◽  
pp. 1484-1487 ◽  
Author(s):  
Matthew T. Stib ◽  
Michael Johnson ◽  
Alan Siu ◽  
M. Isabel Almira-Suarez ◽  
Zachary Litvack ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Radiation Treatment ◽  
High Grade Glioma ◽  
Brain Parenchyma ◽  
Anterior Skull Base ◽  
High Grade ◽  
Who Grade ◽  
Who Grade Iii ◽  
Grade Iii

The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion. MR imaging findings revealed a large intracranial lesion with intranasal extension. Endoscopic nasal biopsy revealed pathology consistent with an infiltrating glioma. The patient subsequently underwent a combined transcranial/endonasal endoscopic approach for resection of this lesion. Pathological diagnosis revealed a WHO Grade III oligoastrocytoma. This report reviews the mechanisms of extradural glioma extension. To the authors' knowledge, it is the second report of a high-grade glioma exhibiting nasal extension without prior surgical or radiation treatment.

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