Clinical characteristics and outcome of 60 pediatric patients with malignant melanoma registered with the German Pediatric Rare Tumor Registry (STEP)

2017 ◽  
Vol 229 (06) ◽  
pp. 322-328 ◽  
Author(s):  
Sonja Offenmueller ◽  
Ulrike Leiter ◽  
Benedikt Bernbeck ◽  
Claus Garbe ◽  
Thomas Eigentler ◽  
...  
Keyword(s):  
Overall Survival ◽  
Malignant Melanoma ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Rare Tumor ◽  
Tumor Registry ◽  
Clinical Behavior ◽  
Patients Âgés ◽  
Level I

Abstract Background Malignant melanoma (MM) is a common malignancy in adults while it is rare in children. Thus, information on clinical behavior of pediatric MM is incomplete. Patients The German Pediatric Rare Tumor Registry (STEP) presents a prospective analysis of 60 childhood MM cases diagnosed between June 2006 and December 2014. Method Patients’ ages ranged between 0 and 17 years at initial diagnosis (median age 9.6 years). Information on patient’s and tumor characteristics was obtained by standardized documentation. Three-year overall survival (OS) and event-free survival (EFS) were estimated by the Kaplan-Meier test. Results Follow-up ranged from 0 to 116 months with a median of 36.5 months, however, univariate analysis was performed for 46 cases with a follow-up > 3 months, only. Cases with spitzoid histotype (40%) did not show a significantly different outcome compared to cases with non-spitzoid MM. Breslow thickness ≤ 2.00 mm was identified in 30% of the cases and 18% were Clark level I to III. Adjuvant therapy was used in 45% of cases. OS at 3 years was 100%, EFS 95.2%. Conclusion We present a series of cases with a high number of spitzoid malignant melanoma and advanced pediatric melanoma, but surprisingly good overall survival rates. Spitzoid and non-spitzoid MM do not differ in clinical behavior and survival.

Sarcoligo: Impact of local ablative treatment of oligometastatic sarcomas on overall survival.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10042-10042
Author(s):  
Juliette Thariat ◽  
Laurence Moureau-Zabotto ◽  
Nicolas Penel ◽  
Antoine Italiano ◽  
Jacques-Olivier Bay ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Metastases ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Locoregional Treatment ◽  
Metastatic Sites ◽  
The Impact

10042 Background: 40-50% of sarcomas become metastatic. Median survival of metastatic patients has improved over time. The probably multifactorial reasons for such improvement are not fully clear. Noteworthy, for patients with a controlled primary and a limited number of lung metastases, complete resection of their metastases yields survival rates of up to 40% at three years. Advances in surgery, radiotherapy and radiofrequency have fostered the use of local treatments for various metastatic sites (lung, liver, spine...). Methods: A multicentric retrospective study of the Groupe Sarcome Francais (GSF-GETO); approved by the nationally-review board and ethical committee, was conducted to assess the impact of local ablative treatment on overall survival. Patients who had had oligometastases (any site, 1-5 synchronous metastases) at diagnostic or during the course of disease between 2000 and 2010 were included. Results: Median age of the 243 oligometastatic sarcoma patients was 53 years-old (11-86). Patients had grade I, II and III in 7.5%, 29.6% and 63.3% of cases, respectively with various histologies. 69% of patients underwent local ablative treatment of metastases. Median follow-up was 59 months (4-212) for living patients. Median overall survival was 51 months (1-348). On univariate analysis, grade, histology, absence of chemotherapy, local ablative treatment (surgery, irradiation, radiofrequency or chemoembolisation) correlated with survival but not age or site of oligometastasis. On multivariate analyses, grade (hazard ratio HR 0.12 [CI95 0.3-0.6]) and local ablative treatment (HR 3.8 [CI95 2.1-7.1]) remained significant. Conclusions: Local ablative treatment of metastases is associated with better survival in sarcoma patients with oligometastatic disease. The role of the locoregional treatment of metastases and its impact on quality of life should be assessed prospectively.

Outcomes of stereotactic radiosurgery for pilocytic astrocytoma: an international multiinstitutional study

2021 ◽  
Vol 134 (1) ◽  
pp. 162-170 ◽  
Author(s):  
Erin S. Murphy ◽  
Shireen Parsai ◽  
Hideyuki Kano ◽  
Jason P. Sheehan ◽  
Roberto Martinez-Alvarez ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stereotactic Radiosurgery ◽  
Pilocytic Astrocytoma ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Initial Therapy ◽  
Single Session ◽  
Current Standard

OBJECTIVEThe current standard initial therapy for pilocytic astrocytoma is maximal safe resection. Radiation therapy is considered for residual, recurrent, or unresectable pilocytic astrocytomas. However, the optimal radiation strategy has not yet been established. Here, the authors describe the outcomes of stereotactic radiosurgery (SRS) for pilocytic astrocytoma in a large multiinstitutional cohort.METHODSAn institutional review board–approved multiinstitutional database of patients treated with Gamma Knife radiosurgery (GKRS) between 1990 and 2016 was queried. Data were gathered from 9 participating International Radiosurgery Research Foundation (IRRF) centers. Patients with a histological diagnosis of pilocytic astrocytoma treated using a single session of GKRS and with at least 6 months of follow-up were included in the analysis.RESULTSA total of 141 patients were analyzed in the study. The median patient age was 14 years (range 2–84 years) at the time of GKRS. The median follow-up was 67.3 months. Thirty-nine percent of patients underwent SRS as the initial therapy, whereas 61% underwent SRS as salvage treatment. The median tumor volume was 3.45 cm3. The tumor location was the brainstem in 30% of cases, with a nonbrainstem location in the remainder. Five- and 10-year overall survival rates at the last follow-up were 95.7% and 92.5%, respectively. Five- and 10-year progression-free survival (PFS) rates were 74.0% and 69.7%, respectively. On univariate analysis, an age < 18 years, tumor volumes < 4.5 cm3, and no prior radiotherapy or chemotherapy were identified as positive prognostic factors for improved PFS. On multivariate analysis, only prior radiotherapy was significant for worse PFS.CONCLUSIONSThis represents the largest study of single-session GKRS for pilocytic astrocytoma to date. Favorable long-term PFS and overall survival were observed with GKRS. Further prospective studies should be performed to evaluate appropriate radiosurgery dosing, timing, and sequencing of treatment along with their impact on toxicity and the quality of life of patients with pilocytic astrocytoma.

scholarly journals Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors

2020 ◽  
Author(s):  
Yuki Mukai ◽  
Yuichiro Hayashi ◽  
Izumi Koike ◽  
Toshiyuki Koizumi ◽  
Madoka Sugiura ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Clinical Stage ◽  
Performance Status ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Free Survival

Abstract Background: We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC).　Methods: We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n=66; SCRT group: n=18).Results: The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8%, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4%, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6%, 95% CI: 62.7–85.2; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2%, 95% CI: 64.2–86.4; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups.Conclusions: This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.

Metastatic osteosarcoma at diagnosis: Analysis of 92 cases from a single institution.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23506-e23506
Author(s):  
Alessandra Longhi ◽  
Valquiria Broll ◽  
Alberto Righi ◽  
Antonio Carella ◽  
Michela Pierini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Lung Nodules ◽  
Primary Tumor Site ◽  
Experimental Drugs ◽  
Metastatic Osteosarcoma ◽  
Line Chemotherapy

e23506 Background: Metastatic osteosarcoma (MOS) with synchronous metastases accounts for 20-25% of all new cases of osteosarcoma. Lungs are the most common site of metastases at presentation (80%) followed by Bone (10%). 5- years Overall Survival (OS) of MOS ranges from 11 to 40%. In a previous study from our institution (Bacci G 2006) on 57 pts < 40 years old (1995-2000) the 2- and 5-year OS were 55% and 18%. Methods: Data of patients with pathologic and radiologic confirmed MOS with adequate follow up were reviewed (EC Approval N 916/2020/Oss/IOR). Time-to-event outcomes were estimate with Kaplan-Meier method and compared between groups with log-rank test and Cox model. Results: From August 2000 to October 2018, 92 patients had a diagnosis of MOS: median age 16.5 yrs (6-73, twelve pts > 40 ), gender rate was M 51/F 41, axial primary tumor in 15 cases, extremity in 77. Lung only metastases were described in 66 (71.7%). In 75/90 cases primary tumor was surgically removed, 43 (46%) cases had at least one surgical metastasectomy. All patients received chemotherapy: preoperative only in 6 cases, postoperative in 6, and pre and postoperative in 66 patients. The 1st line chemotherapy was a combination of drugs: Adriamycin in 91/92 pts, Cisplatin in 89/92, Ifosfamide in 88/92, Methotrexate in 83/92; 59 patients received a 2nd line chemotherapy, 34 pts received a 3rd line; most employed regimen were Gemcitabine-Docetaxel, Ifosfamide 15 gr/m2, Cyclophosphamyde-Etoposide, TKI (Pazopanib, Sorafenib), and a few received experimental drugs. Complete remission (CR) was obtained in 26/92 (28%), in 19 cases after surgical metastasectomy.In 30 pts the information of PGP (P- glycoprotein) was available; patients with positive PGP (19/30) had a worst overall survival as compared to those PGP negative (P = 0.038). Of those in Complete Remission 14/26 relapsed. At December 2020 with a median follow-up of 95 ms (IQR 34-159): 65/92 (70%) died , 12 are alive and free from disease , 6 are alive with disease, 9 were lost . The 2-yrs OS for all 92 pts from diagnosis was 66% (95%CI 55-75) and 5-yrs OS was 26% (95% CI 16-37). From the end of treatment, for those who reached a CR the 5-year OS was 57% vs 9% for those who did not (P < 0.001). At univariate analysis, primary tumor site (2-y OS 48% axial vs 72% extremity, P < 0.001), site of metastases (2-y OS 74% only lung vs 48% other, P = 0.004) and number of lung nodules (P = 0.007), were significantly associated to OS. At multivariate analysis, only site of metastases (other vs. only lung HR = 2.26, 95%CI: 1.21-4.22) and number of lung nodules (≥10 nodules vs ≤3 HR = 2.44, 95%CI: 1.24-4.81) were confirmed as significant for OS. Conclusions: Compared to our previous report from 20 yrs ago, 2-years and 5 yrs OS of MOS has improved but it remain unsatisfactory (66% vs 55% and 26% vs 18%).

scholarly journals Granulosa Cell Tumor of the Ovary: A Retrospective Study of 31 Cases and a Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Manel Dridi ◽  
Nesrine Chraiet ◽  
Rim Batti ◽  
Mouna Ayadi ◽  
Amina Mokrani ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Mitotic Index ◽  
Granulosa Cell ◽  
Early Stage ◽  
Abdominal Mass ◽  
Univariate Analysis ◽  
Hepatic Metastases ◽  
Stage I

Background. Adult granulosa cell tumors (AGCTs) are the most common sex cord-stromal tumors. Unlike epithelial ovarian tumors, they occur in young women and are usually detected at an early stage. The aim of this study was to report the clinical and pathological characteristics of AGCT patients and to identify the prognostic factors. Methods. All cases of AGCTs, treated at Salah Azaïz Institute between 1995 and 2010, were retrospectively included. Kaplan-Meier’s statistical method was used to assess the relapse-free survival and the overall survival. Results. The final cohort included 31 patients with AGCT. The mean age was 53 years (35–73 years). Patients mainly presented with abdominal mass and/or pain (61%, n=19). Mean tumor size was 20 cm. The majority of patients had a stage I disease (61%,  n=19). Two among 3 patients with stage IV disease had liver metastasis. Mitotic index was low in 45% of cases (n=14). Surgical treatment was optimal in almost all cases (90%, n=28). The median follow-up time was 14 years (1–184 months). Ten patients relapsed (32%) with a median RFS of 8.4 years (6.8–9.9 years). Mean overall survival was 13 years (11–15 years). Stage I disease and low-to-intermediate mitotic index were associated with a better prognosis in univariate analysis (resp., p=0.05 and p=0.02) but were not independent prognostic factors. Conclusion. GCTs have a long natural history with common late relapses. Hence, long active follow-up is recommended. In Tunisian patients, hepatic metastases were more frequent than occidental series. The prognosis remains good and initial staging at diagnosis is an important prognostic factor.

scholarly journals P03.02 Risk of leptomeningeal dissemination in patients treated with postoperative stereotactic radiotherapy of brain metastases

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii24-iii25
Author(s):  
A Mousli ◽  
B Bihin ◽  
T Gustin ◽  
G Koerts ◽  
M Mouchamps ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Safety Margin ◽  
Incidence Rates ◽  
Leptomeningeal Dissemination ◽  
En Bloc ◽  
Tumor Dissemination

Abstract Background There is a body of evidence that the risk of leptomeningeal dissemination (LMD) is increased in the postoperative stereotactic radiotherapy (SRT) of brain metastases (BM) compared to adjuvant whole brain radiotherapy (WBRT). The proposed mechanism is an iatrogenic tumor dissemination into the cerebrospinal fluid at time of surgery. Including a wider volume of meningeal wall and the entire surgical track in the definition of the postoperative SRT clinical target volume (CTV) to decrease LMD is still controversial. The aim of this study was to retrospectively analyze the outcome of adjuvant SRT targeted at resection cavities of BM without previous WBRT. MATERIAL / METHODS We reviewed 70 patients treated with postoperative SRT for BM. Stereotactic planning computed tomography and planning MRI were imported into iPlan RT image software for image registration and TV delineation. The CTV consisted of any residual enhancement and all resected cavity including a safety margin of 1 to 2 mm. Only in cases of superficial initial tumor with meningeal contact was the CTV enlarged to the adjacent meningeal wall, but never included edema or the entire surgical track. Patients underwent regular follow-up MRI. The cumulative incidence rates of LMD was retrospectively calculated as well as patterns of failure. RESULTS The most common histological type was non small cell lung cancer in 61.4%. There were 38.6% infratentorial locations and 37.2 % superficial lesions. En bloc resection was achieved in 60% and compete resection in 75.7%. After a median imaging follow up time of 16.7 months, 54.3% of patients experienced distant brain failure. LMD occurred in 9 of 70 patients (12.9 %) at a median time of 10.7 months. Survival without LMD was 88% at 1 year (IC 95% 79%-97%) and 82% at 2years (IC 95% 72%-94%). In three quarter of cases, LMD interested superficial lesions. In univariate analysis, survival rates without LMD at 1 year for superficial and deep lesions were 88 % and 94 %, respectively (p=0.49). We report only one recurrence in the surgical track (1.42%). CONCLUSION The risk of LMD was comparable to the literature (11–17%). Superficial lesions were slightly more likely to relapse in the meninges, but it was non-significant. The risk of recurrence in the surgical track is negligible. Our results do not support the current guidelines recommending the systematic inclusion of the surgical track and the related meninges in the CTV.

scholarly journals Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuki Mukai ◽  
Yuichiro Hayashi ◽  
Izumi Koike ◽  
Toshiyuki Koizumi ◽  
Madoka Sugiura ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Clinical Stage ◽  
Performance Status ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Free Survival

Abstract Background We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC). Methods We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n = 66; SCRT group: n = 18). Results The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6, 95% CI: 62.7–85.2; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2, 95% CI: 64.2–86.4; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups. Conclusions This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.

Adjuvant Radiotherapy and Chemotherapy for Pancreatic Carcinoma: The Mayo Clinic Experience (1975-2005)

2008 ◽  
Vol 26 (21) ◽  
pp. 3511-3516 ◽  
Author(s):  
Michele M. Corsini ◽  
Robert C. Miller ◽  
Michael G. Haddock ◽  
John H. Donohue ◽  
Michael B. Farnell ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Mayo Clinic ◽  
Univariate Analysis ◽  
R0 Resection ◽  
Clinic Experience ◽  
Tumor Types ◽  
High Histologic Grade

PurposeTo determine prognostic factors and impact of adjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) after resection of pancreatic adenocarcinoma.Patients and MethodsWe performed a retrospective review 472 consecutive patients who underwent complete resection with negative margins (R0) for invasive carcinoma (T1-3N0-1M0) of the pancreas between 1975 and 2005 at the Mayo Clinic in Rochester, MN. Exclusion criteria included metastatic or unresectable disease at surgery, positive surgical margins, and indolent tumor types (islet cell tumors and mucinous cystadenocarcinoma). Median RT dose was 50.4 Gy in 28 fractions; 98% of RT patients also received concurrent fluorouracil-based CT.ResultsSix patients died within 30 days of surgery. For the 466 surviving patients, median follow-up was 32.4 months; median OS was 21.6 months. Median OS after adjuvant CT-RT was 25.2 versus 19.2 months after no adjuvant therapy (P = .001). Two-year OS was 50% versus 39%, and 5-year OS was 28% versus 17%. Adverse prognostic factors identified by univariate and multivariate analysis included positive lymph nodes (risk ratio [RR] = 1.3; P < .001), high histologic grade (RR = 1.2; P < .001), and no adjuvant therapy (RR = 1.3; P < .001). Tumor extension beyond the pancreas was an adverse prognostic factor by univariate analysis alone (P = .03). Patients receiving adjuvant therapy had more adverse prognostic factors than those not receiving adjuvant therapy (P = .001).ConclusionThis study represents one of the largest, single-institution, retrospective reviews of adjuvant therapy in patients after R0 resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CT-RT.

Addition of Rituximab (R) to CHOP Improves Survival in the Non-GCB Subtype of Diffuse Large B Cell Lymphoma (DLBCL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 816-816 ◽  
Author(s):  
Pedro Farinha ◽  
Laurie Sehn ◽  
Brian Skinnider ◽  
Joseph M. Connors ◽  
Randy D. Gascoyne
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
De Novo ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Cell Of Origin ◽  
Chop Chemotherapy ◽  
Entire Study ◽  
Survival Difference

Abstract Background: The cell of origin (COO) distinction provides a prognostic and biologically relevant subclassification of DLBCL. Germinal center B cell (GCB) and non-GCB subtypes were originally characterized by gene expression studies and subsequently validated at the protein level by Hans et al., Blood 193: 275–82 (2004). The addition of R to CHOP chemotherapy has been shown to improve the outcome of patients with DLBCL. The underlying mechanism(s) responsible for this effect is largely unknown. However, it is known that R may preferentially prevent chemotherapy failure in DLBCLs that express Bcl-2 protein or fail to express Bcl-6 (Mounier et al., Blood101: 4279–84 2003, Winter et al., Blood107: 4207–13 2006). Bcl-2 over-expression and absence of Bcl-6 is more common in the non-GCB subtype. Thus, R may benefit mostly non-GCB lymphomas. To test this hypothesis we assessed the clinical impact of CHOP-R vs CHOP in DLBCL distinguished by COO subtypes. Method: We identified 163 patients with DLBCL treated with either CHOP or CHOP-R with available paraffin blocks and interpretable immuno-staining. All were de novo DLBCL cases diagnosed between 1999 and 2002 at the BCCA. The two treatment cohorts represent consecutive eras of therapy (Sehn et al., JCO2005; 23: 5027–33), and thus the median follow-up of living patients was 5.1 and 4.0 y for CHOP and CHOP-R, respectively. HIV+ patients or those with active secondary malignancies were excluded. Tissue microarrays (TMA) were built using duplicate 0.6mm cores from paraffin embedded formalin fixed (FFPE) tissues and stained with antibodies against CD10, Bcl-6, MUM1, and Bcl-2. The COO distinction was determined using the method of Hans. Results: Patients were treated with either CHOP (81) or CHOP-R (82). Their clinical characteristics, including the IPI, were evenly matched. The median follow-up of living patients was 4.4 y. The IPI was predictive of overall survival (OS) (p&lt;0.0001) for the entire study population. Six cases had uninterpretable immunostains resulting in 74 cases with a GCB phenotype and 83 with a non-GCB phenotype (n = 157). Overall, 71% and 75% of the cases over-expressed Bcl-2 and Bcl-6, respectively. Bcl-2 protein was expressed in 70% GCB cases and 73% non-GCB (p= 0.72). Bcl-6 was expressed in 96% GCB cases and 63% non-GCB cases (p&lt;0.0001). In univariate analysis, the addition of R was associated with a better prognosis in the non-GCB cases (p=0.02), but not in the GCB cases (p=0.3). This survival difference was not solely explained by either Bcl-2 or Bcl-6 expression. The addition of R to CHOP chemotherapy and IPI were independent predictors of OS in non-GCB DLBCL (p=0.02; p=0.016, respectively). The addition of R was also of prognostic importance in the lymphomas over-expressing Bcl-2 (p=0.0081). Conclusion: Immuno-chemotherapy using CHOP-R is associated with better OS in DLBCL, due largely to its effect on the non-GCB subgroup. Although Bcl-2 expression does not contribute to the determination of COO distinctions, the OS of Bcl-2-positive DLBCL patients is significantly improved by the addition of R. These results provide insight into the possible mechanisms by which R exerts its beneficial therapeutic effect. Overall Survival for 157 DLBCL Based on Cell of Origin Overall Survival for 157 DLBCL Based on Cell of Origin

Durable Local Disease Control and Survival in Patients with Limited-Stage Diffuse Large B-Cell Lymphoma Receiving Involved-Node Radiation Therapy Plus Short-Course R-CHOP or CHOP Chemotherapy: Involved-Node Versus Involved-Field Radiation Therapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3665-3665
Author(s):  
Harumi Kato ◽  
Takeshi Kodaira ◽  
Kazuhito Yamamoto ◽  
Yukihiko Oshima ◽  
Yasuhiro Oki ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Survival Rates ◽  
Secondary Malignancy ◽  
Limited Stage ◽  
Short Course ◽  
Field Radiation ◽  
Involved Field ◽  
Overall Survival Rates

Abstract Abstract 3665 Background: Chemoradiotherapy is considered as one of standard treatment for limited-stage diffuse large B-cell lymphoma (DLBCL). Involved-node radiation therapy (IN-RT) is a newly defined concept for patients with early Hodgkin lymphoma. However, there are as yet few reports of applying the strategy to DLBCL and the optimal radiation treatment fields for patients with limited-stage DLBCL have not been well defined. We conducted a retrospective study to evaluate efficacy and long-term toxicities in limited-stage DLBCL patients receiving IN-RT or involved-field radiation therapy (IF-RT) plus short-course chemotherapy. Patients and Methods: Subjects were consecutive patients newly diagnosed as limited-stage DLBCL and receiving local radiation therapy after short-course CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or R-CHOP (rituximab-CHOP) chemotherapy in our institute from 1993 to 2010. Each patient underwent CT simulation for treatment planning and decided to receive either IN-RT or IF-RT regarding diagnostic imaging after chemotherapy including FDG-PET or PET-CT. The concept of IFRT included the whole initially involved lymph node regions according to the Ann Arbor staging diagram. IN-RT was defined as radiation therapy fields that encompass the initially involved lymph nodes exclusively and to encompass their initial volume with adequate margin less than 3 cm. Results: A total of 108 patients were identified, of which 70 patients received IF-RT. The median age was 62 years (range: 19 to 81). Twelve patients (11%) had bulky disease (≥ 5cm). Baseline patients' characteristics were given in Table 1. There was no statistically difference in risk factors as defined by the stage-modified International Prognostic Index score (IPI) between the two groups (P= 0.25). Most patients (94%) received three courses of chemotherapy (range: 2 to 4). Median dose of radiation was 40Gy (range: 23.4 to 51.2). With a median follow-up of 5.5 years (range: 0.35–17), the 5-year overall survival rates were 94% (95%CI: 87 to 97) in all 108 patients, and 94% (95%CI: 79 to 99) and 94% (94%CI: 84 to 98), in the groups of IN-RT and IF-RT, respectively (P=0.76). Estimated 5-year overall survival rates in patients undergoing IF-RT plus CHOP or R-CHOP were 92% and 94%, respectively (P=0.65). Estimated 5-year overall survival rates in patients treated with IN-RT plus CHOP or R-CHOP were 88% and 100%, respectively (P=0.10). Four patients in the IF-RT group experienced relapses [median: 1.8 years after the start of therapy (range: 0.9 to 7.6)], on the other hand, no patient had relapse in the IN-RT group. Three out of the four patients had three adverse risk factors as defined by the stage-modified IPI. Two patients had the relapsed diseases outside radiation fields. Cumulative incidence of relapse at 5 year was 0% and 4.6% (95%CI: 1.2 to 12) in the patients receiving IN-RT and IF-RT, respectively (P= 0.13). During long-term follow-up, a total of nine patients (8%) developed solid cancer, including skin (n=2), lung (n=2), breast (n=1), gastric (n=2) and bladder (n=2). Seven of which occurred outside radiation fields. No patients developed secondary MDS/AML. Cumulative incidence of secondary malignancy at 5 year was 2.7% (95%CI: 0.20 to 12) and 9.5 % (95%CI: 3.3 to 19) in the groups of IN-RT and IF-RT, respectively, and the cumulative incidence at 10 year was estimated to be 22% (95%CI: 4.0 to 49) and 23% (95%CI: 4.4 to 51) in the groups of IN-RT and IF-RT, respectively. There was no statistically difference in the occurrence of secondary malignancy between the two treatment arms. (P=0.70). Conclusions: IN-RT with short-course CHOP or R-CHOP chemotherapy could be expected as good as IF-RT in terms of local disease control and could produce excellent survival rates. However, incidence of secondary malignancy in patients receiving IN-RT was not decreased compared to that of IF-RT and the incidence was estimated to have been gradually increased until after 10 years. Physicians might consider the development of follow-up programs for patients with DLBCL undergoing chemoradiotherapy. Overall survival according to types of irradiation. The 5-year overall survival rates in patients receiving involved-node (IN-RT) and involved-field radiation therapy (IF-RT) were 94% (95%CI: 79 to 99) and 94% (94%CI: 84 to 98), respectively (p=0.76). Disclosures: Kinoshita: Chugai Pharmaceutical Co., LTD.: Honoraria, Research Funding; Zenyaku Kogyo: Honoraria.

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