scholarly journals Residual proliferative cancer burden to predict long-term outcome following neoadjuvant chemotherapy

2015 ◽  
Vol 26 (1) ◽  
pp. 75-80 ◽  
Author(s):  
A. Sheri ◽  
I.E. Smith ◽  
S.R. Johnston ◽  
R. A'Hern ◽  
A. Nerurkar ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cancer Burden

Integration of Ki67 with residual cancer burden (RCB) compared to Ki67 or RCB alone to predict long-term term outcome following neoadjuvant chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 535-535
Author(s):  
Amna Sheri ◽  
Roger A'Hern ◽  
Robin Lewis Jones ◽  
William Fraser Symmans ◽  
Ashutosh Nerurkar ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Statistical Significance ◽  
Cox Proportional Hazards Model ◽  
Prognostic Information ◽  
Residual Cancer ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cancer Burden

535 Background: RCB and Ki67 after neoadjuvant chemotherapy have each been shown to predict long-term outcome. Their combined use might provide greater prognostic information. RCB requires collection of data beyond that in routine pathological work-up of residual disease, which may not be required when Ki67 is added. Aims: (i) To test the hypothesis that combining Ki67 and RCB as the residual proliferative cancer burden (R-P-CB) provides significantly more prognostic information than either alone. (ii) To determine if a simplified algorithm integrating Ki67 and standard characteristics of residual disease can provide as much information. Methods: Cases at the Royal Marsden Hospital between 2002-2010 were identified and residual disease assessed. The primary endpoint of the study was time to recurrence. The primary analysis compared the prognostic information from Ki67, RCB and R-P-CB. Analyses employed a Cox proportional hazards model. Prognostic indices (PIs) were also created adding Ki67, grade and ER to the RCB and AJCC staging. Leave-one-out cross validation was used to reduce bias. The overall change in chi-square (ΔX2) of the best model for each index was used to compare the prognostic ability of the different indices a ΔX2 of more than 3.84 indicates statistical significance. Results: A total of 222 evaluable patients were included in the study, median age was 50 with a median follow up of 60 months. The addition of Ki67 improved the prognostic power of all indices. The R-P-CB (ΔX2=69.5) was significantly more prognostic than the RCB alone (ΔX2=35) and Ki67 alone (ΔX2=41.4). A novel proliferative residual cancer index (PRECI) using post-treatment values of T size, number of involved lymph nodes, grade, ER status (±) and Ki67 gave ΔX2=81.1 and performed similarly to a model including the RCB, Ki67, ER and grade (ΔX2=80.2). Conclusions: Addition of Ki67 to RCB improved prediction of long-term outcome. In this study, a novel index the PRECI provided as much prognostic information as a more complex assessment involving RCB and warrants further investigation for estimating post-neoadjuvant risk of recurrence.

Long-Term Outcome for Patients With Nonmetastatic Osteosarcoma of the Extremity Treated at the Istituto Ortopedico Rizzoli According to the Istituto Ortopedico Rizzoli/Osteosarcoma-2 Protocol: An Updated Report

2000 ◽  
Vol 18 (24) ◽  
pp. 4016-4027 ◽  
Author(s):  
Gaetano Bacci ◽  
Stefano Ferrari ◽  
Franco Bertoni ◽  
Pietro Ruggieri ◽  
Piero Picci ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Tumor Necrosis ◽  
Poor Responders ◽  
High Dose ◽  
Second Malignancies ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

PURPOSE: To provide an estimate of long-term prognosis for patients with osteosarcoma of the extremity treated in a single institution with neoadjuvant chemotherapy and observed for at least 10 years. PATIENTS AND METHODS: Patients with nonmetastatic osteosarcoma of the extremity were preoperatively treated with high-dose methotrexate, cisplatin, and doxorubicin (ADM). Postoperatively, good responders (90% or more tumor necrosis) received the same three drugs used before surgery, whereas poor responders (less than 90% tumor necrosis) received ifosfamide and etoposide in addition to those three drugs. RESULTS: For the 164 patients who entered the study between September 1986 and December 1989, surgery was a limb salvage in 136 cases (82%) and a good histologic response was observed in 117 patients (71%). At a follow-up ranging from 10 to 13 years (median, 11.5 years), 101 patients (61%) remained continuously free of disease, 61 relapsed, and two died of ADM-induced cardiotoxicity. There were no differences in prognosis between good and poor responding patients. ADM-induced cardiotoxicity (six patients), male infertility (10 of the 12 assessable patients), and second malignancies (seven patients) were the major complications of chemotherapy. Despite the large number of limb salvages performed, only four local recurrences (2.4%) were registered. CONCLUSION: With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them. Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients.

Laparoscopic transhiatal esophagectomy with neoadjuvant chemotherapy to treat carcinoma of the upper esophagus.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15181-e15181
Author(s):  
Ji-xiang Wu ◽  
Lei Yu ◽  
Jian-ye Li
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Transhiatal Esophagectomy ◽  
Cervical Esophageal Cancer ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Complex Procedure ◽  
Hospital Stays ◽  
Indications For Operation

e15181 Background: Esophagectomy for Carcinoma of the upper esophagus has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 14 days. Laparoscopic transhiatal esophagectomy (LTHE) with neoadjuvant chemotherapy has the potential to improve these results and may lead to a sound outcome, but only a few articles have reported it. The objective of this study is to investigate the method of LTHE with neoadjuvant chemotherapy treating cervical esophageal cancer. Methods: From 2011 to 2012, LTHE was performed in 15 patients with carcinoma of the upper esophagus. There were 11 men and 4 women. Median age was 64 years (range, 44–79). Indications for operation included high-grade dysplasia (n = 4) and cancer (n = 11). Neoadjuvant chemotherapy was used in 15 patients. Results: There was no conversion to open procedure. LTHE was successfully completed in 15 patients. The median intensive care unit stay was 1.5 days (range, 1–8); hospital stay was 10.5 days (range, 8–23). Anastomotic leak rate was 6.7% (n=1). At a mean follow-up of 13 months (range, 1–24), quality of life scores were similar to preoperative values and population norms. Conclusions: LTHE with neoadjuvant chemotherapy is a safe and relatively advanced, complex procedure with little blood loss and less-invasion. Its long-term outcome needs to be investigated with large-volume cases.

Sign in / Sign up

Export Citation Format

Share Document