P-OGC34 Pandemic paradigms: Early outcomes of radical chemoradiotherapy for patients with operable oesophageal and oesophago-gastric junctional adenocarcinoma

Abstract Background The peak waves of the COVID pandemic necessitated a paradigm shift in surgical management of patients with oesophageal adenocarcinoma due to both pressure on services and high mortality rates for those with COVID undergoing surgery. The Association of Upper GI Surgeons (AUGIS) guidance on treating Upper gastrointestinal cancers in the COVID era made suggestions to treat operable adenocarcinomas using definitive/consolidation chemoradiation (DCRT) over standard neo-adjuvant chemotherapy (NAC) and our unit altered practice accordingly for a cohort of patients. For affected patients we monitored and audited clinical outcomes and the initial results from this are presented here. Methods Patients with oesophageal or oesophago-gastric junctional (O/OGJ) adenocarcinoma with potentially curative disease where initial management was altered from a treatment path which would have included surgery (with or without neoadjuvant therapy) to DCRT discussed at our regional multidisciplinary team (MDT) meeting between 1st February-1st June 2020 were included. Patient demographics, investigations, treatment given and clinical outcomes were prospectively recorded. Results 31 Patients with operable adenocarcinoma of O/OGJ had treatment altered to DCRT (mean age 65.4, [range 43 – 79]), 28 (90%) Male. 1 patient deteriorated prior to starting, leaving 30 who completed DCRT. Of these 4 patients had already had NAC prior to DCRT. Follow up was for a median of 8 (range 4-8) months following start of treatment. Post- vs pre-treatment FDG-PET imaging demonstrated a significant reduction in the mean maximum standardized uptake value (SUVmax) (p = 0.003, Sign test), in all but 3 patients. 11 patients had DCRT alone, (all alive at the time of data collection), of whom 3 patients had no sign of tumour. 19 (56%) patients proceeded to salvage oesophagectomy at a median of 15(range 10-25) weeks after completion of DCRT. 42% of these patients had a complete pathological response to treatment. There was a 5% perioperative mortality rate for this group and 1 patient was found to be unresectable on the day of surgery. At the time the data was reviewed overall survival of the entire cohort was 91%, 56% of whom had no sign of residual or recurrent disease. Conclusions A disease free survival of 56% compares poorly with the literature at the 3-month interval. The long-term follow-up of these patients will only be apparent in the coming months and years. This data does not support the use of this modality in the future and alternate treatment plans should be devised for future pandemics.

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Clinical Outcomes and Multidisciplinary Patterns of Failure for Olfactory Neuroblastoma: The Ohio State Experience

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692479 ◽

2019 ◽

Vol 81 (03) ◽

pp. 287-294 ◽

Cited By ~ 1

Author(s):

Adam R. Wolfe ◽

Dukagjin Blakaj ◽

Nyall London ◽

Adriana Blakaj ◽

Brett Klamer ◽

...

Keyword(s):

Clinical Outcomes ◽

Surgical Resection ◽

Cox Regression ◽

Disease Free Survival ◽

Olfactory Neuroblastoma ◽

Cancer Center ◽

Treatment Intensification ◽

Cox Regression Analysis ◽

Failure Patterns

Purpose Olfactory neuroblastoma (ONB) is a rare head and neck cancer believed to be originated from neural crest cells of the olfactory membrane located in the roof of the nasal fossa. This study evaluates clinical outcomes and failure patterns in ONB patients of those patients treated with surgical resection at a high-volume tertiary cancer center. Methods and Materials Thirty-nine ONB patients who underwent surgical resection at our institution from 1996 to 2017 were retrospectively identified. Univariate, multivariate, and survival analysis were calculated using Cox regression analysis and Kaplan–Meier log-rank. Results Median follow-up time was 59 months (range: 5.2–236 months). The median overall survival (OS) and disease-free survival (DFS) for the entire cohort were 15 and 7.6 years, respectively. The 5-year cumulative OS and DFS were 83 and 72%, respectively. The 5-year OS for low Hyams grade (LHG) versus high Hyams grade (HHG) was 95 versus 61% (p = 0.041). LHG was found in 66% of the early Kadish stage patients compared with 28% in the advanced Kadish stage patients (p = 0.057). On multivariate analysis, HHG and positive node status predicted for worse OS and only HHG predicted for worse DFS. Of note, five patients (all Kadish stage A) who received surgical resection alone had no observed deaths or recurrences with a median follow-up of 44 months (range: 5–235 months). Conclusion In this retrospective cohort, patients with positive nodes or HHG have significantly worse clinical outcomes. Future studies should explore treatment intensification for HHG or positive nodes.

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Imaging findings of patients undergoing SBRT for HCC after prior TACE.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.252 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 252-252

Author(s):

Aneliya Maleeva ◽

Tarita Thomas ◽

Joseph H Yacoub

Keyword(s):

Stereotactic Body Radiation Therapy ◽

Lesion Size ◽

The Other ◽

Response To Treatment ◽

Imaging Findings ◽

Inclusion Criteria ◽

Before And After ◽

Liver Sbrt ◽

Pre Treatment

252 Background: Our purpose is to assess the treatment response using follow up MRI or CT in lesions treated with stereotactic body radiation therapy (SBRT) after transarterial chemoembolization (TACE). Methods: Twenty-six patients treated with liver SBRT at our institution in the period between 2015 and 2017. Of these we included patients who had lesions diagnosed as HCC (LR-5) or probable HCC (LR-4), and who had prior TACE with a residual/recurrent enhancing component on the pre SBRT images with adequate post SBRT imaging. One radiologist (5 year experience) evaluated all pre and post SBRT imaging and measured the lesion size and the size of the largest enhancing component. Lesion decrease or increased in size was assessed based on the mRECIST criteria. Explant pathology results were collected for patients who received transplant. Necrosis > 90% on explant was considered full response to treatment. AFP (alpha-fetoprotien) values before and after SBRT were collected. Results: Eight patients with 9 lesions meet our inclusion criteria, 3 of which were LR-5 and 6 LR-4 prior to the TACE. At 3 month, 2 lesions had no residual enhancing component, 2 lesions decreased in size, 2 lesions increased in size, 3 lesions remain unchanged. After maximum available follow-up (ranging from 3 to 8 months), 3 lesions had no residual enhancing component, 2 decreased, 2 lesions increased in size, 2 lesions remain unchanged. Of the 3 lesions that were definitive HCC (LR-5): 1 lesion decreased in size, 2 lesions increased in size. 4 of 8 patients (4 lesions) underwent transplant, 3 of them showed only 50% necrosis on explant. 1 of 3 lesions showed no change in size by imaging, the other 2 lesions had no residual enhancing component. Only 1 lesion had full response on the transplant. This lesion was unchanged on 3 and 6 months follow up. The AFP was not helpful since the majority of the patient had low pre-treatment AFP. Conclusions: Patient with viable disease on imaging after TACE subsequently treated with SBRT demonstrated variable behavior on imaging. Close to half demonstrated resolution of the enhancing component, however, in the few that had explant follow up there was no correlation between imaging findings and pathology.

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High-sensitive basal serum thyroglobulin 6–12 months after thyroid ablation is strongly associated with early response to therapy and event-free survival in patients with low-to-intermediate risk differentiated thyroid carcinomas

Acta Endocrinologica ◽

10.1530/eje-16-1011 ◽

2017 ◽

Vol 176 (5) ◽

pp. 497-504 ◽

Cited By ~ 7

Author(s):

P Trimboli ◽

V Zilioli ◽

M Imperiali ◽

L Ceriani ◽

L Giovanella

Keyword(s):

Disease Free Survival ◽

Roc Curves ◽

Early Response ◽

Differentiated Thyroid Carcinoma ◽

Response To Therapy ◽

Response To Treatment ◽

Intermediate Risk ◽

Serum Thyroglobulin ◽

Free Survival

Objective High-sensitive thyroglobulin assays (hsTg) has decreased the need for stimulated Tg measurements in patients with differentiated thyroid carcinoma (DTC). However, multiple assays analyzing the same samples may report different values. Accordingly, appropriate assay-specific cut-off levels should be selected in representative patient series. Here, we evaluate the role of a new hsTg assay in low-to-intermediate risk DTC patients and select appropriate assay-specific clinical cut-off limits. Design This was a retrospective study. The response to treatment was assessed according to ATA. Methods Patients with low-to-intermediate risk DTC treated and regularly followed-up in our thyroid center. Tg was measured on the Kryptor Compact Plus Instrument (BRAHMS Thermo Fisher Scientific). Results The study series comprised 201 DTC patients and excellent response (ER) was demonstrated in 184 (91.5%). Optimized threshold of basal Tg (onT4-Tg) measured 6–12 months after initial treatment was set by ROC curves analysis at 0.28 ng/mL. Having onT4-Tg <0.28 ng/mL at 6–12 months after treatment was associated with longer disease-free survival of Kaplan–Meier (P < 0.001), ER at early follow-up (odds ratio (OR): 165, P < 0.001) and absence of relapse during follow-up (OR: 328, P = 0.0001). Conclusions Patients with low- and intermediate-risk DTC could be considered cured when they have onT4-Tg levels <0.28 ng/mL coupled with negative imaging at their first post-ablation visit.

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Minimum 20 Year Follow-Up of Semi-Constrained Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000008 ◽

2017 ◽

Vol 2 (2) ◽

pp. 2473011416S0000

Author(s):

Taylor Den Hartog ◽

Samuel Carlson ◽

Greg Alvine ◽

Frank Alvine ◽

Bryan Den Hartog ◽

...

Keyword(s):

Clinical Outcomes ◽

The United States ◽

Ankle Arthrodesis ◽

Total Ankle Arthroplasty ◽

Cobalt Chromium ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

Entire Cohort ◽

Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: With the introduction of newer generations of total ankle arthroplasty (TAA) constructs, the incidence of TAA in the United States has been increasing. While TAA has emerged as an alternative to ankle arthrodesis for the management of end-stage ankle arthritis, long-term data evaluating clinical outcomes and the survivorship of ankle prostheses is lacking. The purpose of this study was to report the clinical outcomes and radiographic survivorship of a second-generation, semi-constrained titanium and cobalt-chromium total ankle prosthesis at minimum twenty-year follow-up in order to provide a benchmark comparison for future generations of TAA design. Methods: 132 total ankle replacements in 126 patients were performed by a single surgeon between July 1984 and October 1994. Follow-up evaluation consisted of determining revision status, completion of the validated ankle osteoarthritis scale, a short questionnaire, and a review of the available radiographs. All radiographs were evaluated for evidence of progressive radiolucent lines, osteolysis and component subsidence. Results: At minimum twenty-year follow-up, 37 patients were alive, 89 were deceased, and 5 were lost to follow-up. For living patients, average clinical follow up was 25.3 years. Average radiographic follow-up was 21.4 years. Over the minimum 20 year follow-up, 29 ankles were revised (23%). For living patients, 13 ankles were revised (35%). Conclusion: Twenty-three percent of all patients and 35% of living patients required a revision over the minimum 20 year follow up interval. 65% of living patients have retained their prosthesis and 75% of the entire cohort are still functioning with their original ankle replacement or died with the original ankle replacement in place. This study should provide a benchmark for newer designs when they obtain this length of follow-up.

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Adding KIT Inhibitor Dasatinib (DAS) to Chemotherapy Overcomes the Negative Impact of KIT Mutation/over-Expression in Core Binding Factor (CBF) Acute Myeloid Leukemia (AML): Results from CALGB 10801 (Alliance)

Blood ◽

10.1182/blood.v124.21.8.8 ◽

2014 ◽

Vol 124 (21) ◽

pp. 8-8 ◽

Cited By ~ 24

Author(s):

Guido Marcucci ◽

Susan Geyer ◽

Weiqiang Zhao ◽

Andrew J Caroll ◽

Donna Bucci ◽

...

Keyword(s):

Complete Remission ◽

Clinical Outcomes ◽

Research Funding ◽

Negative Impact ◽

Treatment Protocol ◽

Disease Free Survival ◽

High Dose ◽

Pleural Effusions ◽

Kit Mutation

Abstract In AML, t(8;21)(q22;q22) and inv(16)(p13q22)/t(16;16)(p13;q22) and corresponding molecular rearrangements RUNX1/RUNX1T1 and CBFB/MYH11 (each involving a gene encoding a subunit of CBF) predict for favorable outcome in patients (pts) receiving consolidation with high-dose cytarabine (HiDAC) after achievement of complete remission (CR). However, 40-45% of these pts relapse. The subset of CBF AML pts harboring gain-of function mutations in the KIT gene (25%) and others overexpressing wild type (wt) KIT have inferior outcomes. Therefore, inhibiting KIT with DAS is a rational therapeutic strategy in CBF AML. We provide updated results (median follow-up 21.3 months (mo); range: 1.8-32.3 mo) for CALGB 10801, a phase II trial that combined DAS with standard chemotherapy for newly diagnosed with CBF AML pts. Enrollment required confirmation of CBF AML by the Alliance Molecular Pathology central lab using RT-PCR and Sanger sequencing-based assays for RUNX1/RUNX1T1 or CBFB/MYH11. Positive pts received induction chemotherapy with cytarabine (C) 200 mg/m2/day continuous intravenous (IV) infusion d (d) 1-7, daunorubicin (DNR) 60 mg/m2/d IV bolus d 1-3 and DAS 100 mg/d PO d 8-21. Pts with residual disease (>5% blasts) on d 21 were re-induced with same doses of C d1-5, DNR d1-3 and DAS d6-19. Pts who achieved CR received consolidation with HiDAC 3000 mg/m2 over 3 hours (if <60 years (yr) old) or 1000 m/m2 (if older) q12h on d1,3,5 and DAS 100 mg/d PO on d6-26 x 4 courses. Pts in CR after consolidation received DAS 100mg/d PO x 12 mo. The primary goals of this study were to ensure the safety of the combination and a CR rate not inferior to historical controls. Between April 2011 and January 2013, we screened 779 pts and 61 adult CBF AML pts were enrolled. Two pts were excluded from these analyses – one had no follow-up information and one was not molecularly eligible. Median age was 51 yr (range: 19-85 yrs); 14 pts (24%) were older (>60 yr). Fifty-two% of patients were male; 76% were Caucasian. Of the 59 pts, 65% were CBFB/MYH11-positive and 35% were RUNX1/RUNX1T1-positive; 18% of the 56 who were molecularly evaluable harbored KIT-mutated (mut). Treatment (tx) began on average 4 d from molecular diagnosis (range: 0-11 d). Seven pts are still undergoing tx; 4 pts died on tx (2 older), 9 (4 older) had an adverse event (AE) requiring tx interruption, and 8 refused to complete the tx (mainly DAS maintenance). Observed AEs were those expected with C and DNR (hematologic and non-hematologic) and with DAS (nausea, liver toxicity, pleural effusions). Only 2 and 3 pts had gr4 pleural effusions or increased liver function tests, respectively. Gr 5 AEs included respiratory failure (1) and sepsis (2). Three pts died during induction (2 older CBFB/MYH11 and 1 younger RUNX1/RUNX1T1). One pt died from sepsis during consolidation in CR (CBFB/MYH11, 48 yr). The 30-d survival rate was 97% overall (98% in younger and 93% in older pts). The outcomes of all pts and molecular subsets are summarized in the Table. Table Clinical outcomes All (n=59) Younger (n= 45) Older (n= 14) RUNX1/RUNX1T1 (n= 20) CBFB/MYH11 (n= 38) KIT-wt (n=46 ) KIT-mut(n=10 ) CR* (%) 90 93 79 90 89 89 90 Relapseº (%) 17 13 29 20 16 17 20 2-yr DFS# (%) 72 74 65 79 67 72 70 2-yr OS¶ (%) 87 96 61 85 89 86 90 *CR, complete remission; º Relapse rate at any time #DFS, disease-free survival, ¶OS, overall survival These updated results suggest that 1) rapid molecular screening and treatment-protocol allocation for CBF AML are feasible within a cooperative group, 2) DAS+chemotherapy is tolerable in CBF AML pts of all ages, 3) clinical outcomes for CBF pts receiving DAS+chemotherapy remain at least comparable to those historically observed in CBF pts who received chemotherapy alone; 4) older CBF AML pts seem to benefit from this intensive approach; 5) among pts treated with DAS+chemotherapy, outcomes of KIT-mut pts seem similar to those of KIT-wt pts (see Figure), although we recognize the limitations with relatively small numbers. Pts on CALGB 10801 continue to be followed for survival endpoints. Overall, these results support the continued evaluation of KIT inhibitors in CBF AML through prospective randomized trials but emphasize that further outcome enhancements in this disease subset could be achieved via the use of additional rationally targeted agents. Figure 1 Figure 1. Disclosures Stock: Sigma-Tau: Membership on an entity's Board of Directors or advisory committees, Research Funding. Larson:Ariad: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Pfizer: Consultancy.

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Pathologic complete response to standard preoperative chemoradiation in patients with locally advanced rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.686 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 686-686

Author(s):

Madiha Naseem ◽

Joshua Murray ◽

Christine E. Simmons ◽

Nancy Baxter ◽

Marcus J. Burnstein ◽

...

Keyword(s):

Locally Advanced ◽

Pathologic Complete Response ◽

Disease Free Survival ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Response To Treatment ◽

Significant Response ◽

Free Survival

686 Background: Pathologic complete response (pCR) is associated with lower rates of recurrences and longer disease-free survival rates in locally advanced rectal cancer (LARC) patients. The purpose of this study was to evaluate clinical outcomes of neoadjuvant chemoradiation and pCR among these patients. Methods: A retrospective chart review was performed for all patients treated for LARC between August 2005 and May 2011 at St. Michael's Hospital, Toronto. Patients were stratified into pCR and no-pCR groups and compared with respect to tumor size, nodal status, and treatment characteristics. Descriptive statistics were calculated for all variables of interest. Chi-square and t-tests were conducted to test for associations between categorical and continuous variables respectively. Disease free survival was calculated as the time between diagnosis and recurrence date, censored at last follow up. Results: A total of 92 patient charts were reviewed; 21 patients had metastatic carcinoma and were excluded from analysis. 63.4% (45/71) were male, with a mean age of 61.2 years and median follow up of 15 months. 12.7% (9/71) of patients achieved a pCR, while the remaining 87.35% (62/71) were no-pCR. All pCR patients received and completed standard pre-operative chemotherapy-radiotherapy. 73.4% (52/71) of the patients had complications from chemoradiotherapy. Furthermore, there was a significant association between having a significant response to treatment and achieving a pCR; where 78% (7/9) of pCR patients had a significant response to treatment. Overall, 4/71 patients had a local recurrence, 22.2% (2/9) pCR and 3.2% (2/62) no-pCR. Those with no-pCR had a recurrence at 1 and 2.2 years post diagnosis, while those with pCR had a recurrence at 3.7 years. Conclusions: This study suggests that patients undergoing standard pre-operative chemoradiotherapy are likely to have a significant response and achieve a pCR. Based on this study, although a pCR does not prevent the risk of recurrence, it delays the onset of local recurrence. Longer follow-up is required to determine if these results are robust and to develop future studies to improve efficacy of treatment delivery in LARC patients.

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Evaluation of TOP2A and TIMP-1 as predictive markers of pathologic complete response to neoadjuvant anthracycline-based chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e11503 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e11503-e11503

Author(s):

Joyce Maria L. Maia ◽

Elizabeth Santana Santos ◽

Rafael Costa Lessa ◽

Felipe D'Almeida Costa ◽

Stephania Bezerra ◽

...

Keyword(s):

Breast Cancer ◽

Pathologic Complete Response ◽

Neoadjuvant Treatment ◽

Disease Free Survival ◽

Predictive Biomarker ◽

Complete Response ◽

Tissue Inhibitor Of Metalloproteinase ◽

Her2 Breast Cancer ◽

Pre Treatment

e11503 Background: Factors predictive of response to anthracyclines can help selecting patients who really benefit from its use. HER2 amplification, TOP2A aberrations, and changes in tissue inhibitor of metalloproteinase (TIMP-1) expression in breast carcinomas have been shown to be associated with incremental benefit from anthracycline chemotherapy. Methods: We retrospectively analyzed data on the outcome of patients undergoing neoadjuvant anthracycline-based chemotherapy. Evaluated nuclear TOP2A protein expression and cytoplasmatic TIMP-1 expression in tumor cells in breast cancer biopsies by immunohistochemistry (IHC) and reviewed the pathological responses after completion of neoadjuvant treatment. Results: From 2002 to 2012, data from 97 patients was reviewed. Sixty four patients had the paraffin blocks corresponding to the pre-treatment biopsy to analysis the TOP2A and forty nine to TIMP-1. Patients were considered positive for TOP2A if the level of expression in IHC was higher than 20% and graduated TIMP-1 as weak, moderate or strong expression. Thirty percent of the patients achieved pathologic complete response (pCR) in pos-treatment surgical specimens. There was an association between TOP2A IHC expression and tumor pathological complete response (pCR) with higher pCR in TOPO2A positive tumors (pCR 44% vs 14%; p=0.008). There was no association between TIMP-1 expression and pCR. A moderate or strong TIMP-1 expression was associated with higher disease-free survival in multivariate analysis (p=0,005). No difference in PFS and OS was observed between patients with pCR after a median follow-up of 36 months. Conclusions: The expression of TOP2A seems to be a promising predictive biomarker of pCR to antracycline-based neoadjuvant chemotherapy in HER2 breast cancer. The predictive value and form of assessment of TIMP-1 remain uncertain. These findings should be better evaluated in prospective neoadjuvant trials.

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Immunologic Autograft Engineering: 13 Years Follow-up

Blood ◽

10.1182/blood-2021-148454 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3936-3936

Author(s):

Luis F. Porrata ◽

David J. Inwards ◽

Stephen M. Ansell ◽

Ivana N. Micallef ◽

Patrick B. Johnston ◽

...

Keyword(s):

Stem Cell ◽

Confidence Interval ◽

Clinical Outcomes ◽

Research Funding ◽

Myelogenous Leukemia ◽

Phase Iii ◽

Double Blind ◽

Hematopoietic Stem ◽

Entire Cohort

Abstract Our group published a double blind, randomized phase III study (Porrata et al, BBMT 2016; 22: 1017-1023) showing that the infusion of autograft absolute lymphocyte count (A-ALC) ≥ 0.5 x 10 9 cells/kg is a survival prognostic factor for lymphoma patients undergoing autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT). However, a limitation of the study was the short-term follow-up duration of two years post-APBHSCT. To assess if the A-ALC still provide survival benefit we looked at the 121 lymphoma patients enrolled in the phase III from December 10, 2007 until October 12, 2010 survival outcomes with a longer follow-up duration of up to 13 years post-APBHSCT. Since the accrual for the study, 52 patients had died of recurrence lymphoma, 4 patients of therapy-related acute myelogenous leukemia, 3 patients of unknown causes, 1 patient of acute respiratory distress syndrome, 1 patient of anaplastic astrocytoma, and 1 patient of septic shock. The current median follow-up is 86 months (range: 2.1-158.1 months) for the entire cohort and 127.8 months (range: 5.9-158.1 months) for patients still alive. Patients infused with an A-ALC ≥ 0.5 x 10 9 cells/kg continue to experience superior overall survival (OS) (HR = 0.392, 95%CI 0.224-0.687, P < 0.001) and progression-free survival (PFS) (HR = 0.413, 95%CI 0.253-0.677, P < 0.0004). The 10-year OS rates for the A-ALC ≥ 0.5 x10 9 cells/kg patients was 70% (95% confidence interval [CI], 55%-81%) and for the A-ALC < 0.5 x10 9 cells/kg patients was 36% (95% CI, 25%-49%) (Figure 1A). The 10-year PFS rates for the A-ALC ≥ 0.5 x10 9 cells/kg group was 57% (95% CI, 43%-70%) and for the A-ALC < 0.5 x10 9 cells/kg group was 28% (95% CI, 19%-40%) (Figure 1B). Autograft lymphocyte subset analysis including autograft-CD3 (A-CD3), autograft CD4 (A-CD4), autograft CD8 (A-CD8), and autograft natural killer cells (A-NK), showed that the infusion of A-NK was a predictor for OS (HR = 0.518, 95%CI 0.292-0.919, P < 0.02) and PFS (HR = 0.393, 95%CI 0.230-0.670, P < 0.0006). The 10-year OS rates for the A-NK ≥ 0.09 x10 9 cells/kg patients was 67% (95% confidence interval [CI], 50%-80%) and for the A-NK < 0.09 x10 9 cells/kg patients was 42% (95% CI, 31%-54%) (Figure 1C). The 10-year PFS rates for the A-NK ≥ 0.09 x10 9 cells/kg group was 59% (95% CI, 43%-73%) and for the A-NK < 0.09 x10 9 cells/kg group was 32% (95% CI, 23%-44%) (Figure 1D). Both the A-ALC and A-NK were independent predictor for OS [ A-ALC: HR = 0.367, 95%CI 0.195-0.690, P < 0.001) and A-NK: HR = 0.411, 95%CI 0.275-0.892, P < 0.01] and for PFS [ A-ALC: HR = 0.477, 95%CI 0.271-0.840, P < 0.01) and A-NK: HR = 0.490, 95%CI 0.266-0.903, P < 0.02]. With a longer follow-up of 13 years, this study shows that the infusion of A-ALC continues to provide better clinical outcomes to lymphoma patients undergoing APBHSCT. These study findings support our standard practice changed of not only collecting CD34 stem cell for hematologic engraftment, but also A-ALC for lymphoma patients undergoing APBHSCT to improve clinical outcomes. Further, autograft immune effector studies are warranted such as A-NK to develop a more immunocompetent targeted autologous graft verus tumor effect. Figure 1 Figure 1. Disclosures Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding. Paludo: Karyopharm: Research Funding.

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Concurrent platinum-based chemotherapy with intensity modulated radiation therapy (IMRT) for locally advanced squamous cell carcinoma of the head and neck (SCCHN): A retrospective single institution analysis

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.16511 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 16511-16511

Author(s):

N. F. Saba ◽

J. Gaultney ◽

S. Edelman ◽

M. Tighiouart ◽

L. W. Davis ◽

...

Keyword(s):

Locally Advanced ◽

Disease Free Survival ◽

Nodal Status ◽

Entire Cohort ◽

Excellent Outcome ◽

Stage Distribution ◽

T Stage ◽

Platinum Based Chemotherapy ◽

N Stage

16511 Background: Randomized clinical and meta-analysis data support the use of concurrent chemoradiation for treatment of locally advanced (SCCHN). IMRT is increasingly being used in treating SCCHN. We present outcome data from Emory University Winship Cancer Institute (WCI) with concurrent platinum based chemotherapy and IMRT, and analyze results according to primary site and nodal status. Methods: Between February 2003, and November 2005, 87 patients with locally advanced SCCHN underwent concurrent IMRT and platinum based chemotherapy. A total of 62 patients were treated with Cisplatin 100 mg/m2 d1,21,43, while 19 were treated with paclitaxel and carboplatin weekly for 7 weeks. Five patients were treated with other platinum based regimens. Follow up was documented in all cases with a median of 520 days (range 107 - 1269 days). Results: Patients were distributed among primary sites as follows: Hypopharynx (HP) 7 (8.0%), Larynx (L) 11(12.4%), Nasopharynx (NP) 13 (14.6%), and Oropharynx (OP) 56 (63.0%). T stage distribution was: T1: 16 patients (18.0%); lesions more advanced than T1 (>T1): 68 (76.4%). N stage distribution was, N0 :16 patients (18.0%), N1: 8 (9.0 %),nodal stage N2a or higher: 61 (68.5%). Median age was 57 years (range 32–75), and 63 patients (71.0%) were male. The median overall survival (OS) and disease-free survival (DFS) post-therapy was not reached. The 3 year OS rate for the entire cohort was 86% (L 82%, NP 89 %, OP 86 % HP 80%). The 3 year DFS rate for the entire cohort was 74%, (L 85%, NP 60%, and OP 75%, HP 76%). There was no correlation between OS and T or N stage (p=0.143 and 0.44 respectively), or between DFS and T-stage (p=0.4). A significant correlation was found between DFS and N stage (p=0.008). Conclusion: With moderate follow up, this retrospective analysis reveals an excellent outcome for patients with locally advanced SCCHN treated with chemotherapy and IMRT concurrently, supporting concurrent therapy as the current standard of care. The significant correlation of DFS and nodal status suggests a possible greater impact future approaches such as induction therapy may have on patients with advanced nodal disease. No significant financial relationships to disclose.

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CT imaging interval after complete cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) for well-differentiated adenocarcinoma of the appendix (WDAA).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.434 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 434-434

Author(s):

Karen A. Beaty ◽

Joshua S. Hill ◽

Safia Rafeeq ◽

Michael J. Overman ◽

Tara L. Sagebiel ◽

...

Keyword(s):

Cytoreductive Surgery ◽

Disease Free Survival ◽

Ct Scans ◽

Metastatic Colon Cancer ◽

Free Survival ◽

Entire Cohort ◽

Time To Recurrence ◽

Surveillance Imaging ◽

Disease Free

434 Background: WDAA with peritoneal dissemination (PD) is a rare disease with a prognosis related to the ability to perform adequate cytoreductive surgery (CRS) with cytoreductive scores of 0 or 1 (CC0 or CC1) followed by HIPEC. Diagnostic imaging is an important aspect of post-operative surveillance. Often, surveillance imaging follows metastatic colon cancer guidelines with frequent CT scans performed during the first 5 years after resection (every 3 months for 2 years, then every 6 months). Minimal evidence-based data exists to direct recommendations regarding optimal imaging intervals in patients with WDAA. Methods: All patients with a pathologic diagnosis of WDAA with PD who were evaluated at a single institution between August 1993 and January 2010 were retrospectively reviewed to identify patients who underwent a CC0 CRS and HIPEC. Parameters evaluated included demographics, time to recurrence and time to intervention after recurrence. Disease free survival was calculated using the Kaplan-Meier method. Results: 688 patients were evaluated during the study period. 67 patients (9.7%) had WDAA and underwent CC0 CRS/HIPEC. The mean age at diagnosis was 54.8 years. Twenty-two (32%) were male. Mean follow-up was 50.4 months. Disease free survival of the entire cohort at 10 yrs was 72 %. Eleven patients (16 %) experienced a recurrence. Median time to recurrence was 18.2 months. After recurrence, mean time to intervention was 6 months. In those patients that recurred, only 3 patients underwent intervention within 24 months of the index CRS/HIPEC (4% of overall cohort). Recurrence after 36 months occurred in only one patient (1.5% of cohort). Conclusions: Patients with WDAA/PD who undergo CC0 CRS/HIPEC have an overall very favorable prognosis and low risk of recurrence. Surveillance imaging, as often done for colorectal cancer, every 3-4 months is inappropriate. For this group of patients, follow-up CT scans every 6 months for 2 years, and then annually is recommended.

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