scholarly journals Post-mastectomy radiation therapy without usage of a bolus may be a reasonable option

2017 ◽  
Vol 58 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Naoki Nakamura ◽  
Satoko Arahira ◽  
Sadamoto Zenda ◽  
Kimiyasu Yoneyama ◽  
Hirofumi Mukai ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Locoregional Recurrence ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Cancer Center ◽  
Luminal Subtype ◽  
Center Hospital ◽  
Grade 3

Abstract To clarify the efficacy and toxicity of post-mastectomy radiation therapy (PMRT) without usage of a bolus, we identified 129 consecutive patients who received PMRT at the National Cancer Center Hospital East between 2003 and 2012. Seven of the 129 patients who received breast reconstruction before PMRT were excluded. All patients received PMRT of 6 MV photons, without usage of a bolus. The median follow-up duration for all eligible patients was 47.7 months (range: 4.0–123.2). Local, locoregional and isolated locoregional recurrence was found in 12 (9.8%), 14 (11%) and 5 patients (4.1%), respectively. The 3- and 5-year cumulative incidence of local recurrence, locoregional recurrence and isolated locoregional recurrence was 9.2 and 10.7%, 10.8 and 12.4%, and 4.3 and 4.3%, respectively. Although Grade 2 dermatitis was found in 11 patients (9.0%), no Grade 3–4 dermatitis was found. On univariate analysis, only a non-luminal subtype was a significant predictor for local recurrence (P < 0.001). On multivariate analysis, a non-luminal subtype remained as an independent predictor for local recurrence (P = 0.003, odds ratio: 10.9, 95% confidence interval: 2.23–53.1). In conclusion, PMRT without usage of a bolus resulted in a low rate of severe acute dermatitis without an apparent increase in local recurrence. PMRT without usage of a bolus may be reasonable, especially for patients with a luminal subtype.

scholarly journals Bronchoscopic Local Nd:YAG Laser Hyperthermia in the Treatment of Lung Cancer

1995 ◽  
Vol 1 (3) ◽  
pp. 159-164
Author(s):  
Ryosuke Ono
Keyword(s):  
Lung Cancer ◽  
Local Recurrence ◽  
Partial Response ◽  
Nd:Yag Laser ◽  
Alternative Therapy ◽  
Complete Response ◽  
Cancer Center ◽  
Laser Hyperthermia ◽  
Center Hospital

Between March 1989 and July 1990, 13 patients with tracheobronchial cancer were treated by laser hyperthermia at the National Cancer Center Hospital. A complete response was achieved in 9 patients (with 9 carcinoma lesions), with no evidence of local recurrence on follow-up ranging from 4 to 29 months. Four patients had a partial response, requiring alternative therapy.The surface area of the lesions showing complete response was less than 3 cm2. These lesions had a superficial appearance by bronchoscopic observation. Our experience suggests that laser hyperthermia may be a useful alternative to surgical resection in patients with small localized tumors confined within the tracheobronchial wall.

Treatment of ductal carcinoma in situ (DCIS) with lumpectomy and accelerated whole breast radiation therapy with concomitant boost (ARTB).

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 93-93
Author(s):  
M. Chadha ◽  
J. Portenoy ◽  
S. K. Boolbol ◽  
L. Kierstin ◽  
K. Baoch-Abaje ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Local Relapse ◽  
Sequential Boost ◽  
Concomitant Boost ◽  
Significant Difference ◽  
Grade 3

93 Background: The efficacy of accelerated radiation therapy (RT) for treating early stage invasive breast cancer has been established (Whelan T et al: NEJM, February 2010). But the role of accelerated schedules in treating patients with DCIS still needs to be defined. We have previously described the feasibility and low toxicity when using ARTB after lumpectomy (Chadha M et al: Int J Radiat Oncol Biol Phys 2007; 69). The objective of this study is to evaluate early outcomes in patients with DCIS treated with lumpectomy and ARTB, and to compare local recurrence rates of ARTB and conventional fraction (fr) RT with sequential boost (CRT). Methods: This study includes patients diagnosed to have primary DCIS treated with lumpectomy and RT. Patients with DCIS who had history of contralateral synchronous or metachronous invasive cancer were excluded. We identified 215 patients from our breast cancer database as having met this selection criteria; 54 patients received ARTB on an IRB approved protocol, and 161 patients matched by prognostic factors constituted the comparative CRT group. ARTB delivered 40.5Gy in 15fr to the breast, and with concomitant boost 45Gy in15fr was delivered to the lumpectomy boost volume. CRT delivered 46.8Gy in 26fr with sequential boost of 14Gy in 7fr. The patients were well matched with no significant difference in the distribution of known prognostic factors including age, nuclear grade, margin status, receptor status, and Body Mass Index between the groups. Results: The overall median follow up was 3.5 years (0.5 years–11.4 years). Actuarial 5-year local relapse-free survival was 95%. The actuarial 3-year local relapse rate was 2% and 0% for CRT and ARTB groups, respectively (p = 0.22). Local recurrence was observed in 9 patients with a median time to failure of 4.3 years (0.5 years to 8.6 years); 4/9 had grade 3 DCIS; 1 patient with grade 3 had close final margin (<1 mm); 5/9 patients received hormone therapy. Conclusions: With the follow up to date, we observed excellent outcomes in patients with DCIS treated by lumpectomy and RT. These preliminary results suggest comparable local control between ARTB and CRT. Additional studies and longer follow-up are needed.

Association of perioperative radiation therapy with outcome in 204 patients with primary retroperitoneal sarcoma: A two-institution study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10520-10520
Author(s):  
Kaitlyn Jane Kelly ◽  
Sam S. Yoon ◽  
Deborah Kuk ◽  
Li-Xuan Qin ◽  
Katerina Dukleska ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Background Radiation ◽  
Univariate Analysis ◽  
Tumor Grade ◽  
Lower Percentage ◽  
Free Survival ◽  
Pelvic Tumors ◽  
Local Recurrence Free Survival

10520 Background: Radiation therapy (RT) for retroperitoneal and pelvic sarcomas (RPS) is controversial. We examined the association of perioperative, advanced modality RT on outcomes in primary RPS. Methods: Prospectively maintained databases were reviewed to compare primary RPS patients (pts) treated at two institutions between 2003 and 2011. Clinicopathologic variables were analyzed with endpoints of local recurrence-free survival (LRFS) and disease-specific survival (DSS). Results: At one institution 172 pts were treated with surgery alone while at the other 32 pts were treated with surgery and perioperative proton beam or intensity-modulated RT ± intraoperative RT. The groups were similar in age, gender, tumor grade, tumor size, and margin status (p = NS). The RT group had a lower percentage of retroperitoneal versus pelvic tumors and leiomyo/liposarcoma versus other histologies (p < 0.05). Median follow-up was 38.7 months (36.9 for RT group, 38.8 for surgery alone). Five-year predicted LRFS was 91% (95% CI, 79-100%) in the RT group and 65% (57-74%) in the surgery only group (p = 0.06). RT was marginally significant in univariate analysis of LRFS. Upon adjusting for univariate predictors, RT was significantly associated with better LRFS (p = 0.046; Table). Five-year predicted DSS was 93% (95% CI, 82-100%) in the RT group and 84% (78-91%) in the surgery-only group (p = 0.25). The only independent predictor of DSS was age. Morbidity was higher in the RT group (41% vs 17%; p= 0.004). Conclusions: In this retrospective study, the addition of advanced modality RT to surgery for primary RPS was associated with a reduced risk of local recurrence, although this did not translate into a statistically significant improvement in DSS. This treatment strategy warrants further investigation in a randomized trial. [Table: see text]

scholarly journals Stereotactic prostate focal reirradiation therapy for local recurrence: preliminary results of Hartmann Oncology Radiotherapy Group

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20180027 ◽  
Author(s):  
Nathaniel Scher ◽  
Olivier Bauduceau ◽  
Marc Bollet ◽  
Hanah Lamallem ◽  
Tomer Charas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Cancer Recurrence ◽  
Pelvic Mri ◽  
Radiotherapy Group ◽  
Prostate Biopsies ◽  
Grade 3 ◽  
Experienced Grade

Objective: Our objective was to report our experience and to evaluate the feasibility and toxicity of focal salvage stereotactic body radiation therapy (SBRT) in patients with post-radiation local recurrence of prostate cancer. Methods: We retrospectively reviewed medical records of patients treated with Cyberknife ® between October 2014 and April 2017 at our institution for a focal reirradiation delivered to the prostate/prostatic bed for local recurrence after radical or adjuvant radiotherapy. All patients underwent prostate biopsies at recurrence at the time of fiducial markers placement, had choline PET/CT and pelvic MRI. The treatment consisted in 36 Gy in six fractions delivered every other day. Post reirradiation toxicities were assessed according to the CTCAE v4 (Common Terminology Criteria for Adverse Events). Results: 42 patients were treated with followed with a median follow-up of 21 months (range 3 – 31). 34 patients had biopsy proven recurrence. The initial treatment was radical prostatectomy and radiation therapy for 9 patients and radiation therapy alone for 33 patients. 23 patients from the group of prostate reirradiation had placement of rectal spacers. No Grade 4 or 5 toxicity were observed. 27 acute urinary events were recorded: 18 patients experienced Grade 1, 9 patients experienced Grade 2 toxicity and 1 patient experienced Grade 3 urinary toxicity, namely cystitis and/or dysuria. No Grade 2 or more digestive toxicity was observed. Rectal doses were significantly lower with rectal spacers. Conclusion: Salvage focal Cyberknife ® seems feasible and show promising results. Advances in knowledge: SBRT for local prostate cancer recurrence after initial radiotherapy is well tolerated with short follow-up.

scholarly journals Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4339
Author(s):  
Tanguy Perennec ◽  
Loig Vaugier ◽  
Alain Toledano ◽  
Nathaniel Scher ◽  
Astrid Thomin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Cancer Recurrence ◽  
Biochemical Response ◽  
Biochemical Relapse ◽  
Prostate Cancer Recurrence ◽  
Grade 3

Prostate cancer recurrence in patients previously treated with radical prostatectomy and radiation therapy is challenging. Re-irradiation could be an option, but data regarding efficacy and safety are lacking. We retrospectively evaluated salvage re-irradiation for local recurrence after prostatectomy and external beam radiation therapy. We collected data from 48 patients who underwent salvage reirradiation with stereotactic radiation therapy for local prostate cancer recurrence in the prostatic bed at four French centers. Fifteen patients (31%) were on androgen deprivation therapy during stereotactic radiotherapy. Biochemical response and relapse-free survival were analyzed, and post-treatment toxicities were assessed according to the Common Terminology of Adverse Events criteria. Five patients had grade 3 late bladder toxicity (cystitis), three had grade 3 late incontinence, and one had grade 3 late chronic pain. At three months, 83% of patients had a positive biochemical response. The median follow-up was 22 months. At the end of the follow-up, 21 patients (43%) had a biochemical relapse. The median time to biologic relapse was 27 months. The biochemical relapse rates at 1 and 2 years were 80% and 52%, respectively. In conclusion, salvage re-irradiation for recurrent prostate cancer in the prostate bed may generate significant toxicity rates, and a prospective study with appropriate patient selection is needed to evaluate its effectiveness.

scholarly journals 354 Lenvatinib and pembrolizumab in advanced endometrial carcinoma (EC): long-term efficacy and safety update from a phase 1b/2 study

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A381-A381
Author(s):  
Vicky Makker ◽  
Carol Aghajanian ◽  
Allen Cohn ◽  
Margarita Romeo ◽  
Raquel Bratos ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Cancer Center ◽  
Efficacy And Safety ◽  
Open Label ◽  
Phase 3 ◽  
Efficacy Analysis ◽  
Phase 1B ◽  
Grade 3 ◽  
Cutoff Date

BackgroundLenvatinib is a multikinase inhibitor of VEGFR 1–3, FGFR 1–4, PDGFRα, RET, and KIT. Pembrolizumab is an anti-programmed death-1 monoclonal antibody. We previously reported results from a cohort of 108 patients with metastatic EC (data cutoff date, January 10, 2019) who received lenvatinib + pembrolizumab as part of an ongoing multicenter, open-label, phase 1b/2 study evaluating the combination treatment in patients with selected solid tumors (NCT02501096). Lenvatinib + pembrolizumab showed a tolerable safety profile and promising antitumor activity per immune-related (ir) Response Evaluation Criteria In Solid Tumors (RECIST) by investigator assessment, including an objective response rate (ORR) of 38.9% (95% confidence interval [CI], 29.7–48.7), median progression-free survival (PFS) of 7.4 months (95% CI, 5.3–8.7), and median overall survival (OS) of 16.7 months (95% CI, 15.0-not estimable).1 Here we present updated efficacy and safety data (data cutoff date: August 18, 2020).MethodsPatients included in the EC cohort had histologically confirmed, measurable metastatic EC and had received ≤2 prior chemotherapies (unless discussed with the sponsor). Patients received lenvatinib (20 mg orally once daily) and pembrolizumab (200 mg intravenously once every 3 weeks). The phase 2 efficacy endpoints included ORR, PFS, OS, and duration of response. Tumor assessments for primary and secondary endpoints were evaluated by investigators per irRECIST.ResultsThe 108 patients from the key efficacy analysis set for the previously reported results were all included in these updated analyses. Median follow-up duration for the study was 34.7 months. Efficacy outcomes are summarized in table 1. Treatment-related adverse events (TRAEs) occurred in 104 (96%) patients (94 [87%] grade ≤3, 10 [9%] grade ≥4). TRAEs led to study-drug interruption of 1 or both drugs in 80 (74.1%) patients and dose reductions of lenvatinib in 73 (67.6%) patients; 23 (21.3%) patients discontinued 1 or both drugs due to a TRAE. The most common grade ≥3 TRAEs were hypertension (33.3%), lipase increased (9.3%), fatigue (8.3%), and diarrhea (7.4%).Abstract 354 Table 1ConclusionsWith extended follow-up, our updated efficacy analysis continued to show clinical benefit in patients with metastatic EC who received lenvatinib + pembrolizumab. Moreover, the combination had a manageable safety profile that was generally consistent with the established safety profiles of the individual monotherapies. No new safety signals were detected. A phase 3 study of lenvatinib + pembrolizumab versus treatment of physician’s choice in advanced endometrial cancer further supports the lasting clinical benefits observed in our study.2Trial Registration www.clinicaltrials.gov NCT02501096ReferencesMakker V, Taylor MH, Aghajanian C, et al. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer. J Clin Oncol 2020;38(26):2981–2992.Makker V, Colombo N, Casado Herráez A, et al. A multicenter, open-label, randomized, phase 3 study to compare Ethics ApprovalThis study was approved by the following ethics committees/institutional review boards (IRBs): Oregon Health & Sciences University IRB, IntegReview IRB, Memorial Sloan Kettering Cancer Center IRB, University of Pennsylvania Office of Regulatory Affairs IRB, Dana-Farber Cancer Institute IRB, The University of Chicago Biological Sciences Division IRB, University of Texas MD Anderson Cancer Center IRB, Western IRB, Quorum Review IRB, US Oncology, Inc. IRB, CEIm - Comité de Ética de la Investigación con Medicamentos, Regional Komite for Medisinsk og Helsefagli Forskningsetikk, and REC - Regional Committees for Medical and Health Research Ethics. All participants gave informed consent before taking part in this study.ConsentNo identifying information is contained in this abstract so no permission from participants is considered necessary.

scholarly journals Long-term outcome of indigenous 177Lu-DOTATATE PRRT in patients with Metastatic Advanced Neuroendocrine Tumours: a single institutional observation in a large tertiary care setting

2021 ◽  
Vol 94 (1117) ◽  
pp. 20201041
Author(s):  
Keerti Sitani ◽  
Rahul V Parghane ◽  
Sanjay Talole ◽  
Sandip Basu
Keyword(s):  
Primary Tumour ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Previous History ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wide Range ◽  
Grade 3

Objectives: Assessment of long-term outcome and toxicity of indigenous 177Lu-DOTATATE PRRT in patients of metastatic/advanced NETs in a large tertiary-care PRRT setting. Methods: A total of 468 metastatic/advanced NET patients (wide range of primary sites including CUP-NETs), who underwent at least two cycles of 177Lu-DOTATATE PRRT with available follow-up information, were included and analysed retrospectively in this study. In-house labelling of DOTATATE with 177Lu (direct route produced) was carried out in the hospital radiopharmacy and treatment administered in cycles (dose: 5.55 to 7.4 GBq per patient), at 10–12 weeks interval. The assessment of long-term outcome was undertaken under three broad headings: (a) Therapeutic response, (b) Survival outcome and (c) Toxicity assessment. The median point estimate with 95% CI for progression free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic covariates for association with PFS and OS was investigated by Cox proportional hazards model (univariate and multivariate Hazard Ratios) and with disease control rate (DCR) by Chi-square test, with significant P value defined as <0.05. Results: Long-term outcome (follow-up ranging from 4 to 97.6 months; median period:46 months following first 177Lu-DOTATATE PRRT) results showed, (i) on symptomatic response evaluation scale, complete response (CR) in 214 patients (45.7%), partial response (PR) in 108 (23.1%), stable disease (SD) in 118 (25.2%), progressive disease (PD) in 28 (6%). (ii) Biochemical response evaluation showed CR in 52 (12%), PR in 172 (40%), SD in 161 (38%), and PD in 42 patients (10%). (iii) Molecular imaging response (by PERCIST criteria) showed CR in 29 (6%), PR in 116 (25%), SD in 267 (57%) and PD in 56 (12%) patients. (iv) On RECIST 1.1 criteria, CR was observed in 14 patients (3%), PR in 126 patients (27%), SD in 282 patients (60%) and PD in 46 patients (10%). The median PFS and OS were not reached at a median follow-up of 46 months. Observed PFS and OS at 7 years were 71.1% 95% CI (62.4–79.7%) and 79.4% 95% CI (71.4–86.9%) respectively. PFS was dependent on previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake, site of primary tumour, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake and number of PRRT cycles. The OS was dependent on baseline 68Ga-DOTATATE uptake, site of primary tumour, presence of bony metastatic disease, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for bony metastatic disease and number of PRRT cycles. Transient haematological toxicity of Grade 1, Grade 2, and Grade 3 was found in 8 (1.7%), 1 (0.2%) and one patient (0.2%), respectively. Nephrotoxicity of Grade 1, Grade 2, Grade 3, and Grade 4 were seen in 16 (3.5%), 3 (0.6%), 2 (0.4%) and one patient (0.2%), respectively. On a separate sub-analysis of 322 NET patients with progressive disease at the initiation point of PRRT, overall response rates (CR + PR + SD) were 93.5%, 88.5%, 89.1 and 87.9% on symptomatic, biochemical, RECIST 1.1 and PERCIST criteria and PFS and OS at 7 years 68.3% and 79.2%, respectively. Conclusions: The present results demonstrate that 177Lu-DOTATATE PRRT improved symptoms and biochemical markers substantially in most of the NET patients, with disease stabilisation on both anatomical and molecular imaging in majority and response in a sizeable fraction. Additionally, the therapeutic protocol with lesser dose per cycle (mean 5.92 GBq/cycle) and prolonged duration (over 5 cycles and 1.5 years) in a metastatic NET setting proved equally efficacious (with superior PFS and OS rates) and relatively better tolerated with minimal toxicity. Advances in knowledge: The present work critically examines the long-term results, survival outcome and toxicity profile of the indigenous 177Lu-DOTATATE (produced through direct neutron activation of enriched 176Lu) in metastatic progressive NETs across a wide range of primary sites and malignancies. Such long-term outcome data establishes the favourable impact of PRRT in a wide patient base and also the therapeutic efficacy of the product.

Stereotactic Radiosurgical Salvage Treatment for Locally Recurrent Esthesioneuroblastoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 332-340 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Matthew L. Carlson ◽  
Bruce E. Pollock ◽  
Eric J. Moore ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Additional Patient ◽  
Median Dose ◽  
Single Institution ◽  
Treatment Volume ◽  
Locally Recurrent ◽  
Assess Treatment Response ◽  
Grade 3

Abstract BACKGROUND: Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available. OBJECTIVE: To determine whether SRS is effective in providing local control for recurrent ENB. METHODS: This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962–2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported. RESULTS: The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm3 (mean, 18.9 cm3; range, 1.4-76.3 cm3), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS. CONCLUSION: SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.

Platelets Recovery and Transfusion Needs after Reduced Intensity Conditioning (RIC) Allogeneic Peripheral Blood Stem Cell (PBSC) Transplantation (allo-SCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2989-2989
Author(s):  
Thomas Prebet ◽  
Mohamad Mohty ◽  
Patrick Ladaique ◽  
Christian Chabannon ◽  
Catherine Faucher ◽  
...  
Keyword(s):  
Platelet Count ◽  
Acute Gvhd ◽  
Univariate Analysis ◽  
Conditioning Regimen ◽  
Platelet Recovery ◽  
Gvhd Prophylaxis ◽  
Study Population ◽  
Grade 3 ◽  
Few Data

Abstract Few data are currently available regarding platelets trasfusion needs and the kinetics and predicitive factors for platelets recovery after RIC allo-SCT. In this study, we analyzed the profile of platelets recovery and transfusion needs in the first 100 days after sibling PBSC RIC in a single institution series of 166 consecutive transplantations. Patients and graft characteristics were: age 49 y. (range: 18–70), diagnoses: 66 myeloid malignancies (40%), 64 lymphoid malignancies (39%), and 36 metastatic solid tumors (21%). 112 pts (67%) received an ATG-based RIC, while 54 pts (33%) received a low dose irradiation-based RIC. 75 pts (45%) developed grade 2–4 acute GVHD. Platelets recovery (>20 G/L) was observed at a median of 9 days (range: 0–99). The kinetics profile of platelets recovery is shown in the figure below. In the whole study population, the nadir was observed around day +7 after allo-SCT, and a plateau was reached about day +35. Filtered and irradiated donor apheresis platelets were used and patients needed a median of 1 unit (range: 0–53). In this series, 83 pts (50%) did not require any platelets transfusion during the follow-up period (median follow-up: 442 days) and 83 patients (50%) received at least one transfusion of platelets (54 were not transfused beyond day +100 after allo-SCT). Platelets count prior to RIC allo-SCT (median count 144 G/L; HR 0.44 (0.28–0.7) p=0.002), conditioning regimen (use of ATG; HR 1.86 (1.08–3.2) p=0.025) and the occurrence of acute (HR 1.54 (1.17–2.01); p=0.001) and severe GVHD (HR 2.36 (1.38–3.05) p=0.0006; 82% of patients with grade 3–4 acute GVHD were transfused) were the parameters significantly associated with platelets transfusion needs in multivariate analysis. In this cohort, 145 pts could be assessed for platelets recovery at day +100: among them, 99 (68%) had a platelet count >99 G/L. Univariate analysis found a significant impact of acute GVHD (p=0.0001) and platelet count prior to conditioning (p=0.012) but only acute GVHD (HR 5.52 (2.48–12.25); p=0.001) was associated with a delayed platelet recovery in a multivariate model. No impacts of pathology, GVHD prophylaxis regimen or CD34+ cell dose were demonstrated. Overall, these observations show a significantly lower rate of platelets transfusions and a quicker kinetic of platelets recovery after RIC allo-SCT and point out the effect of acute GVHD. In addition, considering the low level of myeloablation observed, RIC could be an appropriated field of investigation for the testing of megakaryocytic stimulating agents, towards further improving the safety and outcome of RIC allo-SCT. Platelets recovery after PBSC RIC allo-SCT Platelets recovery after PBSC RIC allo-SCT

Long-term evaluation of ifosfamide-related nephrotoxicity in children: The French experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9551-9551
Author(s):  
O. Fawaz ◽  
A. Rey ◽  
P. Niaudet ◽  
D. Orbach ◽  
C. Bergeron ◽  
...  
Keyword(s):  
Renal Toxicity ◽  
Univariate Analysis ◽  
Multivariate Analyse ◽  
French Experience ◽  
Term Evaluation ◽  
Tubular Toxicity ◽  
Grade 3 ◽  
Median Interval

9551 Background: Ifosfamide-induced nephrotoxicity is a significant issue in patients treated for tumours during childhood. This study aimed at documenting incidence of late renal toxicity of ifosfamide and its risk factors. Methods: 183 patients have been investigated. 100 were male. Median age at treatment was 9.3 years (0.4–18 years). Median dose of ifosfamide was 54 g/m2 (18–77 g/m2). No patients received cisplatin and/or carboplatinum. Diagnoses included rhabdomyosarcoma (77), other soft tissue sarcoma (39), Ewing (39), and osteosarcoma (28). Investigations were performed at a median interval of 10.3 years (5–20.7) after the end of the treatment, at a median age of 21.6 years (7.1–44.2). No patient had electrolyte or vitamine supplementation. Glomerular and tubular functions were graded according to the Skinner's system. Results: After 5 year minimal follow-up 55% had normal tubular and 79% had normal glomerular functions. Natraemia, kalaemia, serum HCO3 and calcaemia were normal in all patients. Hypomagnesaemia was observed in 4, hypophosphaetemia in 8 %. The tubular threshold for phosphate was reduced in 44% of the patients (grade 2 or 3 in 15%, grade 3 in 1 pt). Significant glycosuria (> 0.5 g/24h) was detected in 5 % of the patients but it was clearly abnormal only in 5 patients. 34% of the patients had beta2 microglobulinuria, however, proteinuria was observed in only 12%. Cumulative dose of ifosfamide, older age at treatment and follow-up since treatment were predictor for tubulopathy in univariate and multivariate analyse. The glomerular filtration rate was normal in 79% of the patients. 21% had a grade 1 toxicity and 1 patient a grade 2. Univariate analysis did not find any prognostic factor for glomerular toxicity apart from the association with tubular toxicity. Conclusions: Since ifosfamide-induced renal toxicity can be severe, long term evaluation is important and this risk should be balanced carefully against efficacy. No significant financial relationships to disclose.

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