scholarly journals MBCL-02. ROLE OF PREOPERATIVE CHEMOTHERAPY IN METASTATIC MEDULLOBLASTOMA: A COMPARATIVE STUDY IN 92 CHILDREN

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii387-iii387
Author(s):  
Léa Guerrini-Rousseau ◽  
Rachid Abbas ◽  
Sophie Huybrechts ◽  
Virginie Kieffer-Renaux ◽  
Stéphanie Puget ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Pilot Studies ◽  
Tumor Excision ◽  
Intellectual Quotient ◽  
Initial Surgery ◽  
Group A ◽  
Group B ◽  
Complete Tumor

Abstract BACKGROUND Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed. METHODS Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy, France, between 2002 and 2015: surgery at diagnosis (n=54; group A) and surgery delayed after carboplatin and etoposide-based preoperative therapy (n=38; group B). Treatment strategies were similar in both groups. RESULTS The rate of complete tumor excision was significantly higher in group B than in group A (93.3% versus 57.4%, p=0.0013). Post-operative complications, chemotherapy-associated side effects and local progressions were not increased in group B. Preoperative chemotherapy led to a decrease in the primary tumor size in all patients, 4/38 patients experiencing meanwhile a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after preoperative chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up). CONCLUSION Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival.

scholarly journals Role of neoadjuvant chemotherapy in metastatic medulloblastoma: a comparative study in 92 children

2020 ◽  
Vol 22 (11) ◽  
pp. 1686-1695 ◽  
Author(s):  
Léa Guerrini-Rousseau ◽  
Rachid Abbas ◽  
Sophie Huybrechts ◽  
Virginie Kieffer-Renaux ◽  
Stéphanie Puget ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Preoperative Chemotherapy ◽  
Positive Impact ◽  
Neuropsychological Outcome ◽  
Pilot Studies ◽  
Tumor Excision ◽  
Initial Surgery ◽  
Group A ◽  
Group B ◽  
Complete Tumor

Abstract Background Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed. Methods Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy between 2002 and 2015: surgery at diagnosis (n = 54, group A) and surgery delayed after carboplatin and etoposide-based neoadjuvant therapy (n = 38, group B). Treatment strategies were similar in both groups. Results The rate of complete tumor excision was significantly higher in group B than in group A (93.3% vs 57.4%, P = 0.0013). Postoperative complications, chemotherapy-associated side effects, and local progressions were not increased in group B. Neoadjuvant chemotherapy led to a decrease in the primary tumor size in all patients; meanwhile 4/38 patients experienced a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after neoadjuvant chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up). Conclusion Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival. Key Points 1. Preoperative chemotherapy increases the rate of complete tumor removal. 2. No additional risk (toxic or disease progression) is linked to the delayed surgery. 3. Preoperative chemotherapy could have a positive impact on the neuropsychological outcome of patients.

scholarly journals The Clinical Outcome in Patients with Peritoneal Metastasis

2020 ◽  
pp. 1-3
Author(s):  
Spiliotis J ◽  
◽  
Farmakis D ◽  
Raptis A ◽  
Kopanakis N ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Survival Rates ◽  
Peritoneal Metastases ◽  
Mortality And Morbidity ◽  
Chemotherapy Group ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D

Cytroreductive surgery (CRS) and HIPEC are controversial effective treatment options for selected patients with peritoneal metastases. We retrospectively examined 4.500 patients with peritoneal metastases from different tumors from 2005 to 2020. Patients were divided in 4 groups, surgery plus HIPEC and then systemic chemotherapy: Group A n=730, Group B n=700, R0 surgery plus systemic chemotherapy, Group C n=870, palliative surgery plus systemic chemotherapy and Group D n=2.200, palliative care and best support. The postoperative outcomes, morbidity, mortality were compared between the 4 groups. The mean survival rates Group A=24,4+10,2m, Group B= 18,4+6,3m, Group C=12,3+5,7m, Group D=5,8+2,3m (p<0.05 between Gr A vr Gr B). There was no statistically significant difference in the 30-day mortality and morbidity. In conclusion CRS + HIPEC are feasible in 16% of our patients with peritoneal metastases and are associated with pro-longed survival.

Mechanical ventricular support using pulsatile Abiomed BVS 5000 and centrifugal Biomedicus-pump in postcardiotomy shock

1994 ◽  
Vol 17 (9) ◽  
pp. 492-498 ◽  
Author(s):  
K. Minami ◽  
H. Posival ◽  
A. El-Bynayosy ◽  
M.M. Körner ◽  
H. Schrofel ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Survival Rates ◽  
Valve Surgery ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Postcardiotomy Shock ◽  
Group A ◽  
Group B ◽  
Long Term Survivors

Since we started using ventricular assist devices (VAD) in July 1987 up to August 1993, 63 of 15,650 (0.4%) patients (pts) who underwent open heart sugery were supported postoperatively by VAD at out institution. Forty-three were male and 20 female, mean age 55.5 years. In 49 pts coronary artery bypass grafting (CABG), in 8 pts valve surgery, in 3 pts combined CABG and valve surgery and in 3 pts corrective procedures for congenital heart disease were performed. Perioperative myocardial infarction was the most frequent indication (73%). In 37 of the 63 pts (58.7%) a centrifugal (Biomedicus pump (group A) was used and in 26 pts (41.3%) a pulsatile Abiomed BVS 5000 (group B). Fourteen of 37 pts (38%) in group A were weaned from the VAD and all of them were discharged. Twenty-three pts were unable to be weaned and 19 of these pts died. The remaining 4 pts were transplanted successfully and subsequently 3 died and 1 was discharged. In all, 15 pts (39%) were long-term survivors. Sixteen of 26 pts (62%) in group B were weaned from VAD and 13 (50%) of them were discharged of whom 3 died. Ten patients were unable to be weaned and 7 of these died. The remaining 3 pts were transplanted successfully. In all, 16 pts (61.5%) were long-term survivors. The shorter the interval between beginning resuscitation and application of VAD the better the outcome. Younger age, VAD installation in OR, support time between 2 and 7 days and Abiomed pump, influence the survival rate positively. Because of higher recovery and survival rates in patients assisted by Abiomed compared to the Biomedicus pump, we recommend the Abiomed pump in postcardiotomy cardiac failure.

scholarly journals Superior Mesenteric-Portal Vein Resection in Patients With Pancreatic Adenocarcinoma Is Safe and May Increase Survival

2017 ◽  
Vol 102 (7-8) ◽  
pp. 356-361
Author(s):  
Wei-Ding Wu ◽  
Hong-Guo Yang ◽  
Jia Wu ◽  
Kai Jiang ◽  
Kun Guo ◽  
...  
Keyword(s):  
Portal Vein ◽  
Pancreatic Adenocarcinoma ◽  
Survival Rates ◽  
Vein Wall ◽  
Venous Resection ◽  
Group A ◽  
Tumor Involvement ◽  
Artery First ◽  
Vein Resection ◽  
Group B

Extension of pancreatic adenocarcinoma into adjacent vasculature often necessitates resection of the portal vein (PV) and or superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD). Our study describes the surgical technique and results of PV/SMV resection in pancreatic adenocarcinoma patients. Between January 2008 and October 2013, 252 patients underwent PD for pancreatic malignancy. A total of 42 PV/SMV resections were performed (28 men, 14 women). Patients were categorized into 2 groups according to the degree of invasion into the portal vein wall: Group A (n = 16), extended compression of the portal vein wall by the surrounding carcinoma without true invasion, and Group B (n = 26), true invasion including intramural and transmural invasion. Morbidity of the 42 patients was 35%; there was no operative mortality, and overall 1-, 3-, and 5-year survival rates were 60%, 21%, and 12%, respectively. No differences in tumor size, margin positivity, nodal positivity, or survival rates were observed between groups. Resection of the PV/SMV is safe and does not increase morbidity or mortality. Tumor involvement of the PV/SMV is not associated with histopathologic signs that are predictive of a poor prognosis. The “artery first” approach should be considered as a means to facilitate safe venous resection and reconstruction.

scholarly journals Optimization of the Staged scheme for the Treatment of complicated (OTA C3) Tibial Pilon Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Zhang Hui
Keyword(s):  
Operative Time ◽  
Stage I ◽  
Stage Ii ◽  
Operative Strategy ◽  
Tibial Pilon ◽  
Initial Surgery ◽  
Group A ◽  
Definitive Surgery ◽  
Group B ◽  
Pilon Fractures

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Trauma Introduction/Purpose: To explore and evaluate the optimization operative strategy reported on our results using a direct approach with posterior malleolar plating in combination with staged anterior? xation in complex pilon fractures. Methods: 43 patients were diviede into group A (23 cases, posterior plating and external? xator for stage I, ORIF through anterior approach for stage II)and group B(20 cases, closed reduction and external? xator for stage I, ORIF through anterior- posterior approach for stage II) between 2013 and 2014. With an average follow-up of 16.6 months, Results: The statistics showed that there were statistically significant differences (P<0.05)between two groups in the time before definitive surgery and the operative time of the stage II surgery, but in the time before initial surgery and the operative time of the initial surgery(P>0.05). The AOFAS and MLFAS scores in the group A were better than (P < 0.05) the Group B. 4 patients in the group A had some evidence of symptomatic arthrosis compared with 6 in the group B. The rate of tourniquet paralysis for the group A was 4.35% versus 35% (P < 0.05) for the Group B. Conclusion: The optimization operative strategy offers direct visualization for reduction, and allows the anterior components to be secured to a stable posterior fragment at a later date. The staged strategy not only obtains the leg fascia chamber decompression, also shortens the waiting time for operation, reduces reduction difficulties in definitive operation.

Progression and hyperprogression after anti-PD1 therapy for unresectable stage III or IV melanoma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21021-e21021
Author(s):  
Elise Colle ◽  
Stéphane Dalle ◽  
Laurent Mortier ◽  
Bernard Guillot ◽  
Caroline Dutriaux ◽  
...  
Keyword(s):  
Survival Rates ◽  
Real Life ◽  
Advanced Melanoma ◽  
First Line ◽  
Best Response ◽  
Unresectable Stage ◽  
Group A ◽  
Similar Survival ◽  
Group B ◽  
Response Group

e21021 Background: Primary progression (PP) and secondary progression (SP) to anti-PD1 therapy (APD) are poorly described in advanced melanoma in real life practice. Hyperprogression with a deleterious effect is reported in many cancers but is poorly assessed in advanced melanoma. Methods: Characteristics of 793 patients treated by APD (nivolumab or pembrolizumab) between July 2014 and May 2018 were collected from MelBase, a prospective French biobank (NCT02828202).We considered: group A (progressive disease as best response), group AHP (hyperprogression) within group A patients (progression/death within 3 months with normal initial LDH and ECOG at baseline, and either ECOG increased from 0 to 3-4, either LDH increased from normal to elevated or both), group B SP (response or stable disease then progression). Characteristics for all and survival for patients alive at progression (AAP) were also described. Results: Median follow-up was 11.3 months (Q1-Q3 4.8–23.6). Characteristics at baseline are in the table. In group A, 14% patients died at progression; within 262 patients AAP, 17% continue APD (the same or switch), 15.1% (CI95 11.1-20.6) were alive 1-year after progression (1YAP); 20.5% for patients in first line and 11.5% for pretreated. In group AHP, 41% patients died at progression; within 48 patients AAP, 12% continue APD, 11.1% (CI95 7.8-13.6) were alive 1YAP. In group B, 11% patients died at progression; within 88 patients AAP, 36% continue APD, 10.3% (CI95 5.2-20.1) were alive 1YAP, 15.9% for patients in first line and 7.0% for pre-treated. Conclusions: Our study shows that PP and SP to APD differ at baseline, but have similar survival rates at progression, while mechanisms involved might be different, providing important landmarks to build second line trials. This study thus highlights the existence of hyperprogressors among which 41% patients died within 3 months, as well as describes their associated characteristics. [Table: see text]

scholarly journals Oncological and Functional Evaluation of Open Conservation Surgery for Hypopharyngeal Cancer with/without Reconstruction

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Tsutomu Nomura ◽  
Daisuke Maki ◽  
Sadahiro Kishishita ◽  
Fumihiko Matsumoto ◽  
Seiichi Yoshimoto
Keyword(s):  
Survival Rates ◽  
Oral Intake ◽  
Functional Results ◽  
Hypopharyngeal Cancer ◽  
Transoral Surgery ◽  
Functional Evaluation ◽  
Kaplan Meier ◽  
Conservation Surgery ◽  
Group A ◽  
Group B

Objectives. Oncological and functional results of open conservation surgery for hypopharyngeal cancer have been desired. Methods. We performed a chart review of 33 patients with hypopharyngeal cancer who underwent open conservation surgery. Oncological and functional results were evaluated in surgery with primary closure (Group A) and surgery with reconstruction (Group B). Postoperative functions were evaluated by interval to resumption of oral intake, Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS). Results. Five-year disease-specific and overall cumulative survival rates by Kaplan-Meier method for all cases were 95.7% and 82.3%, respectively. Duration from surgery to full oral intake was 12 days in Group A and 14 days in Group B. FOSS rates were 83.3 in Group A and 95.5 in Group B. CS was 0 in both groups. Conclusion. Oncological and functional results of open conservation surgery were comparable to those with transoral surgery and chemo/radiotherapy. Our technique represents a reliable treatment for hypopharyngeal cancer.

scholarly journals PREVALENCE AND MANAGEMENT OF THE DIABETIC FROZEN SHOULDER

2020 ◽  
Vol 8 (10) ◽  
pp. 944-954
Author(s):  
Niraj Kumar ◽  
Keyword(s):  
Functional Ability ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Treatment Strategies ◽  
Insidious Onset ◽  
Group A ◽  
Shoulder Syndrome ◽  
Shoulder Condition ◽  
Group B

The term frozen shoulder was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease. Long before Codman, in 1872, the same condition had already been labelled periarthritis by Duplay. In 1945, Naviesar coined the term adhesive capsulitis. [2] The pathophysiology of idiopathic adhesive capsulitis (frozen shoulder) is poorly understood. Most authors have reported various degrees of inflammatory changes in the synovial membrane. Adhesions between the shoulder capsule and the humeral head have been noted by some, but not all, authors. [4] The aetiology of periarthritis of the shoulder, however, is not clearly understood. Amongst the factors suggested are trauma myocardial infarction hemiplegia, pulmonary tuberculosis, thyrotoxicosis, cerebral tumour, and epilepsy. [7] Subjects with Frozen Shoulder Syndrome group A treated with ERM and MWM and group B treated with MRM. The duration of each treatment was 3 weeks. There was an improvement in mobility and functional ability at 12 weeks in subjects treated with the 3 mobilization techniques. Comparing the effectiveness of the 3 treatment strategies in subjects with unilateral Frozen Shoulder Syndrome, ERM and MWM were more effective than MRM in increasing mobility and functional ability. [22].

scholarly journals Significance of Hepatitis B Recurrence in Liver Transplantation Recipients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Hong-Shiue Chou ◽  
Chih-Hsien Cheng ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
Yu-Chao Wang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B ◽  
Liver Function ◽  
Survival Rates ◽  
Clinical Manifestations ◽  
Antiviral Agent ◽  
Close Monitoring ◽  
Group A ◽  
Group B ◽  
Hcc Recurrence

Background. A combination of antihepatitis B immunoglobulin and antiviral agents is the most common regimen for prophylaxis of hepatitis B recurrence after liver transplantation. However, hepatitis B recurrence still happens. The significance of hepatitis B recurrence is less mentioned. Materials. Forty-eight of the 313 hepatitis B liver transplant recipients having hepatitis B recurrence were included in this study. The patients were divided into group A, the patients transplanted for hepatitis B-related liver failure, and group B, the patients transplanted for hepatitis B-related cirrhosis and HCC. The clinical manifestations after hepatitis B recurrence were recorded. Results. Among the 48 patients with hepatitis B recurrence, 23 patients were in group A and 25 patients in group B. The age was 51.6±9.4 years in group A and 52.8±6.4 in group B (p=0.869). The MELD score prior to transplantation was 23.1±9.9 in group A patients and 12.9±5.6 in group B patients (p<0.001). The median (interquartile) interval from transplantation to hepatitis B recurrence was 10 (2-19) months for group A patients and 13 (8.5-35) months for group B patients (p=0.051). After hepatitis B recurrence, the liver function was almost normal in both groups. In group B patients, 10 patients had HCC recurrence with 7 of 10 patients having hepatitis B recurrence earlier than HCC recurrence. The interval between hepatitis B and HCC recurrence was 1 to 15 months. The 1-, 3-, and 5-year survival rates were 82.6%, 73.9%, and 69.0%, respectively, for group A patients and 96%, 76%, and 68%, respectively, for group B patients (p=0.713). Conclusion. The patients have uneventful liver function under antiviral agent while hepatitis B recurred. For the patients having HCC prior to transplantation, close monitoring of HCC recurrence is necessary if hepatitis B recurs.

scholarly journals Traditional Approach vs Posterior Approach for Ankle Fractures Involving the Posterior Malleolus

2020 ◽  
pp. 107110072096943
Author(s):  
Kristian Pilskog ◽  
Teresa Brnic Gote ◽  
Heid Elin Johannessen Odland ◽  
Knut Andreas Fjeldsgaard ◽  
Håvard Dale ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Traditional Approach ◽  
Articular Surface ◽  
Treatment Strategies ◽  
Outcome Evaluation ◽  
Ankle Fractures ◽  
Posterior Malleolus ◽  
Patient Reported ◽  
Group A ◽  
Group B

Background: In the past, posterior malleolus fragments (PMFs) commonly have been indirectly reduced and fixed when fragments involve 25% or more of the tibial articular surface, while smaller fragments were left unfixed. The posterior approach has become increasingly popular and allows fixation of even smaller fragments. This study compares clinical outcome for the 2 treatment strategies. Methods: Patients with ankle fractures involving a PMF treated from 2014 to 2016 were eligible for inclusion. Patients were allocated to group A (treated with a posterior approach) or group B (treated with the traditional approach) according to the treatment given. A one-to-one matching of patients from each group based on the size of the PMF was performed. Patient charts were reviewed, and outcome evaluation was performed clinically, radiographically, and by patient-reported outcome measures (PROMs; Self-Reported Foot and Ankle Score, RAND-36, visual analog scale [VAS] of pain, and VAS of satisfaction). Forty-three patients from each group were matched. Median follow-up was 26 (interquartile range [IQR], 19-35) months postoperatively. Results: The median PMF size was 17% (IQR, 12-24) in both groups, and they reported similar results in terms of PROMs. Fixation of the PMF was performed in 42 of 43 (98%) patients in group A and 7 of 43 (16%) patients in group B ( P < .001). The former group more frequently got temporary external fixation (56% vs 12%, P < .01) and less frequently had syndesmotic fixation (14% vs 49%, P < .01), and they had less mechanical irritation and hardware removal but more noninfectious skin problems (28% vs 5%, P < .01). Median time from injury to definitive surgery (8 vs 0 days, P < .001) and median length of stay (12 vs 3 days, P < .001) were longer in group A. Conclusion: Comparison of treatment strategies for ankle fractures involving the posterior malleolus showed similar results between patients treated with a traditional approach and a posterior approach. Level of Evidence: Level III, retrospective comparative study.

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