INNV-23. CASE REPORT OF CISPLATIN + ETOPOSIDE FOR THE TREATMENT OF METASTATIC MALIGNANT MENINGIOMA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi110-vi110
Author(s):  
Minhdan Nguyen ◽  
Judy Truong ◽  
Akanksha Sharma ◽  
Santosh Kesari ◽  
Jose Carrillo ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Vision Loss ◽  
Performance Status ◽  
Benign Tumors ◽  
Rapid Progression ◽  
Malignant Meningioma ◽  
Mri Imaging ◽  
Who Grade ◽  
Repeat Resection ◽  
The Subject

Abstract INTRODUCTION Meningioma have an annual incidence of 5 per 100,000 and is the most frequent primary tumor of the central nervous system. Risk factors include radiotherapy and hormone intake. Most meningioma are grade I benign tumors, but up to 15% are atypical and 2% anaplastic according to the WHO 2016 histological criteria. Extra-CNS metastasis is exceedingly rare but carry a poor prognosis. Surgical resection and radiation therapy are the only approved therapies for the treatment of high grade or recurrent meningioma. Chemotherapy options have been limited and none have shown significant response rates. METHODS We report a case of a 33 year old male with an anaplastic meningioma (WHO Grade III) with metastasis to the lungs and rapid progression despite repeat resection. The subject was previously treated with resection and radiation therapy to a skull base/sinonasal lesion. Progression occurred at anterior cranial fossa, which required repeat resection. Within a month, the meningioma showed substantial progression with invasion into the orbit and nasopharynx as well as metastasis to the lung. The subject experienced significant clinical decline which included bilateral vision loss. The subject was treated with Cisplatin and Etoposide for 4 cycles. RESULTS The patient had immediate clinical improvement after the first cycle. Repeat MRI imaging of the brain showed partial response with approximately 40% tumor reduction, and CT of the chest showed complete response. The subject’s performance status also improved significantly with treatment including recovery of eyesight bilaterally. CONCLUSION This case showed that the use of Cisplatin + Etoposide for metastatic malignant meningioma can have significant objective and clinical response. The use of this regimen warrants further investigation. A clinical trial is currently being developed.

RADT-23. RECURRENT OLIGODENDROGLIOMAS AFTER FIRST CHEMO-RADIATION THERAPY RESPONDED REMARKABLY TO RE-RADIATION

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi46-vi46
Author(s):  
Fumi Higuchi ◽  
Takeo Uzuka ◽  
Keisuke Ueki
Keyword(s):  
Radiation Therapy ◽  
Primary Tumor ◽  
Radiation Treatment ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Lateral Side ◽  
Who Grade ◽  
Recurrent Tumors ◽  
Conventional Radiation ◽  
Before And After

Abstract Oligodendrogliomas with 1p/19q-codeletion are relatively slow progressive tumors that show good response to chemo-radiation therapy after resection. The median survival is about 15 years regardless of WHO grade, although recurrences are mostly inevitable and there is no standard treatment for recurrence. We experienced 5 oligodendroglioma cases who underwent re-radiation for recurrent tumors after chemo-radiation treatment. We retrospectively investigated those for response to re-radiation, the duration from first radiation to second radiation, and Karnofsky Performance Status (KPS) before and after the re-radiation. Patients were all male; the median radiation dose for primary tumor was 60Gy (54-60Gy), the median age at first radiation was 46 years (35-59), the median duration from the first radiation to re-radiation was 65 months (range 18-116 months), and the median follow-up period after re-radiation was 15 months (1-39 months). In all 5 cases, tumors showed good response to re-radiation. In 3 of the 5 cases, tumor recurred in corpus callosum and/or lateral side of cerebral hemisphere or basal ganglia contiguous with primary tumor sites and were radiated by IMRT (50Gy/25fr) . In 2 cases, tumors recurred around the fourth ventricle and posterior fossa and underwent conventional radiation (54Gy/30fr and 30Gy/10fr). In 2 of the 5 cases, the tumors re-recurred 24 months later after re-radiation, but the KPS were maintained until re-recurrence. For oligodendrogliomas, re-radiation therapy appears to be very effective to recurrent tumors after first chemo-radiation. Although evaluation for longer-term side effects is to be examined, re-radiation appears to be a good option for recurrent oligodendrogliomas after first chemo-radiation therapy.

Ultrafractionated radiation therapy (3x per day) for glioblastoma: Preliminary results of a phase II study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1570-1570
Author(s):  
P. D. Beauchesne ◽  
L. Taillandier ◽  
V. Bernier ◽  
M. Djabri ◽  
X. Michel ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase Ii ◽  
High Efficiency ◽  
Phase Ii Study ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Progression Free Survival ◽  
Who Grade ◽  
Primary Endpoints ◽  
Grade 3

1570 Background: Ultrafractionation radiation therapy consists in irradiating cells or tumors several times daily, delivering low doses at which hyperradiosensitivity occur. We recently reported the high efficiency of ultrafractionation radiotherapy in glioma cell lines and xenografts, and are now conducting a phase II clinical trial to determine the effect of an ultrafractionation regimen for glioblastoma patients. Methods: A prospective, multicenter, phase II study has opened for accrual in September 2003. Patients over 18 years of age who are able to give informed consent and have histologically proven, newly diagnosed and unresectable, supratentorial glioblastoma (WHO grade IV) are eligible. Three doses of 0.75 Gy spaced by at least four hours are delivered daily, five days a week for six consecutive weeks for a total of 67.5 Gy. Conformal irradiation includes the tumor bulk including a margin of 2.5 cm. Tolerance and toxicity are the primary endpoints; survival and progression-free survival are secondary endpoints. Results: To date 25 patients have been enrolled in this study, 19 currently evalualbe: 11 men and 8 women, median age 58 (range 37 to 76), median Karnofsky performance status (80 range from 70 to 100). The median time between histological diagnosis and the start of treatment is 7 weeks. The ultrafractionated radiation therapy has been well tolerated; no acute grade 3 and/or 4 CNS toxicity has been observed. Minor responses at the end of irradiation were seen in 5 patients. Median survival from initial diagnosis was 13.5 months, nine patients remain alive. Conclusions: Ultrafractionated radiation therapy is safe and well tolerated. No acute CNS toxicitiy has been observed. Overall survival of over 13 months for patients without prior debulking surgery compares favorably with other reports. Updated definitive results will be presented. No significant financial relationships to disclose.

scholarly journals PEDT-05 USEFULNESS OF BEVACIZUMAB IN MAINTAINING QOL AT DIPG RELAPSE

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii16-ii16
Author(s):  
Akira Gomi ◽  
Taku Uchiyama ◽  
Hirofumi Oguma ◽  
Takashi Yamaguchi ◽  
Kensuke Kawai
Keyword(s):  
Radiation Therapy ◽  
Treatment Group ◽  
Side Effects ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Untreated Group ◽  
The Other ◽  
Mri Imaging ◽  
Karnofsky Performance Status Scale

Abstract INTRODUCTION Even in the age of molecular diagnosis, diffuse intrinsic pontine glioma (DIPG) is still a dismal disease, and there is no effective treatment. The usefulness of bevacizumab for DIPG relapse is reported. SUBJECTS AND METHODS The treatment and outcomes of 10 patients with DIPG who were treated at our institute since 2001 were retrospectively reviewed. All patients were diagnosed with DIPG by MRI imaging and underwent radiation therapy first. Chemotherapy was performed in combination with radiation therapy in 4 cases, and 3 of them did not receive chemotherapy at the time of relapse (Untreated Group). In 7 cases, chemotherapy was performed at the time of relapse with ACNU/vincristine or interferon beta (Other Treatment Group), and 2 cases with bevacizumab (Bv Group). The change in the Karnofsky Performance Status Scale (KPS) from the time of relapse was compared. RESULTS The average overall survival (OS) for all 10 cases was 10.0 months, 8.1 months in the Untreated Group, 9.5 months in the Bv Group, and 11.4 months in the Other Treatment Group. No prolongation of OS by bevacizumab was observed. However, it was only in the Bv Group that the KPS increased from the time of relapse. Comparison of the KPS at the time of relapse and the KPS after 4 months showed that the Bv Group remained unchanged or increased from 80 to 90, while the Untreated Group decreased by 60–100, and the Other Treatment Group also decreased by 20–50. In the Other Treatment Group, hospitalization was required for treatment, and side effects of bone marrow suppression were observed. However, in the Bv Group, outpatient treatment was possible, there were no side effects, and all could be observed at home. CONCLUSION From the above results, bevacizumab appears useful for palliative treatment for maintaining quality of life after DIPG relapse.

Combination Therapy of Cisplatin and Other Agents for Osteosarcoma: A Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Mohamad Zahid Kasiram ◽  
Hermizi Hapidin ◽  
Hasmah Abdullah ◽  
Azlina Ahmad ◽  
Sarina Sulong
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Chemotherapeutic Agents ◽  
New Combination ◽  
Rapid Progression ◽  
Combination Regimen ◽  
Chemotherapeutic Drugs ◽  
Primary Bone Tumor ◽  
Phytochemical Compounds

Background: Osteosarcoma is the most common type of primary bone tumor in children and adolescents, which is associated with rapid progression and poor prognosis. Multimodal therapy is the most common approach utilized for osteosarcoma management, such as the application of chemotherapy in combination with surgery or radiation therapy. Cisplatin is one of the predominantly used chemotherapeutic agents for osteosarcoma. Optimally, it is employed in combination with other chemotherapeutic drugs along with surgery or radiation therapy. Despite the availability of numerous treatment approaches, patient survival rate has not definitively improved over the past three decades. Methods: We summarized all findings regarding the combination of cisplatin with other chemotherapeutic agents as well as with phytochemical compounds. Results: A combination of cisplatin with phytochemical compound synergistically enhances the killing effect of cisplatin on osteosarcoma cells with fewer side effects compared to combination with other chemotherapeutic agents. Conclusion: Conclusively, a combination of cisplatin with selected chemotherapeutic drugs, has been shown to be effective. However, the unchanged survival rate urges for the search of a new combination regimen. As a collaborative effort to substantiate the therapeutic efficacy, the combination with phytochemical compounds shows a promising response both in vitro as well as in the preclinical study.

scholarly journals Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1451
Author(s):  
Michele Da Broi ◽  
Paola Borrelli ◽  
Torstein R. Meling
Keyword(s):  
Skull Base ◽  
Clinical Outcomes ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Advanced Age ◽  
Final Visit ◽  
Subtotal Resection ◽  
Who Grade ◽  
Skull Base Meningiomas

Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.

scholarly journals Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Zhaoliang Sun ◽  
Emel Avci ◽  
Mustafa K. Başkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Vision Loss ◽  
Internal Carotid ◽  
Extent Of Resection ◽  
World Health ◽  
Who Grade ◽  
The Right ◽  
Supraclinoid Internal Carotid Artery

AbstractAnterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0

scholarly journals Exceeding Radiation Dose to Volume Parameters for the Proximal Airways with Stereotactic Body Radiation Therapy Is More Likely for Ultracentral Lung Tumors and Associated with Worse Outcome

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3463
Author(s):  
Mark Farrugia ◽  
Sung Jun Ma ◽  
Mark Hennon ◽  
Chukwumere Nwogu ◽  
Elisabeth Dexter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Propensity Score ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Bronchial Tree ◽  
Lung Tumors ◽  
Gender Performance ◽  
Dose Fractionation ◽  
Stereotactic Body Radiation ◽  
History Of

The preferred radiotherapeutic approach for central (CLT) and ultracentral (UCLT) lung tumors is unclear. We assessed the toxicity and outcomes of patients with CLT and UCLT who underwent definitive five-fraction stereotactic body radiation therapy (SBRT). We reviewed the charts of patients with either CLT or UCLT managed with SBRT from June 2010–April 2019. CLT were defined as gross tumor volume (GTV) within 2 cm of either the proximal bronchial tree, trachea, mediastinum, aorta, or spinal cord. UCLT were defined as GTV abutting any of these structures. Propensity score matching was performed for gender, performance status, and history of prior lung cancer. Within this cohort of 83 patients, 43 (51.8%) patients had UCLT. The median patient age was 73.1 years with a median follow up of 29.9 months. The two most common dose fractionation schemes were 5000 cGy (44.6%) and 5500 cGy (42.2%) in five fractions. Multivariate analysis revealed UCLT to be associated with worse overall survival (OS) (HR = 1.9, p = 0.02) but not time to progression (TTP). Using propensity score match pairing, UCLT correlated with reduced non-cancer associated survival (p = 0.049) and OS (p = 0.03), but not TTP. Within the matched cohort, dosimetric study found exceeding a D4cc of 18 Gy to either the proximal bronchus (HR = 3.9, p = 0.007) or trachea (HR = 4.0, p = 0.02) was correlated with worse non-cancer associated survival. In patients undergoing five fraction SBRT, UCLT location was associated with worse non-cancer associated survival and OS, which could be secondary to excessive D4cc dose to the proximal airways.

NCOG-16. RELEVANCE OF GERIATRIC ASSESSMENT FOR PRIMARY BRAIN TUMOR PATIENTS: IMPLICATIONS FOR RESEARCH AND CARE

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi155-vi155
Author(s):  
Heather Leeper ◽  
Anna Choi ◽  
Elizabeth Vera ◽  
Alvina Acquaye ◽  
Nicole Briceno ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Older Patients ◽  
Performance Status ◽  
Age Groups ◽  
Symptom Burden ◽  
Tumor Grade ◽  
Primary Brain Tumor ◽  
Functional Impairments ◽  
Who Grade ◽  
Patient Reported

Abstract BACKGROUND The utility of geriatric assessment (GA) has been evaluated in older adults diagnosed with solid tumors other than primary brain tumors (PBT). We assessed several key GA domains in adults with PBT receiving tumor-directed treatment. METHODS Patient and disease characteristics and key GA domains within patient-reported outcomes (PROs) including symptom burden (MDASI-BT), Anxiety/ Depression (PROMIS-short forms) and general health status (EQ-5D-3L) were systematically and prospectively collected between 9/2016–8/2019 from adults diagnosed with PBT. Descriptive statistics and regression analyses were used to assess PROs. RESULTS Of 581 participants, 92 were 65 – 85 years old (median age = 70 years; “older”) and 489 were ≤ 64 years (median age = 46 years; “younger”). Tumor grade distribution in the older group was 74% WHO grade III/IV, 26% WHO grade I/II; tumor types included gliomas and meningiomas with no tissue diagnosis in 3 patients. Older patients were 49% less likely to receive chemotherapy and twice as likely to have KPS ≤ 80 (p=0.003, OR=0.51, OR=1.98). More older patients reported problems with mobility (57% vs 44%), self-care (38% vs 26%), and usual activities (64% vs 51%) than younger patients. Charlson Comorbidity Index mean scores were significantly higher in older patients (3.5 vs 0.6, p&lt; 0.001). The top 3 most frequently reported moderate-to-severe symptoms were similar in older vs younger groups: fatigue (44% vs 41%), feeling drowsy (29% vs 30%) and difficulty remembering (28% vs 29%). Feeling distressed was the only symptom whose frequency differed between the age groups (11% older vs 27% younger, p=0.001). CONCLUSION Older PBT patients had lower performance status, more co-morbidities and increased functional impairments, affirming that GA is relevant. Symptom burden was similarly high in both age groups. These findings support conducting GA concurrently in future symptom intervention and therapeutic clinical trials for adults with PBT receiving tumor-directed treatment.

scholarly journals Small Cell Carcinoma of the Prostate in an Elderly Patient: A Case Report and Review of the Literature

Rare Tumors ◽  
2016 ◽  
Vol 8 (4) ◽  
pp. 176-178 ◽  
Author(s):  
Dale Alan Whitaker ◽  
Daniel H. Miller ◽  
Niveditha Jagadesh ◽  
Gerald W. Strong ◽  
Lauren Hintenlang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Current Knowledge ◽  
Case Reports ◽  
The United States ◽  
Small Cell ◽  
Rapid Progression ◽  
Retrospective Case

Prostate cancer is the most common malignancy of men in the United States. Small-cell carcinoma (SCC), which typically presents as an aggressive lung malignancy, is a rare diagnosis within the setting of prostate cancer pathology. Due to its limited prevalence, little information regarding the treatment and prognosis of this disease in large populations is available. To date our current knowledge base is largely limited to case reports and retrospective case reviews. The mainstay of treatment for this particular histology most often involves a multimodality approach utilizing chemotherapy in conjunction with radiation therapy, androgen deprivation therapy, or prostatectomy. Here we present the case of an elderly 89-year-old Caucasian male who was diagnosed with SCC of the prostate. Despite proceeding with a course of definitive radiotherapy, the patient experienced rapid progression of disease and ultimately elected to discontinue radiation therapy and receive hospice care.

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