Multimodality Treatment of Skull Base Chondrosarcomas: The Role of Histology Specific Treatment Protocols

Neurosurgery ◽  
2017 ◽  
Vol 81 (3) ◽  
pp. 520-530 ◽  
Author(s):  
Shaan M. Raza ◽  
Paul W. Gidley ◽  
Jeanne M. Meis ◽  
David R. Grosshans ◽  
Diana Bell ◽  
...  
Keyword(s):  
Skull Base ◽  
Adjuvant Radiotherapy ◽  
Histological Grade ◽  
Specific Treatment ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Positive Trend ◽  
Histological Subtype ◽  
Treatment Protocols ◽  
The Impact

Abstract BACKGROUND: Limited data exist to guide the multimodality management of chondrosarcomas (CSAs) arising in the skull base. OBJECTIVE: To determine the impact of histological subtype/grade on progression-free survival (PFS) and the indications for surgery, radiation, and chemotherapy based on histology. METHODS: A retrospective review was performed of 37 patients (conventional type: 81%, mesenchymal: 16.2%, dedifferentiated: 2.7%) treated at The University of Texas M.D. Anderson Cancer Center. Of the conventional subtype, 23% were grade 1, 63% were grade 2, and 14% were grade 3. In addition to surgery, mesenchymal/dedifferentiated CSAs (18% of the cohort) underwent neoadjuvant chemotherapy and 48.6% of the overall cohort received adjuvant radiotherapy. Histological grade/subtype and treatment factors were assessed for impact on median PFS (primary outcome). RESULTS: Conventional subtype vs mesenchymal/dedifferentiated was positively associated with median PFS (166 vs 24 months, P < .05). Increasing conventional grade inversely correlated with median PFS (P < .05). Gross total resection positively impacted PFS in conventional CSAs (111.8 vs 42.9 months, P = .201) and mesenchymal/dedifferentiated CSAs (58.2 vs 1.0 month, P < .05). Adjuvant radiotherapy significantly impacted PFS in conventional grades 2 and 3 (182 vs 79 months, P < .05) and a positive trend with mesenchymal/dedifferentiated CSAs (43.5 vs 22.0 months). Chemotherapy improved PFS for mesenchymal/dedifferentiated CSAs (50 vs 9 months, P = .089). CONCLUSION: There is a potential need for histological subtype/grade specific treatment protocols. For conventional CSAs, surgery alone provides optimal results grade 1 CSAs, while resection with adjuvant radiotherapy yields the best outcome for grade 2 and 3 CSAs. Improvements in PFS seen with neoadjuvant therapy in mesenchymal/dedifferentiated CSAs indicate a potential role for systemic therapies. Larger studies are necessary to confirm the proposed treatment protocols.

scholarly journals Adenoid cystic carcinoma of the skull base: results with an aggressive multidisciplinary approach

2016 ◽  
Vol 124 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Rohan Ramakrishna ◽  
Shaan M. Raza ◽  
Michael Kupferman ◽  
Ehab Hanna ◽  
Franco DeMonte
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Skull Base ◽  
Adjuvant Radiotherapy ◽  
Multidisciplinary Approach ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Adenoid Cystic ◽  
Md Anderson

OBJECT Adenoid cystic carcinoma (ACC) is a locally aggressive tumor of salivary gland origin. Little data exist to guide treatment when this tumor extends to involve the structures of the skull base. METHODS Fifty-one patients with a diagnosis of ACC affecting the skull base were identified from a prospective database at MD Anderson Cancer Center (from 1992 to 2010). RESULTS Median follow-up for study patients was 6.75 years. The 5- and 10-year overall survival (OS) rates were 78% and 50%, respectively. Sixty-six percent of patients had progression of their disease. The 5- and 10-year progression-free survival (PFS) rates were 46.7% and 21.0%, respectively. Gross-total resection was achieved in 75% of patients, with 49% having microscopically negative margins at the time of first operation. On univariate analysis, resections with microscopically negative margins were associated with a significant OS advantage (20.1 ± 3.3 years) compared with resections that left residual disease, even if microscopic (10.3 ± 1.6 years, p = 0.035). In patients who underwent reoperation, the effect persisted, with improved OS in those with negative margins (21.4 ± 0.0 vs 16.7 ± 4.0 years, p = 0.06). The use of adjuvant radiotherapy was associated with an OS advantage (16.2 ± 2.5 vs 5.5 ± 2.2 years, p = 0.03) at initial diagnosis and improved PFS (7.8 ± 1.0 vs 2.1 ± 0.62 years, p = 0.005), whereas repeat irradiation provided no benefit. The use of adjuvant chemotherapy at diagnosis or at recurrence was not associated with any significant advantage. Multivariate analysis revealed margin-negative resection at initial operation and at recurrence retained OS significance, even after controlling for age, radiation therapy, and T stage. CONCLUSIONS ACC of the skull base is best treated with a multidisciplinary approach aimed at maximal, safe resection. Adjuvant radiotherapy should be offered, whereas chemotherapy does not confer benefit.

Treatment of advanced soft tissue sarcoma by histological subtype: wish, prediction or reality?

2019 ◽  
Vol 15 (26s) ◽  
pp. 5-10 ◽  
Author(s):  
Jean-Yves Blay
Keyword(s):  
Soft Tissue ◽  
Specific Treatment ◽  
Soft Tissue Sarcomas ◽  
Histological Subtype ◽  
Common Goal ◽  
First Line ◽  
Advanced Soft Tissue Sarcoma ◽  
Treatment Protocols ◽  
Key Factor ◽  
The Common

Soft tissue sarcomas (STS) are heterogenous cancers encompassing more than 100 histological and molecular subtypes. Their extreme rarity underscores the need for international collaboration to identify specific treatment protocols. Increasing knowledge of STS complexity as defined by molecular biology has led to the introduction of targeted therapies for several sarcoma subtypes, which is an encouraging start. In advanced STS, doxorubicin-based regimens are standard first-line chemotherapy. Options for second and later lines include ifosfamide, trabectedin, pazopanib, eribulin and gemcitabine-based regimens. Histological subtype has become a key factor when selecting best options to treat advanced sarcoma; however, the challenges of identifying optimal treatments for all STS histotypes are undeniably formidable. Fortunately, the sarcoma community shares the common goal of seeking greater knowledge about the characteristics of each subtype in order to improve diagnosis and outcomes. Progress made to date in this regard suggests that the vision to treat by subtype is achievable.

scholarly journals Switching between bacteriostatic and bactericidal antimicrobials for retreatment of bovine respiratory disease (BRD) relapses is associated with an increased frequency of resistant pathogen isolation from veterinary diagnostic laboratory submissions

2019 ◽  
Author(s):  
Johann F. Coetzee ◽  
Drew R. Magstadt ◽  
Lendie Follett ◽  
Pritam K. Sidhu ◽  
Adlai M. Schuler ◽  
...  
Keyword(s):  
Pasteurella Multocida ◽  
Specific Treatment ◽  
State University ◽  
Iowa State University ◽  
Diagnostic Laboratory ◽  
Treatment Protocols ◽  
Antimicrobial Studies ◽  
Stewardship Program ◽  
Histophilus Somni ◽  
The Impact

AbstractAlthough 90% of BRD relapses are reported to receive retreatment with a different class of antimicrobial, studies examining the impact of antimicrobial selection (i.e. bactericidal or bacteriostatic) on retreatment outcomes and the emergence of antimicrobial resistance (AMR) are deficient in the published literature. A survey was conducted to determine the association between antimicrobial class selection for retreatment of BRD relapses on antimicrobial susceptibility of Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni. Pathogens were isolated from samples submitted to the Iowa State University Veterinary Diagnostic Laboratory from January 2013 to December 2015. A total of 781 isolates with corresponding animal case histories, including treatment protocols, were included in the analysis. Original susceptibility testing of these isolates for ceftiofur, danofloxacin, enrofloxacin, florfenicol, oxytetracycline, spectinomycin, tilmicosin, and tulathromycin was performed using Clinical and Laboratory Standards Institute guidelines. Data were analyzed using a Bayesian approach to evaluate whether retreatment with antimicrobials of different mechanistic classes (bactericidal or bacteriostatic) increased the probability of resistant BRD pathogen isolation in calves. The posterior distribution we calculated suggests that an increased number of treatments is associated with a greater probability of isolates resistant to at least one antimicrobial. In addition, the frequency of resistant M. haemolytica isolates was greater with retreatment using antimicrobials of different mechanistic classes than retreatment with the same class. Specifically, treatment protocols using a bacteriostatic drug first followed by retreatment with a bactericidal drug was associated with a higher frequency of resistant BRD pathogen isolation. This effect was more profound with specific treatment combinations; tulathromycin (bacteriostatic) followed by ceftiofur (bactericidal) was associated with the highest probability of resistant isolates among all antimicrobial combinations. These findings suggest that the selection of antimicrobial mechanistic class for retreatment of BRD should be considered as part of an antimicrobial stewardship program.

Doxorubicin and concurrent radiotherapy for anaplastic thyroid cancer: We need to do better

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16506-16506 ◽  
Author(s):  
S. Lim ◽  
N. Y. Lee ◽  
M. G. Fury ◽  
R. A. Ghossein ◽  
A. R. Shaha ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Progression Free Survival ◽  
Anaplastic Thyroid Cancer ◽  
Median Number ◽  
Cancer Center ◽  
Published Data ◽  
Histologic Subtype ◽  
Kaplan Meier ◽  
Prior Surgery ◽  
The Impact

16506 Background: Anaplastic thyroid cancer (ATC) is a rare, aggressive malignancy. The potential for pathologic misclassification complicates the interpretation of published data. One treatment option for locoregionally (LR) advanced disease is weekly low-dose doxorubicin (D) with concurrent radiation therapy (RT), based on reported 2-year local control rates of 68% (ATC)/77% (other TC histologic subtypes) (Cancer 1987;60:2372). We looked to evaluate our experience with this general approach, but in a larger series which included pathologic confirmation of all ATC cases. Methods: Patients (pts) were identified through the Memorial Sloan-Kettering Cancer Center (MSKCC) Radiation Oncology and Pathology Databases. Inclusion criteria: diagnosis of ATC between 1984–2006, with pathology review at MSKCC; LR disease only, able to be encompassed within a RT portal; treatment at MSKCC with planned weekly D (10 mg/m2) and concurrent radiation. Prior surgery was allowed. Documentation of failure was based on clinical/radiographic assessment. Principal outcomes assessed: LR control (LRC: no failure at the primary site, in the neck, or the mediastinum), progression-free survival (PFS), and overall survival (OS). The Kaplan-Meier method was applied. Results: Thirty-seven patients were included in our analysis (median age 64; 54% female, 46% male). Median RT dose 5760 cGy, >4500 cGy in 32 (87%), administered through hyperfractionated or once-daily schedules. Median number of D treatments received 5.5, >4 in 24 (65%). 2-year outcomes: LRC 25%; PFS 8%; OS 18%. 6 patients remain alive at the time of last follow-up with survival durations of 4.1, 11.4, 11.7, 57.3, 58.5, and 140.7 months, respectively. A subset analysis was performed limited to the 24 patients (65%) who completed >4,500 cGy of radiation and >4 doses of D. 2-year outcomes were improved in this latter group, but remained disappointing, even among these more highly selected pts (LRC 30%; PFS 11%; OS 27%). Conclusions: Better therapy is needed for this poor prognostic disease. Future analyses will evaluate the impact of histologic subtype of ATC, radiation technique/dose, and surgical resection on outcome. No significant financial relationships to disclose.

Clinical and prognostic features of adult patients with gangliogliomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2063-2063
Author(s):  
Shlomit Yust-Katz ◽  
Mark Daniel Anderson ◽  
Diane Liu ◽  
Ying Yuan ◽  
Greg Fuller ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Histological Grade ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Tumor Grade ◽  
Histologic Grade ◽  
Low Grade ◽  
Prognostic Features ◽  
Grade 3 ◽  
The Impact

2063 Background: Gangliogliomas (GG) represent less than 1% of primary brain tumors in adults. Little is known regarding prognostic features, clinical characteristics or the impact of treatment on patient (pt) outcomes. Methods: In this IRB approved retrospective study, our neuro-oncology longitudinal database was screened for pts with GG from 1992-2012. 67 adult pts (age>18) were identified. Results: 60 pts presented with low grade GG and 7 with anaplastic GG. The median age at diagnosis was 27 years (18-59). 22 pts developed recurrent disease (18 low grade and 4 high grade) with a median time to recurrence of 87 weeks from surgery. 7 of the pts with low grade GG had malignant transformation to a malignant tumor (anaplastic GG or GBM). 22 pts received radiation therapy, 16 at diagnosis. 14 pts received chemotherapy at recurrence. Pts with incomplete resections or higher grade tumors were more likely to receive chemotherapy or radiation. The median overall survival (OS) time for these pts was not reached with a median follow-up time of 4.6 years. The 2-, 5- and 10-year OS were 98%, 87%, and 76%. Factors on univariate analysis that were significantly associated with OS were KPS at presentation (HR 10.1; 95% CI 2.6, 39.1; p = 0.0008), extent of resection (EOR) (biopsy vs gross total; HR 12.1; 95% CI 2.3, 63.6; p = 0.003), histologic grade (Grade 1-2 vs Grade 3-4; HR 0.06; 95% CI 0.01, 0.3; p = 0.0002), and seizure control following surgery (Engel I vs Engel 2-3; HR 0.1; 95% CI 0.01, 0.9; p = 0.02). Factors on univariate analysis that were significantly associated with progression free survival (PFS) were EOR (biopsy vs gross total; HR 4.0; 95% CI 1.4, 11.9; p = 0.01) and histologic grade (Grade 1-2 vs .Grade 3-4; HR 0.3; 95% CI 0.08, 0.8; p = 0.02). On multivariate analysis, EOR is most significant for PFS (p = 0.01), while tumor grade is most significant for OS (p = 0.004). Conclusions: While GG have an excellent prognosis, malignant histological grade, diagnosis with a biopsy only, poor initial KPS, and presence of seizures following surgery could indicate a worse prognosis. The role of chemotherapy and radiation therapy for incompletely resected or inaccessible low grade GG is unclear.

Building a Caring Arts Program with Oncology Patients: From Inception to Impact

2021 ◽  
pp. 089801012110374
Author(s):  
Patty Magee ◽  
Diane Raines
Keyword(s):  
Patient Satisfaction ◽  
Positive Impact ◽  
Family Care ◽  
Cancer Center ◽  
Positive Trend ◽  
For Profit ◽  
Patient Satisfaction Scores ◽  
Field Notes ◽  
Md Anderson ◽  
The Impact

A Caring Arts Program (CAP) was inspired and carried out by the vision of an in-resident nurse-artist and the chief nursing officer in a private, not-for-profit health system. Together they envisioned a program that would impact family, patients, and staff while improving patient/family care practices. The impact of the CAP was evaluated through mixed methods which included stories, fieldnotes, comments, and the Listen360(R) which rates patient satisfaction scores. The synergy between the evaluations and the attempt to understand what creates patient satisfaction using creative arts was a prime objective of this article. The qualitative results represented by field notes and written patient comments revealed a positive impact on participants. The quantitative results demonstrated an improvement in patient satisfaction scores during the time of the project. The positive trend in the scores combined with the qualitative stories and interviews suggests that the CAP contributed to the improvement in patient satisfaction at Baptist MD Anderson Cancer Center. During a worldwide pandemic, supporting human caring and self-expression was more critical than ever.

Pathology of Spinal Ependymomas

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 247-255 ◽  
Author(s):  
Phiroz E. Tarapore ◽  
Peter Modera ◽  
Agne Naujokas ◽  
Michael C. Oh ◽  
Beejal Amin ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Histological Grade ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
World Health ◽  
Subtotal Resection ◽  
Who Grade ◽  
Grade Ii ◽  
Health Organization ◽  
Grade Iii

AbstractBACKGROUND:Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS).OBJECTIVE:This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy.METHODS:We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging.RESULTS:There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P < .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P < .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P < .36).CONCLUSION:Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

scholarly journals The Impact of Same Day Infusion Treatment Protocols for Uncomplicated Vaso-Occlusive Crises within an Embedded Sickle Cell Care Model

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2976-2976
Author(s):  
Stefanie Sacknoff ◽  
Jessica Groesbeck ◽  
Srila Gopal
Keyword(s):  
Quality Of Care ◽  
Sickle Cell ◽  
Case Manager ◽  
Time Frame ◽  
Care Plan ◽  
Cancer Center ◽  
Treatment Protocols ◽  
Clinical Trial Research ◽  
The Impact

Abstract Background: Infusion Center (IC) based care of uncomplicated sickle cell disease (SCD) vaso occlusive crises (VOCs) is very effective and results in better outcomes. At low volume sickle cell programs, it is challenging to acquire resources for a dedicated infusion program. Our goal was to create an embedded infusion program within our cancer center infusion services utilizing existing resources to improve the quality of care for our SCD patients. Methods: A multi-disciplinary team consisting of a Nurse Case Manager, Advanced Practice Provider, MD, IC scheduler and IC charge nurse was assembled. An agreement was made between the SCD team and IC leadership that at least one time slot would be made available for a SCD VOC visit every day. A workflow was created and all team members were educated regarding the workflow. Visit numbers for IC visits, emergency department (ED) and inpatient (IP) hospitalizations were collected from the EMR and compared for pre IC development (Jan 1, 2017- Dec 31, 2018) and post IC (January 1, 2019 - Dec 31, 2020). Results: Between 2017-2020, 182 patients with SCD were seen in the emergency room and 163 patients in our outpatient clinics. After the institution of an IC based care plan in January 2019, IC visit volume increased (270 visits pre IC vs.1076 visits post IC). ED treat and release (not requiring admissions) visits decreased from 373 visits pre IC to 286 visits post IC. The number of inpatient admissions did not change significantly during this time frame. However, the percentage of admissions from the ED increased (43% pre IC to 50% post IC), indicating a higher complexity of patients seeking care from the ED. 10 of 35 patients who used the IC in 2020 had no acute visits (ED or IP) in 2020, while these individual patients had a total of 37 ED visits in the pre IC timeframe, of which 20 were inpatient admissions with a total length of stay of 137 days and 17 treat and release episodes at the ED. Conclusions: Our project successfully utilized existing infusion based resources to facilitate outpatient management of acute uncomplicated SCD VOCs. This project presents an effective strategy that can be utilized by smaller volume sickle cell programs who do not have a stand alone infusion program to improve the quality of care for their SCD patients. Disclosures Gopal: Pharming: Consultancy; GBT: Consultancy; Alexion: Speakers Bureau; Rigel Pharmaceuticals: Other: Clinical Trial, Research Funding.

Association of clinical phenotype and treatment history with survival in adult brainstem glioblastoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13539-e13539
Author(s):  
Jooyeon Nam ◽  
Rebecca A. Harrison ◽  
Shiao-Pei S. Weathers ◽  
Clement Pillainayagam ◽  
John Frederick De Groot ◽  
...  
Keyword(s):  
Functional Status ◽  
Clinical Features ◽  
Tumor Therapy ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
High Rate ◽  
Concurrent Chemoradiation ◽  
Cancer Center ◽  
Gait Abnormality ◽  
The Impact

e13539 Background: Brainstem gliomas are rare, comprising 1-2% of malignant primary brain tumors. Brainstem glioblastoma (bGBM) often poses a therapeutic challenge due to scarcity of evidence guiding treatment, and the high rate of neurologic morbidity. We examined bGBM cases at MD Anderson Cancer Center (MDACC) to characterize the salient clinical features of bGBM, and the impact of therapy on patient survival. Methods: Adult patients with pathologically-confirmed bGBM (N = 34) treated at MDACC between June 2005 and June 2015 were identified from the neurosurgical database. Patients’ clinical, radiographic, and treatment data were extracted from the medical record. Descriptive statistics and Kaplan-Meier analyses were performed. Results: Mean age was 52.5 years (SD = 12.1) and median KPS was 80 (SD = 14.2) at time of diagnosis. Initial surgical intervention included biopsy (82.4%) and resection (17.6%). Most patients were treated with concurrent chemoradiation (N = 18, 52.9%) or sequential radiation followed by chemotherapy (N = 8, 23.5%), and the remainder had no documented post-operative anti-tumor therapy. At the time of this analysis, 82.4% of the cohort had died. Median progression free survival (PFS) was 5.8 months (SD = 6.7) and overall survival (OS) was 8.9 months (SD = 19.6). On univariate analysis, gait abnormality (p = .02), incoordination (p = .002), dysphagia (p = .04), or facial numbness (p = .01) at presentation was associated with shorter OS. KPS of ≥70 at diagnosis was significantly associated with better OS (15.6 vs 3 months, p = .001), and the patients with good functional status were more likely to receive concurrent chemoradiation. Bevacizumab was given as concurrent or adjuvant treatment in 2 and 3 cases, respectively, and did not affect OS (p = .82). Conclusions: This retrospective analysis demonstrates a significant and complex relationship between presenting clinical features, functional status and variable treatments in bGBM and survival outcomes. This evidence contributes to our understanding of bGBM, and highlights areas for further study in this malignant condition.

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