Patterns of practice and outcomes in intermediate- and high-risk stage I and II endometrial cancer: a population-based study

2007 ◽  
Vol 17 (2) ◽  
pp. 433-440 ◽  
Author(s):  
J. S. Kwon ◽  
M. S. Carey ◽  
E. F. Cook ◽  
F. Qiu ◽  
L. Paszat
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Risk Group ◽  
Population Based ◽  
Stage I ◽  
Surgical Staging ◽  
Intermediate Risk ◽  
Population Based Study ◽  
Grade 3 ◽  
Patterns Of Practice

To evaluate patterns of practice and outcomes in intermediate- and high-risk stage I and II endometrial cancer in the province of Ontario, Canada. This was a retrospective population-based study of women diagnosed with stage I and II endometrial cancer in Ontario from 1996 to 2000. After excluding low-risk (stages IA and IB, grades 1 and 2) and nonendometrioid histologies, the population was stratified into two risk groups: intermediate risk (stages IA and IB, grade 3; stages IC and IIA, grades 1 and 2; stage IIA, grade 3 if <50% myometrial invasion) and high risk (stage IC, grade 3; stage IIA, grade 3 if >50% myometrial invasion, and all stage IIB). Patterns of practice were assessed in each risk group, including use of surgical staging and adjuvant pelvic radiotherapy (APRT). Cox proportional hazards models determined effects of prognostic factors on 5-year overall survival (OS), including age, income, comorbidities, lymphvascular space invasion (LVSI), surgical staging, and APRT. There were 995 women in this study: 748 intermediate risk (75.2%) and 247 high risk (24.8%). Only 69 (9.2%) and 40 (16.2%) women underwent surgical staging in the intermediate- and high-risk groups, respectively. Surgical staging did not reduce rates of APRT. Determinants of survival included age >60 and comorbidities in the intermediate-risk group, and age >60, income, and LVSI in the high-risk group. In this population-based study, there were variable patterns of practice for intermediate- and high-risk stage I and II endometrial cancer. Surgical staging and APRT did not affect OS

Differences In Community and Academic Practice Patterns For Newly Diagnosed Myelodysplastic Syndromes (MDS) Patients In Minnesota: A Population Based Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2798-2798 ◽  
Author(s):  
Daniel Pease ◽  
Julie A Ross ◽  
Phuong L. Nguyen ◽  
Betsy Hirsch ◽  
Adina Cioc ◽  
...  
Keyword(s):  
High Risk ◽  
Supportive Care ◽  
Practice Patterns ◽  
Risk Group ◽  
Population Based ◽  
Low Risk ◽  
Risk Scores ◽  
First Year ◽  
Newly Diagnosed ◽  
Population Based Study

Abstract Introduction Expanding treatment options for MDS have changed therapeutic decision-making for clinicians. To better characterize therapeutic choices in newly diagnosed MDS, we report the practice patterns captured during the first year of MDS diagnosis for patients enrolled in our statewide population-based study. We highlight a comparison of treatment in community and academic centers. Methods Adults in Minnesota with MDS (AIMMS) is a statewide prospective population-based study conducted by the University of Minnesota (UMN), Mayo Clinic, and Minnesota Department of Health. Starting in April 2010, all newly diagnosed adult cases (ages 20+) of MDS were invited to participate. After patient enrollment, central review was performed consisting of independent hematopathology and cytogenetic review coupled with oncologist chart review assigning prognostic risk scores [International Prognostic Scoring System (IPSS) and IPSS-R (Revised)] and abstracting treatment exposures. All enrolled patients with one year follow-up were included in this analysis. Treatment was divided into supportive, active, transplant, or other. Supportive care included observation, growth factors, and transfusions. Active care included azacitidine, decitabine, lenalidomide, or 7+3 chemotherapy. Academic centers were defined as the UMN and Mayo Clinic; all other centers were designated as community based practices. Results The median patient age was 73 years, with 68% males. IPSS and IPSS-R risk scores were calculated for 100% and 97% of patients, respectively. Treatment choices stratified by IPSS risk group showed 89% low risk, 53% INT-1, 31% INT-2, and 13% high risk with supportive care; active and transplant strategies were utilized for 9% low risk, 44% INT-1, 64% INT-2, and 88% high risk. INT-1 in the community received 70% supportive treatment, in academic 35%. Active treatment for INT-1 was 30% in community and 45% in academic. Community INT-2 received supportive care in 45% of cases, in academic 23%. Transplants were limited to academic centers, with the highest rate in INT-2 at 34%. Among community diagnoses, 100% of high risk, 52% INT-2, 26% INT-1, and 13% low risk were referred to an academic center. Comparison of age <65 and 65+ years showed 83% of transplants occurred in those <65. INT-2/high risk group patients <65 received 95% active therapy or transplant, compared to 51% of those 65+. Discussion This prospective, population based study provides a well-defined patient cohort based on central review of pathologic and clinical data. Evaluation of practice patterns during the first year after diagnosis showed higher utilization of active and transplant treatment strategies as IPSS risk score increased. Further, compared to community, higher utilization occurred for patients at academic centers, suggesting more aggressive treatment in these settings. Age was also a predictor of treatment choice. In addition, referral patterns followed IPSS score. Whether these treatment differences are driven by patient preference and/or translate into improved disease control and decreased mortality requires continued prospective analysis and will be detailed in future reports. Disclosures No relevant conflicts of interest to declare.

High-dose-rate brachytherapy boost in prostate cancer: a New Zealand case series

2015 ◽  
Vol 15 (1) ◽  
pp. 23-29
Author(s):  
John K. L. Chin ◽  
Kenanao D. Rantshilane ◽  
Paul K. L. Chin ◽  
Anupam Chaudhuri ◽  
Leanne K. Tyrie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
Risk Group ◽  
Late Toxicity ◽  
High Dose Rate ◽  
High Dose ◽  
Intermediate Risk ◽  
High Dose Rate Brachytherapy ◽  
Grade 3

AbstractAimThe aim of the present study was to report the survival outcomes and late toxicity of high-dose-rate brachytherapy (HDRBT) boost for dose escalation in patients with intermediate-to-high-risk prostate cancer.Materials and methodsRetrospective data were collected from 137 patients who had undergone definitive radiotherapy for prostate cancer between 2006 and 2010. All patients had external-beam radiotherapy (median dose 46Gy) and HDRBT. Brachytherapy dose was 19Gy in two fractions (6 hours apart) with one implant using Ir-192.ResultsThere were 94 high-risk and 43 intermediate-risk patients (NCCN classification). The median follow-up period was 60 months. The 5-year biochemical progression-free survival was 92 and 76% for intermediate- and high-risk groups, respectively. Prostate cancer-specific survival for the intermediate-risk group was 100% and for the high-risk group it was 92% at 5 years. For the entire cohort, the 5-year rate of urethral stricture formation was 13%, and the 5-year rate of late grade 2 and grade 3 gastrointestinal toxicity was 4·7 and 4·6%, respectively. There was no grade 3 or greater genitourinary toxicity.FindingsOur data add to the growing body of literature supporting the use of HDRBT in prostate cancer. Late toxicity rates were marginally higher than that expected.

Comparative effectiveness of intensity-modulated radiation therapy versus three-dimensional conformal radiation for localized prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 89-89
Author(s):  
Talha Shaikh ◽  
Karen Ruth ◽  
Nicholas George Zaorsky ◽  
Mark Hallman ◽  
Daniel M. Geynisman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Risk Group ◽  
Three Dimensional ◽  
Intensity Modulated Radiation Therapy ◽  
Intermediate Risk ◽  
Intensity Modulated ◽  
Grade 3 ◽  
3D Crt

89 Background: Intensity-modulated radiation therapy (IMRT) has become the standard radiation delivery option for patients (pts) with localized (PCa) prostate cancer despite limited prospective data and increased cost relative to three-dimensional conformal radiation therapy (3D-CRT). The purpose of this study was to compare the treatment outcomes and toxicities of pts undergoing definitive dose-escalated radiation therapy using either 3D-CRT or IMRT for localized PCa. Methods: We identified men with clinically localized PCa treated with definitive external beam radiation at a single institution using >74 Gy between 1997-2013. Within each NCCN risk group, propensity score matching of 3D-CRT pts with one or two IMRT pts was performed accounting for age, race, diabetes, hypertension, Gleason score, T-stage, PSA, and hormone use. Conditional logistic and conditional Cox proportional hazards models were used to adjust for matched groups, with dose included as a separate covariate. Results: After matching,1,253 men (474 3D-CRT, 779 IMRT) were included. There were no significant differences between the IMRT and 3D-CRT pts according to clinical or treatment factors. There was no difference in biochemical failure (BCF), distant metastasis (DM), cancer specific survival (CSS), or overall survival (OS) amongst the low or intermediate risk subgroups. When examining the high-risk subgroup, pts receiving IMRT had higher rates of DM (HR 2.21 95% CI 1.04-4.74 p=0.040). There was a trend towards increased rates of BCF in pts receiving IMRT for high-risk disease (HR 1.60 95% CI 0.96-2.66 p=0.072). There was no difference in CSS or OS in the high-risk subset. In the intermediate risk group, patients receiving IMRT had increased rates of acute grade 3+ genitourinary toxicity versus 3D-CRT patients (OR 8.30 95% CI 2.13-2.15 p=0.002). There were otherwise no differences in acute or late grade 3+ genitourinary or gastrointestinal toxicity amongst IMRT versus 3D-CRT pts. Conclusions: Despite the widespread adoption of IMRT for localized PCa, our results do not demonstrate an improvement in outcomes or toxicity versus 3D-CRT. Further research is warranted to explain these findings.

Vaginal high dose rate brachytherapy alone in patients with intermediate- to high-risk stage I endometrial carcinoma after radical surgery

2008 ◽  
Vol 18 (6) ◽  
pp. 1294-1299 ◽  
Author(s):  
I. L. Atahan ◽  
E. Ozyar ◽  
F. Yildiz ◽  
G. Ozyigit ◽  
M. Genc ◽  
...  
Keyword(s):  
High Risk ◽  
Dose Rate ◽  
Endometrial Adenocarcinoma ◽  
High Dose Rate ◽  
Stage I ◽  
Surgical Staging ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Vaginal Cuff ◽  
Grade 3

The objective of this study was to analyze the efficacy and morbidity of vaginal cuff brachytherapy alone in intermediate- to high-risk stage I endometrial cancer patients after complete surgical staging. Between October 1994 and November 2005, 128 patients with intermediate- to high-risk stage I endometrial adenocarcinoma were treated with high dose rate (HDR) brachytherapy alone after complete surgical staging. The intermediate- to high-risk group was defined as any stage I with grade 3 histology or stage IB grade 2 or any stage IC disease. The comprehensive surgery was in the form of total abdominal hysterectomy, bilateral salpingo-oophorectomy in addition to infracolic omentectomy, and routine pelvic and para-aortic lymphadenectomy. The median number of the lymph nodes dissected was 33. The median age at the time of diagnosis was 60 years. Forty patients were staged as IB (grade 2: 25 and grade 3: 15), and 88 patients were staged as IC (grade 1: 31, grade 2: 41, and grade 3: 16). A total dose of 27.5 Gy with HDR brachytherapy, prescribed at 0.5 cm, was delivered in five fractions in 5 consecutive days. Median follow-up was 48 months. Six (4.7%) patients developed either local recurrence (n= 2) or distant metastases (n= 4). Five-year overall survival and disease-free survival (DFS) rates are 96% and 93%, respectively. Only age was found to be significant prognostic factor for DFS. Patients younger than 60 years have significantly higher DFS (P= 0.006). None of the patients experienced grade 3/4 complications due to the vaginal HDR brachytherapy. Vaginal cuff brachytherapy alone is an adequate treatment modality in stage I endometrial adenocarcinoma patients with intermediate- to high-risk features after complete surgical staging with low complication rates.

scholarly journals Presenting stage and risk group in men dying of prostate cancer

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
S. Parimi ◽  
S. Bondy ◽  
M. Aparicio ◽  
K. Sunderland ◽  
J. Cho ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
British Columbia ◽  
High Risk ◽  
Gleason Score ◽  
Metastatic Disease ◽  
Risk Group ◽  
Specific Antigen ◽  
Population Based ◽  
Low Risk ◽  
Intermediate Risk

Introduction Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods The population-based BC Cancer databases were used to identify all patients diagnosed between Jan­uary 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan–Meier method. Results A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% met­astatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on sur­vival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results.

Prognostic Factors for Survival After 2-CdA-Based Therapy for Symptomatic Waldenström Macroglobulinemia (WM) Stratify Patients Into Low- and High-Risk Groups.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1668-1668
Author(s):  
Sheeba K Thomas ◽  
Lei Feng ◽  
Kay B Delasalle ◽  
Michael Wang ◽  
Jatin J Shah ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Retrospective Studies ◽  
Risk Group ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Primary Therapy ◽  
Intermediate Risk

Abstract Abstract 1668 Poster Board I-694 Introduction Retrospective studies performed by others between 2001-2009, have identified various prognostic factors for survival among patients with symptomatic WM. These include hemoglobin, platelet count, albumin, and β2-micrglobulin (β2M) at varied cutoffs, as well as gender, age, IgM level, monoclonal (M) protein level, hyperviscosity syndrome, prior therapy, presence of splenomegaly/organomegaly, stage as defined by the International Staging System for multiple myeloma (ISSMM) and risk score as defined by the International prognostic scoring system for Waldenström macroglobulinemia (IPSSWM). Methods We retrospectively analyzed our experience with 80 previously untreated patients with symptomatic WM who participated on one of four 2-chlorodeoxyadenosine (2-CdA)-based clinical trials between 3/90-5/02, to identify factors predicting overall survival. Patients received either 2 consecutive 4-6 week courses of 2-CdA at 1.5 mg/m2 subcutaneously three times daily for 7 days (d) alone (10 patients), with prednisone (Pred) at 60 mg/m2 orally (po) d1-7 (21 patients), with cyclophosphamide (Cy) at 40 mg/m2 po twice daily (bid) for 7d (31 patients), or with Cy at 40 mg/m2 po bid for 7d + rituximab (Rit) at 375 mg/m2 intravenously weekly for 4 weeks (18 patients). Overall survival (OS) from the start of therapy was censored as of April 1, 2009. Predictive factors identified by multivariate analysis in other retrospective studies, as well as other clinically relevant factors, were evaluated. Results Median age of patients was 62.1 years (range 35.9-80.1), and 41 were male. Median hemoglobin was 10 g/dL (5.6-15.6), platelet count was 243 K/μL (26-654), albumin was 4.1 g/dL (2.5-5.4), and β2M was 3.3 mg/L (1.4-15.9). Splenomegaly and lymphadenopathy (≥ 2 cm) were present in 29.1% and 28.8% of patients, respectively. By ISSMM, 38 patients were Stage I, 29 were Stage II, and 13 were Stage III. By IPSSWM, 24 patients were low-risk, 45 were intermediate-risk, and 11 were high-risk. With a median follow-up of 9.9 years (yrs; range 0.9-16.8), median OS for all patients was 8.9yrs (0.1 yrs-not reached (NR)). By univariate analysis, age <65y, primary therapy (2CdA/Cy/Rit >2CdA/Cy > 2CdA >2CdA/Pred), albumin ≥3.5 g/dL, B2M <3.5 mg/L vs. 3.5-5.5 mg/L vs. >5.5 mg/L, ISSMM and IPSSWM, were all significant (p< 0.05). In multi-covariate models, primary therapy (2CdA/Cy/Rit vs. other 2CdA regimens), age, ISSMM, and IPSSWM remained significant. Removing the 2CdA/Pred cohort (which had the poorest OS) from the analysis of primary therapy, the trend toward superior OS with 2CdA/Cy/Rit vs. 2CdA+2CdA/Cy persisted (NR vs. 9.2 yrs), but did not reach statistical significance (p=0.12). Median OS for patients of age <65 yrs was 15.4 yrs compared with 6.2 yrs for those age ≥65 yrs (p=0.03). ISSMM stage I disease was associated with a median OS of 12.5 yrs, while stage II was 6.3 yrs, and stage III was 6.0 yrs (p=0.02). By comparison, median OS has not yet been reached among those classified as having low-risk disease by IPSSWM, while the intermediate-risk group has a median OS of 6.5 yrs, and the high-risk group has a median OS of 5.8 yrs (p=0.03). Conclusion Both ISSMM and IPSSWM are predictive of overall survival among patients with symptomatic WM treated first-line with 2CdA-based regimens. In our experience, rates of 10 year OS were better stratified by age, <65 yrs (62%) vs. ≥65 yrs (30%), and IPSSWM risk score, low (63%) vs. intermediate (46%) vs. high (24%), than by ISSMM stage (stage I [58%] vs. stage II [49%] vs. stage III [0%]). Novel therapeutic strategies are needed to improve the survival of patients with WM who are of older age, or who have high-risk IPSSWM or higher stage ISSMM disease. Longer follow-up is needed to confirm the trend toward improved survival seen with the addition of rituximab to 2CdA-based therapy. Disclosures No relevant conflicts of interest to declare.

A new prognostic model comprising p53, EGFR, and tumor grade in early stage epithelial ovarian carcinoma and avoiding the problem of inaccurate surgical staging

2004 ◽  
Vol 14 (2) ◽  
pp. 259-270 ◽  
Author(s):  
I. Skírnisdóttir ◽  
T. Seidal ◽  
B. Sorbe
Keyword(s):  
High Risk ◽  
Prognostic Model ◽  
Risk Group ◽  
Tumor Grade ◽  
Figo Stage ◽  
High Risk Group ◽  
Epithelial Ovarian Carcinoma ◽  
Intermediate Risk ◽  
Grade 3 ◽  
Group Grade

Epithelial ovarian carcinoma rarely occurs because of a single event. Therefore, no single biological tumor factor will give accurate prognostic information for all ovarian cancer patients. On the other hand, a combination of two or more independent factors may yield an improved overall prognostic index. Because FIGO stage is included in most of the previously presented models, inaccurate surgical staging in patients with apparently early disease has been a problem. In a series of 226 patients with epithelial ovarian carcinomas in FIGO stages IA–IIC, a number of clinicopathological factors (age, FIGO stage, histopathologic type, and tumor grade) were studied in relation to the biological factors p53 and epidermal growth factor receptor (EGFR), important regulators of the apoptosis and mitosis. Immunohistochemical techniques were used. All patients received adjuvant radiotherapy or chemotherapy after the primary surgery. Expression of p53 was significantly associated with the tumor grade and disease-free survival (DFS). EGFR expression was also associated with DFS. In a Cox multivariate analysis, tumor grade, p53 status, and EGFR status were all independent and significant prognostic factors with regard to DFS. A prognostic model was proposed using these factors. A low-risk group, an intermediate-risk group, and a high-risk group were defined. DFS amounted to 89% in the low-risk group (grades 1–2, p53-negative, and EGFR-negative), 66% in the intermediate-risk group (grade 3, p53-negative, and EGFR-negative or grades 1–2, p53-positive or EGFR-positive) and 39% in the high-risk group (grade 3, p53-positive, and EGFR-positive).

scholarly journals Cause-Specific Effects of Radiotherapy and Lymphadenectomy in Stage I–II Endometrial Cancer: A Population-Based Study

2013 ◽  
Vol 105 (21) ◽  
pp. 1656-1666 ◽  
Author(s):  
Loren K. Mell ◽  
Ruben Carmona ◽  
Sachin Gulaya ◽  
Tina Lu ◽  
John Wu ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Population Based ◽  
Stage I ◽  
Population Based Study ◽  
Specific Effects
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