CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors

Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors.Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma.Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs.Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding.

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Rituximab in the Treatment of Adults with Chronic Idiopathic Thrombocytopenic Purpura (ITP) and Autoimmune Hemolytic Anemia (AIHA).

Blood ◽

10.1182/blood.v104.11.3930.3930 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3930-3930 ◽

Cited By ~ 2

Author(s):

Ghassan Zalzaleh ◽

Ahmad Jajeh ◽

Diemante Tamoseviciene

Keyword(s):

Partial Response ◽

Hemolytic Anemia ◽

Complete Response ◽

Pure Red Cell Aplasia ◽

Lymphocytic Leukemia ◽

Overall Response ◽

Medical Centers ◽

History Of ◽

Refractory Itp

Abstract Corticosteroids have been the first line of treatment of ITP since 1950, however some patients do not respond to this treatment (refractory) and some will relapse after its discontinuation. For such patients second line treatments were introduced. Some patients will continue to be refractory to this treatment and need other therapy modality. Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen exposing B Lymphocytes, causing its depletion. This could alter the production of auto-antibodies in some Auto-Immune diseases and thus could be used in their treatment. Few medical centers had reported using Rituximab in the treatment of refractory (ITP) and (AIHA), yet its definite role could not be determined, and here we share our experience. Patients with documented diagnosis of ITP or AIHA who were refractory to at least two lines of therapy including steroids were offered to receive Rituximab (375mg/m2 weekly for 4 weeks). 15 patients were enrolled, 10 with ITP, 4 with AIHA, 1 with Coombs negative Hemolytic anemia, and 1 with pure red cell aplasia. One had both ITP and AIHA. 10 were females and 5 males. 5 were >60 years old and 10 were < 60 years old. 2 out of the 10 patients with ITP had also Chronic Lymphocytic Leukemia (CLL). Duration of follow up ranged from 2 months to 17 months (average 7 mos). Of the 10 patients with refractory ITP treated with Rituximab overall response was 60%. 4 were NR (no response), 2 were MR (minimal response: Platelets increased to <50000), 2 were PR (Partial response: Platelets increased to <100000) and 2 were complete response (Platelets became normal). 3 patients of 6 with Hemolytic anemia or PRC aplasia had NR, 1 had MR (Hct <30), and 2 had partial response (Hct 30–35). No complete response was observed in this group. In 3 patients with hemolytic anemia and CLL 1 had MR, 1 had PR and 1 had NR. 2 patients with hemolytic anemia who had NR died as a complication of their disease (one with septic shock and one with severe autoimmune flare up). Only one patient with refractory ITP had mild allergic side effects and did not complete 4 doses. No Rituximab related mortality was observed. CONCLUSION: Rituximab therapy had a variable but valuable effect in the treatment of patients with chronic refractory ITP and refractory/ relapsed AIHA. Overall response in our group reached 60%. No clinical or laboratory parameters were found to predict response, although there was a suggestion that males, younger age, and no history of splenectomy have a better chance of response. As we lack an effective alternative treatment in chronic refractory ITP and AIHA, Rituximab use could be a valid option in view of its mild toxicity. Further follow up of our patients and input from other institutions in this regard are needed.

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Efficacy of Thalidomide in the Treatment of Severe Recurrent Epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT): Preliminary Results of an Ongoing Study

Blood ◽

10.1182/blood.v120.21.629.629 ◽

2012 ◽

Vol 120 (21) ◽

pp. 629-629

Author(s):

Carlo L Balduini ◽

Francesca Bellistri ◽

Fabio Pagella ◽

Francesco Chu ◽

Elina Matti ◽

...

Keyword(s):

Partial Response ◽

Severity Score ◽

Hereditary Hemorrhagic Telangiectasia ◽

Vascular Malformations ◽

Complete Response ◽

Open Label ◽

Off Label ◽

Preliminary Results ◽

Recurrent Epistaxis

Abstract Abstract 629 Introduction. Hereditary hemorrhagic telangiectasia (HHT; OMIM 187300 and 600376), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant disease that leads to multiregional angiodysplasia. It affects approximately one in 5000 people. Recurrent and severe epistaxis, due to the presence of telangiectasias in nasal mucosa, is the most common presentation of HHT, frequently leading to severe anemia requiring iron supplements and blood transfusions. Multiple approaches, including surgical options, have been tried In the management of HHT epistaxis, but all of them are largely palliative with variable and temporary results. As a consequence, most patients require repeated interventions. Recently, angiogenesis has been implicated in the pathogenesis of HHT and, therefore, it has been suggested that anti-angiogenic substances may be effective in the treatment of vascular malformations. A recent study (Nat Med 2010; 16:420–428) found that oral administration of 100 mg of thalidomide daily lowered the frequency of epistaxis in six of seven treated subjects. The aim of our prospective, non-randomized, phase II, open-label trial is to confirm the effectiveness of this drug in reducing epistaxis and to identify the lowest effective dose in patients with HHT refractory to standard therapy (ClinicalTrials.gov Identifier: NCT01485224). Methods. HHT patients with at least one episode of overt bleeding/week requiring at least one blood transfusion during the last three months and refractory to mini-invasive surgical procedures are enrolled. Thalidomide is administered at a starting dose of 50 mg/day orally. In the event of no response, thalidomide dosage is increased by 50 mg/day every 4 weeks until complete (cessation of nose bleeding) or partial response (reduction in the severity of epistaxis less than complete response) to a maximum dose of 200 mg/day. After the achievement of complete/partial response patients are treated for 16 additional weeks. Monthly follow-up evaluates the epistaxis severity score and the transfusion need, with adverse events being reported. The study, which wants to enroll 34 patients, is currently recruiting participants. Results. Eleven patients, 7 M and 4 F, aged 45–80 years (median 67), with mutations in either ACVRL1 (8 cases) or ENG gene (3 cases) have been enrolled so far and 5 have completed at least 16 weeks of treatment (median follow-up 11 weeks, range 1–28). Treatment was effective in all 9 evaluable patients. Five patients responded within 4 weeks of starting the drug: cessation of nose bleeding was observed in one case, and a large reduction of nose bleeding measured according to a well defined epistaxis severity score (Am J Rhinol Allergy 2009;23:52–58) has been obtained in 4 cases. Four patients achieved a good, partial response after 8 weeks of treatment. As a consequence, thalidomide therapy significantly increased hemoglobin levels and abolished or greatly decreased the need for red blood cell transfusions. Only nonserious, drug-related adverse effects were observed during treatment, including constipation and drowsiness. Three patients completed the treatment and remained stable, off of thalidomide, without the loss of response during the immediate follow-up period. Conclusions. These preliminary results strongly support the hypothesis that low-dose thalidomide is very effective for the treatment of epistaxis in patients with severe HHT who did not benefit from other available modalities of treatment. Disclosures: Off Label Use: Thalidomide is used off-label for tretment of hereditary hemorrhagic telangiectasia.

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Clapd (Clarithromycin, Pomalidomide, Dexamethasone) Therapy In Relapsed Or Refractory Multiple Myeloma

Blood ◽

10.1182/blood.v122.21.1955.1955 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1955-1955 ◽

Cited By ~ 6

Author(s):

Tomer M Mark ◽

Angelique Boyer ◽

Adriana C Rossi ◽

Dennis Kwon ◽

Roger N Pearse ◽

...

Keyword(s):

Partial Response ◽

Board Of Directors ◽

Research Funding ◽

Complete Response ◽

Response Analysis ◽

Muscular Weakness ◽

Advisory Committees ◽

Disease Response ◽

Grade 3

Abstract Background Pomalidomide is a distinct IMiD® immunomodulatory agent with activity in subjects with relapsed or refractory MM (RRMM), including those with prior lenalidomide treatment. We have previously reported that the addition of clarithromycin enhances the anti-myeloma activity of pomalidomide+dexamethasone (Pom/Dex) in the treatment of RRMM (Mark et al, ASH 2012). We now report updated results with extended follow up from a phase 2 trial of large group of patients treated with ClaPd in RRMM. Methods One hundred nineteen patients with heavily pretreated RRMM were enrolled into a single-institution study to investigate the effectiveness and tolerability of ClaPd. Eligible subjects had at least 3 prior lines of therapy, one line of which must have included lenalidomide. ClaPd is clarithromycin 500mg twice daily; pomalidomide 4mg for days 1-21, and dexamethasone 40mg on days 1,8,15,22 of a 28-day cycle. All subjects had thromboprophylaxis with 81mg aspirin daily. Disease response evaluation was performed monthly with immunoelectrophoresis and free light chain analysis; bone marrow biopsy with skeletal imaging was used to confirm MM progression or complete response (CR). Treatment was continued as tolerated by the patient until disease progression. Results One hundred fourteen patients had completed at least 1 cycle of ClaPd and were eligible for disease response analysis at data cut-off. All patients were included in the safety analysis. Patients had undergone a median of 5 (range 3-15) prior lines of therapy. The proportion of patients who were refractory to lenalidomide, refractory to bortezomib, and double (lenalidomide+bortezomib) refractory were 85%, 79%, and 68% respectively. The median number of ClaPd cycles received was 7 (range 1-34). Overall response rate (ORR, ≥PR, entire cohort/double-refractory subgroup) was 61.4/56.4% [stringent complete remission (sCR): 4.4/4%, complete response (CR): 0.9/1.3%, very good partial response (VGPR): 14.9/11.5%, partial response (PR): 41.2/38.5%, minimal response (MR): 7/9%, stable disease (SD): 21.9/21.8%, progressive disease (PD): 9.6/12.8%, ³VGPR rate of 20.2/16.7%]. Clinical benefit (³ MR) was achieved in 68.4/65.4%. Median time to PR and maximum response was 1 (range 1-7) and 2 (range 1-18) cycles, respectively. After a mean follow up time of 11.9 months, 40 patients (34%) remain free from progression, with a median progression free survival of 8.1 months (95% CI: 5.1, 9.8). Median duration of response (DOR) was 9.3 months (95% CI: 7.2,16.1). Median overall survival (OS) has not been reached with 68 patients (57%) alive at last follow-up. Median PFS, DOR, OS were not significantly different in the double-refractory subgroup at 6.3 (CI 4.7, 8.7; p = 0.21), 8.6 (CI 6.5, 16.1; p = 0.87), and 16.8 months (CI 12.4, 28.7; p = 0.11) respectively. The most common (³% grade 3 and 4 toxicities were: neutropenia (49%), thrombocytopenia (39%), anemia (27%), pneumonia (10%), fatigue 8%, and muscular weakness 7%. Febrile neutropenia was uncommon at 2%. There were 6 cases of lower extremity venous thrombosis (5%, 1 grade 1, 4 grade 2, 1 grade 3) and no instances of pulmonary embolism. Mild peripheral neuropathy was present in 32% (19% grade 1, 13% grade 2), 0% grade 3 or 4). Grade 2 congestive heart failure, due to dexamethasone, emerged in 1 subject (0.8%). Four patients (3.3%) withdrew due to treatment related toxicity (1 with Grade 3 muscular weakness, 2 due to Grade 3 fatigue, 1 grade 4 neutropenic sepsis). There was no treatment related mortality. Conclusions ClaPd is a highly effective and tolerable regimen for heavily treated RRMM that has progressed after prior treatments. Response to ClaPd is rapid and sustained at > 8 months in the majority of subjects. The presence of double refractory disease did not significantly impact clinical outcomes. The ORR and PFS compare favorably and toxicity profile is similar to other published reports of Pom/Dex. Disclosures: Mark: Celgene: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millennium: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Onyx: Research Funding, Speakers Bureau. Rossi:Celgene: Speakers Bureau. Zafar:Celgene: Speakers Bureau; Millennium: Speakers Bureau; Onyx: Speakers Bureau. Pekle:Millennium: Speakers Bureau; Celgene: Speakers Bureau. Niesvizky:Millennium: The Takeda Oncology Company: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Onyx: Consultancy, Honoraria, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau.

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Fever after anti-programmed cell death-1 treatment to predict the response in advanced hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.5_suppl.90 ◽

2018 ◽

Vol 36 (5_suppl) ◽

pp. 90-90 ◽

Cited By ~ 1

Author(s):

San-Chi Chen

Keyword(s):

Cell Death ◽

Programmed Cell Death ◽

Partial Response ◽

Tumor Lysis Syndrome ◽

Laboratory Data ◽

Complete Response ◽

Advanced Hepatocellular Carcinoma ◽

Sorafenib Treatment ◽

Tumor Lysis

90 Background: Anti-programmed cell death (PD)-1, an immune checkpoint inhibitor, has been recently approved for the treatment of patients with HCC following prior sorafenib. However, a reliable predictor of treatment response has not been established. Patients who experienced immune-related adverse events (irAEs) of any grade yielded a significantly higher response rate than did those did not experience irAEs. Methods: Three cases of advanced HCC with or without previous sorafenib treatment, underwent anti-PD-1 treatment (pembrolizumab, 2 mg/kg, at 3-week interval) with or without combination of sorafenib (400mg daily). Results: Case 1 Fever (38.3°C) developed 2 days after anti-PD-1 treatment. The fever persisted for 2 months and gradually subsided (Figure 2B). Follow-up computed tomography (CT) revealed persistent tumor shrinkage and complete response at the latest time of examination (Figure 1B); the treatment is ongoing. Case 2 Spiking fever developed after each time of anti-PD-1 treatment. Follow-up CT revealed a remarkable decrease in the tumor size (3 cm), resulting in a partial response (Figure 1D); the treatment is ongoing. Case 3 Twelve days after the treatment, the patient complained of fever and general weakness. Laboratory data revealed tumor lysis syndrome and disseminated intravascular coagulopathy (DIC). HBV, hepatitis B virus; HCV, hepatitis C virus; BCLC, Barcelona Clinic Liver Cancer; AFP, alpha-fetoprotein; TACE, transarterial chemoembolization; CR, complete response; PR, partial response. Conclusions: Fever may be an early predictor of response to anti-PD-1 treatment. The degree of fever seemed to be correlated with tumor burden. High fever may suggest cytokine storm and possible tumor lysis syndrome. Early detection is necessary for the immediate prescription of steroids and management of tumor lysis.[Table: see text]

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

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.1.159 ◽

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.

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Retrospective and Prospective Study of Childhood Autoimmune Hemolytic Anemia. a Preliminary Report from the Red Cell Working Group of the Paediatric Hemato-Oncology Italian Associations (AIEOP)

Blood ◽

10.1182/blood-2019-124735 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 947-947

Author(s):

Saverio Ladogana ◽

Raffaella Colombatti ◽

Silverio Perrotta ◽

Angela Maggio ◽

Matteo Maruzzi ◽

...

Keyword(s):

Partial Response ◽

Prospective Study ◽

Autoimmune Hemolytic Anemia ◽

Complete Response ◽

High Dose ◽

Red Cell ◽

Line Treatment ◽

Secondary Form ◽

Hb Concentration

Autoimmune hemolytic anemia (AIHA) is an uncommon disease of childhood caused by the premature destruction of erythrocytes by autoantibodies. In this rare disease both diagnostic criteria and therapeutic approaches are not well standardized. The Red Cell Working Group of the Pediatric Italian Hematogy and Oncology Association (AIEOP) developed specific recommendations to help Physicians for AIHA management. The document is available on the AIEOP website since November 1st 2013. The Italian Pediatric AIHA Group began an observational, retrospective and prospective study in order to monitor the management of children with AIHA diagnosed from 2010 to 2018, and to assess whether the availability of AIEOP recommendations had an impact on the clinical management of such patients in AIEOP Centers. We collected a national cohort of 159 children with AIHA from 21 AIEOP Centers; 48 patients were diagnosed before November 2013 and 111 patients after that date. Gender was 56% males and 44% females; median age at diagnosis was 47 months, with 11.9% under 12 months of age; 8.2% of children were born prematurely and 3.9% showed congenital malformations. 23.2 % of patients had a familiar history of immunological, hematological or oncological diseases. The median hemoglobin level at diagnosis was 6.1 gr/dL. Table 1 reports the distribution of our cases, according to the different type of autoantibodies. The comparison between the retrospective and prospective study did not reveal significative differences in clinical and biological presentation. The cold IgM forms were mainly post infective (38.4%) or primary forms (53.8%), only one patient had a secondary form due to a primitive immunodeficiency. These patients did not develop other diseases during follow up (median follow up: 28,6 months). The preliminary results of treatment and follow up of the 146 patients with warm antibody AIHA revealed the following: The treatment with conventional dose of steroids (median dose 2 mg/Kg, range 0.7- 3.5 mg/Kg) was started in 94.4% of patients, in 53% of cases on the same day of diagnosis. A high number of children used additional treatment: red blood cell transfusions (51.4%), high dose Prednisolone (59.7%), high dose i.v. Immunoglobulin (49.7%) and Plasma Exchange (1.4%). 9.5% of patients, with poor responsive disease, needed alternative drugs during the first four weeks of therapy. Response criteria were so defined: a complete response was defined as the achievement of an Hb concentration greater than or equal to the lower normal limit for age with no signs of haemolysis, i.e. normal reticulocyte count and bilirubine concentration. A partial response was defined as an increase of Hb >2 g/dL without the Hb concentration reaching a normal value for the patient age and no response as an increase of Hb< 2 g/dL and/or dependence on transfusion. A complete response was reached by 62.5%, 79.3%, 85.1% at 3, 4, 6 weeks respectively. 14.9% of patients had either a partial response or a resistant disease at 6 weeks. IgG/IgG+C3d positivity was a negative prognostic factor, as compared to positivity to C3d only, with the need of a second line treatment (prevalently Mabthera or Mycophenolate Mofetil) in 31.7% vs 0, respectively (p 0.009). Currently 6.1% of the patients were lost to follow up, 1.3% died, 55,8% are in Complete Response without events and 21.9% of the patients are still on treatment . At the last follow up, in the whole "cohort" of warm AIHA, 58% have a Primary form, 15.7% an isolated post infective form and 27.7% a Secondary form (56% Evans Syndrome). The management of the patients diagnosed after November 2013 was mostly in agreement with our recommendations, whose comprehensive therapeutic algorithm is reported in table 2, with prolonged steroid tapering in order to extend the treatment for at least 6 months. The most important difference between the retrospective and prospective study was the duration of first line treatment: 6 months or more, for steroid dependence, in 71.6% of patients in the prospective study versus 52.3% of the retrospective (p 0.031) and, more importantly, the percentage of relapsed patients: 8.3% in the prospective study versus 29.8% of the retrospective (p 0.001), these data need a longer follow up (median follow up: 24 months in the prospective study versus 63 in the retrospective) Disclosures Colombatti: Global Blood Therapeutics: Consultancy; Novartis: Consultancy; AddMedica: Consultancy.

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Comparison of the efficacy of 3-weekly chop with CHOEP for treatment of patients with aggressive non-Hodgkin’s lymphoma.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.4104 ◽

2020 ◽

Vol 27 (03) ◽

pp. 631-634

Author(s):

Tahir Mehmood ◽

Muhammad Khalid ◽

Nasir Mehmood ◽

Shahbaz Ahmed ◽

Saeed Ahmed ◽

...

Keyword(s):

Partial Response ◽

Hodgkin’S Lymphoma ◽

Complete Response ◽

Hodgkin's Lymphoma ◽

Female Patients ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Group A ◽

Group B

Objectives: To compare the efficacy of 3-weekly CHOP with CHOEP for the treatment of patients with aggressive Non-Hodgkin’s Lymphoma. Study Design: Randomized control trial. Setting: Department of Medical Oncology, Jinnah Hospital Lahore. Period: From January 2016 to June 2016. Material & Methods: Conducted on 200 patients of biopsy confirmed aggressive non-Hodgkin’s lymphoma. The cases were allocated into two groups by using random numbers table i.e. group A & B having 100 patients each. Group A received CHOP-21 regimen which is defined as cyclophosphamide (750mg/m2 intravenously), doxorubicin (50mg/m2 intravenously), vincristine (2mg i/v) & prednisone (100mg/m2 d1-5 PO). Group B received CHOEP-21 regimen which is defined same as CHOP-21 but with the addition of etoposide 100mg/m2 intravenously for day 1-3. Observation regarding efficacy was including all the number of cases in which complete remission of disease was noted one month after completion of chemotherapy. Results: The mean age of the patients in group A was 44.6±13.9 years and in group B was 45.6±11.5 years. In group A, 74 (74%) male and 26 (26%) female patients and in group B, 72 (72%) male and 28 (28%) female patients. In the distribution of patients by complete response after 6 cycles, in group A, 66 (66%) patients had complete response, 30 (30%) patients had partial response, 1 (1%) patient expired, 2 (2%) patients had progressive disease (shifted to salvage therapy) and 1 (1%) patient lost the follow up. In group B, 80 (80%) patients had complete response, 16 (16%) patients had partial response, 2 (2%) patients expired, and 2 (2%) patients lost the follow up. Conclusion: It is concluded from this study that viability was accomplished in a greater number of patients treated with CHOEP-21 than those treated with CHOP-21 in the management of patients with aggressive Non hodgkin's lymphoma.

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The role of 131-I-metaiodobenzylguanidine (13II-MIBG) therapy in irresectable and compromising localized neuroblastoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.10053 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 10053-10053

Author(s):

R. A. Schoot ◽

G. Bleeker ◽

H. A. Heij ◽

B. L. van Eck ◽

H. N. Caron ◽

...

Keyword(s):

Partial Response ◽

Primary Tumour ◽

Therapy Response ◽

Progression Free Survival ◽

Staging System ◽

Complete Response ◽

Incomplete Resection ◽

Life Threatening ◽

Localized Neuroblastoma

10053 Background: According to current practice, observation only is justified in patients with localized, irresectable neuroblastoma with favorable biologic features. However, when organ or life threatening symptoms arise, therapy is required. Side effects of treatment should be minimal, since outcome is good. The aim of this study was to evaluate the response and outcome of neuroblastoma under these circumstances, when treated with 131-I-metaiodobenzylguanidine (131I-MIBG). Methods: Between 1989 and 2008, 21 patients (8 boys/13 girls) with localized neuroblastoma were included. Median age was 1.6 years (range of 0–5.5 years). Patients were eligible when the primary tumour was irresectable and organ or life threatening. Diagnosis and staging were performed according to the International Neuroblastoma Staging System (INSS). Fixed dosages of 131I-MIBG (50–200 mCi) were given with an interval of four weeks. The median number of infusions was two (range 1 to 7).131I-MIBG was given according to standard directions for targeted therapy. Response was graded according to the International Neuroblastoma Response Criteria (INRC). Results: Four patients were classified as stage I, three as stage II, and fourteen as stage III. Three tumors were NMYC amplified and two had loss of heterozygosity of 1p. Minimal pretreatment was given to nine patients, because of organ or life threatening symptoms. These patients responded insufficiently or showed return of tumor growth. After 131I-MIBG treatment, 8/21 regressed. Resection became possible in 13/21 patients. In 10/13 patients resection was macroscopically complete. Three other patients had incomplete resection of their tumor. They had longterm progression free survival. At the end of treatment 16/21 patients achieved complete response (CR) and 3/21 had stable disease (2 very good partial response (VGPR), 1 partial response (PR)). Two patients died, one of progressive disease, one due to complications of surgery (CR). One patient was lost to follow-up. Ten years OS was 90.5%, 10 years EFS was 72.4%. Median follow-up was 7.5 years (range 1 to 17.4). Conclusions: 131I-MIBG treatment is an effective treatment modality in irresectable, localized neuroblastoma, in case of organ or life threatening situations. No significant financial relationships to disclose.

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Stereotactic body radiotherapy (SBRT) in combination with surgery for primary and metastatic liver tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.347 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 347-347

Author(s):

Erik Lappinen ◽

Ngoc Thai ◽

Kusum Tom ◽

Akhtar Khan ◽

Ellen Day ◽

...

Keyword(s):

Liver Tumors ◽

Hepatic Metastases ◽

Normal Liver ◽

Liver Parenchyma ◽

Metastatic Lesion ◽

Hepatic Lesions ◽

Unresectable Metastasis ◽

Metastatic Liver Tumors ◽

Metastatic Liver

347 Background: Evaluate the feasibility, safety, and efficacy of SBRT in combination with surgery for primary and metastatic liver tumors. Methods: 12 patients completed hepatectomy and SBRT for either hepatocellular carcinoma (HCC) (3) or metastases from colorectal (4), neuroendocrine (2), uterine (2), or sarcoma (1) primary. All patients with metastases completed chemotherapy. Most patients (7) had resection of their operable metastases, total of 19, and gold fiducials placed in the unresectable lesions, total of 9, to facilitate definitive adjuvant SBRT. One patient with an unresectable metastasis received preoperative SBRT. Two patients with HCC had SBRT as a bridge to liver transplant. Two patients had salvage SBRT for recurrence after surgery. All patients completed 4D-CT for ITV definition and SPECT/CT to define functional normal liver parenchyma volume (NLV). MV-fluoro was performed to confirm tumor/fiducial respiratory motion within the PTV. Results: All patients successfully completed a combination of hepatectomy and SBRT. Seventeen hepatic lesions (≤ 2/patient) were treated with SBRT with a mean PTV 186.0 cc (15.1-803.5). The mean dose was 49.3 Gy (39-60) prescribed to the PTV in 5-6 fractions. With median follow-up of 9.2 months (2.8-15.3) there was no RILD > Grade 1 observed. The most common toxicity was Grade ≤ 2 fatigue. Nine patients had reduced SPECT-NLV vs. calculated NLV by a mean of 487.5 cc (p = 0.0004). In 6 of these, the SPECT-NLV vs. the CT-NLV was reduced by a mean of 253.9 cc (44.6 - 1076.2) reflecting the importance of SPECT functional imaging for SBRT planning. Postoperative morbidity was ≤ Grade 1. All surgical margins were negative. Three patients developed intrahepatic failures post SBRT. However, on follow-up imaging no in-field failures have occurred. Conclusions: The combination of liver SBRT with hepatic resection is safe and effective. It can be used preoperatively to increase resectability or to salvage surgical failures. We also report on the combination of limited hepatectomy for peripheral (including bilobar) hepatic metastases with planned SBRT to unresectable metastatic lesion(s). SBRT planning with SPECT/CT allows identification and preservation of the NLV.

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Long Term Significance of Response in Multiple Myeloma After Stem Cell Transplantation.

Blood ◽

10.1182/blood.v114.22.1811.1811 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1811-1811

Author(s):

Joaquin Martínez-López ◽

Joan Blade ◽

M. Carmen Gomez del Castillo ◽

Maria Victoria Mateos ◽

Adrian Alegre ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Stem Cell ◽

Partial Response ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Complete Response ◽

Long Term Follow Up

Abstract Abstract 1811 Poster Board I-837 The prognostic significance of achieving complete remission (CR) in Multiple Myeloma (MM) has finally been accepted. However, available studies have been based on series with a median follow-up around 5 years. This time period is insufficient according to the current life expectation of MM. Aim To establish the real effect of prognosis of the different response categories in a cohort of MM patients treated with autologous stem cell transplantation (ASCT) after long term follow up. Patients and methods Follow-up from diagnosis of 344 MM patients transplanted between 1989 and 1998 has been updated. These patients were previously included in a study aimed at establishing the post-ASCT response significance in MM and to validate the EBMT classification (Br J Haemat 2000;109:438-46). It was possible to update the follow up of 322 patients as at April 2009. At this date 99 patients were alive with a median follow-up form diagnosis of 12.5 years. Response categories and evaluated cases were: i) Complete Response (IF-) (CR), n= 84 ii) near Complete Response (EF-/IF+) (nCR), n= 66 iii) Very good partial response (VGPR) (<90% reduction of M component), n= 66 iv) Partial response PR (reduction of M component between 90-50%), n= 113 v) Stable Disease (SD), n= 12, y vi) Progression (PD), n=14 Survival analyses were performed by Kaplan-Meier curves (log-rank test). Cox logistic regression was employed to establish variables associated with a higher survival. Results Significant differences in overall survival (OS) and event free survival (EFS) were found between CR and nCR groups (p 0.01 and 0.0022, respectively); or between CR and VGPR (p 0.0001 and 0.0035); no differences were detected between nRC and VGPR groups (p 0.21 and 0.99) and between these groups and PR group (p 0.1 y p 0.8). OS and EFS of patients with ED o PD were lower than the rest of the groups. Overall survival at 12 years was 43% in CR patients, 21% in nCR, 20% in VGPR, 30% in PR, 8% in SD and 0% in PD groups. Median survival (OS, EFS respectively) of each group was 91 months and 36 m, 26 m and 21 m, 20 m and 15 m, 31 m and 12 m, 8 m and 5 m, and 6 and 1 month. Land-mark study (10 years) found a plateau phase in OS and EFS after 11 years. Twenty two percent of patients are still alive with stable status between 11 and 15.54 years and only two cases had relapsed in the non CR group. In a regression study for OS, response was only one variable with statistical significance (CR P <0.0000, OR 0.044, IC-95%: 0.020-0.30). Conclusions In MM achieving CR after ASCT is the most important prognostic factor even after long-term follow-up. Relapse rate is very low in patients with >11 years of follow-up, this could mean a cure for patients in CR. Disclosures No relevant conflicts of interest to declare.

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