scholarly journals Improving outcomes of surgery in advanced infiltrative thymic tumours: the benefits of multidisciplinary approach

2021 ◽  
pp. 030089162110231
Author(s):  
Andrea Billè ◽  
Rajdeep Bilkhu ◽  
Giulia Benedetti ◽  
Gianluca Lucchese
Keyword(s):  
Treatment Plan ◽  
Clinical Stage ◽  
Median Sternotomy ◽  
Postoperative Mortality ◽  
Local Relapse ◽  
Complete Resection ◽  
Stage Iii ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Extrapleural Pneumonectomy

Background: For stage III or IVa thymic tumours, a multimodality approach is recommended. The role of surgery is to achieve complete resection. Aim: To present the outcomes of patients undergoing surgery for stage III or IVa thymoma. Methods: Retrospective review of patients undergoing open surgery for stage III or IVa thymoma between 2016 and 2020 at a single centre was performed. Preoperative imaging, treatment plan, surgical approach, and postoperative outcomes were analyzed. Results: Forty-seven patients underwent surgery for thymoma. Patients with clinical stage I/II thymoma or minimally invasive thymectomy were excluded. Thirteen patients with clinical stage III or IVa were included. Median sternotomy approach was used in four patients, of which one was redo sternotomy; a hemi-clamshell in four; and a combination of approaches in the remaining five patients. There was no postoperative mortality. Four patients had postoperative complications. Complete resection was achieved in all but two patients. At a median follow-up of 17.9 months, all patients were alive with no evidence of recurrence except one who died 4 months after surgery from coronavirus disease 2019 (COVID-19) pneumonia. Conclusions: Surgery for stage III and IVa thymoma is safe and can be achieved with complete macroscopic resection. To obtain adequate exposure of all structures involved in the tumour, combined surgical approaches can be used with no increased morbidity. The majority of patients, even after extrapleural pneumonectomy, did not receive adjuvant radiotherapy and had no evidence of local relapse.

Surgical resection of large anterior mediastinal masses: Results of median sternotomy approach.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20005-e20005
Author(s):  
Raj Mohan
Keyword(s):  
Superior Vena ◽  
Germ Cell Tumors ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Postoperative Mortality ◽  
Surgical Approaches ◽  
Femoral Access ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Cardiac Bypass

e20005 Background: Anterior mediastinal masses are a diverse group of tumors generally presenting as compressive symptoms. Larger masses require open surgical approaches including median sternotomy or sterno-thoracotomy. In this study we analyzed the surgical and pathological outcomes of large anterior mediastinal masses resected through sternotomy approach. Methods: Data of 16 patients with anterior mediastinal masses ( > 10 cms) treated surgically was analyzed retrospectively. All the patients were evaluated preoperatively with MRI, CT guided biopsy and pulmonary function test followed by exploration through median sternotomy approach with/without cardiac bypass (through femoral access). Adjuvant chemo-radiation was used according to histopathological features. Results: A total of 10 male and 6 females with median age 42 years (range: 6-62) underwent resection. Three patients received neoadjuvant chemotherapy and the mean tumor size was 12.2 cms. Histopathologies included mature teratomas/dermoids (4), thymic carcinoma (3), nerve sheath tumors (3), malignant germ cell tumors (3), synovial sarcoma (1) primary mediastinal goiter (1) and inflammatory pseudo tumor (1). There was no postoperative mortality and two patients required cardiac bypass. Bovine pericardium was used in two patients for the loss of large are of pericardium. One patient required biograft for replacement of resected superior vena cava. Major morbidities included prolonged ventilation and intrathoracic collection in two patients. All the patients were disease free after a median follow up of 14 months. Conclusions: Large anterior mediastinal masses are challenging surgically. An aggressive surgical approach through median sternotomy in association with cardiac bypass helps in complete resection and may lead to optimal results.

Neoadjuvant and adjuvant nivolumab (nivo) with anti-LAG3 antibody relatlimab (rela) for patients (pts) with resectable clinical stage III melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9502-9502
Author(s):  
Rodabe Navroze Amaria ◽  
Michael A. Postow ◽  
Michael T. Tetzlaff ◽  
Merrick I. Ross ◽  
Isabella Claudia Glitza ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Clinical Stage ◽  
Pathologic Response ◽  
Stage Iii ◽  
Toxicity Profile ◽  
Radiographic Response ◽  
Recist 1.1 ◽  
Viable Tumor ◽  
Stage Iii Melanoma ◽  
Favorable Toxicity Profile

9502 Background: Neoadjuvant therapy (NT) for pts with clinical stage III melanoma remains an active area of research interest. Recent NT trial data demonstrates that achieving a pathologic complete response (pCR) correlates with improved relapse-free (RFS) and overall survival (OS). Checkpoint inhibitor (CPI) NT with either high or low dose ipilimumab and nivolumab regimens produces a high pCR rate of 30-45% but with grade 3-4 toxicity rate of 20-90%. In metastatic melanoma (MM), the combination of nivo with rela (anti Lymphocyte Activation Gene-3 antibody) has demonstrated a favorable toxicity profile and responses in both CPI-naïve and refractory MM. We hypothesized that NT with nivo + rela will safely achieve high pCR rates and provide insights into mechanisms of response and resistance to this regimen. Methods: We conducted a multi-institutional, investigator-initiated single arm study (NCT02519322) enrolling pts with clinical stage III or oligometastatic stage IV melanoma with RECIST 1.1 measurable, surgically-resectable disease. Pts were enrolled at 2 sites and received nivo 480mg IV with rela 160mg IV on wks 1 and 5. Radiographic response (RECIST 1.1) was assessed after completion of NT; surgery was conducted at wk 9 and specimens were assessed for pathologic response per established criteria. Pts received up to 10 additional doses of nivo and rela after surgery, with scans every 3 mo to assess for recurrence. The primary study objective was determination of pCR rate. Secondary objectives included safety, radiographic response by RECIST 1.1, event-free survival (EFS), RFS, and OS analyses. Blood and tissue were collected at baseline, at day 15, day 28, and at surgery for correlative analyses. Results: A total of 30 pts (19 males, median age 60) were enrolled with clinical stage IIIB/IIIC/IIID/IV (M1a) in 18/8/2/2 pts, respectively. 29 pts underwent surgery; 1 pt developed distant metastatic disease while on NT. pCR rate was 59% and near pCR ( < 10% viable tumor) was 7% for a major pathologic response (MPR, pCR + near pCR) of 66%. 7% of pts achieved a pPR (10-50% viable tumor) and 27% pNR (≥50% viable tumor). RECIST ORR was 57%. With a median follow up of 16.2 mos, the 1 -year EFS was 90%, RFS was 93%, and OS was 95%. 1-year RFS for MPR was 100% compared to 80% for non-MPR pts (p = 0.016). There were no treatment related gr 3/4 AEs that arose during NT; 26% of pts had a gr 3/4 AE that began during adjuvant treatment. Conclusions: Neoadjuvant and adjuvant treatment with nivo and rela achieved high pCR and MPR rates with a favorable toxicity profile in the neoadjuvant and adjuvant settings. Pts with MPR had improved outcomes compared to non-MPR pts. Translational studies to discern mechanisms of response and resistance to this combination are underway. Clinical trial information: NCT02519322.

scholarly journals Molecular alterations in clinical stage III cutaneous melanoma: Correlation with clinicopathological features and patient outcome

2014 ◽  
Vol 8 (1) ◽  
pp. 47-54 ◽  
Author(s):  
PIOTR RUTKOWSKI ◽  
ALEKSANDRA GOS ◽  
MONIKA JURKOWSKA ◽  
TOMASZ ŚWITAJ ◽  
WIRGINIUSZ DZIEWIRSKI ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cutaneous Melanoma ◽  
Clinical Stage ◽  
Clinicopathological Features ◽  
Stage Iii ◽  
Molecular Alterations

scholarly journals Surgical management of bronchopulmonary carcinoids: A single center experience

2017 ◽  
Vol 06 (01) ◽  
pp. 006-010 ◽  
Author(s):  
Ashish Jakhetiya ◽  
Pankaj Kumar Garg ◽  
Rambha Pandey ◽  
Palaniappan Ramanathan ◽  
Sunil Kumar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Histopathological Examination ◽  
Postoperative Mortality ◽  
North India ◽  
Biological Behavior ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Delayed Presentation ◽  
Duration Of Symptoms ◽  
Tertiary Teaching

Abstract Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

scholarly journals Late stage presentation of HIV-positive patients to antiretroviral outpatient clinic in Zambia

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Timothy Martin ◽  
Morgan Mweene
Keyword(s):  
Clinical Stage ◽  
Primary Objective ◽  
World Health ◽  
Stage Iii ◽  
Clinical Staging ◽  
Hiv Positive ◽  
Eligibility Criteria ◽  
Design Data ◽  
Cross Sectional ◽  
Clinical Records

Background: The World Health Organization (WHO) and the Zambian Ministry of Health set out new guidelines on combination antiretroviral therapy (cART) in 2013 expanding the eligibility criteria for patients with HIV.Objectives: The primary objective were to determine when cART was initiated in HIV-positive outpatients according to clinical and immunological criteria, and to identify what proportion of patients who were eligible for cART according to 2013 WHO and 2013 Zambian cART guidelines were currently on cART.Methodology: This was a clinical audit of HIV-positive outpatients attending the cART clinic at Ndola Central Hospital in Ndola, Zambia, with retrospective cross-sectional chart review and survey design. Data were collected from clinical records and interviews with patients.Results: A total of 99% of patients eligible for cART according to 2013 guidelines were on treatment. Clinical staging of patients at initiated on cART (n = 206) was as follows: 28% clinical stage I, 21% clinical stage II, 36% clinical stage III and 15% clinical stage IV. The median CD4 count when patients were started on cART was 147 cells/mm3 .Conclusion: The results show that a majority of patients were initiated on cART late in their disease course according to immunological (CD4 < 200 cell/mm3 ) and clinical criteria (stage III or IV). However, the vast majority of patients eligible for cART were currently on treatment. The late initiation of cART appears to be a result of late diagnosis of HIV.

Crossover and rechallenge with pembrolizumab in recurrent patients from the EORTC 1325-MG/Keynote-054 phase 3 trial, pembrolizumab versus placebo after complete resection of high-risk stage III melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9500-9500
Author(s):  
Alexander M. Eggermont ◽  
Andrey Meshcheryakov ◽  
Victoria Atkinson ◽  
Christian U. Blank ◽  
Mario Mandalà ◽  
...  
Keyword(s):  
Disease Progression ◽  
Objective Response ◽  
Stage Iv ◽  
Median Number ◽  
Complete Resection ◽  
Stage Iii ◽  
Phase 3 ◽  
Double Blind ◽  
Grade 3 ◽  
To Receive

9500 Background: The phase 3 double-blind EORTC 1325/KEYNOTE-054 trial evaluated pembrolizumab (pembro) vs placebo in stage III cutaneous melanoma patients (pts) with complete resection of lymph nodes. Pembro improved RFS (hazard ratio [HR] 0.57) and DMFS (HR 0.60) (Eggermont, NEJM 2018, TLO 2021). In the pembro group, the incidence of immune related AE (irAE) grade 1-5 was 37%, and of grade 3-5 was 7%. We present the safety profile, response rate and PFS for the subset of pts who had a recurrence and crossed over or were rechallenged with pembrolizumab, within protocol. Methods: Pts were randomized to receive iv. pembro 200 mg (N=514) or placebo (N=505) every 3 weeks for a total of 18 doses (~1 year). Upon recurrence with no brain metastases, pts with an ECOG PS 0-2 were eligible to enter part 2 of the study, i.e. to receive pembro 200 mg iv. every 3 weeks for a maximum of 2 years, for crossover (those who received placebo) or rechallenge (those who recurred ≥6 months after completing one year of pembro therapy). Treatment was stopped in case of disease progression (RECIST 1.1) or unacceptable toxicity. Results: At the clinical cut-off (16-Oct-2020), 298 (59%) pts had a disease recurrence in the placebo group; 155 pts participated in the crossover part 2 of the trial. A total of 297 (58%) pts completed the 1-yr pembro adjuvant treatment, of whom 47 had a recurrence ≥6 mths from the stop of treatment and 20 entered in the rechallenge part of the trial. Among 175 pts who started pembro in Part 2, 160 discontinued due to completion of therapy (N=24), disease progression (N=88), toxicity (N=20), investigator's decision (N=21), or other reason (N=7); 15 pts were still on-treatment. Results for the 2 groups are provided in the table. The median number of doses was 12 and 5.5, respectively (resp), and the median follow-up was 41 and 19 mts, resp. Among the 175 pts, 51 (29%) had a grade 1-4 irAE (by group: 47 [30%] and 4 [20%] resp) and 11 (6%) a grade 3-4 irAE. Conclusions: Pembrolizumab treatment after crossover yielded a 39% ORR in evaluable pts and an overall 3-yr PFS of ̃32%, but after rechallenge the efficacy was lower. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA The median PFS (95% CI) from start of Part 2 was 14 (5-27) and 8 (5-15) mts for stage III-resected and III/IV various, resp. Among the 80 stage IV crossover pts with evaluable disease, 31 (39%) had an objective response: 14 (18%) CR, 17 (21%) PR. The 2-yr PFS rate from response was 69% (95% CI 48-83%). For these 80 pts, the median PFS was 6.1 mts and the 3-yr PFS rate was 31% (95% CI 21-41%). Among 9 stage IV rechallenged pts with an evaluable disease, 1 (11%) reached CR, 3 had SD and 5 PD. Clinical trial information: NCT02362594. [Table: see text]

Anatomic Sphenoid Cell Variants: Introduction of the Retrosphenoid Cell and Relevance in the Presentation and Management of Sinus Disease

2019 ◽  
Vol 34 (2) ◽  
pp. 170-175
Author(s):  
Anali Dadgostar ◽  
Aneela Hashmi ◽  
Judy Fan ◽  
Amin R. Javer
Keyword(s):  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Ct Scans ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Anatomic Variations ◽  
Sinus Disease ◽  
Anatomic Variants ◽  
Air Cells

Background Despite the well-appreciated variability in sphenoid sinus anatomy, there are no documented cases of retrosphenoid cells in the literature to date. Objective This study defines and determines the prevalence of retrosphenoid cells as identified on computed tomography (CT) imaging and intraoperative endoscopy and reviews the prevalence of other related anatomical variants of the sphenoid sinus. Methods Retrospective study of 300 random noncontrast sinus CT scans of patients with chronic rhinosinusitis presenting to a tertiary rhinology center. All identifiable anatomic variations and any presence of retrosphenoid cells and their pneumatization patterns were recorded. The prevalence of various anatomic variations of the sphenoid sinus was also calculated. Results A total of 300 sinus CT scans were included in the study. Protrusion of both the internal carotid artery (42.6%) and optic nerve (19.7%) into the sinus was more prevalent than the dehiscence of either one. A retrosphenoid cell was identified in 2% of CT scans. Other anatomic variants were less prevalent. Conclusion Meticulous review of preoperative imaging is key in identifying rare and complex sphenoid cell variations in planning surgical approaches and potential treatment strategies for the unusually pneumatized sphenoid air cells. Various manifestations of sinus disease can be localized to this area, and suspicion of a retrosphenoid cell should be raised in patients presenting with recalcitrant headache.

Staging Breast Cancer - Screening for Occult Metastases

1985 ◽  
Vol 71 (4) ◽  
pp. 339-344 ◽  
Author(s):  
Stefano Ciatto ◽  
Paolo Pacini ◽  
Patrizia Bravetti ◽  
Luigi Cataliotti ◽  
Gaetano Cardona ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Detection Rate ◽  
Clinical Stage ◽  
Preoperative Staging ◽  
Stage I ◽  
Stage Iii ◽  
Prognostic Impact ◽  
Detection Rates ◽  
Occult Metastases

The authors report on 1,017 consecutive breast cancer cases without symptomatic metastases staged by means of chest X-ray (CXR), skeletal survey (BXR) and bone scintigraphy (BS). Occult metastases (DM) detection rate was 0.88 %: 0.29 % for lung and 0.59 % for bone DM. The detection rate was correlated with clinical stage: 0.36 % for stage I, 0.20 % for stage II, 0.26 % for stages I and II, and 2.77 % for stage III cases. The sensitivity based on DM cases prevalent or surfacing within 6 months of follow-up was 0.30 for CXR, 0.22 for BXR and 0.55 for BS; specificity was 0.99, 0.98 and 0.90, respectively. The study confirms the possibility of early detection of DM with preoperative staging, but the extremely low detection rates in stage I and II cancers do not advise such a routine procedure. The higher detection rate of DM may suggest adoption of the routine staging procedure in stage III cancers. In these cases, although no evidence is available of a favorable prognostic impact of early detection and treatment of DM, an unnecessary mastectomy could be avoided in about 3 % of cases in the presence of DM detected by the staging procedure.

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