scholarly journals Evaluation of a Simple and Safe Tumor Drilling Technique to Potentiate the Effect of Intraperitoneal Chemotherapy in the Treatment of Recurrent Epithelial Ovarian, Tubal, and Peritoneal Cancer: A Matched Retrospective Cohort Study

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481986377
Author(s):  
Wei-Ting Chao ◽  
Ching-Hui Chien ◽  
Chung-Ru Lai ◽  
Hui-Ju Wu ◽  
Chi-Mu Chuang
Keyword(s):  
Ovarian Cancer ◽  
Retrospective Cohort ◽  
Comparison Group ◽  
Group Versus ◽  
Rank Test ◽  
Second Line ◽  
Cohort Group ◽  
Log Rank Test ◽  
Drilling Technique

Frontline intraperitoneal chemotherapy (IPCT) in the treatment of epithelial ovarian cancer has been well established. However, the role of second-line IPCT is yet to be confirmed. With a view to implementing IPCT to treat recurrent disease, a prerequisite is to perform a cytoreductive procedure to minimize residual tumor size. However, the role of cytoreductive procedure is still in debate due to a higher chance of complications. A matched retrospective cohort study was conducted. From 2008 to 2015, we adopted a relatively simple and safe tumor drilling technique to maximize tumor exposure to second-line IPCT. Patients who received tumor drilling followed by second-line IPCT constituted the cohort group. Concurrently, patients who received standard second-line systemic chemotherapy were selected as the comparison group. After propensity score matching, 85 patients in each group entered into the final analysis. The median progression-free survival was 7.3 months (95% confidence interval [CI], 6.2-7.8) for the cohort group versus 4.1 months (95% CI, 4.0-4.3) for the comparison group (hazard ratio = 0.25 [95% CI, 0.17-0.36]; P < .001, by log-rank test). The median overall survival was 33.6 months (32.1-36.6) for the cohort group versus 25.9 months (20.5-26.9) for the comparison group (hazard ratio = 0.33 [95% CI, 0.23-0.48]; P < .001, by log-rank test). Toxicities in the cohort group were not different from those that were published in reports of IPCT for ovarian cancer. The most commonly observed toxicity was gastrointestinal origin (51.7%), and it may be attributed to the intraperitoneal pharmacokinetic clearance of cisplatin and taxol and we also discussed the mechanism of gastrointestinal toxicity. Tumor drilling followed by second-line IPCT may confer a survival advantage over standard second-line systemic chemotherapy in the treatment of recurrent ovarian cancer.

Potential role of MAD1 1673G>A and ERCC1 8092C>A polymorphisms in the resistance to chemotherapy in advanced ovarian cancer: A pilot study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17045-e17045
Author(s):  
Irwin Alejandro Hernandez Cruz ◽  
Diddier Prada ◽  
José Díaz-Chávez ◽  
Salim Barquet-Munoz ◽  
David Francisco Cantu De Leon ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pilot Study ◽  
Gynecological Cancer ◽  
Advanced Ovarian Cancer ◽  
Rank Test ◽  
Log Rank Test ◽  
Response To Chemotherapy ◽  
Chi Squared ◽  
Resistance To Chemotherapy

e17045 Background: Ovarian cancer (OC) is the most lethal gynecological cancer and 70% of cases are in advanced stages at diagnosis. The standard treatment for those stages is optimal cytoreduction plus chemotherapy based on carboplatin-paclitaxel. Nevertheless, 60%-70% of patients will progress after diagnosis, becoming resistant in some point of the disease. There are no biomarkers to predict response to chemotherapy in OC. Some polymorphisms, including MAD1 1673G > A and ERCC1 8092C > A have shown potential to predict chemoresistance in other tumors. Thus, we explored the role of these polymorphisms in the resistance to chemotherapy in advanced OC. Methods: We genotypified 89 OC patients samples, and also determined the mRNA expression for both genes by RT-PCR. We compared distributions using chi-squared test and determined differences in overall survival and free-relapse survival using Kaplan-Meier curves and log-rank test. Results: Most of cases were IIIC stage (35.48%), papillary histological subtype (32.26%), highly differentiated (67.74%), and 35.48% tumors with recurrence. Distribution for MAD1 genotype was 35.48% for wild-type (WT), 32.26% for heterozygous (HT), and 32.26% for homozygous polymorphic condition (Poly). For ERCC1, we found a distribution of 25.81% for WT, 51.61% for HT, and 22.58% for Poly. When comparing distributions, we found statistically significant differences between sensitive vs. resistant tumors ( p= 0.02), with lack of the WT condition for ERCC1 in sensitive tumors. When analyzing haplotypes in regard to platinum-sensitivity, we also found statistical differences in the distribution of haplotypes ( p = 0.02). No association between genotypes and expression was observed. Remarkably, we found a lower free-relapse survival in the presence of at least one WT allele for the MAD1 polymorphism (p = 0.021, log-rank test). Conclusions: In this pilot study, we have found that ERCC1 8092C > A polymorphism, as well as haplotypes for these two genes, could be associated with chemoresistance. MAD1 1673G > A polymorphism could play also a role in recurrence in advanced OC.

scholarly journals Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanrui Liang ◽  
Liying Zhao ◽  
Hao Chen ◽  
Tian Lin ◽  
Tao Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Adjuvant Chemotherapy ◽  
Elderly Patients ◽  
Retrospective Cohort ◽  
Stage Iii ◽  
Rank Test ◽  
Oral Capecitabine ◽  
D2 Gastrectomy ◽  
Log Rank Test

Abstract Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

2014 ◽  
Vol 13 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Jordan D. Lane ◽  
John Mugamba ◽  
Peter Ssenyonga ◽  
Benjamin C. Warf
Keyword(s):  
Cohort Study ◽  
Low Income ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Shunt Infection ◽  
Low Income Countries ◽  
Rank Test ◽  
Log Rank Test ◽  
Significant Difference ◽  
Chi Square Analysis

Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

Craniopharyngioma: a comparison of tumor control with various treatment strategies

2010 ◽  
Vol 28 (4) ◽  
pp. E5 ◽  
Author(s):  
Isaac Yang ◽  
Michael E. Sughrue ◽  
Martin J. Rutkowski ◽  
Rajwant Kaur ◽  
Michael E. Ivan ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Treatment Strategies ◽  
Group Versus ◽  
Outcome Data ◽  
Treatment Modalities ◽  
Rank Test ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Log Rank Test ◽  
Significant Difference

Object Craniopharyngiomas have a propensity to recur after resection, potentially causing death through their aggressive local behavior in their critical site of origin. Recent data suggest that subtotal resection (STR) followed by adjuvant radiotherapy (XRT) may be an appealing substitute for gross-total resection (GTR), providing similar rates of tumor control without the morbidity associated with aggressive resection. Here, the authors summarize the published literature regarding rates of tumor control with various treatment modalities for craniopharyngiomas. Methods The authors performed a comprehensive search of the English language literature to identify studies publishing outcome data on patients undergoing surgery for craniopharyngioma. Rates of progression-free survival (PFS) and overall survival (OS) were determined through Kaplan-Meier analysis. Results There were 442 patients who underwent tumor resection. Among these patients, GTR was achieved in 256 cases (58%), STR in 101 cases (23%), and STR+XRT in 85 cases (19%). The 2- and 5-year PFS rates for the GTR group versus the STR+XRT group were 88 versus 91%, and 67 versus 69%, respectively. The 5- and 10-year OS rates for the GTR group versus the STR+XRT group were 98 versus 99%, and 98 versus 95%, respectively. There was no significant difference in PFS (log-rank test) or OS with GTR (log-rank test). Conclusions Given the relative rarity of craniopharyngioma, this study provides estimates of outcome for a variety of treatment combinations, as not all treatments are an option for all patients with these tumors.

Stanozolol and the Treatment of Venous Ulceration — An Interim Report

1986 ◽  
Vol 1 (3) ◽  
pp. 197-203 ◽  
Author(s):  
G. T. Layer ◽  
M. C. Stacey ◽  
K. G. Burnand
Keyword(s):  
Rank Test ◽  
Inclusion Criteria ◽  
Double Blind ◽  
Venous Ulceration ◽  
Compression Bandaging ◽  
Venous Ulcers ◽  
Log Rank Test ◽  
Initial Area ◽  
Standard Regime

A report on an interim analysis of a large placebo-controlled double-blind randomized clinical trial evaluating the role of fibrinolytic enhancement in the management of venous ulceration is described. Seventy-five patients with venous ulcers have entered the trial and fulfilled the inclusion criteria. The ulcers were treated by a standard regime of compression bandaging combined with the oral administration of placebo or stanozolol (Stromba; Sterling Research Laboratories, Guildford). Treatment was continued until healing, and the healing times were compared between the two groups. Sixty-five per cent of ulcers treated with stanozolol have healed and 61.5 % on placebo. There was no overall difference in the healing times of patients treated with stanozolol or placebo. When the healing times were analysed after stratification into initial size, there was no difference between the ulcers of small (less than 2 cm2) or large (greater than 5 cm2) initial area, but for the ulcers between 2 and 5 cm2 there was a trend in favour of improved healing for those ulcers treated with stanozolol ( P = 0.13, log rank test).

Hand-foot syndrome (HFS) in patients treated with capecitabine (CAP) and the role of thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8615-8615 ◽  
Author(s):  
V. Juneja ◽  
G. Black ◽  
J. Thornton ◽  
S. Russo ◽  
M. Johnson ◽  
...  
Keyword(s):  
Dihydropyrimidine Dehydrogenase ◽  
Rank Test ◽  
Toxicity Data ◽  
Log Rank Test ◽  
Hand Foot Syndrome ◽  
Median Cumulative Dose ◽  
Dose Modifications ◽  
Ecog Ps ◽  
Pharmacological Basis

8615 Background: HFS is the most common toxicity of CAP. Preclinical studies have shown that radiation (XRT) up-regulates TP, which may in turn increase efficacy of CAP. CAP is degraded by DPD, and a deficiency in this enzyme may increase toxicity of CAP. However, effect of XRT on frequency of HFS and association with TP and DPD has not been fully characterized. Methods: Toxicity data were collected from pts with LA pancreatic cancer enrolled in 3 clinical trials conducted at UAB between Apr 2001 and Jul 2005. Overall results of these trials have been reported elsewhere. Pts received XRT (50.4 Gy) with CAP (1,200–1,600 mg/m2 BID M-F) followed CAP (2,000 mg/m2 BID x 14 days). Pts were classified into 2 groups to evaluate HFS: CAP-XRT and CAP. Roche grading was used to assess HFS. Dose modifications were according to drug insert. Pts received prophylactic udder cream and pyridoxine. Tumor specimens were procured in 36 pts by EUS-FNA 1 wk pre- and 2 wks post XRT to evaluate TP and DPD. Age, race, sex, and PS were evaluated as prognostic factors. Results: Median duration of CAP was 6 wks (range: 3–6) for CAP-XRT and 2.5 cycles (range: 0–17) for CAP. Among 58 pts, 14 developed HFS (24%). CAP group had a higher incidence of HFS than CAP-XRT (17.2 % vs. 10.3 %; P = 0.12). Grade 2/3 HFS was observed in 15.5 % of CAP and 1.7 % of CAP-XRT (P = 0.0078). Median cumulative dose of CAP for first development of HFS was 235,000 mg/m2 in CAP-XRT group and 3,185,000 mg/m2 in CAP, with relative frequency of an event occurring in CAP-XRT vs. CAP of 0.59. HFS occurred at a median of 5 wks in CAP-XRT and 6 wks in CAP. Log-rank test showed neither age, sex, ECOG PS, or race was associated with development of HFS. There was no difference in tumor responses of pts with vs. without HFS. Mean tumor TP was higher among pts with vs. without HFS (275.77 vs. 215.29; P = 0.32). Mean tumor DPD was lower among pts with vs. without HFS (55.18 vs. 63.58; P = 0.49). Mean TP:DPD ratio was higher among pts with vs. without HFS (10.29 vs. 3.04; P = 0.31). Conclusions: This study suggests that incidence, severity, and time to occurrence of HFS with CAP-XRT < CAP, indicating no effect of XRT. No significant association of HFS with higher tumor TP or lower tumor DPD was found. Pharmacological basis for HFS with CAP needs to be explored. [Table: see text]

Pharmacogenetic analysis in metastatic colorectal cancer (mCRC) patients (pts) treated with second-line irinotecan (IR)+/− cetuximab (CB): The EPIC experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4022-4022
Author(s):  
D. Yang ◽  
A. Pohl ◽  
W. Zhang ◽  
G. Lurje ◽  
Y. Ning ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Phase Iii ◽  
Rank Test ◽  
Second Line ◽  
Ca Repeat ◽  
Ras Mutation ◽  
Mutation Status ◽  
Log Rank Test

4022 Background: EPIC, a multinational phase III clinical trial with IR + CB vs IR alone in mCRC pts in the second-line setting after failure of FOLFOX demonstrated a benefit for IR+CB in progression-free survival (PFS) and response rate (RR). We evaluated functional germline polymorphisms involved in the EGFR- (EGF, EGFR), angiogenesis- (VEGF, IL-8, CXCR-2) - and drug- metabolism related genes (UGT1A1, MTHFR) for their potential role as molecular predictors for clinical outcome in pts treated with CB/IR vs. IR alone. Methods: DNA was extracted from all available formalin-fixed paraffin-embedded tumor samples from the phase III EPIC trial (US sites only). Genotyping was performed using PCR-RFLP assays and 5’ -end [g-33P] ATP’ labeled PCR-protocols. Results: 186 pts were treated either with IR/CB (arm A, 84 pts) or IR (arm B, 102 pts) only. In arm A, 11/84 pts (13%) showed CR or PR, whereas 73/84 (87%) pts had SD or PD. For arm B, 6/102 pts (6%) showed CR or PR, whereas 96/102 pts (94%) had SD or PD. Median PFS in arm A was 3.0 months (95%CI: 2.4- 4.1 months) vs 2.7 months (95%CI: 2.2–2.9 months) in arm B; median overall survival (OS) was 9.3 months (95%CI: 7.1–12.1 months) in arm A vs. 12.3 months (95%CI: 10.4- 17.9 months) in arm B. K-ras mutation status was not significantly associated with PFS or response to CB/IR in the subgroup of 186 patients. We found an EGFR-CA- repeat in intron 1 in arm A to be associated with PFS (p=0.031, log-rank test). In arm B, we found a significant association with RR (p=0.0103, Fisher's exact test) for MTHFR1298. Furthermore, MTHFR 677 (p =0.0048, log-rank test) and MTHFR 1298 (p=0.038, log-rank test) were also found to be associated with OS in arm B. In multivariate analysis, EGFR-CA-repeat was significantly associated with PFS (adjusted p= 0.023). Furthermore, MTHFR 677 and MTHFR 1298 was associated with OS (adjusted p=0.028 and 0.026, respectively, Cox-proportional hazards models), independent from K-ras mutation status, race and number of disease sites. Conclusions: Our study demonstrates the potential predictive value of polymorphisms in the EGFR- and MTHFR- gene in mCRC pts treated with IR+ CB. Further validation in additional clinical trials is necessary. [Table: see text]

The role of serum carcinoembryonic antigen in predicting objective responses to chemotherapy and overall survival in patients with non-small cell lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18084-e18084
Author(s):  
Hongbing Liu
Keyword(s):  
Protective Factor ◽  
Cox Regression ◽  
Rank Test ◽  
Small Cell Lung ◽  
Baseline Serum ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Serum Cea ◽  
Nsclc Patients

e18084 Background: Previous studies indicated the carcinoembryonic antigen (CEA) could predict the therapeutic objective response (OR) and overall survival (OS) of patients with cancers, including non-small cell lung cancer (NSCLC). However, the role it could play in evaluating therapeutic responses and OS in patients with NSCLC requires further elucidation. Herein, we investigated the potential role of CEA in predicting OR and OS in patients with NSCLC. Methods: 689 patients with NSCLC were enrolled between January 2000 and August 2011. The correlations between the CEA levels and OR or OS were examined via statistical analyses including the chi-squared test, logistical regression, paired-samples t-test, receiver operator characteristic curve, Kaplan-Meier survival analysis, log-rank test and Cox regression model. Results: The calculated cut-off for predicting an OR to chemotherapy in patients with NSCLC was a reduction of 5.28% in serum CEA. This value demonstrated a sensitivity of 61.3% and a specificity of 62.4%. Serum CEA levels significantly decreased after two cycles of chemotherapy in NSCLC patients (t = 2.196, P = 0.031). The Kaplan-Meier survival analysis indicated no significant correlation between baseline CEA and OS (log rank test =0.079). However, according to the Cox regression analysis the number of distant metastatic organs (=1 and ≥2) was the independent risk factor of the OS (P = 0.026; P =0.003), and the cycle numbers of chemotherapy was the protective factor for OS in patients with NSCLC (P=0.011).More importantly, baseline serum CEA was significantly associated with lung adenocarcinoma and adenosquamous subtypes (P = 0.014; P = 0.017, respectively). Conclusions: Our study shows that baseline serum CEA was significantly associated with lung adenocarcinoma and adenosquamous subtypes. While the baseline level of serum CEA was not a prognostic factor, the post-treatment reduction of serum CEA level can predict the OR in patients with NSCLC,. The number of chemotherapy cycles was the independent protective factor, while the numbers of distant metastatic organs was the independent risk factor for NSCLC patients’ OS.

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