Management dilemmas in pineoblastoma recurrence diagnosed during pregnancy

2020 ◽  
pp. 1753495X2095833
Author(s):  
Sonal Garg ◽  
Dilip K Maurya ◽  
Gopalakrishnan M Sasidharan ◽  
Shyama S Prem ◽  
Prasanth Ganesan ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Surgical Decompression ◽  
Diagnosis And Treatment ◽  
Increased Risk ◽  
Intracranial Neoplasm

Pineoblastoma is an extremely rare intracranial neoplasm, with increased risk of craniospinal metastasis. There is only one case reported in the literature who presented during pregnancy. Described here is a woman who presented at five months of gestation with recurrence of pineoblastoma, who had previously defaulted adjuvant therapy following surgical decompression. The challenges in the diagnosis and treatment of pineoblastoma and its effects on pregnancy are also discussed.

Multidisciplinary Approach of a Very Rare Infected Verrucous Carcinoma of the Scrotum

2019 ◽  
Vol 70 (4) ◽  
pp. 1476-1478
Author(s):  
Laura Raducu ◽  
Adelaida Avino ◽  
Cristina-Nicoleta Cozma ◽  
Sorin Nedelea ◽  
Andra-Elena Balcangiu-Stroescu ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Rare Disease ◽  
Chronic Inflammation ◽  
Male Patient ◽  
Multidisciplinary Approach ◽  
Verrucous Carcinoma ◽  
Surgical Excision ◽  
Diagnosis And Treatment ◽  
Wide Surgical Excision ◽  
The Right

Verrucous carcinoma of the scrotum is an extremely rare disease and most cases are thought to result from poor hygiene and chronic inflammation. Currently, it has not been well characterized, the etiology, diagnosis and treatment remaining poorly understood. We present the case of a 50-year-old male patient diagnosed with verrucous carcinoma of the right hemiscrotum. Wide surgical excision was performed. Favorable outcomes can be achieved by surgery, even without any adjuvant therapy, but patients should be carefully followed up.

scholarly journals Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 407
Author(s):  
Reetta Holma ◽  
Reijo Laatikainen ◽  
Helena Orell ◽  
Heikki Joensuu ◽  
Katri Peuhkuri ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Therapy ◽  
Gastrointestinal Symptoms ◽  
Mucosal Injury ◽  
Dietary Carbohydrates ◽  
Food Diary ◽  
High Consumption ◽  
Increased Risk ◽  
Symptom Diary ◽  
Low Consumption

Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.

scholarly journals Adjuvant Hormonotherapy and Cardiovascular Risk in Post-Menopausal Women with Breast Cancer: A Large Population-Based Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2254
Author(s):  
Matteo Franchi ◽  
Roberta Tritto ◽  
Luigi Tarantini ◽  
Alessandro Navazio ◽  
Giovanni Corrao
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Adjuvant Therapy ◽  
Large Population ◽  
Positive Association ◽  
Population Based ◽  
Study Cohort ◽  
Increased Risk ◽  
Post Menopausal ◽  
New Diagnosis

Background: Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women. Methods: By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting. Results: The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia. Conclusions: Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.

scholarly journals Treatment of Pathological Fractures of the Humerus with a Locked Intramedullary Nail

2003 ◽  
Vol 11 (1) ◽  
pp. 34-37 ◽  
Author(s):  
AJ Bauze ◽  
MT Clayer
Keyword(s):  
Adjuvant Therapy ◽  
Intramedullary Nail ◽  
Cement Augmentation ◽  
Retrograde Nailing ◽  
Common Site ◽  
Pathological Fractures ◽  
Distal Locking ◽  
Local Progression ◽  
Increased Risk ◽  
Progression Of Disease

Purpose. The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus. Methods. 29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients. Results. Fixation failed in 6 patients: 2 due to intra-operative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients. Conclusion. Retrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.

Persistence of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients predicts increased risk for relapse—Results of pooled European data

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10083-10083 ◽  
Author(s):  
W. J. Janni ◽  
G. Wiedswang ◽  
T. Fehm ◽  
J. Jueckstock ◽  
E. Borgen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Prognostic Significance ◽  
Primary Diagnosis ◽  
Nodal Status ◽  
Breast Cancer Patients ◽  
Increased Risk

10083 Background: The prognostic significance of DTC in the BM of breast cancer patients at the time of primary diagnosis has recently been confirmed by a large pooled analysis. If the persistence of DTC after adjuvant therapy confers a similar risk for relapse, there might be an indication for secondary adjuvant treatment. Methods: We analyzed BM aspirates of 697 patients from academic breast cancer units in Oslo (n=356), Munich (n=228) and Tuebingen (n=113) during recurrence-free follow-up at a median interval of 32.4 months (standard deviation [std] 19.4 mon) after primary diagnosis of breast cancer pT1–4, pN0–3 pM0. Carcinoma cells were detected using a standardized immunoassay with the monoclonal antibodies A45-B/B3 (Munich, Tuebingen), or AE1 and AE3 (Oslo), directed against cytokeratin (CK). Patients were followed for a median of 54.2 months (std 24.5 mon) after primary diagnosis. Results: Persistent DTC in the BM were detected in 15.6% of the patients (n=109). The Kaplan-Meier estimate for mean distant relapse-free survival estimate was 155.6 mon (142.4 - 168.9 95%CI) in patients with negative and 102.3 mon (93.6 - 111.0, 95% CI, p< .0001, log rank test) in patients with positive BM status. Patients without evidence of persistent DTC had a significantly longer overall survival (164.4 [155.6 - 173.3]), than patients with positive BM status (101.7 mon [89.4 - 113.9], p< .0001). In multivariate Cox regression analysis, allowing for bone marrow status, tumor size, nodal status, histopathological grading and hormone receptor status, DTC was of higher independent prognostic significance for subsequent reduced breast cancer specific survival (RR 5.9, 2.8 - 12.8, 95% CI, p< .0001), than nodal status at time of primary diagnosis (RR 1.2, 1.0 - 1.3, 95% CI, p=.014). Conclusion: Evidence of persistent DTC in breast cancer patients indicates an increased risk for subsequent relapse, and may serve for monitoring in future clinical trials. Such trials might investigate the benefit of individualized secondary adjuvant treatment or extended adjuvant therapy of patients with DTC. No significant financial relationships to disclose.

Micro-RNA-21 (miR21) expression in colorectal cancer (CRC) as a predictor for fluoropyrimidine-based adjuvant chemotherapy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 408-408
Author(s):  
Albert Y. Lin ◽  
Natalia B. Kouzminova ◽  
Jonathan Pollack ◽  
Gerard Nuovo
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cancer Recurrence ◽  
Cox Proportional Hazards ◽  
Micro Rna ◽  
Tissue Proliferation ◽  
Non Coding Rna ◽  
Increased Risk

408 Background: Fluoropyrimidine-based adjuvant chemotherapy is a standard treatment option for patients with high risk II or stage III CRC. It is, however, unclear if a subset of patients will benefit from chemotherapy more than others. MiR21, a small non-coding RNA, has been associated with promotion of tumor cell growth and metastasis. To assess the effect of miR21 on chemotherapy, we analyzed the association of miR21 expression with clinical outcomes and known prognostic factors. Methods: MicroRNA detection was performed by in situ hybridization on a CRC tissue microarray containing specimens from 130 cases (stage I, 21 patients; II: 44; III: 33; IV: 32). MiR21 expression was graded as negative (no staining in all tissue cores), low (0-10% staining), moderate (20-40%) and strong (50-100%), and was analyzed with stage, grade, expression of VEGF, Ki67, LEF1, OPN and MSH2 by immunohistochemistry. Cox proportional hazards regression analysis was performed to assess the association of miR21 expression with 10-year recurrence-free survival in the subgroup of 77 stage II or III patients. Results: In all, miR21 expression had moderate positive correlation with genes associated with tissue proliferation and invasion, including Ki67 (Spearman's r=0.42, p<0.001), VEGF (r=0.32, p<0.001) and OPN (r=0.32, p<0.001), and weak correlation with LEF1 (r=0.22, p=0.012) and MSH 2 (r=0.18, p=0.039). In the subgroup of 36 patients treated with adjuvant therapy, low or negative miR21 expression (≤10%, n=15) was associated with increased recurrence (HR =3.5; p=0.05). In the multivariate Cox regression model including stage, grade and LEF1 expression, the association of low or negative miR21 with cancer recurrence remained significant along with grade and LEF1. Ki67 was excluded from the multivariate model because of significant association with miR21 (r=0.44, p=0.007) in the analyzed group. Conclusions: Our results suggest that low miRNA21 expression is associated with increased risk for recurrence in CRC patients received adjuvant chemotherapy. Further investigation of miR21 in randomized studies is warranted to establish its role as a predictor for CRC in the setting of adjuvant therapy.

Association of adjuvant therapy in early-stage low-risk endometrial cancer with increased mortality: A statewide cancer registry analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5095-5095
Author(s):  
Michael R. Milam ◽  
Bin Huang ◽  
Mana Moghadamfalahi ◽  
Lynn Parker ◽  
Daniel Metzinger ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
Cancer Registry ◽  
Cox Regression ◽  
Early Stage ◽  
Low Risk ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Stage Ia ◽  
Registry Analysis

5095 Background: National Comprehensive Cancer Network (NCCN) guidelines state that patients with early stage low risk endometrial cancer (defined with 2009 criteria as stage IA endometrioid endometrial cancer) may be managed with observation with consideration of adjuvant therapy.The premise of this study is to review the patterns of care of those patients who received adjuvant therapy and its impact on survival. Methods: This is a retrospective cohort analysis of 1044 women from 2004-2008 in the Kentucky Cancer Registry (KCR) one of the affiliates utilized in the Surveillance, Epidemiology and End Results (SEER) Program database. Inclusion criteria for the patients in this analysis were those women with 2009 Stage IA uterine cancer of endometrioid histology, moderate and well differentiated tumor grade, who received definitive primary surgery. Adjuvant therapy was defined as any postoperative radiotherapy and/or chemotherapy after definitive surgical treatment. Patients with adjuvant therapy after surgery (AT) were compared to those patients who underwent surgery only (SO). Chi-square tests were used to identify associations between type of treatment and clinical/demographic factors. K-M plots and Cox regression models were used to examine survival between the two treatment groups. Results: 5.3% (55/1044) of patients with early stage low risk endometrial cancer were treated with AT compared to 94.7% (989/1044) of SO patients.No statistical differences in mean age, race, tumor size, smoking status, insurance status, lymph node dissection and gynecologic oncology care were found among the AT or SO groups. Five year survival was significantly better in the SO cohort compared to the AT cohort (92% alive at 5 years for SO vs. 66% alive at 5 years; p<0.0001). Controlling for other confounders in the multivariate Cox regression analysis, SO patients had substantially less risk for death compared to the AT groups (HR: 0.21; 95%CI 0.12-0.38; p<0.0001). Conclusions: In this statewide cancer registry analysis, adjuvant therapy after surgery in early stage low risk endometrial cancer patients is uncommon and is associated with an increased risk of mortality.

The Complexity of ADHD: Diagnosis and Treatment of the Adult Patient With Comorbidities

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S12) ◽  
pp. 1-16 ◽  
Author(s):  
Jeffrey H. Newcorn ◽  
Margaret Weiss ◽  
Mark A. Stein
Keyword(s):  
Adult Adhd ◽  
Depressive Disorders ◽  
Sleep Problems ◽  
Treatment Plan ◽  
Treatment Compliance ◽  
Psychosocial Interventions ◽  
Diagnosis And Treatment ◽  
Comprehensive Overview ◽  
Oppositional Defiant ◽  
Increased Risk

AbstractAttention-deficit/hyperactivity disorder (ADHD) is an impairing but usually treatable condition. Popular culture propagates the myth that ADHD recedes with age; this is not the case. Although it is common, <20% of adults with ADHD are diagnosed or treated. Adults with ADHD show significant comorbidities with depressive disorders, anxiety disorders, substance use, oppositional defiant disorder, personality disorders, sleep problems, and learning disabilities. However, symptoms that result from ADHD, such as mood symptoms or lability, are often mistaken for comorbid disorders. Comorbidity with ADHD impacts treatment compliance, treatment response, and patient insight. Insufficient data on the interaction between ADHD and comorbidities impedes proper diagnosis and treatment. Better clinical tools for assessing these conditions are needed. Food and Drug Administration-approved pharmacologic treatments for adult ADHD include stimulants, dexmethylphenidate, and the nonstimulant atomoxetine. Effect sizes of approved medicines at approved doses are half those seen in children. Adults may also need longer duration of medication effects than children. Short-acting stimulants are likely to result in poorer adherence and have a higher risk for diversion or abuse. Risk of abuse is a major concern; stimulant treatments are controlled substances, and children with ADHD show increased risk of substance abuse. Psychosocial interventions may be beneficial in treating both ADHD and comorbidities.In this expert roundtable supplement, Margaret Weiss, MD, PhD, presents a comprehensive overview of complications surrounding differential diagnosis in adults with ADHD. Next, Mark A. Stein, PhD, reviews evaluation, comorbidity, and development of a treatment plan in this population. Finally, Jeffrey H. Newcorn, MD, provides a discussion on the pharmacologic options available for adults with ADHD, considering dosages specific to adults and common comorbidities.

scholarly journals Change in Practice of Radioactive Iodine Administration in Differentiated Thyroid Cancer: A Single-Centre Experience

2021 ◽  
pp. 1-8
Author(s):  
Ayanthi Wijewardene ◽  
Matti Gild ◽  
Carolina Nylén ◽  
Geoffrey Schembri ◽  
Paul Roach ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Radioactive Iodine ◽  
Temporal Trends ◽  
Low Risk ◽  
American Thyroid Association ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Risk Patients

<b><i>Objective:</i></b> Our study aimed to analyse temporal trends in radioactive iodine (RAI) treatment for thyroid cancer over the past decade; to analyse key factors associated with clinical decisions in RAI dosing; and to confirm lower activities of RAI for low-risk patients were not associated with an increased risk of recurrence. <b><i>Methods:</i></b> Retrospective analysis of 1,323 patients who received RAI at a quaternary centre in Australia between 2008 and 2018 was performed. Prospectively collected data included age, gender, histology, and American Joint Committee on Cancer stage (7th ed). American Thyroid Association risk was calculated retrospectively. <b><i>Results:</i></b> The median activities of RAI administered to low-risk patients decreased from 3.85 GBq (104 mCi) in 2008–2016 to 2.0 GBq (54 mCi) in 2017–2018. The principal driver of this change was an increased use of 1 GBq (27 mCi) from 1.3% of prescriptions in 2008–2011 to 18.5% in 2017–2018. In patients assigned as low risk per ATA stratification, lower activities of 1 GBq or 2 GBq (27 mCi or 54 mCi) were not associated with an increased risk of recurrence. In patients assigned to intermediate- or high-risk categories who received RAI as adjuvant therapy, there was no difference in risk of recurrence between 4 GBq (108 mCi) and 6 GBq (162 mCi). <b><i>Conclusions:</i></b> Our data demonstrate an evolution of RAI activities consistent with translation of ATA guidelines into clinical practice. Use of lower RAI activities was not associated with an increase in recurrence in low-risk thyroid cancer patients. Our data also suggest lower RAI activities may be as efficacious for adjuvant therapy in intermediate- and high-risk patients.

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