Long-term follow-up of Holmium-YAG laser vaporisation of bladder urothelial carcinoma

2020 ◽  
pp. 205141582098120
Author(s):  
Alvaro Bazo ◽  
Arjun Gowda ◽  
Henry Han-I Yao ◽  
Robert Radcliffe ◽  
Phillip Goodall ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Bladder Tumour ◽  
Progression Free Survival ◽  
Low Grade ◽  
High Grade ◽  
Level Of Evidence ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Yag Laser

Introduction: Many patients with non-muscle invasive bladder cancer (NMIBC) will develop recurrences of their tumour after their first resection. Flexible cystoscopy under local anaesthesia with Holmium-YAG laser ablation of tumour (FHoLAT) is safe, well tolerated procedure with significant cost savings when compared to cystoscopy under general or regional anaesthesia. We retrospectively analysed the outcomes of a large series of patients undergoing FHoLAT at our institution between April 2006 and September 2013. Patients and methods: Patients were offered FHoLAT if the tumour recurrence was small and/or they were deemed unfit for regional or general anaesthesia. Patient data was extracted from medical records. The primary outcomes were overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS) and recurrence-free survival (RFS). Results: 232 patients with a total 522 FHoLAT procedures were included. The median follow-up was 74.8 (43.5–101) months; 18% were discharged after a recurrence free follow-up duration; 52.2% had one FHoLAT, 19.8% had two FHoLATs, 11.2% had three FHoLATs and 16.8% had four or more FHoLAT. At initial diagnosis 24.1% of patients had G1pTa, 47% G2pTa, 9.9% G3pTa and T1 in 18.9%. 4.3% had concurrent carcinoma in situ. At 10 years, OS was 47.4%, CSS was 94.1%, PFS was 82.1%, RFS was 15.8%. Conclusions: FHoLAT for bladder tumour recurrences has an acceptable CSS and PFS for patients with small low-grade tumours or patients with high-grade or T1 tumours who are unfit for regional or general anaesthesia. The role of FHoLAT in unfit patients seems clear, but further prospective trials are needed to define its role in other patient groups, particularly high-grade NMIBC. Level of evidence: 3b-4

KAI-1 Expression in Pediatric High-Grade Osteosarcoma

2006 ◽  
Vol 9 (3) ◽  
pp. 219-224 ◽  
Author(s):  
Patrick J. Leavey ◽  
Charles Timmons ◽  
William Frawley ◽  
Donald Lombardi ◽  
Raheela Ashfaq
Keyword(s):  
Prognostic Markers ◽  
Clinical Phenotype ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Surface Proteins ◽  
High Grade ◽  
Free Survival ◽  
Treatment Groups ◽  
High Grade Osteosarcoma

Recent evidence implicates cell surface proteins of the tetraspanin superfamily in the process of metastasis whereas the downregulation of KAI-1, a member of the tetraspanin family, is associated with an aggressive clinical phenotype in several types of human cancers. To determine if expression of KAI-1-1 is associated with any known prognostic marker or clinical outcome in high-grade osteosarcoma, we examined 91 nondecalcified archival samples from 47 patients for the expression of KAI-1. Archival, paraffin-embedded, and decalcified pathologic samples were examined by immunohistochemistry and results were correlated to clinical outcomes and known prognostic markers. There were 46 samples from diagnostic biopsies (1 diagnostic sample was not available), 32 tumor resection samples, and 13 metastasis samples. Thirty-three percent (n = 30) of the samples expressed KAI-1 (16 biopsies, 9 resections, and 5 metastasis). KAI-1 expression was not significantly related to known prognostic markers or to either tumor necrosis after neoadjuvant therapy or the incidence of metastasis at diagnosis. KAI-1 expression was not significantly different between paired diagnostic tumor samples and either resection or metastasis tumor samples. Twenty-five patients remain alive at a median follow-up of 95 months. The overall and progression-free survival percentages at 5 years were 62% and 47% for KAI-1-positive patients and 49% and 38% for KAI-1-negative patients, respectively. This difference was not statistically significant. We conclude that KAI-1 is expressed in a proportion of high-grade osteosarcoma but is not of clinical significance and cannot be used to stratify treatment groups for these patients.

scholarly journals Validation of a clinicopathological score for the prediction of post-surgical evolution of pituitary adenoma: retrospective analysis on 566 patients from a tertiary care centre

2019 ◽  
Vol 180 (2) ◽  
pp. 127-134 ◽  
Author(s):  
S Asioli ◽  
A Righi ◽  
M Iommi ◽  
C Baldovini ◽  
F Ambrosi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Proliferative Activity ◽  
Disease Free Survival ◽  
Low Grade ◽  
High Grade ◽  
Tumour Type ◽  
Disease Evolution ◽  
Free Survival ◽  
Disease Free

Objective and design A clinicopathological score has been proposed by Trouillas et al. to predict the evolution of pituitary adenomas. Aim of our study was to perform an independent external validation of this score and identify other potential predictor of post-surgical outcome. Methods The study sample included 566 patients with pituitary adenomas, specifically 253 FSH/LH-secreting, 147 GH-secreting, 85 PRL-secreting, 72 ACTH-secreting and 9 TSH-secreting tumours with at least 3-year post-surgical follow-up. Results In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumours were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL-, ACTH- and FSH/LH-secreting tumours as compared to those with somatotroph tumours, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed tumour type and grade to be independent predictors of disease-free-survival. Tumour invasion, Ki-67 and tumour type were the only independent prognostic factors of disease-free survival. Conclusions Our data confirmed the validity of Trouillas’ score, being tumour type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumour histological subtype, in the clinical setting to early identify patients at higher risk of recurrence.

scholarly journals Everolimus and Bevacizumab in the Management of Recurrent, Progressive Intracranial NF2 Mutated Meningioma

2019 ◽  
Vol 12 (1) ◽  
pp. 126-130 ◽  
Author(s):  
Vinay Mathew Thomas ◽  
Poorva Bindal ◽  
James J. Vredenburgh
Keyword(s):  
Survival Time ◽  
Progression Free Survival ◽  
Genetic Alteration ◽  
Cns Tumors ◽  
Good Effect ◽  
Genomic Sequencing ◽  
Low Grade ◽  
High Grade ◽  
Free Survival

Meningiomas are primary CNS tumors that arise from the arachnoid layer of the meninges. Genomic sequencing has revealed that NF2 mutations are the most common genetic alteration seen in meningiomas. Meningiomas although usually low grade, can sometimes progress to high grade. A patient who had several recurrences of meningiomas since childhood presented with recurrent headaches. Imaging showed that he had another recurrence of a meningioma. He underwent surgery for resection of the meningioma and histopathology showed NF2 mutation. He was started on everolimus and bevacizumab with good effect. Studies have shown that NF-2 mutated meningiomas have a good response to everolimus and bevacizumab with increased progression-free survival time and progression-free survival time at 6 months.

scholarly journals Safety and Efficacy of Everolimus in Adult Patients with Neuroendocrine Tumors

2012 ◽  
Vol 6 ◽  
pp. CMO.S7319 ◽  
Author(s):  
Paul E. Oberstein ◽  
M. Wasif Saif
Keyword(s):  
Neuroendocrine Tumors ◽  
Progression Free Survival ◽  
Best Supportive Care ◽  
Significant Advance ◽  
Low Grade ◽  
Mtor Inhibition ◽  
Free Survival ◽  
Disease Stabilization ◽  
To Receive

Neuroendocrine tumors (NETs) consist of a diverse family of tumors which are derived from the neuroendocrine system. Most NETs are well or moderately differentiated tumors with a relatively indolent growth pattern. However, these tumors can cause significant clinical disease due to release of functional products that mediate the carcinoid syndrome and other diverse sequela. They also can grow progressively and cause symptoms from local invasion or distant metastasis. NETs are optimally treated with surgery and somatosatin analogs (SSAs) to control symptoms but are relatively insensitive to systemic chemotherapy. As a result, patients with advanced unresectable NETs have a poor prognosis. In 2011, two targeted therapies, sunitinib and everolimus were approved in the subset of progressive pancreatic NETs (pNETs). Everolimus is an oral inhibitor of the growth stimulatory mTOR pathway. In Phase 2 trials in NETs and pNETs, everolimus was well tolerated and associated with some response and widespread disease stabilization. In follow-up, randomized Phase 3 trials, everolimus was compared to placebo. In the RADIANT-2 trial, everolimus and a somatostatin analog were used in patients with functional NETs and treatment was associated with an an improvement in progression-free survival (PFS). In the RADIANT-3 trial, patients with pNET were randomized to receive everolimus or placebo along with best supportive care. Everolimus was again associated with improvement in PFS compared to placebo and it has been approved by the FDA for patients with progressive pNET. Everolimus is associated with frequent low grade toxicity but is also notable for increased rates of infection as well as non-infectious pneumonitis. mTOR inhibition with everolimus represents a significant advance in the treatment of advanced neuroendocrine tumors.

Long-term outcomes for low-grade intracranial ganglioglioma: 30-year experience from the Mayo Clinic

2012 ◽  
Vol 117 (5) ◽  
pp. 825-830 ◽  
Author(s):  
Julia J. Compton ◽  
Nadia N. Issa Laack ◽  
Laurence J. Eckel ◽  
David A. Schomas ◽  
Caterina Giannini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Mayo Clinic ◽  
Progression Free Survival ◽  
Low Grade ◽  
Term Survival ◽  
Free Survival

Object Gangliogliomas comprise less than 1% of all brain tumors and occur most often in children. Therefore, there are a limited number of patients and data involving the use or role of adjuvant therapy after subtotal resections (STRs) of gangliogliomas. The objective of this study was to examine and review the Mayo Clinic experience of 88 patients with gangliogliomas, their follow-up, risk of recurrence, and the role of radiation therapy after STR or only biopsy. Methods Eighty-eight patients with gangliogliomas diagnosed between 1970 and 2007 were reviewed. Data on clinical outcomes and therapy received were analyzed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival. Results The median age at diagnosis was 19 years. The median potential follow-up as of June 2008 was 142 months (range 9–416 months). Fifteen-year overall survival was 94%, median PFS was 5.6 years, with a 10-year PFS rate of 37%. Progression-free survival was dramatically affected by extent of initial resection (p < 0.0001). Conclusions This single-institution retrospective series of patients with gangliogliomas is unique given its large cohort size with a long follow-up duration, and confirms the excellent long-term survival rate in this group. The study also shows the importance of resection extent on likelihood of recurrence. Patients with gangliogliomas who undergo STR or biopsy alone have poor PFS. Radiation therapy may delay time to progression in patients with unresectable disease.

Weekly vinblastine in chemotherapy-naive children with unresectable or progressive low grade glioma: A Canadian cooperative study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10029-10029 ◽  
Author(s):  
Eric Bouffet ◽  
Katrin Scheinemann ◽  
Shayna M. Zelcer ◽  
Juliette Hukin ◽  
Beverley Wilson ◽  
...  
Keyword(s):  
Response Rate ◽  
Previous Treatment ◽  
Progression Free Survival ◽  
Neurofibromatosis Type ◽  
Low Grade ◽  
Free Survival ◽  
Best Response ◽  
Response To Chemotherapy ◽  
Grade 3

10029 Background: Vinblastine has shown promising activity in a phase II study in children with recurrent/refractory LGG. The aim of this study was to assess the activity of vinblastine in chemotherapy naïve children. Methods: Patients < 18 years old with unresectable or progressive LGG were eligible if they had not received any previous treatment with chemotherapy or radiation. Vinblastine was administered weekly at a dose of 6 mg/m2over a period of 70 weeks. Patients who showed progression on 2 consecutive imaging studies or evidence of clinical progression were removed from treatment. Results: 54 patients (23 female) were enrolled between 2007 and 2010. Median age at inclusion was 7 years, 13 patients were < 3 years. 32 had chiasmatic/hypothalamic tumours, 6 had evidence of dissemination. 13 had neurofibromatosis type 1. Histology was pilocytic astrocytoma (25), pilomyxoid astrocytoma (4), low grade astrocytoma variant (8); 17 patients had no histological diagnosis. Treatment was well tolerated; however, only 14 patients received full dose for the duration of the study. Most common toxicity was haematological: 40 patients who experienced grade 3+ neutropenia. There were only 6 episodes of febrile neutropenia, 3 RBC transfusions and no toxic death. Best response to chemotherapy was assessed centrally by an independent radiologist: 1 CR, 10 PR, 3 MR, 28 SD, 12 PD, for a response rate of 24.5%. With a median follow-up of 2 years (9-48 months), progression-free survival at 2 years was 72.1% (95%CI: 58.1-82.2). One patient died of progression. Conclusions: Weekly vinblastine is well tolerated in paediatric LGG patients. Although the response rate appears inferior to other common LGG regimens, progression free survival at 2 years favourably compares to most currently used regimens. Supported by a grant from the Ontario Institute Cancer Research. Clinical trial information: 1000011227.

Phase II Trial of Individualized Rituximab Dosing for Patients With CD20-Positive Lymphoproliferative Disorders

2005 ◽  
Vol 23 (6) ◽  
pp. 1096-1102 ◽  
Author(s):  
Lucio N. Gordan ◽  
William B. Grow ◽  
Annette Pusateri ◽  
Vonda Douglas ◽  
Nancy P. Mendenhall ◽  
...  
Keyword(s):  
Progressive Disease ◽  
Overall Response Rate ◽  
Progression Free Survival ◽  
Lymphoproliferative Disorders ◽  
Entire Group ◽  
Low Grade ◽  
Free Survival ◽  
Maintenance Strategies ◽  
Maintenance Schedule

Purpose To determine the feasibility and efficacy of pharmacokinetic (PK) -based maintenance dosing of rituximab and possibly design a more rational maintenance schedule. Patients and Methods Patients with CD20-positive lymphoproliferative disorders were treated with four weekly infusions of rituximab 375 mg/m2. All patients without progressive disease were then monitored for 1 year and received a single infusion of 375 mg/m2 when the level decreased below 25 μg/mL. Results Twenty-nine of 31 patients were assessable with a variety of histologic subtypes. The overall response rate (ORR) for the entire group was 59% with 27% complete responses (CRs) and 32% partial responses. The median PFS for all patients was 19 months, with a median follow-up of 25 months. In 22 patients with low-grade non-Hodgkin's lymphoma (LGNHL), the ORR was 63% with 36% CR and median progression-free survival (PFS) has not been reached. Of 29 assessable patients, 22 were available for PK-based maintenance. The median time to repeat bolus was 5 months (range, 1 to 9 months) for the first, 3.5 months (range, 2 to 5 months) for the second, and 3 months (range, 2 to 4 months) for the third infusion. Ninety-five percent of patients required three or fewer infusions to be maintained in the therapeutic range. Conclusion Individualized PK dosing for rituximab produced efficacy comparable to other published maintenance strategies. PK data from this trial suggest that a rational maintenance strategy in patients with LGNHL would be a single dose of 375 mg/m2 of rituximab every 3 to 4 months.

High Response Rate to Cisplatin/Etoposide Regimen in Childhood Low-Grade Glioma

2002 ◽  
Vol 20 (20) ◽  
pp. 4209-4216 ◽  
Author(s):  
Maura Massimino ◽  
Filippo Spreafico ◽  
Graziella Cefalo ◽  
Riccardo Riccardi ◽  
John David Tesoro-Tess ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Objective Response ◽  
Progression Free Survival ◽  
Neurofibromatosis Type ◽  
High Response Rate ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Free Survival

PURPOSE: The aim of this study was to avoid radiotherapy and to induce an objective response in children with low-grade glioma (LGG) using a simple chemotherapy regimen based on cisplatin and etoposide. PATIENTS AND METHODS: Thirty-four children (median age, 45 months) with unresectable LGG were treated with 10 monthly cycles of cisplatin (30 mg/m2/d on days 1 to 3) and etoposide (150 mg/m2/d on days 1 to 3). Tumor originated in the visual pathway in 29 patients, in the temporal lobe in two, in the frontal lobe in two, and in the spine in one. Eight children were affected by neurofibromatosis type 1. Objective tumor response and toxicity were evaluated by magnetic resonance imaging and neurologic and functional tests at 3-month intervals. RESULTS: An objective response was obtained in 24 (70%) of 34 patients, whereas the others had stable disease. None of the children were electively irradiated. In 31 previously untreated children, overall survival was 100% and progression-free survival was 78% at 3 years, with a median follow-up of 44 months. Acute toxicity was unremarkable; 28% patients evaluated for acoustic neurotoxicity revealed a loss of perception of high frequencies. CONCLUSION: Cisplatin and etoposide combined treatment is one of the most active regimens for LGG in children and allows avoidance of radiotherapy in the vast majority of patients.

Non-Myeloablative Umbilical Cord Blood Transplantation (UCBT): Low Transplant-Related Mortality in 59 High-Risk Adults.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 825-825 ◽  
Author(s):  
Juliet N. Barker ◽  
Daniel J. Weisdorf ◽  
Todd E. Defor ◽  
John E. Wagner
Keyword(s):  
High Risk ◽  
Progression Free Survival ◽  
Low Grade ◽  
Free Survival ◽  
Neutrophil Recovery ◽  
Prior Therapy ◽  
Cell Dose ◽  
Co Morbidity ◽  
Related Mortality

Abstract Conventional allogeneic HSC transplantation is limited by lack of rapidly available, HLA-matched donors & excess transplant-related mortality (TRM) in high-risk adults. Therefore, we investigated the combined use of unrelated donor UCB, utilizing 2 units to augment graft cell dose, with non-myeloablative (NMA) conditioning in adults with advanced or high-risk hematologic malignancy. From 10/01 to 3/04, 59 consecutive adults [median age 49 years (range 19–60), median weight 78 kg (range 53–114)] received NMA UCB UCBT. Patients were eligible if: age >45 years (n=43; 73%); &/or extensive prior therapy (n=25; 42%, inc. 14 prior transplants); &/or serious co-morbidity (n=18; 31%). Patients received cyclophosphamide 50 mg/kg (day-6), fludarabine 200 mg/m2 (40 mg/m2 days−6 to −2), & 200 cGy TBI (day-1), with cyclosporine-A to at least day 100 & mycophenolate mofetil to day 30. Twelve patients without recent chemotherapy also received ATG during conditioning. Patients received either single (n=14) or double (n=45) UCB units with a median total infused cell dose of 3.4 x 107 NC/kg (range 1.1–5.7). Of the 104 units used, 61 were 4/6, 35 were 5/6 & 8 were 6/6 HLA-A,B,DRB1-antigen matched with the recipient. Of 58 evaluable patients, neutrophil recovery to >0.5 x 109/l occurred at a median of 8 days (range 5–32) with a cumulative incidence of sustained donor engraftment of 89% (95%CI: 81–97). In patients with sustained donor engraftment the median BM chimerism was 85% (range 8–100) at day 21, 100% (range 72–100) at day 100, & 100% (range 87–100) at 1 year after transplant. Four patients had primary graft failure & 2 had secondary graft rejection. Of the 44 patients with a prior autograft or chemotherapy within 3 months prior to UCBT, 43 (98%) achieved sustained engraftment as compared to 9/14 (64%) patients who had no chemotherapy or whose chemotherapy was at least 4 months prior to UCBT. The cumulative incidences of grade II–IV & III–IV acute GVHD were 63% (95%CI: 49–77) & 25% (95%CI: 14–36) at day 100, & chronic GVHD was 28% (95%CI: 16–40) at 1 year. TRM was 19% (95%CI: 9–29) at day 180, & relapse/progression was 33% (95%CI: 20–46) at both 1 & 2 years. Regression of relapsed or persistent disease has been seen in patients with MDS (n=2), CML (n=1), intermediate and low grade NHL/CLL (n=11), Hodgkins disease (n=1) & myeloma (n=1). With a median follow-up of 16 months (range 4–30), the probability of overall & progression-free survival was 52% (95%CI: 39–65) & 37% (95%CI: 24–50) at 1 year, & 44% (95%CI: 30–58) & 37% (95%CI: 24–50) at 2 years, with no difference in outcome between single & double unit recipients. Notably, day 180 TRM in patients aged >45 years was 14% (95%CI: 4–24), & in those with extensive prior therapy was 24% (95%CI: 8–40). Serious co-morbidity, however, was associated with a higher day 180 TRM of 44% (95%CI: 20–68)(p<0.01). Despite HLA disparity & NMA conditioning, NMA UCBT is associated with prompt neutrophil recovery, a high incidence of sustained engraftment & relatively low TRM in older or extensively pre-treated adults. Further, a graft-vs-malignancy effect is suggested in both myeloid & lymphoid malignancies. Extended follow-up confirms that the progression-free survival is reasonable given the high-risk nature of this patient population. This approach allows transplantation to be offered to many adults who would otherwise be ineligible based on lack of donor &/or inability to tolerate conventional conditioning.

Patterns in the care of oligodendrogliomas and oligoastrocytomas: A single center experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e13034-e13034
Author(s):  
S. H. Kizilbash ◽  
L. Nadeau
Keyword(s):  
Radiation Therapy ◽  
Surgical Resection ◽  
Progression Free Survival ◽  
Low Grade ◽  
High Grade ◽  
Single Center Experience ◽  
Data Collection And Analysis ◽  
Unique Identity

e13034 Background: Although rare, oligodendrogliomas (ODs) and oligoastrocytomas (OAs) have established a unique identity due to their sensitivity to chemotherapy, especially if they exhibit combined loss of heterozygosity (LOH) of 1p and 19q. However, optimal management is still controversial and data is lacking on actual practice patterns. This study describes the epidemiology of ODs/OAs at a community based hospital in Michigan and evaluates the management of these tumors, especially with respect to 1p/19q LOH. Methods: A retrospective review was conducted of all cases of OD and OA that were managed at our institution from 1975 to 2007. 135 patients were isolated. Of these, 48 patients had already been evaluated for 1p/19q LOH. This latter subset underwent data collection and analysis. Results: 31 patients had low-grade tumors (either ODs or OAs) while 17 had high grade tumors (anaplastic ODs or anaplastic OAs). Of the low grade tumors, 35% had combined 1p/19q LOH. 71% underwent surgical resection, 35% received chemotherapy, and 26% received radiation therapy. As for the high grade tumors, 47% had combined 1p/19q LOH. 88% underwent surgical resection, 76% received chemotherapy, and 59% received radiation therapy. At a mean of 29 months of follow up, eight patients had tumor progression while 12 died. Median progression free survival (MPFS) for patients receiving chemotherapy was increased in patients with combined 1p/19q LOH, for both low-grade tumors (34 vs. 20 months) and high-grade tumors (14 vs. 8 months). Also, significantly more patients with low-grade tumors and combined 1p/19q LOH were offered chemotherapy when compared to those without 1p/19q LOH (64% vs 20%, p = 0.04, Fisher exact). However, in patients with high-grade tumors, knowledge of 1p/19q LOH did not significantly impact the choice to administer chemotherapy (88% vs. 67%, p = 0.67). Conclusions: Patients with ODs/OAs and combined 1p/19q LOH who have been treated with chemotherapy demonstrate increased MPFS when compared with those without this genotype. Despite this, determination of 1p/19q LOH significantly affects physician choice to offer chemotherapy only in patients with low-grade tumors, but not in those with high-grade tumors. A future study is in development to determine 1p/19q LOH status for the remaining 87 patients. No significant financial relationships to disclose.

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