scholarly journals Long-term cancer survivors treated with multiple courses of repeat radiation therapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sebastian M. Christ ◽  
Maiwand Ahmadsei ◽  
Lotte Wilke ◽  
Anja Kühnis ◽  
Matea Pavic ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Overall Survival ◽  
Anatomical Site ◽  
Curative Intent ◽  
Palliative Intent ◽  
Number Of Patients ◽  
Treatment Intent ◽  
Long Term Survivors ◽  
Median Interval

Abstract Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.

The impact of treatment intent on overall survival after radiofrequency ablation of colorectal cancer liver metastases: The Royal Marsden Hospital experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 622-622
Author(s):  
Khurum Hayat Khan ◽  
Anita Wale ◽  
James McCall ◽  
Nevin Wijesekera ◽  
Nasir Khan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Survival Outcomes ◽  
Curative Intent ◽  
Palliative Intent ◽  
Palliative Procedure ◽  
Treatment Intent

622 Background: 50% of patients with colorectal cancer will develop liver metastases (CLM), for many patients this will be the first and only site of metastatic disease. A minority of the patients will undergo surgical resection with curative intent, the remainder may be offered treatment with chemotherapy and local ablative techniques. Radiofrequency ablation (RFA) is increasingly used to treat patients deemed unsuitable for surgery, as an adjunct to or holding procedure before hepatic resection or for patients with recurrent disease. In addition some centres use RFA in the palliative setting. The aim of this study was to determine survival outcomes according to RFA treatment intent in patients with CLM. Methods: Clinical characteristics and survival outcomes of all patients with CLM treated with RFA between 2005-2011 were recorded. Patients were grouped according to the intent with which they underwent their first RFA procedure, namely "curative intent", "holding intent" or "palliative intent". Overall survival was compared between the groups using Kaplan-Meier survival analysis and Log Rank testing. Results: A total of seventy eight pts with CLM (M:F= 44:34), age (median=66, range 43-65 years), who underwent their first RFA procedure between 2005 and 2011 were identified. Thirty pts underwent RFA as a curative procedure (38%), 18 (23%) as a “holding procedure” before hepatic resection and 30 (38%) as a palliative procedure. The median OS for all patients was 25 months after first RFA treatment. Log Rank test showed survival was significantly different according to treatment intent; patients who underwent RFA as a holding procedure before hepatic resection had improved survival over those who underwent RFA with curative intent, who in turn had improved survival over those who underwent RFA with palliative intent (47 vs. 32 vs. 16 months, p = <0.001). Conclusions: Our study demonstrates that patients do best if RFA is used as neo-adjuvant treatment prior to hepatic resection, compared to when it is used as curative or palliative procedure. Careful selection of pts is required to optimise outcomes for the pts receiving RFA.

scholarly journals Pattern of the First Recurrence Has No Impact on Long-Term Survival after Curative Intent Surgery for Perihilar Cholangiocarcinomas

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Madalina Maria Blaga ◽  
Vladislav Brasoveanu ◽  
Cezar Stroescu ◽  
Mihnea Ionescu ◽  
Irinel Popescu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Median Overall Survival ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Term Survival ◽  
Long Term Survival ◽  
First Recurrence ◽  
Isolated Local Recurrence

Aim. To explore the pattern of the first recurrence and impact on long-term survival after curative intent surgery for perihilar cholangiocarcinomas (PHC). Materials and Methods. Patients with curative intent surgery for PHC between 1996 and 2017 were analyzed. Survival times were estimated using the Kaplan-Meier method. Comparisons were made with the log-rank test. Results. A number of 139 patients were included. The median overall survival was 26 months. A recurrence was observed in 86 patients (61.9%), during a median follow-up time of 89 months. The median disease-free survival was 21 months with 1-, 3-, 5-, and 10-year estimated recurrence rates of 38%, 60%, 69%, and 77%, respectively. A number of 57 patients (41%) developed distant only recurrence, while 26 patients (18.7%) presented local and distant recurrences. An isolated local recurrence was observed in 3 patients (2.2%). The median overall survival was 15 months for patients with local recurrence, 15 months for patients with liver metastases, and 17 months for patients with peritoneal carcinomatosis (p=0.903) as the first recurrence. Conclusion. Curative intent surgery for PHC is associated with high recurrence rates. Most patients will develop distant metastases, while an isolated local recurrence is uncommon. The pattern of recurrence does not appear to have a significant impact on survivals.

Aggressive Treatment in Glioblastoma: What Determines the Survival of Patients?

2020 ◽  
Author(s):  
Lei Yu ◽  
Guozhong Zhang ◽  
Songtao Qi
Keyword(s):  
Overall Survival ◽  
Malignant Gliomas ◽  
Epidemiological Studies ◽  
Control Cohort ◽  
Poor Overall Survival ◽  
Term Survival ◽  
Significant Difference ◽  
Positive Rate ◽  
Long Term Survivors

Abstract Background and Study Aims The exact reason of long-term survival in glioblastoma (GBM) patients has remained uncertain. Molecular parameters in addition to histology to define malignant gliomas are hoped to facilitate clinical, experimental, and epidemiological studies. Material and Methods A population of GBM patients with similar clinical characteristics (especially similar resectability) was reviewed to compare the molecular variables between poor (overall survival [OS] < 18 months, control cohort) and long-term survivors (overall survival > 36 months, OS-36 cohort). Results Long-term GBM survivors were younger. In the OS-36 cohort, the positive rate of isocitrate dehydrogenase (IDH) mutation was very low (7.69%, 3/39) and there was no statistical difference in OS between IDH mutant and wild-type patients. The results of 1p/19q codeletions are similar. Besides, there were no significant difference in MGMT promoter methylation, telomerase reverse transcriptase (TERT) promoter mutation, and TP53 mutations between OS-36 cohort and control cohort. Conclusions No distinct markers consistently have been identified in long-term survivors of GBM patients, and great importance should be attached to further understand the biological characteristics of the invasive glioma cells because of the nature of diffuse tumor permeation.

scholarly journals Long-Term Survival and Value of 18F-FDG PET/CT in Patients with Gastroenteropancreatic Neuroendocrine Tumors Treated with Second Peptide Receptor Radionuclide Therapy Course with 177Lu-DOTATATE

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 198
Author(s):  
Margarida Rodrigues ◽  
Kevin-Klaus Winkler ◽  
Hanna Svirydenka ◽  
Bernhard Nilica ◽  
Christian Uprimny ◽  
...  
Keyword(s):  
Overall Survival ◽  
Fdg Pet ◽  
Median Overall Survival ◽  
Peptide Receptor Radionuclide Therapy ◽  
Term Survival ◽  
Peptide Receptor ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Peptide receptor radionuclide therapy (PRRT) has been recognized as a promising therapy against neuroendocrine tumors (NETs). The use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in NETs has been a matter of controversy. The purpose of this study was to evaluate the long-term survival and efficacy of a second PRRT course with 177Lu-DOTATE in patients with advanced gastroenteropancreatic (GEP) NETs. Furthermore, the value of 18F-FDG PET/CT in these patients was evaluated. 40 patients with GEP NETs who underwent two PRRT courses with 177Lu-DOTATATE and combined examinations with 68Ga-DOTA-TOC and 18F-FDG PET/CT were evaluated. After the second PRRT course, two patients (5.0%) were in partial remission, 21 patients (52.5%) in stable disease and 17 patients (42.5%) had progressive disease. The median overall survival was 122.10 months. After the second PRRT course, the median overall survival was significantly higher (p = 0.033) in the 18F-FDG-negative group compared to the 18F-FDG-positive group (145.50 versus 95.06 months, respectively). The median time to progression was 19.37 months. In conclusion, a second PRRT course with 177Lu-DOTATE is an effective treatment approach for GEP NET patients with disease progression. A change in 18F-FDG status after PRRT may predict the disease course and survival. Patients who are 18F-FDG-negative have a significantly longer overall survival than those who are 18F-FDG-positive.

Outcomes of isolated distant lymph node metastases in colorectal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 84-84
Author(s):  
Vinod Kalapurackal Mathai ◽  
Soe Yu Aung ◽  
Vanessa Wong ◽  
Catherine Dunn ◽  
Jeremy David Shapiro ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Locoregional Therapy ◽  
Curative Intent ◽  
Palliative Intent ◽  
Radical Treatment ◽  
Node Metastases ◽  
Systemic Therapies

84 Background: The optimal management of isolated distant lymph node metastases (IDLNM) in metastatic colorectal cancer (mCRC) is not clearly established. Small case series and prior data from the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) registry support the use of radical treatment with curative intent (local resection, chemo-radiation or stereotactic radiotherapy), which may lead to better outcomes in mCRC patients with IDLNM. Aims: This study investigates the clinical characteristics and outcomes of mCRC patients with IDLNM treated with systemic therapies plus locoregional therapy with curative intent versus systemic therapies with palliative intent. Methods: Clinical data were collected and reviewed from the TRACC registry, a prospective, comprehensive registry for mCRC from multiple tertiary hospitals across Australia from 01/07/2009 to 30/06/2020. Clinicopathological characteristics, treatment modalities and survival outcomes were analyzed in patients with IDLNM and compared to patients with other organ metastases. Fisher exact test was used for significance tests and Kaplan Meier curves for survival analyses. Results: Of 3408 mCRC patients with a median follow-up of 38.0 months, 93 (2.7%) were found to have IDLNM. Compared to mCRC with other organ metastases, patients with IDLNM were younger (mean age: 62.1 vs 65.6 years, p=0.0200), more likely to have metachronous disease (57.0% vs 38.9%, p=0.0005), be KRAS wild-type (74.6% vs 53.9%, p=0.0012) and BRAF mutant (12.9% vs 6.2%, p=0.0100). There was no overall survival difference between with IDLNM and those with other organ metastases (median OS 27.24 vs 25.92 months, p=0.2300). Twenty-four patients (25.8%) with IDLNM received treatment with curative intent, with a trend towards improved overall survival compared to those with other organ metastases treated with curative intent (73.5 vs 62.7 months, p=0.8200). Amongst mCRC patients with IDLNM, those who received treatment with curative intent had a significantly better overall survival than those treated with palliative intent (73.5months vs 23.2 months, p=0.0070). Conclusions: Our findings suggest that there are differences in the patterns of presentation of IDLNM and other organ metastases. Radical treatment with curative intent options should be considered for mCRC patients with IDLNM where appropriate.

scholarly journals IMMU-39. TIM-3 APTAMER IN COMBINATION WITH RADIOTHERAPY RESULTS IN ENHANCED SURVIVAL IN DIPG MODELS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii113-ii113
Author(s):  
Naiara Martinez-Velez ◽  
Marc Garcia-Moure ◽  
Montserrat Puigdelloses ◽  
Virginia Laspidea ◽  
Iker Ausejo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Immune Memory ◽  
Effector Cells ◽  
Genomic Knowledge ◽  
Trial Testing ◽  
Long Term Survivors ◽  
Mouse Glioma ◽  
Anti Tumour Effect ◽  
Murine Glioma

Abstract Pediatric diffuse midline gliomas-H3-K27M-mutant are aggressive brain tumours that arise during childhood. Despite new advances in genomic knowledge and the significant number of clinical trial testing new targeted therapies, patient outcome is still insufficient. Cancer immunotherapy is opening new therapeutic options representing a hope for this orphan disease. Aptamers are single-stranded nucleic acid ligands design to achieve a remarkable affinity and specificity to their targets, comparable to antibodies. TIM-3, is a potential immune checkpoint target, typically involved in T-cell exhaustion. Recent studies showed that TIM-3 is also expressed in tumour and glial cells and it plays an important role in brain tumour responses mediated by myeloid cells. In this work, we examined the anti-tumour effect of an aptamer against TIM-3 alone or in combination with radiotherapy. Of importance, we tested TIM-3 aptamer in a murine glioma and DIPG model, where we not observed any toxicity. TIM-3 administration increased overall survival but was unable to control the disease. Of importance, TIM-3 combination with radiotherapy improved the overall survival of treated mice when compared with single treatments leading to 50% of long-term survivors. TIM-3 aptamer administration increase T-infiltration in the tumour site compared to non-treated or library control. Mechanistic studies performed on day 16 showed an increase in CD8 effector cells, a decrease in T-regulators Foxp3+ cells and an increase in IFN-gamma expression suggesting the triggering of an antitumor-immune response. Rechallenge experiments demonstrated immune memory in the long-term responders that led to reject tumour re-implantation, confirming that TIM-3 aptamer treatment in combination with RT elicits specific antitumor immunity in mouse glioma models. These results suggest that immuno-therapies approaches in combination with radiotherapy would be worth exploring in the treatment of deadly DMG-H3K27-Mutant tumours.

Salvage radiation therapy for localized recurrent ovarian cancer

2019 ◽  
Vol 29 (5) ◽  
pp. 916-921
Author(s):  
Alicia Smart ◽  
Yu-Hui Chen ◽  
Teresa Cheng ◽  
Martin King ◽  
Larissa Lee
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Clear Cell ◽  
Recurrent Ovarian Cancer ◽  
Salvage Radiotherapy ◽  
Platinum Sensitive ◽  
Long Term Survivors ◽  
Disease Free

IntroductionTo evaluate clinical outcomes for patients with localized recurrent ovarian cancer treated with salvage radiotherapy.MethodsIn a retrospective single institutional analysis, we identified 40 patients who received salvage radiotherapy for localized ovarian cancer recurrence from January 1995 to June 2011. Recurrent disease was categorized as: pelvic peritoneal (45%, 18), extraperitoneal/nodal (35%, 14), or vaginal (20%, eight). Actuarial disease-free and overall survival estimates were calculated by Kaplan–Meier and prognostic factors evaluated by the Cox proportional hazards model.ResultsMedian follow-up was 42 months. Median patient age was 54 years (range, 27–78). Histologic subtypes were: serous (58%, 23), endometrioid (15%, six), clear cell (13%, five), mucinous (8%, three), and other (8%, three). At the time of salvage radiotherapy, surgical cytoreduction was performed in 60% (24) and 68% (27) had platinum-sensitive disease. Most patients (63%, 25) received salvage radiotherapy at the time of first recurrence. Relapse after salvage radiotherapy occurred in 29 patients at a median time of 16 months and was outside the radiotherapy field in 62%. 18 At 3 years, disease-free and overall survival rates were 18% and 80%, respectively. On multivariate analysis, non-serous histology (hazards ratio 0.3, 95% CI 0.1–0.7) and platinum-sensitivity (hazards ratio 0.2, 95% CI 0.1–0.5) were associated with lower relapse risk. Platinum-sensitivity was also associated with overall survival (hazards ratio 0.4, 95% CI 0.1–1.0). Four patients (10%) were long-term survivors without recurrence 5 years after salvage radiotherapy. Of the five patients with clear cell histology, none experienced relapse at the time of last follow-up.DiscussionPatients with non-serous and/or platinum-sensitive ovarian cancer had the greatest benefit from salvage radiotherapy for localized recurrent disease. Although relapse was common, radiotherapy prolonged recurrence for > 1 year in most patients and four were long-term survivors.

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