Combined modality therapy for tumor stage mycosis fungoides: results of a 10-year follow-up.

1988 ◽  
Vol 6 (7) ◽  
pp. 1177-1183 ◽  
Author(s):  
D E Hallahan ◽  
M L Griem ◽  
S F Griem ◽  
M Medenica ◽  
K Soltani ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Mycosis Fungoides ◽  
Combined Modality Therapy ◽  
Disease Free Survival ◽  
Initial Response ◽  
Tumor Stage ◽  
Free Survival ◽  
Combined Modality ◽  
Disease Free

Twenty-one patients with tumor stage mycosis fungoides (MF) with or without lymph node (LN) involvement, were treated with total skin electron beam irradiation (TSEB) followed by six monthly cycles of systemic chemotherapy (CT) of either mechlorethamine (HN2) or cyclophosphamide (CTX) with vincristine (VCR), procarbazine, and prednisone (PRD) (COPP or MOPP). All patients had complete clearing of the skin after TSEB. However, while receiving chemotherapy, two patients developed visceral involvement and eight patients relapsed with limited cutaneous plaques (LCP). The median duration of remission was 12 months from the completion of TSEB, and all patients relapsed with cutaneous plaques within 25 months. Complete remission was again achieved using additional electron irradiation and maintenance therapy in all but one patient. Multiple cutaneous recurrences occurred in all patients. Median survival from the initiation of TSEB is 6 years. Five patients are living beyond 8 years (four off treatment without disease for 1 to 7 years). LN involvement did not influence initial response or survival. Combined modality therapy for tumor stage MF using TSEB followed by systemic CT and subsequent maintenance therapy may lead eventually to prolonged disease-free survival (DFS) in selected patients.

Long-Term Follow-Up of a Prospective Study of Combined Modality Therapy for Stage I–II Indolent Non-Hodgkin’s Lymphoma

2003 ◽  
Vol 21 (11) ◽  
pp. 2115-2122 ◽  
Author(s):  
John F. Seymour ◽  
Barbara Pro ◽  
Lillian M. Fuller ◽  
John T. Manning ◽  
Fredrick B. Hagemeister ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Follicular Lymphoma ◽  
Combined Modality Therapy ◽  
Disease Free Survival ◽  
Stage I ◽  
Low Grade ◽  
Free Survival ◽  
Combined Modality ◽  
Disease Free

Purpose: Standard therapy for patients with stage I–II indolent lymphoma has been involved-field radiation therapy (IF-XRT), which achieves 10-year disease-free survival in 40% to 50% of patients, with many of these patients cured. We investigated the potential for combined-modality therapy to increase the disease-free survival for such patients. Patients and Methods: A total of 102 eligible patients with stage I–II low grade lymphoma (International Working Formulation criteria) were enrolled from 1984 to 1992. Treatment comprised 10 cycles of risk-adapted chemotherapy (cyclophosphamide, vincristine, prednisone, bleomycin [COP-Bleo], and with doxorubicin added for some [CHOP-Bleo]) and 30 to 40 Gy IF-XRT. Results: The patients’ median age was 56 years (range, 28 to 77), with follicular histology in 83%, bulky disease (≥ 5 cm) in 24%, and stage II in 52%. There were no treatment-related deaths and 99% of patients attained complete remission. With a median follow-up of 10 years, the 10-year time to treatment failure and overall survival were 76% and 82%, respectively. For patients with follicular lymphoma, these figures were 72% and 80%, respectively. The only factor associated with treatment failure, for follicular lymphoma patients, was stage-modified International Prognostic Factors Index score (P = .02). None of 17 patients with diffuse small lymphocytic or mucosa-associated lymphoid tissue histology have relapsed. Elevated serum beta2-microglobulin was associated with shorter survival (P < .0001). The 10-year survival after relapse was 46%. There have been two cases of myelodysplasia and 12 other new malignancies, including four arising within radiation fields. Conclusion: With prolonged follow-up, combined-modality therapy with risk-adapted COP-/CHOP-Bleo and IF radiation has attained higher rates of disease control and survival than previously reported with IF-XRT alone. This apparent improvement is being further explored in an ongoing randomized trial.

Long-Term Results of Combined-Modality Therapy for Locally Advanced Breast Cancer With Ipsilateral Supraclavicular Metastases: The University of Texas M.D. Anderson Cancer Center Experience

2001 ◽  
Vol 19 (3) ◽  
pp. 628-633 ◽  
Author(s):  
Rogelio A. Brito ◽  
Vicente Valero ◽  
Aman U. Buzdar ◽  
Daniel J. Booser ◽  
Frederick Ames ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Combined Modality Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Local Therapy ◽  
Free Survival ◽  
Combined Modality ◽  
Disease Free

PURPOSE: To determine outcomes in local-regional control, disease-free survival, and overall survival in patients with locally advanced breast cancer (LABC) who present with ipsilateral supraclavicular metastases and who are treated with combined-modality therapy.PATIENTS AND METHODS: Seventy patients with regional stage IV LABC, which is defined by our institution as LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease, received treatment on three prospective trials of neoadjuvant chemotherapy. All patients received neoadjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil, or cyclophosphamide, doxorubicin, vincristine, and prednisone. Patients then received local therapy that consisted of either total mastectomy and axillary lymph node dissection (ALND) or segmental mastectomy and ALND before or after irradiation. Patients with no response to neoadjuvant chemotherapy were treated with surgery and/or radiotherapy. After completion of local therapy, chemotherapy was continued for four to 15 cycles, followed by radiotherapy. Patients older than 50 years who had estrogen receptor–positive tumors received tamoxifen for 5 years.RESULTS: Median follow-up was 11.6 years (range, 4.8 to 22.6 years). Disease-free survival rates at 5 and 10 years were 34% and 32%, respectively. The median disease-free survival was 1.9 years. Overall survival rates at 5 and 10 years were 41% and 31%, respectively. The median overall survival was 3.5 years. The overall response rate (partial and complete responses) to induction chemotherapy was 89%. No treatment-related deaths occurred.CONCLUSION: Patients with ipsilateral supraclavicular metastases but no other evidence of distant metastases warrant therapy administered with curative intent, ie, combined-modality therapy consisting of chemotherapy, surgery, and radiotherapy. Patients with ipsilateral supraclavicular metastases should be included in the stage IIIB category of the tumor-node-metastasis classification because their clinical course and prognosis are similar to those of patients with stage IIIB LABC.

scholarly journals Efficacy of Maintenance Therapy after Autologous Hematopoietic Stem Cell Transplantation in High-Risk Aggressive Lymphoma: A Single-Center Prospective Non-Randomized Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5753-5753
Author(s):  
Yongquan Chen ◽  
Zhihong Zheng ◽  
Xiaofeng Luo ◽  
Jinhua Ren ◽  
Haili Geng ◽  
...  
Keyword(s):  
High Risk ◽  
Maintenance Therapy ◽  
Disease Free Survival ◽  
Aggressive Lymphoma ◽  
Observation Group ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Disease Free ◽  
Maintenance Group

Abstract OBJECTIVE: Relapse after autologous hematopoietic stem cell transplantation (ASCT) is still challenging for high-risk aggressive lymphoma. This study was to investigate the efficacy and safety of maintenance therapy post-ASCT. METHODS: From June 2009 to March 2018, patients with high-risk aggressive lymphoma in our hospital were treated with maintenance therapy post-ASCT according to the patient's wishes, and then assigned to maintenance group or observation group. The end point of follow-up was disease progression or death. The 3-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups. RESULTS: A total of 79 patients were enrolled, with a median age of 38 years (8-64 years), 50 males and 29 females. IPI score ≥2 points in 28 cases, stage III-IV in 58 cases, B symptoms in 21 cases, Extranodal lesions ≥ 2 in 17 cases, bone marrow infiltration in 15 cases, and 24 cases with partial remission (PR) prior to ASCT. In addition to 2 cases of early death, the remaining 77 patients with lymphoma were underwent successfully transplantation and achieved CR post-ASCT. 54 patients were assigned to the observation group, and 23 patients to the maintenance group, including 17 with rituximab and 6 with DPP/DCEP-G alternation regimen. There were no s ignificant differences in gender, age, pre-transplant disease status, and hematopoietic reconstitution between the two groups. The main causes of death were disease recurrence. No serious adverse reactions occurred during the maintenance treatment period. After a median follow-up of 616 days (12-2854 days), the relapse rates of the observation group and the maintenance group were 49.1% vs 12.9%, and the DFS of the 1st, 2nd, and 3rd years were 62.8% VS 93.8%, 48.1% VS 87.1%, and 45.3% VS 87.1% (P = 0.007), respectively. The OS of the 1st, 2nd, and 3rd years were 89.3% VS 100%, 83.2% VS 92.9%, and 76.2% VS 92.9% (P=0.212), respectively. Conclusion: Maintenance therapy post-ASCT could reduce the risk of relapse and promote disease-free survival, which deserves further investigation. Disclosures No relevant conflicts of interest to declare.

scholarly journals MON-LB87 Recombinant Human TSH vs Thyroid Hormone Withdrawal Preparation for Radioiodine Ablation in Pediatric Differentiated Thyroid Cancer

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Max A Schumm ◽  
Howard Q Pyo ◽  
Michael W Yeh ◽  
Jiyoon Kim ◽  
Chi-Hong Tseng ◽  
...  
Keyword(s):  
Biochemical Recurrence ◽  
Differentiated Thyroid Cancer ◽  
Pediatric Patients ◽  
Disease Free Survival ◽  
Tumor Stage ◽  
Free Survival ◽  
Thyroid Hormone Withdrawal ◽  
Disease Free ◽  
Historical Controls

Abstract Introduction: Recombinant human TSH (rhTSH) is commonly used to prepare patients with differentiated thyroid cancer (DTC) for radioiodine (I-131) ablation after total thyroidectomy (TT). In adults, rhTSH is associated with equivalent oncologic efficacy and improved health-related quality of life in comparison to thyroid hormone withdrawal (THW). In this study, we aimed to measure disease-free survival after rhTSH stimulation vs. THW in pediatric patients with DTC. Methods: A prospective database was analyzed for pediatric patients under the age of 21 with DTC who underwent TT and I-131 ablation with rhTSH preparation at a single tertiary institution from 2012 through 2018. These patients were compared against historical controls prepared with THW. Tumor stage, I-131 treatment details, disease-free survival, structural recurrence, biochemical recurrence (defined as serum Tg &gt; 2 at one year), and postoperative serum TSH, thyroglobulin (Tg) and Tg antibody levels were recorded. The log-rank test was used to compare groups, and time to recurrence was estimated by Kaplan-Meier analysis. Results: Seventeen patients who received rhTSH (mean age, 16.6±3.2 [SD] years) were compared to 28 historical controls prepared with THW. No differences were observed in RAI dose (mean 2.3±0.7 mCi/kg), tumor stage, or follow-up time (median [IQR] 2.6 [1.1-3.1] years) between groups. The THW group exhibited a nonsignificantly greater recurrence rate (14 [50%], 7 with biochemical recurrence and 7 with structural recurrence) than the rhTSH group (three [18%], 2 with biochemical recurrence and 1 with structural recurrence, p=0.2). A trend toward improved disease-free survival was identified in those treated with rhTSH compared to THW. Conclusion: In this cohort of pediatric patients with DTC, we observed a trend toward improved disease-free survival among those prepared with rhTSH compared to historical controls prepared with THW. Long-term follow up is needed to better characterize outcomes associated with rhTSH stimulation prior to I-131 ablation in the pediatric population.

Prognostic significance of indeterminate lung nodules in renal cell carcinoma.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 377-377
Author(s):  
Rena Xu ◽  
Nora Horick ◽  
Francis J. McGovern ◽  
Douglas M. Dahl ◽  
Adam S. Feldman ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Disease Free Survival ◽  
Tumor Stage ◽  
Lung Nodules ◽  
Chest Imaging ◽  
Free Survival ◽  
Comorbidity Score ◽  
Charlson Comorbidity Score ◽  
Disease Free

377 Background: Many patients with newly diagnosed renal cell carcinoma (RCC) are found to have indeterminate lung nodules at the time of diagnosis. Current guidelines are vague about the necessity and frequency of additional chest imaging. We sought to determine whether the presence of indeterminate lung nodules at the time of diagnosis affects long-term survival for patients with early stage RCC. Methods: A retrospective review was performed of all patients at our institution who underwent nephrectomy for stage I-III RCC between 2001 and 2006 and had baseline chest imaging available for review. Presence of indeterminate lung nodule(s) on preoperative chest imaging was determined, along with tumor stage, grade, and histology; patient age, gender, body mass index, and smoking status; and Charlson comorbidity score. The time from diagnosis to last documented follow-up, and to first detected metastasis and/or death if applicable, was determined. Univariate and multivariate analyses were performed. The primary outcome of interest was disease-free survival; the secondary outcome was overall survival. The study follow-up period extended to July 2012. Results: In a multivariate analysis of 240 patients, disease-free survival was significantly associated with the presence of indeterminate lung nodules (HR 1.900, 95% CI: [1.042, 3.463]; p = 0.036). The number and size of the nodules did not add statistical significance. Disease-free survival was also associated with tumor stage (stage II: HR 5.611, p < 0.001; stage III: HR 2.488, p = 0.0129) and grade (HR 2.433 for grade 3 or 4, p = 0.005). Overall survival was only associated with Charlson comorbidity score (HR 1.294, p < 0.0001) and primary tumor size (HR 1.287, p < 0.0001). Conclusions: The presence of indeterminate lung nodules at the time of diagnosis of RCC had a negative impact on disease-specific survival. Tumor stage and grade were also significant prognostic factors. These findings underscore the importance of baseline chest imaging as well as vigilant surveillance of patients in whom lung nodules are identified.

scholarly journals Elevated Biomarkers of Inflammation Are Associated With Reduced Survival Among Breast Cancer Patients

2009 ◽  
Vol 27 (21) ◽  
pp. 3437-3444 ◽  
Author(s):  
Brandon L. Pierce ◽  
Rachel Ballard-Barbash ◽  
Leslie Bernstein ◽  
Richard N. Baumgartner ◽  
Marian L. Neuhouser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Mass Index ◽  
Overall Survival ◽  
Cancer Survival ◽  
Disease Free Survival ◽  
Tumor Stage ◽  
Breast Cancer Patients ◽  
Free Survival ◽  
Disease Free

Purpose Chronic inflammation is believed to contribute to the development and progression of breast cancer. Systemic C-reactive protein (CRP) and serum amyloid A (SAA) are measures of low-grade chronic inflammation and potential predictors of cancer survival. Patients and Methods We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health, Eating, Activity, and Lifestyle (HEAL) Study (a multiethnic prospective cohort study of women diagnosed with stage 0 to IIIA breast cancer). Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival (approximately 4.1 years of follow-up) and overall survival (approximately 6.9 years of follow-up) in 734 disease-free breast cancer survivors. Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios (HRs) and 95% CIs. Results Elevated SAA and CRP were associated with reduced overall survival, regardless of adjustment for age, tumor stage, race, and body mass index (SAA P trend < .0001; CRP P trend = .002). The HRs for SAA and CRP tertiles suggested a threshold effect on survival, rather than a dose-response relationship (highest v lowest tertile: SAA HR = 3.15; 95% CI, 1.73 to 5.65; CRP HR = 2.27; 95% CI, 1.27 to 4.08). Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths. Elevated CRP and SAA were also associated with reduced disease-free survival, although these associations were of borderline significance (SAA P trend = .04; CRP P trend = .07). Conclusion Circulating SAA and CRP may be important prognostic markers for long-term survival in breast cancer patients, independent of race, tumor stage, and body mass index.

scholarly journals EPEN-49. RESPONSE OF RECURRENT EPENDYMOMA TO MEMMAT BASED METRONOMIC ANTIANGIOGENIC COMBINATION THERAPY UTILIZING TAPERED BEVACIZUMAB AND MAINTENANCE THERAPY WITH CELECOXIB AND FENOFIBRATE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii317-iii317
Author(s):  
Eileen Gillan
Keyword(s):  
Combination Therapy ◽  
Maintenance Therapy ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Time To Progression ◽  
Free Survival ◽  
Dismal Prognosis ◽  
Recurrent Ependymoma ◽  
Disease Free

Abstract Recurrent ependymomas have a dismal prognosis (2 year survival rates 29% OS and 23% EFS) and are relatively resistant to conventional chemotherapy. We previously reported five relapsed ependymoma patients treated with a MEMMAT based metronomic antiangiogenic combination therapy. All patients are currently alive, including four patients who were multiply relapsed with at least three recurrences. These four patients received between 44–52 weeks of therapy with minimal toxicity. Three had recurrent disease within an average of 44 months (median 42 months) after discontinuation of therapy. One patient who received the following tapering bevacizumab schedule: q3 weeks x 3, q4 weeks x 4 and q5 weeks x 5 followed by maintenance therapy with fenofibrate and celecoxib is in complete remission 12 months post treatment. This regimen was well tolerated with good quality of life in this patient population. Our results suggest that the chosen anti-angiogenic drug combination prolonged the time to progression in these multiply relapsed patients and thus may be particularly beneficial for patients with recurrent ependymoma. Tapered bevacizumab and maintenance therapy with celecoxib and fenofibrate may be modifications worth further investigation for prolonged disease free survival in relapsed ependymoma patients.

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