Asymptomatic recurrence detection with surveillance scanning in children with medulloblastoma.

1997 ◽  
Vol 15 (5) ◽  
pp. 1811-1813 ◽  
Author(s):  
D W Shaw ◽  
J R Geyer ◽  
M S Berger ◽  
J Milstein ◽  
K L Lindsley
Keyword(s):  
Early Detection ◽  
Median Time ◽  
Recurrent Disease ◽  
Time To Recurrence

PURPOSE To assess the utility of surveillance neuroimaging in detecting recurrent disease in patients treated for medulloblastoma. PATIENTS AND METHODS Records and scans of 59 consecutive patients treated for medulloblastoma between 1984 and 1993 in one institution were retrospectively reviewed. RESULTS Nineteen of 59 patients had recurrence of tumor, of which 17 were available for this study. Eleven of the 17 recurrent patients were asymptomatic at the time of detection. The median time to recurrence was 13 months (range, 3 to 90). CONCLUSION Surveillance scanning detected a majority of recurrences before onset of symptoms. Although the outcome of those with recurrent disease remains poor, early detection with minimum disease provides the best setting in which to test newer therapies. Patients and their parents also were more likely to elect pursuing further treatment when relapse was detected asymptomatically.

Recurrent disease in patients with stage III melanoma in the era of adjuvant immune and targeted therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21570-e21570
Author(s):  
Victor Lo ◽  
Valerie Francescutti ◽  
Elaine McWhirter ◽  
Forough Farrokhyar ◽  
Linda May Lee
Keyword(s):  
Targeted Therapy ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Systemic Therapy ◽  
Recurrent Disease ◽  
Stage Iii ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Stage Iii Melanoma

e21570 Background: Advancements in systemic therapy have reduced recurrence, and the adoption of nodal surveillance in place of dissection has reduced morbidity for patients with Stage III melanoma. The objective of this study was to describe the timing and pattern of recurrence in stage III melanoma patients and evaluate the impact of adjuvant treatment and nodal surveillance. Methods: A multicenter retrospective chart review of patients with pathologically confirmed Stage III cutaneous melanoma seen at either the Juravinski Cancer Centre or Walker Family Cancer Centre in Ontario, Canada from January 1, 2017 to December 31, 2019. Results: There were 137 patients with Stage III melanoma: 18% IIIA, 22% IIIB, 52% IIIC, and 8% Stage IIID as per the 8th American Joint Committee on Cancer (AJCC) 2018 staging system. 103 (75%) patients had sentinel lymph node biopsy (SLNB) only as part of initial surgical therapy, 6 (4%) had SLNB with completion dissection, and 25 (18%) had upfront radical nodal dissection. 67 (49%) patients received adjuvant therapy, of which 50 (74%) had immunotherapy, 17 (25%) received BRAF-targeted therapy, and 1 (1%) had interferon. 54 (39%) patients developed recurrent disease, with a median time to recurrence of 8.5 months (IQR: 4.3-14.9). The recurrence rates were 63% in patients who did not have adjuvant treatment and 37% in those who had adjuvant therapy, with a median time-to-recurrence of 7.5 and 9.0 months respectively. There were 30 (56%) loco-regional recurrences and 24 (44%) distant recurrences. Of the patients with loco-regional recurrence, 26 (87%) had SLNB only compared to 4 (13%) who had upfront or completion dissection. 12 (24%) patients recurred while on adjuvant treatment (7 distant recurrences and 5 loco-regional recurrences), and 8 (13%) patients recurred following completion of adjuvant treatment (5 distant recurrences and 3 loco-regional recurrences). Recurrences were detected by patients, clinicians, CT and nodal US surveillance in 43%, 20%, 28% and 9% of cases, respectively. The majority of loco-regional recurrence was detected clinically (67%) rather than by radiologic surveillance (33%). Of the 30 loco-regional recurrences, 24 underwent surgical resection of the recurrence, 4 had subsequent systemic therapy without surgery, 1 had intra-tumoral injections and 1 had no treatment. Conclusions: Recurrences in Stage III melanoma occur early, often within a year, with higher rates of loco-regional rather than distant disease. Recurrence rates were lower in those who received adjuvant therapy, but the majority of recurrences were detected by patients or clinicians, including loco-regional recurrences in patients who had SLNB only despite surveillance nodal US.

Long-Term Health Utilization and Outcomes in Chronic Suppurative Otitis Media

2021 ◽  
pp. 019459982110506
Author(s):  
Anthony Thai ◽  
Ksenia A. Aaron ◽  
Adam C. Kaufman ◽  
Peter L. Santa Maria
Keyword(s):  
Otitis Media ◽  
Median Time ◽  
Clinic Visit ◽  
Chronic Suppurative Otitis Media ◽  
Inactive Disease ◽  
Public Health Issue ◽  
Care Utilization ◽  
Health Utilization ◽  
Suppurative Otitis Media ◽  
Time To Recurrence

Objective To report health utilization patterns and outcomes of medical and surgical management in patients with chronic suppurative otitis media (CSOM). Study Design Retrospective cohort. Setting Academic otology clinic. Methods This study included 175 patients with CSOM with a first clinic visit at our institution between March 2011 and November 2016. All patients displayed a diagnosis of CSOM by International Classification of Diseases code, had at least 1 episode of active CSOM (defined as perforation with otorrhea), and had a documented history of chronic ear infections. The mean age was 49.5 ± 1.5 years, 53% were female, and mean follow-up time was 3.5 ± 0.3 years. Results Patients had an average of 9.5 ± 0.5 otology visits, 4.7 ± 0.4 prescriptions, and 1.7 ± 0.1 surgeries, with estimated per patient cost ranging from $3927 to $20,776. Under medical management, 69% of patients displayed recurrence of disease, with a median time to recurrence of 4 months. For tympanoplasty and tympanomastoidectomy, median time to recurrence was similar at 5 and 7 years, respectively ( P = .73). At the most recent visit, the prevalence of all patients with CSOM displaying moderate or worse sensorineural hearing loss (SNHL) was 41%. Conclusions CSOM represents a major public health issue with high health care utilization and associated costs. Surgery is superior to medical therapy for achieving short- to medium-term inactive disease. Patients with CSOM display a high SNHL burden.

scholarly journals Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259073
Author(s):  
Nadine Mayasi Ngongo ◽  
Gilles Darcis ◽  
Hippolyte Situakibanza Nanituna ◽  
Marcel Mbula Mambimbi ◽  
Nathalie Maes ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Early Detection ◽  
Hiv Infection ◽  
Median Time ◽  
Clinical Stage ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Time To Initiation ◽  
Advanced Hiv Disease

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

scholarly journals Role of neoadjuvant Radio-Chemotherapy for retroperitoneal Liposarcoma in primary and secondary surgical intervention

2020 ◽  
Author(s):  
Ruth Ladurner ◽  
Jens Strohäcker ◽  
Christian Birkert ◽  
Hans-Georg Kopp ◽  
Alfred Königsrainer ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Recurrent Disease ◽  
Distant Metastases ◽  
Radical Resection ◽  
Soft Tissue Tumors ◽  
High Rate ◽  
Neoadjuvant Radiotherapy ◽  
Time To Recurrence ◽  
Repeated Surgery ◽  
Center Of Expertise

Abstract Background: Approximately 30–40 % of all retroperitoneal soft tissue tumors are sarcomas with liposarcoma prevailing in approximately 50% of these cases. Retroperitoneal liposarcomas typically show a high rate of local recurrence and late distant metastases. The aim of our retrospective analysis was to investigate the efficacy of treatment in our patients with liposarcoma. Methods: Thirty-four consecutive patients underwent surgery in our clinic between October 2004 and November 2017. Liposarcomas arising from the mesenteric or abdominal adipose tissue or the pelvis were excluded. In 2011 we had introduced neo-adjuvant therapy according to IAWS-Guidelines in patients younger than seventy without severe comorbidities to pretreatement. Results: Out of 34 patients, 23 (67,6%) presented with primary and 11 (32,4%) with recurrent disease. In 8 of the 27 patients (30 %), a radical resection (R0) could be achieved, and in 17 patients (63%) resection was marginal (R1). Time to recurrence was not affected by neoadjuvant radiotherapy. Patients that underwent systemic chemotherapy followed by radiotherapy developed earlier recurrences (p = 0.016). Overall survival appeared to be better in the neoadjuvant group but was not significant (0.080) Conclusions: Combining surgical resection with neoadjuvant radiation treatment showed survival benefits in primary but not recurrent disease. Repeated surgery stays a valid approach in carefully selected patients but all patients should be referred to a center of expertise in multimodal treatment approaches for retroperitoneal liposarcomas.

Diagnostic utility of (18)f-fluciclovine positron emission tomography (FACBC) in biochemically recurrent (BCR) prostate cancer (PCa) based on prior primary treatment modality for localized disease and the impact of FACBC findings on treatment selection.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 34-34
Author(s):  
Marina Nasrin Sharifi ◽  
Petra Lovrec ◽  
Jens C. Eickhoff ◽  
Aria Kenarsary ◽  
David Frazier Jarrard ◽  
...  
Keyword(s):  
Median Time ◽  
Treatment Guidelines ◽  
Recurrent Disease ◽  
Primary Treatment ◽  
Prostate Bed ◽  
Primary Treatment Modality ◽  
Positron Emission ◽  
Treatment Data ◽  
Detection And Localization ◽  
The Impact

34 Background: Management of BCR PCa requires accurate assessment of location and extent of recurrent disease. FACBC has been shown to be a sensitive modality for detection and localization of recurrent disease but treatment guidelines are based on the findings of conventional (conv) imaging, including computed tomography, magnetic resonance imaging, or bone scintigraphy, and little is known about how prior treatment impacts FACBC findings and concordance with conv scans. Methods: This single-center retrospective study included 137 patients (pts) who had FACBC for BCR at the University of Wisconsin-Madison from 10/2017-10/2019. Clinical, pathological, imaging, and treatment data were collected by chart review. Pts were classified by type of primary treatment for localized PCa, either radical prostatectomy (RP) or radiation therapy (RT). Findings of conv scans performed within 4 weeks prior or any time after FACBC were collected. Results: 105 pts had RP and 32 pts had RT as their primary PCa treatment. Gleason score and PSA at diagnosis were similar between groups. Median PSA at time of FACBC was higher in the RT compared to RP group (3.3 vs 0.7 ng/dL) and median time from initial diagnosis to FACBC was longer (70 vs 55 months). Frequency of (+) FACBC findings was higher in the RT group (66% vs 47%); only 3% of pts in the RT group had a (-) FACBC compared to 29% in the RP group. The rate of (+) lesions in the prostate/prostate bed was higher in the RT group (41% vs 22%), while the rate of (+) lesions in pelvic nodes and distant sites was similar between groups. Of 69 pts who also had conv imaging, 61% had concordant conv imaging findings. In the RT group, conv and FACBC findings were similar in 47% of pts and not similar in 28%. In the RP group, conv and FACBC findings were similar in 26% of pts and not similar in 17%. Management after FACBC is listed in table. Median time from FACBC to first (+) conv scans was 6 (range: 0-18) and 5 (range: 0-17) months for RT and RP groups, respectively. Conclusions: In this large retrospective cohort, pts treated with initial RT had a longer median time from diagnosis to FACBC and higher median PSA at the time of FACBC compared to the RP group. RT patients had a higher rate of (+) FACBC findings but were more likely to continue on observation. The median time from FACBC to first (+) conv scan was 5-6 months, supporting the role of FACBC in earlier detection of recurrent disease in both groups of patients. Further analysis of concordance between FACBC and conv imaging is in process. [Table: see text]

Triple-negative metastatic/recurrent breast cancer: Treatment with paclitaxel/carboplatin combination chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1086-1086 ◽  
Author(s):  
J. W. Chia ◽  
P. Ang ◽  
H. See ◽  
Z. Wong ◽  
L. Soh ◽  
...  
Keyword(s):  
Median Time ◽  
Metastatic Disease ◽  
Triple Negative ◽  
Recurrent Disease ◽  
Complete Response ◽  
Recurrent Breast Cancer ◽  
Median Number ◽  
High Response Rate ◽  
Breast Cancers ◽  
Chest Wall Recurrence

1086 Background: Patients with triple negative (ER, PR, Her2 negative) breast cancers do not derive benefit from Herceptin or hormonal agents. For them, conventional chemotherapy remains the only option. Recent data suggests that triple negative breast cancers (TNBC) have increased sensitivity to platinum agents. We conducted a retrospective analysis to determine the response rates of such patients treated with paclitaxel and carboplatin (TC) chemotherapy. Methods: Patients with metastatic/recurrent TNBC were included in our study. Chemotherapy administered at weekly (paclitaxel 80mg/m2 and carboplatin AUC2 on D1, D8, D15) or 3 weekly intervals (paclitaxel 175mg/m2 and Carboplatin AUC 5 on D1). ER and PR status was defined using IHC. Her 2 positive was defined by a positive FISH or 3+ IHC staining. Results: 101 patients with TNBC were diagnosed at our centre from 2002 to 2005 and of these only 23 patients had metastatic/ recurrent disease. 14 patients were treated with TC and therefore included in our analysis. Median age of patients was 53 yrs (range 36 to 68yrs). 3 patients had metastatic disease at diagnosis and 11 patients were treated for recurrent disease. Median time to recurrence for this subgroup was 20 months (range 8 to 224mths). 4 and 6 patients had prior adjuvant exposure to taxanes and anthracyclines respectively. Median prior lines of chemotherapy was 1 (range 0–4). Median number of disease sites in patients was 4. Eight patients (57%) experience a partial response (PR) with TC. 2 patients had stable disease and 4 progressive disease. Although no patients experienced complete response, 3 patients had good PR. One patient with metastatic disease had complete resolution of a large, 9cm locally invasive breast tumor after 3 cycles of TC. The second had a 90% reduction in volume of a large chest wall recurrence after 2 cycles TC. Patients who had 2 or 3 prior lines of chemotherapy also continued to show response. The median time to tumor progression was 16 weeks (range 4–28 wks). Conclusions: TC gives a high response rate in patients with metastatic/ recurrent TNBC. Patients with prior exposure to taxanes and those with large volume disease showed good response. Randomised trials are underway to compare the TC regimen with non-platinum containing doublets. No significant financial relationships to disclose.

Feasibility of a national expert panel to determine resectability in patients with initially unresectable colorectal cancer liver metastases (CRLM).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3562-3562
Author(s):  
Karen Bolhuis ◽  
Joost Huiskens ◽  
Cornelis H.C. Dejong ◽  
Marc R.W. Engelbrecht ◽  
Michael F. Gerhards ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Median Time ◽  
Expert Panel ◽  
Induction Treatment ◽  
R0 Resection ◽  
Colorectal Cancer Liver Metastases ◽  
Cancer Group ◽  
Time To Recurrence ◽  
National Expert ◽  
Resectability Criteria

3562 Background: Decision on optimal treatment strategy for CRLM remains complex because uniform (un)resectability criteria are lacking. We hypothesize that the use of an expert panel can improve the identification of patients with potentially resectable CRLM. The Dutch Colorectal Cancer Group (DCCG) Expert Panel was established in conjunction with the CAIRO5 study (Huiskens J et al. BMC Cancer 2015), a multicenter, randomized, phase-3 trial, investigating optimal systemic induction treatment in patients with initially unresectable CRLM. Here, we present the feasibility of this panel. Methods: The DCCG Expert Panel consists of 13 liver surgeons and 4 radiologists. Consensus was reached on predefined (un)resectability criteria at baseline. An online platform allowed resectability-assessment by 3 surgeons in case of inter-surgeon agreement, and 5 surgeons if they disagreed. CRLM were assessed as 1) resectable 2) potentially resectable, or 3) permanently unresectable. Patients with initially unresectable CRLM were evaluated at baseline and subsequently every 2 months as long as CRLM were considered potentially resectable. Results: Overall, 397 panel evaluations in 183 patients were analyzed. Median time to panel conclusion was 7 days (IQR 5-11 days) and 204 (51%) evaluations showed inter-surgeon disagreement, with major disagreement (resectable versus permanently unresectable) in 24 (14%) and 12 (29%) evaluations after 2 and 4 months of systemic treatment. Ultimately, 84 (79%) patients with resectable CRLM underwent resection and 23 (27%) resections included portal vein embolization or 2-stage procedures. In resectable CRLM with inter-surgeon agreement versus disagreement, R0 resection was achieved in 39 (75%) versus 28 (52%) patients, p = 0.013. Median time to recurrence was similar between resections with panel agreement versus disagreement, 8 versus 6 months, p = 0.447. Conclusions: This study shows the feasibility of a national Liver Expert Panel for prospective resectability assessment of patients with initially unresectable CRLM. High inter-surgeon disagreement supports the use of a panel. We aim to further validate the panel with outcome parameters. Clinical trial information: NCT02162563.

Pattern of recurrence after curative resection of stage I-III duodenal adenocarcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 794-794
Author(s):  
Andreina Colina ◽  
Kanwal Pratap Singh Raghav ◽  
Matthew H. G. Katz ◽  
Prajnan Das ◽  
Naruhiko Ikoma ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Median Time ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Cancer Center ◽  
Radiographic Evaluation ◽  
Duodenal Adenocarcinoma ◽  
Time To Recurrence

794 Background: Duodenal adenocarcinoma (DA) is a rare cancer with limited data regarding the pattern of disease recurrence following resection. Methods: A retrospective review of 115 patients with Stage I-III DA from 3/1994 to 6/2018, at a single high-volume cancer center was conducted. Only patients (pts) who underwent a potentially curative surgical resection (R0/R1 margins) and had a postoperative follow-up radiographic evaluation were included. Periampullary adenocarcinomas were excluded. Clinicopathologic features and patterns of recurrence were compared across cohorts. Results: Of 76 patients who met inclusion criteria, 7 (9%) were stage I, 25 (33%) stage II, and 44 (57%) stage III. Histologic grade was moderate in 58% and poor in 38%. Median age was 63 years (range, 29-84), 38% were female, and R0 resection was 97%. Neoadjuvant therapy was given to 14% and adjuvant therapy to 61%. Radiation therapy (XRT) as either adjuvant/neoadjuvant therapy was used in 27%. Median follow-up was 44 (6-293) months. Median time to recurrence was 11mo, with 84% of recurrences occurring within 2 years. Median time to local recurrence (LR) vs. distant recurrence (DR) was 11mo vs. 12mo, respectively, p = 0.42. Stage impacted recurrence rate: 0% in stage 1 vs. 50% stage 2 vs. 71% stage 3 (p = 0.002). Median time to recurrence was 16mo for stage II and 11mo for stage III (p = 0.04). In total, 4 (5%) pts had LR only, 8 (10%) had LR concurrent with DR, and 32 (42%) had DR only. Recurrence distribution was similar across stage II (LR 8%, LR+DR 15%, DR 77%) and stage III (LR 10%, LR+DR 19%, DR 71%). LR was similar in patients that received XRT (10%) compared to those who did not (9%). Most common sites of DR were peritoneal (38%), liver (33%), distant lymph nodes (12%), and lung (10%). Conclusions: The recurrence pattern for resected DA is predominantly distant metastatic disease with the majority of recurrences occurring within the first two years. Future therapies should focus on improved systemic therapy, and surveillance should be most intensive in the first two years.

Combined Dorsolateral and Intraoral Approach for the Resection of Tumors of the Maxilla in the Dog

2003 ◽  
Vol 39 (3) ◽  
pp. 294-305 ◽  
Author(s):  
B. Duncan X. Lascelles ◽  
Maurine J. Thomson ◽  
William S. Dernell ◽  
Rod C. Straw ◽  
Mary Lafferty ◽  
...  
Keyword(s):  
Blood Loss ◽  
Median Time ◽  
Recurrence Rate ◽  
Single Unit ◽  
Combined Approach ◽  
Intraoperative Complication ◽  
The Third ◽  
Time To Recurrence ◽  
Intraoral Approach

This paper describes in detail a combined dorsal and intraoral approach for maxillectomy for tumors involving tissues more caudal to the third premolar. The only intraoperative complication was that of blood loss, with six out of 20 dogs requiring a single unit of blood. Histopathologically clean margins were obtained in 14 of the 20 cases, with a recurrence rate of 50% in these dogs and a median time to recurrence of 24 months. This represents an improvement in outcome over previously reported studies, and the authors postulate this is due to the better exposure and access to the area afforded by the combined approach over the standard intraoral approach.

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