Childhood nasopharyngeal carcinoma: A 4-year single institution experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9069-9069
Author(s):  
A. A. Patel ◽  
P. M. Shah ◽  
K. M. Patel ◽  
S. N. Shukla ◽  
B. J. Parikh ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Complete Remission ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Disease Extent ◽  
Free Survival ◽  
Major Response ◽  
Disease Free

9069 Background: Pediatric nasopharyngeal carcinoma (PNC) represents a locally advanced undifferentiated tumor. In this study, clinical experience and therapeutic results of 24 children with newly diagnosed PNC, treated in a single oncology institution in India over a period of 5 years, are analyzed. Methods: 24 patients (23 males and 1 female) 7–14 years old (median = 12) from Jan 2000 to Sep 2005 with PNC were retrospectively evaluated. 18/24 patients were evaluable. 16 patients received induction chemotherapy followed by radiotherapy while 1 patient was offered concurrent chemoradiotherapy, 1 patient received radiotherapy alone. 15/16 patients received postradiation chemotherapy. The agents used in induction and adjuvant therapy were cisplatin (100 mg/m2) on day 1 and 5-fluorouracil 750 mg/m2 for 5 days. The dose of radiotherapy used was 60 gray in 30 fractions. Results: The time of onset of symptoms to diagnosis ranged from 1 month to 9 months with a median of 5.5 months. Histopathology was lymphoepithelioma in 5 patients (27.7%) while 13 patients (72.2%) had poorly differentiated carcinoma. Disease extent was T2 (n = 7), T3 (n = 6), and T4 (n = 5); N1 (n = 5), N2 (n = 7), and N3 (n = 5). 7 patients had intracranial invasion. None had metastatic disease on presentation. 13 patients (72.2%) achieved major response which included 7 (38.8%) complete remission and 6 (33.3%) partial remission after the induction chemotherapy and radiotherapy. 4 (22.2%) had progressive disease. Another 3 (16.6%) attained complete remission after post radiation chemotherapy which consisted of two cycles of cisplatin and 5-flourouracil. The follow up ranged from 5 months to 84 months with a median follow up of 35 months. The disease free survival ranged from 10 months to 53 months with a median of 33 months. The patients who had a better response to induction chemotherapy had a better disease free survival. Out of 7 patients who attained complete remission 2 relapsed with a median time to first relapse of 9.5 months. Toxicity to therapy was modest. Only one patient had grade 4 neutropenia and mucositis. There was no therapy related mortality. Conclusion: Chemoradiotherapy for nasopharyngeal carcinoma in children is an effective treatment modality with minimal toxicity. No significant financial relationships to disclose.

scholarly journals The Clinical Outcomes and Toxicities of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy Plus Adjuvant Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

2021 ◽  
Vol 10 ◽  
Author(s):  
Rui Zou ◽  
Jing-Jing Yuan ◽  
Qiang Li ◽  
Jian-Wu Ding ◽  
Bing Liao ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Nasopharyngeal Carcinoma ◽  
Adverse Events ◽  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Grade 3 ◽  
Disease Free

PurposeTo analyze the outcomes and toxicities of induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) plus adjuvant chemotherapy (ACT) in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).MethodsRetrospective analysis of 163 patients with LA-NPC referred from August 2015 to December 2018 was carried out. All patients underwent platinum-based ICT followed by CCRT plus ACT.ResultsThe median follow-up time was 40 months, ranging from 5 to 69 months. The 3-year disease-free survival (DFS), overall survival (OS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 80.8, 90.0, 91.6, and 87.4%, respectively. The most frequent acute grade 3/4 adverse events were leukopenia (66.8%), neutropenia (55.8%), mucositis (41.1%), thrombocytopenia (27.0%), and anemia (14.7%).ConclusionICT followed by CCRT plus ACT did not seemingly enhance DFS and OS in LA-NPC patients compared to the addition of ICT to CCRT (historical controls). In contrast, ICT followed by CCRT plus ACT had more acute adverse events than ICT followed by CCRT. Longer-term clinical studies are required to examine the treatment outcomes and late toxicities.

scholarly journals Long-term disease-free survival in acute nonlymphocytic leukemia

Blood ◽  
1981 ◽  
Vol 57 (6) ◽  
pp. 1144-1147
Author(s):  
BA Peterson ◽  
CD Bloomfield
Keyword(s):  
Complete Remission ◽  
Induction Chemotherapy ◽  
Median Survival ◽  
Cytosine Arabinoside ◽  
Disease Free Survival ◽  
Acute Nonlymphocytic Leukemia ◽  
Maintenance Chemotherapy ◽  
Free Survival ◽  
Disease Free

Twenty-six of 45 adults (58%) with acute nonlymphocytic leukemia who were treated with intensive induction chemotherapy over 5 yr ago entered complete remission. All patients entering remission were placed on weekly maintenance chemotherapy consisting of cytosine arabinoside and 6-thioguanine. The median duration of complete remission was 17 mo and 7 patients (27%) remained in their initial remission for 62 + to 102 + mo. All but one of the patients in complete remission over 5 yr have had treatment discontinued. Only 1 of 7 patients in remission for more than 5 yr has relapsed. Median survival is 26.5 mo, and 8 patients (31%) currently remain alive without evidence of leukemia 63--105 mo from diagnosis. It is possible to achieve long-term disease-free survival with chemotherapy alone in acute nonlymphocytic leukemia.

Busulfan/etoposide--initial experience with a new preparatory regimen for autologous bone marrow transplantation in patients with acute nonlymphoblastic leukemia

Blood ◽  
1993 ◽  
Vol 81 (2) ◽  
pp. 319-323 ◽  
Author(s):  
NJ Chao ◽  
AS Stein ◽  
GD Long ◽  
RS Negrin ◽  
MD Amylon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Median Time ◽  
Relapse Rate ◽  
Disease Free Survival ◽  
Autologous Bone Marrow ◽  
Free Survival ◽  
Acute Nonlymphoblastic Leukemia ◽  
Disease Free

Abstract Current intensive chemotherapy for acute nonlymphoblastic leukemia (ANLL) results in a complete remission in the majority of patients. Unfortunately, the duration of remission is short and most of the patients will experience a relapse of their underlying disease. Autologous bone marrow (BM) transplantation is being explored as a treatment modality designed to improve relapse-free survival. We have conducted a phase II trial exploring the combination of busulfan (16 mg/kg) and etoposide (60 mg/kg) in an attempt to improve antitumor efficacy using this novel preparative regimen. To date, 50 patients (48 with ANLL and 2 patients with biphenotypic acute leukemia) have been treated. The first 20 patients received unmanipulated BM; 28 patients subsequently received 4-hydroperoxycyclophosphamide (4–HC) (60 micrograms/mL)-purged bone marrow, and 2 patients with biphenotypic acute leukemia received both 4–HC (60 micrograms/mL) and etoposide (5 micrograms/mL)-purged BM. Thirty-four patients were in first complete remission (CR1), 12 patients in second complete remission (CR2), and 4 patients in relapse. The median time from first complete remission to BM harvest was 3 months (range, 0.8 to 4) compared with median time of 2 months (range, 1.5 to 5.0) for patients in second complete remission. The median time from harvest to transplant was 1 month for both groups (range, 0.4 to 36). A median of 0.7 x 10(8) (range, 0.2 to 1.4) mononuclear cells were infused. Patients achieved an absolute neutrophil count of > or = 500/microL at a median of 26 days (range, 13 to 96), an untransfused platelet count > or = 20,000/microL at a median of 56 days (range, 15 to 278) and a sustained hematocrit > or = 30% at a median of 50 days (range, 19 to 116). Twenty-six patients are alive and in continued CR. Follow-up of the surviving patients ranged from 6 months to 66 months with a median follow-up of 31 months. Patients receiving purged BM have an actuarial disease-free survival of 57% with a relapse rate of 28% compared with patients receiving unpurged BM whose actuarial disease-free survival is 32% with a relapse rate of 62% (P = .06 for relapse rate). The most significant extramedullary toxicities for this regimen are hepatic and cutaneous (including mucositis). The BU/VP-16 regimen is associated with a significant proportion of patients surviving disease free, especially in the group receiving purged BM. Whether this regimen offers a substantial improvement in disease-free survival over currently used regimens will require a prospective randomized study.

Induction chemotherapy with cisplatin and epirubicin followed by radiotherapy and concurrent cisplatin in locally advanced nasopharyngeal carcinoma observed in a nonendemic population

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17040-e17040
Author(s):  
M. Airoldi ◽  
M. Garzaro ◽  
A. Gabriele ◽  
L. Raimondo
Keyword(s):  
Overall Survival ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Objective Response ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Efficient Treatment ◽  
Free Survival ◽  
Therapy Choice

e17040 Background: Chemoradiotherapy (CRT) represents the main therapy choice in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). Aim of this study was the clinical evaluation of neoadjuvant chemotherapy (NACT) followed by CRT in a non endemic population affected by advanced NPC. Methods: Patients with locoregionally advanced NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m2) plus epirubicin (90 mg/m2), followed by cisplatin (100 mg/m2) and concomitant radiotherapy (70 Gy). Results: In 40 patients treated with such protocol, after the completion of induction CHT and CRT we observed the objective response rates of 90% and 100% respectively. Treatment tolerability and toxicity were easily controllable. With a median follow-up time of 54.5 months 3- and 5-years disease-free survival was 75% and 65.4% and 3- and 5-years overall survival was 84% and 77.5%. 3- and 5-years loco-regional control was 82.4% and 70.3%, and 5-years distant metastases-free survival was 75%. Conclusions: NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible, efficient treatment for patients with advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases. No significant financial relationships to disclose.

Does weekly versus daily low-dose of concurrent cisplatin have any effect on compliance and clinical outcomes in cases of locally advanced head and neck cancers?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17569-e17569
Author(s):  
Ayush Garg ◽  
Piyush Kumar ◽  
Arvind Kumar Chauhan ◽  
Pavan Kumar
Keyword(s):  
Statistical Difference ◽  
Low Dose ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Complete Response ◽  
Free Survival ◽  
Group I ◽  
Group Ii ◽  
Disease Free

e17569 Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced squamous cell carcinomas of the head neck.Cisplatin at 35mg/m2(weekly) raise compliance & hospitalization. There are only few reports on efficacy and toxicity of low dose Cisplatin (6mg/m2). Hence the purpose of this study was to evaluate the compliance and clinical outcomes between two concurrent cisplatin chemotherapy regimens & to see long term effects. Methods: Total 50 patients were included in study from Nov 2015 to Mar 2017 with 25 in each group. Radiotherapy given 70Gy/35# in 7weeks & Cisplatin at 35mg/m2 weekly (Group I) and 6mg/m2 daily (Group II). Assessment of toxicity was done by RTOG scoring criteria. WHO Response criterion was used to assess clinical response. Median follow up was 6 months. Results: Group I(80%) and Group II(84%)patients completed Radiotherapy. In Group I 48% patients received less than 6 cycles and Group II 40% received ≤25 cycles chemotherapy. Median OTT in Group I & II in was 51 & 52days. Neutropenia & Mucositis statistically insignificant between both groups.There was no statistical difference in complete response between the two groups. In Group I 40% patients developed Progressive disease on follow up as compared to 12% in Group II(p-0.02). After 1.5 years of follow up, Group I vs Group II 4 patients had complete response, 6 had recurrence & 11 vs 4 patients expired (p-0.03). At a median follow up of 6 months overall survival in Group I and II was 56% and 44%(p-0.39). While as median disease free survival in Group I & II was 6.6 & 11.9 months(p-0.14). Conclusions: Low dose daily Cisplatin offers ease of administration in the outpatient clinic, better tolerability and better quality of life.Group II patients were more compliant in terms of patients receiving chemotherapy or completing radiotherapy. At median follow up of 6 months there was no statistical difference in terms of overall and disease-free survival. The statistical difference was seen in terms of patients expired in Group I (44%) as compared to Group II (16%). Therefore, we need a larger number of patients for the use of low dose Cisplatin to be evaluated in future clinical trials.

Risultati a lungo termine della chemioterapia adiuvante con Cisplatino e Methotrexate nel carcinoma infiltrante della vescica dopo cistectomia

1994 ◽  
Vol 61 (1_suppl) ◽  
pp. 37-40
Author(s):  
V. Scattoni ◽  
P. Rovellini ◽  
A. Bottanelli ◽  
G. Pavia ◽  
G.P. Baroni ◽  
...  
Keyword(s):  
Survival Rate ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Salvage Chemotherapy ◽  
Nodal Involvement ◽  
Free Survival ◽  
Node Metastases ◽  
Disease Free Survival Rate ◽  
Disease Free

From January 1985, 28 patients affected by locally advanced bladder cancer (pT2-pT4a, pNx-N0-N1-2, MO) underwent 4 planned cycles of adjuvant chemotherapy with cisplatin (70 mg/m2 on day 1) and methotrexate (40 mg/m2 on days 8 and 15) after cystectomy. Gastrointestinal toxicity and agranulocytosis were so severe that only 50% of the patients completed the four planned cycles. After a median follow-up of 36 months (range 9-89 months), the overall 5-year disease-free survival rate of 26 evaluable patients was 32%. None of the patients with pathological evidence of lymph node metastases survived longer than 5 years, while the 5-year disease-free survival rate of the patients without nodal involvement was 55%. Seventy-five percent of progressions (12/16) were identified within 24 months. Only 28% of the patients submitted to salvage chemotherapy with an M-VAC regimen after progression showed a partial response of short duration to chemotherapy.

scholarly journals Adjuvant Radiation Therapy for Male Breast Cancer—A Rare Indication?

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3645
Author(s):  
Tobias Forster ◽  
Clara Köhler ◽  
Rami El Shafie ◽  
Fabian Weykamp ◽  
Laila König ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Locally Advanced ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Female Breast Cancer ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Disease Free

Due to its rarity, there are no randomized trials investigating the outcome of adjuvant radiotherapy in MBC. This study reports on patient and tumor characteristics of 41 consecutive MBC patients treated between 1990 and 2018 and on clinical outcomes after surgical resection of tumors and adjuvant radiotherapy of the chest wall or breast. Local control (LC), locoregional control (LRC), overall survival (OS), disease-free survival (DFS), and toxicity were evaluated. After a median follow-up of 80 months (95% CI: 14.6–213.8 months) there was only one recurrence, in a patient’s locoregional lymph nodes 17 months after start of radiotherapy, resulting in an LC rate of 100% at 5 years and a 5-year LRC rate of 97.4% (standard deviation (SD): 0.025). Five-year DFS and OS rates were 64.6% (SD: 0.085) and 57.2% (SD: 0.082), respectively. Adjuvant radiotherapy was tolerated well without high-grade (CTCAE grade > II) adverse events. After tumor resection and adjuvant radiotherapy, LC and LRC rates in MBC patients are excellent and comparable to results found for female breast cancer (FBC) patients. However, as patients are often diagnosed with locally advanced, higher-risk tumors, distant recurrences remain the major failure pattern.

scholarly journals T4-Locally Advanced Nasopharyngeal Carcinoma: Prognostic Influence of Cranial Nerve Involvement in Different Radiotherapy Techniques

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Hsin-I Huang ◽  
Kee-Tak Chan ◽  
Chih-Hung Shu ◽  
Ching-Yin Ho
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Cranial Nerve ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Cranial Nerve Involvement ◽  
Free Survival ◽  
Nerve Involvement ◽  
Disease Free ◽  
3D Crt

Background. Cranial nerve involvement at disease presentation of nasopharyngeal carcinoma was not uncommon. We investigated the prognosis of patients with T4-locally advanced NPC, with or without cranial nerve involvement, and compared the outcome of patients treated using different radiotherapy techniques.Methods. In this retrospective study, 83 T4-locally advanced NPC patients were diagnosed according to the seventh edition of the American Joint Committee on Cancer staging system. All patients were treated using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT). The survival rate was analyzed using the Kaplan-Meier method.Results. The 5-year overall, locoregional-free, and disease-free survival rates of patients treated using IMRT were 88.9%, 75.2%, and 69.2%, respectively. The outcome in these patients was significantly better than that in patients treated using 3D-CRT, with survival rates of 58.2%, 54.4%, and 47.2%, respectively. There was no significant difference in the 5-year overall, locoregional-free, and disease-free survival rates of the patients with (64.2%, 60.5%, and 53.5%, resp.) and without (76.9%, 63.6%, and 57.6%, resp.) cranial nerve involvement.Conclusion. Locally advanced NPC patients treated using IMRT had significantly better outcomes than patients treated using 3D-CRT. Our results showed that the outcome of T4 NPC patients with or without cranial nerve involvement was not different.

scholarly journals Busulfan/etoposide--initial experience with a new preparatory regimen for autologous bone marrow transplantation in patients with acute nonlymphoblastic leukemia

Blood ◽  
1993 ◽  
Vol 81 (2) ◽  
pp. 319-323 ◽  
Author(s):  
NJ Chao ◽  
AS Stein ◽  
GD Long ◽  
RS Negrin ◽  
MD Amylon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Median Time ◽  
Relapse Rate ◽  
Disease Free Survival ◽  
Autologous Bone Marrow ◽  
Free Survival ◽  
Acute Nonlymphoblastic Leukemia ◽  
Disease Free

Current intensive chemotherapy for acute nonlymphoblastic leukemia (ANLL) results in a complete remission in the majority of patients. Unfortunately, the duration of remission is short and most of the patients will experience a relapse of their underlying disease. Autologous bone marrow (BM) transplantation is being explored as a treatment modality designed to improve relapse-free survival. We have conducted a phase II trial exploring the combination of busulfan (16 mg/kg) and etoposide (60 mg/kg) in an attempt to improve antitumor efficacy using this novel preparative regimen. To date, 50 patients (48 with ANLL and 2 patients with biphenotypic acute leukemia) have been treated. The first 20 patients received unmanipulated BM; 28 patients subsequently received 4-hydroperoxycyclophosphamide (4–HC) (60 micrograms/mL)-purged bone marrow, and 2 patients with biphenotypic acute leukemia received both 4–HC (60 micrograms/mL) and etoposide (5 micrograms/mL)-purged BM. Thirty-four patients were in first complete remission (CR1), 12 patients in second complete remission (CR2), and 4 patients in relapse. The median time from first complete remission to BM harvest was 3 months (range, 0.8 to 4) compared with median time of 2 months (range, 1.5 to 5.0) for patients in second complete remission. The median time from harvest to transplant was 1 month for both groups (range, 0.4 to 36). A median of 0.7 x 10(8) (range, 0.2 to 1.4) mononuclear cells were infused. Patients achieved an absolute neutrophil count of > or = 500/microL at a median of 26 days (range, 13 to 96), an untransfused platelet count > or = 20,000/microL at a median of 56 days (range, 15 to 278) and a sustained hematocrit > or = 30% at a median of 50 days (range, 19 to 116). Twenty-six patients are alive and in continued CR. Follow-up of the surviving patients ranged from 6 months to 66 months with a median follow-up of 31 months. Patients receiving purged BM have an actuarial disease-free survival of 57% with a relapse rate of 28% compared with patients receiving unpurged BM whose actuarial disease-free survival is 32% with a relapse rate of 62% (P = .06 for relapse rate). The most significant extramedullary toxicities for this regimen are hepatic and cutaneous (including mucositis). The BU/VP-16 regimen is associated with a significant proportion of patients surviving disease free, especially in the group receiving purged BM. Whether this regimen offers a substantial improvement in disease-free survival over currently used regimens will require a prospective randomized study.

Predictive Factors for Achieving Complete Remission In 69 Mexican Patients with Adult Acute Lymphoblastic Leukemia Treated with Hyper-CVAD

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4340-4340
Author(s):  
Eduardo Chávez-Güitrón ◽  
Fernando Perez Rocha
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Complete Remission ◽  
Disease Free Survival ◽  
Remission Induction ◽  
Free Survival ◽  
Remission Rates ◽  
Disease Free ◽  
Mexican Patients

Abstract Abstract 4340 Background. Acute adult lymphocytic leukemia (ALL) is an infrequent oncologic entity whose rates of global response and cure remain unsatisfactory, when compared to results obtained in treatment of other neoplastic disorders, and of ALL itself in pediatric population, where cure rates approach 90%. Most current induction protocols achieve remission rates of 70 to 90% worldwide, but 5-year disease free survival remains unchanged. MD Anderson Cancer Center (MDACC) published their results with HyperCVAD more than a decade ago, reporting rates of complete remission of 92%, and 5-year disease free survival of 38%. We have used HyperCVAD at our center since 1999, but have not reported the baseline patient characteristics and outcomes. Methods. We conducted a retrospective analysis on 69 patients treated with HyperCVAD from 2005 to 2009, evaluating traits at baseline and response to treatment, using descriptive statistics. Survival analysis (overall survival and disease free survival) were described using the Kaplan-Meier method. Baseline traits and their association to response were measured using Chi-square test. Comparison between the original cohort described by MDACC and ours was also analyzed by this test. Results. Sixty nine patients with a median follow up of 12 months (range 1–144) were evaluated. Complete remission rates were 77%; induction mortality 4.3%; the estimate of overall survival and disease free survival at 60 months was less than 10% in both cases. The pretreatment variables associated to an increased probability of achieving remission were age <30, baseline hemoglobin >10g/dL and pre B phenotype (p<0.001). Leukocyte count and baseline DHL did not predict ability to achieve remission as shown in the original MDACC study. A 15% difference in complete remission response rate between the original series and ours was found to be statistically significant (p<0.0001). Discussion. HyperCVAD as applied to Mexican patients has an efficacy similar to other remission induction protocols, as reported elsewhere, but is inferior to the original results published by MDACC. Survival analysis requires a longer median follow-up for valid conclusions to be drawn. Disclosures: Perez Rocha: genzyme: Employment, Honoraria.

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