Successful Treatment of Childhood High-Risk Hepatoblastoma With Dose-Intensive Multiagent Chemotherapy and Surgery: Final Results of the SIOPEL-3HR Study

2010 ◽  
Vol 28 (15) ◽  
pp. 2584-2590 ◽  
Author(s):  
József Zsíros ◽  
Rudolf Maibach ◽  
Elizabeth Shafford ◽  
Laurence Brugieres ◽  
Penelope Brock ◽  
...  
Keyword(s):  
High Risk ◽  
Partial Hepatectomy ◽  
Lung Metastases ◽  
Tumor Resection ◽  
Primary Objective ◽  
Complete Resection ◽  
Hepatic Veins ◽  
Cure Rate ◽  
Response To Chemotherapy ◽  
Multiagent Chemotherapy

PurposeThe primary objective was to determine the efficacy of a newly designed preoperative chemotherapy regimen in an attempt to improve the cure rate of children with high-risk hepatoblastoma.Patients and MethodsHigh risk was defined as follows: tumor in all liver sections (ie, Pretreatment Extension IV [PRETEXT-IV]), or vascular invasion (portal vein [P+], three hepatic veins [V+]), or intra-abdominal extrahepatic extension (E+), or metastatic disease, or α-fetoprotein less than 100 ng/mL at diagnosis. Patients were treated with alternating cycles of cisplatin and carboplatin plus doxorubicin (preoperatively, n = 7; postoperatively, n = 3) and delayed tumor resection.ResultsOf the 151 patients (150 evaluable for response) 118 (78.7%) achieved a partial response to chemotherapy. Complete resection of the liver tumor could be achieved in 115 patients (76.2%) either by partial hepatectomy (55.6%) or by liver transplantation (20.6%). In 106 children (70.2%), complete resection of all tumor lesions (including metastases) was achieved. Among the patients with initial lung metastases, 52.2% achieved complete remission of the lung lesions with chemotherapy alone. In half of the patients with initial PRETEXT-IV tumor as the only high-risk feature, the tumor could be completely resected with partial hepatectomy. Event-free (EFS) and overall survival (OS) estimates at 3 years were 65% (95% CI, 57% to 73%) and 69% (95% CI, 62% to 77%) for the whole group. EFS and OS for all patients with PRETEXT-IV tumor were 68% and 69%, respectively, and they were 56% and 62%, respectively, for patients with metastasis.ConclusionThe applied treatment rendered a great proportion of tumors resectable, and, in comparison with previously published results, led to an improved survival in patients with high-risk hepatoblastoma.

scholarly journals A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 768
Author(s):  
Yoann Varenne ◽  
Stéphane Corvec ◽  
Anne-Gaëlle Leroy ◽  
David Boutoille ◽  
Mỹ-Vân Nguyễn ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Surgical Site Infections ◽  
Implant Removal ◽  
Pelvic Bone ◽  
Resistance Pattern ◽  
Cure Rate ◽  
Implant Retention ◽  
The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

scholarly journals ETMR-15. USE OF HIGH-DOSE CHEMOTHERAPY FOR TWO CHILDREN WITH EMBRYONAL TUMOR WITH MULTILAYERED ROSETTES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii326-iii326
Author(s):  
Shimpei Kusano ◽  
Junya Fujimura ◽  
Megumi Fujiwara ◽  
Akinori Yaguchi ◽  
Takeshi Ishibashi ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Tumor Resection ◽  
Radical Resection ◽  
Multicenter Trial ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Embryonal Tumor ◽  
The Central Nervous System ◽  
Classification Of Tumors ◽  
Multiagent Chemotherapy

Abstract Embryonal tumor with multilayered rosettes (ETMR) is new entity defined in the 4th revised edition of the WHO classification of tumors of the central nervous system. Although radical resection, radiotherapy, and multiagent chemotherapy are considered to be necessary for ETMR, the efficacy of chemotherapy for ETMR in Japan has not been established. Here, we report different clinical courses for two children with localized ETMR treated with the St. Jude medulloblastoma-96 (SJMB96) regimen, which consists of four cycles of high-dose chemotherapy with autologous peripheral blood stem cell transplantation. For both children, the diagnosis of ETMR, C19MC-altered was confirmed after gross total tumor resection. Multiagent chemotherapy was administered following cranio-spinal irradiation with local boost. One month after completion of the treatment, one patient experienced local recurrence but has been in remission for over 2 years after tumor resection and stereotactic irradiation with a CyberKnife and treatment every three weeks with bevacizumab. The other patient also experienced local recurrence after the third cycle of chemotherapy and several times thereafter. Although she again underwent tumor resection and local irradiation, her tumor grew larger and invaded. Because her prognosis was very poor, her parents choose only palliative care. Based on our experience, we believe that continuous chemotherapy at conventional doses is preferred over intensive-dose chemotherapy such as SJMB96. However, the number of reports on chemotherapy for ETMR is still small, and a prospective multicenter trial is needed to establish effective chemotherapy for ETMR.

scholarly journals Predictive value of the early response to chemotherapy in high-risk stages II and III Hodgkin's disease

Cancer ◽  
1987 ◽  
Vol 60 (8) ◽  
pp. 1713-1719 ◽  
Author(s):  
Alessandro Levis ◽  
Umberto Vitolo ◽  
Maria A. Ciocca Vasino ◽  
Giovanni Cametti ◽  
Alessandro Urgesi ◽  
...  
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Early Response ◽  
Response To Chemotherapy

Curative Effect of Tumor Resection under Microscope for Brain Glioma based on Humanized Nursing Model

2021 ◽  
Vol 7 (5) ◽  
pp. 3266-3275
Author(s):  
Lifeng Huang ◽  
Haiyan Xiang ◽  
Weiming Qian
Keyword(s):  
Tumor Resection ◽  
Postoperative Recovery ◽  
Complete Resection ◽  
Good Effect ◽  
Anxiety And Depression ◽  
Brain Glioma ◽  
Curative Effect ◽  
Data Statistics ◽  
Glioma Resection ◽  
Functional Areas

Previous studies have shown that microsurgery has two main roles in glioma resection, that is, the nerve function is well protected and the degree of tumor resection is improved. On the basis of this experiment, the curative effect of tumor resection under microscope for glioma was studied based on humanized nursing model. By randomly dividing 64 patients into two steps and comparing them in many aspects, the study mainly obtained two inspirations: microglioma resection has good effect, and humanized nursing mode has good effect on postoperative recovery. Finally, some Suggestions and principles for microglioma resection were put forward: the principle of timely operation after diagnosis, the principle of complete resection for nonfunctional areas, the principle of protection for important functional areas, and the principle of recovery plan confirmed by disease examination after surgery. In addition, in terms of the influence of humanized nursing mode on the treatment of glioma under the microscope, the data statistics and SPSS tests show that humanized nursing mode can effectively improve the satisfaction of patients and their families. Relieve anxiety and depression and help patients recover; Lower scores in pain rating statistics, etc. In addition, this experiment has a good basis for development, and all the 64 patients successfully completed the operation without serious complications, which further verified the above conclusions, namely, the maturity and reliability of the technique of microscopic tumor resection for glioma. The technique of tumor resection under microscope can be used in combination with humanized nursing mode, which has good promotion value.

Complete Response to Chemotherapy in Intra-Abdominal Desmoplastic Small round Cell Carcinoma. A Case Report

1998 ◽  
Vol 84 (3) ◽  
pp. 412-416 ◽  
Author(s):  
Mario De Lena ◽  
Maria Lucia Caruso ◽  
Franco Marzullo ◽  
Sergio Mancarella ◽  
Raffaele Armentano ◽  
...  
Keyword(s):  
Good Health ◽  
Complete Response ◽  
Complete Disappearance ◽  
Round Cell ◽  
Small Round Cell ◽  
Response To Chemotherapy ◽  
Lower Abdominal Quadrant ◽  
Antineoplastic Treatment ◽  
Multiagent Chemotherapy ◽  
The Right

Aims and background The authors report the case of a 23-year-old woman affected by intra-abdominal desmoplastic small round cell tumor (DSRCT) who obtained a complete response to multiagent chemotherapy. DSRCT is a rare, highly aggressive neoplasm generally arising in young people and seldom in females (about 20 cases described in the literature). Methods The patient underwent surgical resection of a large 15 × 15 cm mass located in the right lower abdominal quadrant, but after only 2 months later, two liver metastasis were noted. Thus, she was subjected to an aggressive antineoplastic treatment consisting of three groups of alternating non-cross resistant multiagent regimens administered every 21 days (cis-platin-etoposide-adriamycin-bleomicin; gemcitabine-ifosfamide-dacarbazine; methotrexate-5-fluorouracilfolinic acid) for a total of 9 administrations. Results After one cycle of treatment including the administration of all the three alternated schemes of chemotherapy, a complete disappearance of liver disease was noted. The treatment was relatively well-tolerated and the toxicity was acceptable. At present, after 15 months from diagnosis and 12 months after starting chemotherapy, the patient is disease-free and in good health. Conclusions Even though this study regards only a single patient, it is noteworthy because of the rarity of this neoplasm and because of the infrequent complete responses reported in the literature. The efficacy and manageability of the treatment, suggests that both the timing and schedule used could constitute an important therapeutical option for this aggressive and poorly chemo-responsive tumor.

Changes in the Antenatal Utilization of High-Risk Obstetric Services and Stillbirth Rate during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Megan C. Oakes ◽  
Fan Zhang ◽  
Lori Stevenson ◽  
Bree Porcelli ◽  
Ebony B. Carter ◽  
...  
Keyword(s):  
High Risk ◽  
Study Design ◽  
Linear Models ◽  
Care Center ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Primary Objective ◽  
Stillbirth Rate ◽  
Obstetric Services

Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points

Clinicopathological characteristics and impact on efficacy of three versus six months of adjuvant chemotherapy in early-onset colon cancer: ACHIEVE and ACHIEVE-2 trials.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 60-60
Author(s):  
Eiji Oki ◽  
Masahito Kotaka ◽  
Dai Manaka ◽  
Manabu Shiozawa ◽  
Yasuhiro Sakamoto ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Early Onset ◽  
Lung Metastases ◽  
Age Groups ◽  
Disease Free Survival ◽  
Clinicopathological Characteristics ◽  
Related Data ◽  
Incidence And Mortality

60 Background: Colorectal cancer (CRC) incidence and mortality have decreased since the 1970s but several data such as the SEER CRC registry show that the incidence of early onset colon cancer (eoCC, age 20-49) and RC keep increasing. There is limited results suggesting eoCC may have different behaviors compared to traditional CC (tCC, age ≥ 50). Methods: Individual patient data of 1,805 high-risk stage II/III colon cancer (CC) patients (pts) as the modified ITT population in ACHIEVE and ACHIEVE-2 trials were investigated. Clinicopathological features and treatment-related data were assessed by age group. Disease-free survival (DFS) was assessed by Kaplan-Meier curves and Cox multivariable models adjusted by trials, regimen, T and N. Results: Of the 1,805 pts, eoCC were 155 pts (8.6%). Using 5% difference between age groups as clinically meaningful cutoff, eoCC had similar gender (female, 52 vs 48%), PS (PS = 1, 1 vs 4%), risk group (high-risk, 43 vs 42%) and T stage (T4, 30 vs 30%) as tCC, while eoCC were less likely right-sided colon primary (32 vs 39%), had N1 disease (48 vs 54%), and treated by FOLFOX (16 vs 23%). Overall, eoCC significantly had a worse DFS than tCC (3y-DFS, 75 vs 82%; Adjusted Hazard Ratio = 1.40: 95% Confidence Interval, 1.00-1.95: p= 0.0478); in addition, similar DFS were observed among tCC pts (age 50-69 vs >70). eoCC experienced less neutropenia, thrombocytopenia and stomatitis, but had more diarrhea, nausea and/or vomiting. There were 38 and 297 pts with an initial relapse in eoCC and tCC, respectively. Of those, peritoneal metastases were more frequently seen in eoCC (n = 13, 34%) than in tCC (n = 63, 21%) (p = 0.097), whereas liver and lung metastases were similar between the two groups. Impact on DFS of 3 versus 6 months of adjuvant chemotherapy in eoCC (3y-DFS, 75% vs 76%) is similar to that in tCC (83% vs 81%). Conclusions: eoCC had unique characteristics; the difference in DFS between eoCC and tCC were potentially due to a different metastatic spread. eoCC had a different adverse event profile compared to tCC. No impact on DFS of treatment duration in eoCC was suggested. Clinical trial information: UMIN000013036.

scholarly journals Irreversible Electroporation as a Bridge to Liver Transplantation

2019 ◽  
Vol 85 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Robert M. Cannon ◽  
David N. Bolus ◽  
Jared A. White
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Length Of Stay ◽  
Portal Vein ◽  
Irreversible Electroporation ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Bridge To Transplantation ◽  
Adjacent Structures ◽  
Hepatic Vasculature

Hepatocellular carcinoma (HCC) in proximity to major hepatic vasculature poses a risk for invasion, which would contraindicate liver transplantation, yet, is difficult to treat with thermal ablation. This study was undertaken to evaluate the feasibility of irreversible electroporation (IRE) as a bridge to transplantation for high-risk tumors. All patients with HCC in proximity to major hepatic vasculature treated with laparoscopic IRE as bridge to transplantation were studied. Patient and tumor characteristics, length of stay, and treatment-related complications were recorded. Tumor response was assessed with CT and explant pathology. Five patients with a median Model for End Stage Liver Disease (MELD) of 13 (7–21) underwent IRE. The median tumor size was 2.7 cm (1.5–3.7 cm). Adjacent structures included the right portal vein, hepatic veins/inferior vena cava (IVC) and left portal vein. Length of stay was one day for all patients. One patient suffered portal vein thrombosis. The transplant occurred at a median of 142 days (47–264) after IRE. Pathologic necrosis ranged from 30 to 100 per cent, without any vascular invasion. Four patients remain alive with no evidence of disease with median follow-up of 403 (227–623) days. The remaining patients died because of transplant-related complications onpost IRE day 297. IRE shows promise as a bridge to liver transplant for high risk HCC in a preliminary series, justifying further prospective evaluation.

scholarly journals Influence of Surgical Excision on the Survival of Patients With Stage 4 High-Risk Neuroblastoma: A Report From the HR-NBL1/SIOPEN Study

2020 ◽  
Vol 38 (25) ◽  
pp. 2902-2915 ◽  
Author(s):  
Keith Holmes ◽  
Ulrike Pötschger ◽  
Andrew D. J. Pearson ◽  
Sabine Sarnacki ◽  
Giovanni Cecchetto ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Observation Time ◽  
Mycn Amplification ◽  
High Dose ◽  
Local Progression ◽  
Stage 4 ◽  
Operative Complications ◽  
The Impact

PURPOSE To evaluate the impact of surgeon-assessed extent of primary tumor resection on local progression and survival in patients in the International Society of Pediatric Oncology Europe Neuroblastoma Group High-Risk Neuroblastoma 1 trial. PATIENTS AND METHODS Patients recruited between 2002 and 2015 with stage 4 disease > 1 year or stage 4/4S with MYCN amplification < 1 year who had completed induction without progression, achieved response criteria for high-dose therapy (HDT), and had no resection before induction were included. Data were collected on the extent of primary tumor excision, severe operative complications, and outcome. RESULTS A total of 1,531 patients were included (median observation time, 6.1 years). Surgeon-assessed extent of resection included complete macroscopic excision (CME) in 1,172 patients (77%) and incomplete macroscopic resection (IME) in 359 (23%). Surgical mortality was 7 (0.46%) of 1,531. Severe operative complications occurred in 142 patients (9.7%), and nephrectomy was performed in 124 (8.8%). Five-year event-free survival (EFS) ± SE (0.40 ± 0.01) and overall survival (OS; 0.45 ± 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 ± 0.03; 5-year OS, 0.37 ± 0.03; P < .001 and P = .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 ± 0.01) compared with IME (0.30 ± 0.02; P < .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 ± 0.02 v 0.39 ± 0.04; P = .038); CILP was 0.14 ± 0.01 after CME and 0.27 ± 0.03 after IME ( P < .002). A hazard ratio of 1.3 for EFS associated with IME compared with CME was observed before and after the introduction of immunotherapy ( P = .030 and P = .038). CONCLUSION In patients with stage 4 high-risk neuroblastoma who have responded to induction therapy, CME of the primary tumor is associated with improved survival and local control after HDT, local radiotherapy (21 Gy), and immunotherapy.

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