Gallbladder cancer: The forgotten medical oncologist.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 354-354
Author(s):  
M. Teo ◽  
M. O'Keeffe ◽  
E. Moylan ◽  
S. O'Reilly ◽  
B. R. Bird ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Adjuvant Treatment ◽  
Medical Oncology ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Patient Demographics ◽  
Cancer Registry Data ◽  
Stage Disease ◽  
Relapsed Disease

354 Background: Gallbladder cancer (GBC) is rare, is often diagnosed at an advanced stage, and survival >1 yr is uncommon. Recent randomized trials have demonstrated improved survival with well-tolerated chemotherapies. In this light, we retrospectively reviewed referral patterns to medical oncology services in our region. Methods: Prospectively maintained departmental databases from three hospitals serving 480,000 people were reviewed. Patient demographics, disease and treatment details, and outcomes were analyzed. Regional figures were obtained from National Cancer Registry data. Results: Between March 2003 and September 2010, 17 GBCs were referred to medical oncology, representing 25.5% of total GBC diagnosed in the region (Table). Median age at diagnosis was 63.6 years (range 47.0–72.5) and 65% (n=11) were female. The majority (n=13) initially presented with metastatic or locally advanced disease and 6 of these patients underwent cholecystectomy. Of those with early-stage disease, 2 patients were referred with relapsed disease and 2 were referred for adjuvant treatment. Sites of involvement were liver (10), lymph nodes (3), peritoneum (3), duodenum (2), gallbladder bed (1), and pancreas (1). No extra-abdominal metastases were noted. All patients were scheduled for chemotherapy, but 3 were not treated due to worsening performance score. Of the 14 patients who received chemotherapy, 7 received gemcitabine, 5 received 5FU and 2 received cisplatin/gemcitabine. Median duration of chemotherapy was 3.8 months (range 0.7–8.1) and 3 patients (21%) received second-line chemotherapy. 13 patients (76.5%) had died at the time of analysis. Median follow-up was 6.7 months (range 1.7-73.9) and median overall survival was 6 months. Conclusions: A minority of patients with GBC were referred to medical oncology. Given the emergence of level 1 evidence reporting a survival benefit with well-tolerated combination chemotherapy and the potential for adjuvant treatment, higher referral rates may lead to improved outcome. [Table: see text] No significant financial relationships to disclose.

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 406-413 ◽  
Author(s):  
Michelle Fanale
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

Human papillomavirus, radiation dose and survival of patients with anal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
Rafi Kabarriti ◽  
Patrik Brodin ◽  
Nitin Ohri ◽  
Rahul Narang ◽  
Renee Huang ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Advanced Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Locally Advanced Disease ◽  
Stage Disease ◽  
Hpv Status

e15071 Background: To determine if anal cancer patients with HPV positive disease have different overall survival (OS) compared to those with HPV negative disease, and to elucidate differences in the association between radiation dose and OS. Methods: We utilized the National Cancer Database (NCDB) registry to identify a cohort of non-metastatic anal cancer patients treated with curative intent between 2008 – 2015. Propensity score matching was used to account for potential selection bias between patients with HPV positive and negative disease. Multivariable Cox regression was used to determine the association between HPV status and OS. Kaplan-Meier methods were used to compare actuarial survival estimates. Results: We identified 5,927 patients with tumor HPV status for this analysis, 3,523 (59.4%) had HPV positive disease and 2,404 (40.6%) had HPV negative disease. Propensity-matched analysis demonstrated that patients with HPV positive locally advanced (T3-4 or node positive) anal cancer had better OS (HR=0.81 (95%CI: 0.68-0.96), p=0.018). For patients with early stage disease (T1-2 and node negative) there was no difference in OS (HR=1.11 (95%CI:0.86-1.43), p=0.43). In the unmatched cohort, there was an increase in 3-year OS for patients with HPV positive tumors or early stage disease up to 45-49.9 Gy (p<0.001), whereas for patients with HPV negative and locally advanced disease there was an increase in survival from 46% at 30-44.9 Gy, to 64% at 45-49.9 Gy (p=0.093) and further to 71% at 50-54.9 Gy (p=0.005). Conclusions: We found HPV to be a significant prognostic marker in anal tumors, especially for locally advanced disease. We further found that higher radiation dose up to 50-55 Gy was associated with better OS, mainly for locally advanced disease in HPV negative patients. Multivariable Cox proportional hazards regression for OS. [Table: see text]

scholarly journals Institutional experience of the multimodality treatment of cancer tongue

2017 ◽  
Vol 4 (6) ◽  
pp. 1896
Author(s):  
Mrinal Shankar ◽  
Manisa Pattanayak ◽  
Vipul Nautiyal ◽  
Sunil Saini
Keyword(s):  
Early Stage ◽  
Locally Advanced ◽  
Early Recurrence ◽  
Prognostic Indicators ◽  
Medical Sciences ◽  
Early Stage Disease ◽  
Aggressive Approach ◽  
Stage Disease ◽  
Definitive Surgery ◽  
Multimodality Approach

Background: Cancer (Ca) tongue incidence has shown a rising trend in India in the last couple of years. Increasing use of tobacco being the main risk factor. Guidelines available for management of this disease include it broadly under oral cavity cancers. However, the biological behaviour of this disease is warrant of more aggressive approach to treatment. In early stage disease, treatment is mainly with single modality, surgery being the most preferred. Locally advanced disease treated with multimodality approach with surgery and adjuvant RT/chemoRT. Adverse histopathological factors are important prognostic indicators for early recurrence. Even if the mainstay of treatment in metastatic disease is palliation, multimodality approach is preferred. The aim of the study is to study clinical profile of Ca tongue ant to study outcome of multimodality management of SCC tongue and identification of treatment failure.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months on patients attending Surgical Oncology OPD. Written informed consent and ethical committee clearance was obtained in all 64 cases included, and study type is observational.Results: This is an observational study conducted at Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months. 64 patients diagnosed with SCC tongue were included. Treatment protocols were prescribed by the multidisciplinary tumour board, and patients were followed up to 6 months after completion of the planned treatment. 68.75% patients were below 55 years of age. 87.5% were chronic tobacco chewers. 79.68% had lesion in the anterior tongue. 84.37% received treatment with curative intent (of these 16.66% patients showed early recurrence). 71.86% patients underwent definitive surgery (of these 78.26% remained disease free after 6 months of completion of treatment). Radiotherapy was used in both adjuvant and primary setting. Nodal recurrence was the commonest pattern of recurrence in patients who had underwent definitive surgery. Co-relation with adverse histopathological prognostic indicators also establish early recurrence.Conclusions: Ca tongue was found to be commoner in individuals between 36-55 years. Tobacco users were seen to be at high risk. Surgery was the preferred modality of treatment in early stage disease. Regional lymph node metastasis is the commonest site of early treatment failure. Adverse histopathological factors were important indicators of prognosis and need consideration in planning adjuvant treatment.

scholarly journals Spilled gallstones during laparoscopic cholecystectomy

2014 ◽  
Vol 96 (5) ◽  
pp. e18-e20 ◽  
Author(s):  
J Ahmad ◽  
AIW Mayne ◽  
Y Zen ◽  
MB Loughrey ◽  
P Kelly ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Cancer ◽  
Histological Examination ◽  
Early Stage ◽  
Recurrent Pain ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Symptomatic Gallstones ◽  
Incidental Gallbladder Cancer

Introduction Incidental gallbladder cancer is found in 0.6–2.1% of patients undergoing laparoscopic cholecystectomy for symptomatic gallstones. Patients with Tis or T1a tumours generally undergo no further intervention. However, spilled stones during surgery may have catastrophic consequences. We present a case and suggest aggressive management in patients with incidental gallbladder cancer who had spilled gallstones at surgery. Case History A 37-year-old woman underwent a laparoscopic cholecystectomy for symptomatic gallstones, during which some stones were spilled into the peritoneal cavity. Subsequent histological examination confirmed incidental pT1a gallbladder cancer. Hepatopancreatobiliary multidisciplinary team discussion agreed on regular six-monthly follow-up. The patient developed recurrent pain two years after surgery. Computed tomography revealed a lesion in segment 6 of the liver. At laparotomy, multiple tumour embedded gallstones were found on the diaphragm. Histological examination showed features (akin to the original pathology) consistent with a metastatic gallbladder tumour. Conclusions This case highlights the potential for recurrence of early stage disease resulting from implantation of dysplastic or malignant cells carried through spilled gallstones. It is therefore important to know if stones were spilled during original surgery in patients with incidental gallbladder cancer following a laparoscopic cholecystectomy. Aggressive and early surgical management should be considered for these patients.

scholarly journals The role of perioperative radiotherapy in gastric cancer

2012 ◽  
Vol 6 (2) ◽  
pp. 23 ◽  
Author(s):  
Thales Paulo Batista ◽  
Lucas Marque De Mendonça ◽  
Ana Luiza Fassizoli-Fonte
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Locally Advanced Tumors ◽  
Related Mortality

Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

Cisplatin-Based Chemotherapy Is Associated with An Unacceptably High Incidence of Thromboembolic Events: A Large Retrospective Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 456-456 ◽  
Author(s):  
Russell A. Moore ◽  
Nelly G. Adel ◽  
Manisha Bhutani ◽  
Nour Elise Tabbara ◽  
Heather Landau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Retrospective Analysis ◽  
Early Stage ◽  
Locally Advanced ◽  
Primary Cancer ◽  
Thromboembolic Events ◽  
Early Stage Disease ◽  
Stage Disease ◽  
High Incidence ◽  
Extent Of Disease

Abstract Abstract 456 Introduction: Cancer is a well established risk factor for the development of venous and arterial thromboembolic events (TEEs), including deep venous thrombosis, pulmonary embolus, cerebrovascular accident, and unstable angina/myocardial infarction. In addition to cancer itself, cytotoxic chemotherapy has been shown to potentiate the risk of TEEs. Among chemotherapeutic agents, cisplatin may be associated with a particularly high incidence of TEEs as suggested by few small series. The objective of this study was to determine the incidence of TEEs in patients treated with cisplatin based chemotherapy. Patients and Methods: We performed a large retrospective analysis of all patients treated at MSKCC for a variety of malignancies with cisplatin-based chemotherapy in 2008. Patients were included if they were at least 18 years of age, had received their first dose of their planned chemotherapy regimen between January 1, 2008 and December 31, 2008, and had at least 4 weeks of follow-up since the last dose of cisplatin. Patients were identified using the pharmacy information system. The diagnosis of TEE was based on documentation provided by angiography, magnetic resonance imaging, computed tomography, venous Doppler ultrasound, ventilation/perfusion scan, as well as clinical and laboratory documentation of myocardial infarction by EKG/troponin as per the patients' electronic medical record. A TEE was considered cisplatin-associated if it occurred between the time of the first dose of cisplatin administration and 4 weeks after the last dose. Results: Overall, 1,098 patients received at least one dose of cisplatin in 2008, of whom 936 met the inclusion criteria. The underlying cancer diagnoses included lung (21.7%), head and neck (10%), gastric (8.2%), pancreatic (8.1%), and melanoma (7.3%). The extent of disease at the time of cisplatin administration included metastatic disease (46.7%), locally advanced disease (43.6%) and early stage disease (7%). Among the 936 patients, 171 (18.3%) experienced a TEE during cisplatin administration or within 4 weeks of the last dose. TEEs occurred within 90 days of initiation of treatment in 146 out of 171 (85.4%) patients. The thrombotic events included a DVT in 86 patients (50.3%); PE in 45 patients (26.3%); a DVT and a PE in 22 patients (12.9%); an arterial TEE (CVA, MI, or distal arterial thrombosis) in 13 patients (7.6%); or DVT and an arterial TEE in 5 patients (2.9%). The incidence of TEEs varied according to the underlying primary cancer diagnosis with a TEE occurring in 38.2% of patients with pancreatic cancer, 31.2% with gastric cancer, 25% with gastroesophageal junction cancer, 20.7% with ovarian cancer, and 18.9% with germ cell cancer. The incidence of TEEs also varied according to extent of disease with TEEs most frequently seen in patients with metastatic disease (97 patients, 22.2%) compared to locally advanced (60 patients, 14.7%) or early stage disease (11 patients, 16.7%). Likewise, the incidence of TEE varied according to the type of cisplatin based chemotherapeutic combinations with TEE occurring in 27.3% for gemcitabine-containing regimens; in 26.4% for docetaxel-containing regimens; in 24.6% for bevacizumab-containing regimens; in 19.5% for irinotecan-containing regimens; and in 14.1% for vinblastine-containing regimen. Of note, a TEE occurred in 11 out of 16 patients receiving cisplatin plus docetaxel plus 5-FU/leucovorin plus bevacizumab. Conclusions: This large retrospective analysis confirms the unacceptable high incidence of TEEs in patients receiving cisplatin based chemotherapy, which is 18.3% across all underlying primary cancers. As one would expect, the incidence of TEE varied according to primary cancer, extent of disease, and chemotherapeutic regimens. It is likely that the incidences reported in this retrospective analysis represent an under-estimate of the real incidence of TEEs since some patients with TEE may have been missed because of lack of adequate documentation. It is important to highlight that the majority of events occurred within 90 days of the first dose of cisplatin. This study suggests that TEE prophylaxis may be advisable for patients receiving cisplatin-based chemotherapy. A prospective study is currently in progress. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Time, Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 76s-76s
Author(s):  
N. Ballari ◽  
R. Miriyala ◽  
T. Jindia ◽  
S. Gedela ◽  
L. Annam ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Early Stage ◽  
Private Insurance ◽  
Locally Advanced ◽  
Cancer Center ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Time Distance

Background: There is a geographical, socioeconomical and logistic diversity among the cancer patients who reach a regional cancer center. In a developing economy like that of India's, only a minority of patients have medical insurance. So in our setup a cancer patient is met with time, distance and financial challenges. These intangible factors theoretically are expected to influence the ultimate outcome of cancer treatment. Aim: To evaluate the prevailing demographic and economic variables of cancer patients visiting our RCC and to look for any correlation among each other. Methods: The demographic details of cancer patients registered at our RCC between August 2017- September 2017 were retrieved retrospectively. Distance traveled to get to the RCC and get a diagnosis of cancer, time taken for diagnosis and initiation of treatment, and the source of finances for treatment were collected. A correlation among these factors was attempted to be identified. Statistical correlation was identified using Student t-test. Results: Among 591 patients who were analyzed, the median age of patient was 55 years old. The median time taken for the patient to reach the RCC from permanent residence after the beginning of cancer related complaints was 3.19 months. The median distance traveled for the same was 131 km. The source of income was private employment for 223 patients and government employment for 164 patients and self-employment for 200 patients. Only 164 patients had some kind of structured health scheme to manage their health care expenses. Among these, 96 patients had private insurance/reimbursement and 64 patients had government reimbursement. 384 (64%) of patients presented with advanced and locally advanced stage disease while 114 (19%) patients presented to us with early stage disease. However a correlation between delay in presentation to the RCC, distance traveled to reach the RCC, source of income and advanced stage of disease couldn't not be established. Conclusion: Majority of patients visiting our RCC is from far off places and most of these patients pay for the cancer treatment themselves without any support from government or private insurances. All these factors may be responsible for late or advanced stage presentation of cancer patients.

scholarly journals Clinical outcomes and impact of prognostic factors following adjuvant radiotherapy in oral tongue cancer patients

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Sidharth Pant ◽  
Punita Lal ◽  
Shagun Misra ◽  
Piyush Gupta ◽  
K. J. Maria Das ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cancer Patients ◽  
Advanced Disease ◽  
Tongue Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Oral Tongue ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Oral Tongue Cancer

Abstract Background The purpose of the study was to evaluate survival outcomes in post-operative oral tongue cancer patients undergoing adjuvant radiotherapy (RT) at a tertiary cancer care center and to critically review the impact of various clinical-pathological factors on recurrence and survival. Demographic factors, stage of all the histology proven oral tongue cancer, and treatment details were documented. Overall survival (OS) and recurrence-free survival (RFS) were analyzed along with the potential prognostic factors affecting outcome. Results One hundred forty-four post-operative oral tongue cancer patients referred to our department for adjuvant treatment were evaluated. Median age at presentation was 45 years. Forty-seven patients had pathological early stage disease (stages I and II) and 95 had locally advanced (stages III and IV) disease while post-op details were not present in 2 patients. At a median follow-up of 87 months (60–124) of alive patients, the median RFS for entire cohort was 62 months while median OS was 74 months respectively. Age, perineural invasion (PNI), and grade of the tumor emerged as independent prognostic factors for OS and RFS. Among patients with early stage disease, depth of invasion (DOI), age, and PNI were found as independent prognostic factors for RFS and OS. In locally advanced disease, higher grade, age, and PNI independently impacted the respective survival end points. Conclusions Age (> 45 years), higher grade, and presence of PNI showed inferior survival outcomes across the sub-groups (early versus locally advanced disease). This may warrant adjuvant treatment intensification. DOI > 10 mm was particularly found to worsen survival in early node negative SCC oral tongue patients.

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