Intraarterial high-dose cisplatinum (IAHDP) as a part of the treatment of relapsed or locally advanced tumors of the head and neck (H&N): A feasibility study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16000-e16000
Author(s):  
Manuel Sureda Gonzalez ◽  
Antonio Moreno ◽  
Joseba Rebollo ◽  
A. Brugarolas ◽  
Rosa Cañon ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Locally Advanced ◽  
Unknown Origin ◽  
Response Duration ◽  
Complete Response ◽  
Primary Treatment ◽  
High Dose ◽  
Locally Advanced Tumors ◽  
Adenocarcinoma Of Unknown Origin ◽  
Advanced Tumors

e16000 Background: IAHDP has been employed as a part of the treatment of relapsed or locally advanced H&N tumors with controversial results (RADPLAT protocol). We hypothesize that patients (pts) with relapsed or locally advanced tumors in several locations can be treated with IAHDP, in order to achieve a response, to be followed by a consolidation with radiotherapy, surgery or both. Methods: Pts with relapsed or locally advanced tumors of the H&N were treated with IAHDP (150 mg/m2/wk), after an initial supraselective angiography performed with the goal of mapping adequately the arterial supply. Prevention of toxicity with hyperhydration and simultaneous and delayed thiosulfate was done according to the previous schema of the RADPLAT protocol. Results: From June 2007 to September 2011, 11 patients – 8 M/ 3F; age 37-77 y, median 56 y- were treated (10 H&N epidermoid carcinomas, 1 orbitary mts of adenocarcinoma of unknown origin). A total of 50 cycles were administered (2-9 per pt, median 4). In 4 pts IAHDP was part of the primary treatment; 7 pts were treated in relapse. Three pts were retreated after relapse, one of them two times. Five pts received radiotherapy simultaneously with IAHDP. Toxicity was generally mild and reversible. Mucositis g4 was observed in 3 cycles, facial edema requiring extra dexametasone in 7, pain during infusion in 9, nausea and vomiting in 3, lasting ipsilateral hypoacusia in 1, persistent trismus in 1. No significant alterations of renal function were observed. One pt progressed after the first cycle; 7 pts presented partial response (duration 1-6 m, median 2 m; 2 of them were converted to a complete response with surgery); 2 pts presented complete response with IAHDP simultaneous to radiotherapy. Four pts remained with no evidence of disease at 3+, 15+, 16+ and 38+ m respectively. Conclusions: IAHDP constitutes a feasible and promising therapeutic option for selected pts and a consolidation with surgery and/or radiotherapy after IAHDP is possible. Further development of this approach is warranted.

Radio-Chemotherapy of Vulvar Cancer

1998 ◽  
Vol 84 (2) ◽  
pp. 250-251 ◽  
Author(s):  
Roberto Zucali ◽  
Francesco Raspagliesi ◽  
Rado Kenda ◽  
Laura Lozza ◽  
Silvia Tana ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Pathological Examination ◽  
Locally Advanced Tumors ◽  
Cure Rates ◽  
Radio Chemotherapy ◽  
Advanced Tumors

Surgery alone, more or less demolitive, is the treatment of choice of vulvar cancers. Cure rates are high for early cancers only, while locally advanced tumors with or without inguinal adenopathies and recurrences have a bad prognosis. The excellent results of concurrent chemo-radiotherapy of anal cancers suggested to adopt the same approach for locally advanced vulvar cancers. The shrinkage of the tumor allowed surgery, often less demolitive than usual, and the pathological examination demonstrated an overall complete response in 40% of cases. Survival has been improved through this multidisciplinary approach. Patients not suitable for surgery obtained important remissions and an improved quality of life. Clinical experience at the Istituto Tumori of Milano is presented.

scholarly journals Squamous cell carcinoma of the rectum: Practice trends and patient survival.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 625-625
Author(s):  
Sunil W Dutta ◽  
Clayton E Alonso ◽  
Mark Raymond Waddle ◽  
Shiv R. Khandelwal ◽  
Einsley-Marie Janowski ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Neoadjuvant Therapy ◽  
Squamous Cell ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Locally Advanced Tumors ◽  
Advanced Tumors

625 Background: Leverage the National Cancer Database (NCDB) to evaluate trends in management of squamous cell cancer (SCC) of the rectum and their effect on survival for this uncommon tumor. Methods: Data was obtained from the NCDB for patients diagnosed with SCC of the rectum between 2004 and 2014, including cT1-4, cN0-2, cM0 (cohort A, n = 2,296) tumors. A subgroup analysis was performed on locally advanced tumors (cT1-T2, N+ or cT3, N any, subcohort B, n = 883), treated with chemoradiation (n = 706) or trimodality therapy (n = 177) including chemotherapy, radiation, and surgery. Pathological complete response rate following neoadjuvant therapy was obtained. Univariate and multivariate logistic regression analyses were performed to generate hazard ratios (HR) investigating factors associated with overall survival. Kaplan-Meier (K-M) method was used to estimate overall surviving proportion at 5 and 10 years. Results: The median age was 60 years with a strong female predilection (71% female). Among patients treated with neoadjuvant therapy, 36% achieved a complete pathological response at a median interval of 67 days from completion of radiation therapy to surgery. The K-M estimated 5 and 10 year overall survival for stage I disease was 71.3% and 57.8%, respectively; stage II disease was 57.0% and 38.9%, respectively; stage III disease was 57.8% and 41.5%, respectively. On multivariate analysis, increased age, male gender, more co-morbidities, and higher cT category ( P < 0.001 for each) resulted in worse survival. For locally advanced tumors (subcohort B), there was no difference in survival between chemoradiation alone compared to trimodality therapy ( P = 0.909 on multivariate analysis). Conclusions: Most providers manage locally advanced SCC of the rectum similar to anal cancer, which results in equivalent overall survival and spares patients from the additional morbidity associated with surgical resection. [Table: see text]

Hyperfractionated-Accelerated Radiotherapy Followed by Radical Surgery in Locally Advanced Tumors of the Oral Cavity

2006 ◽  
Vol 182 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Ulrike Hoeller ◽  
Iris Biertz ◽  
Sebastian Flinzberg ◽  
Silke Tribius ◽  
Reiner Schmelzle ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Accelerated Radiotherapy ◽  
Locally Advanced Tumors ◽  
Advanced Tumors

scholarly journals Antiemetic Prophylaxis for Chemoradiotherapy-induced Nausea and Vomiting (C-RINV) in Locally Advanced Head and Heck Squamous Cell Carcinoma: a Prospective Phase Ⅱ Trial

2021 ◽  
Author(s):  
Zekun Wang ◽  
Wenyang Liu ◽  
Jianghu Zhang ◽  
Xuesong Chen ◽  
Jingbo Wang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Complete Response ◽  
High Dose ◽  
Advanced Head ◽  
Free Response ◽  
Nausea And Emesis

Abstract Background There is sparse research reporting effective interventions for preventing nausea and emesis caused by concurrent chemoradiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This phase Ⅱ trial was conducted to provide the direct evidence for the current practice of prescribing antiemetic in patients with LA-HNSCC receiving CCRT.Methods Treatment-naïve LA-HNSCC patients received intensity-modulated radiotherapy with concomitant cisplatin 100 mg/m² every 3 weeks for two cycles. All patients were given orally aprepitant 125 mg once on d1, then 80mg once on d2-5; ondansetron 8 mg once on d1; and dexamethasone 12 mg once on d1, then 8mg on d2-5. The primary endpoint was complete response (CR). Pursuant to δ=0.2 and α=0.05, the expected CR rate was 80%. Results A total of 43 patients with LA-HNSCC were enrolled. The median age was 53 years old, and 86.0% were male. All patients received radiotherapy and 86.0% of patients completed both cycles as planned. The overall CR rate was 86.0% (95% CI: 72.1-94.7). The CR rates for cycles 1 and 2 were 88.4% (95% CI: 74.9-96.1) and 89.2% (95% CI: 74.6-97.0). The complete protection rate in the overall phase was 72.1% (95% CI: 56.3-84.7). The emesis-free response and nausea-free response in overall phase were 88.4% (95% CI: 74.9-96.1) and 60.5% (95% CI: 44.4-75.0), respectively. The adverse events related to antiemetics were constipation (65.1%) and hiccups (16.3%), but both were grade 1-2. There was no grade 4 or 5 treatment-related adverse event with antiemetic usage. Conclusion The addition of aprepitant into ondansetron and dexamethasone provided effective protection from nausea and emesis in patients with LA-HNSCC receiving radiotherapy and concomitant high-dose cisplatin chemotherapy. Randomised phase 3 studies are required to further define the potential role of NK1RA in chemoradiotherapy setting.Trial registration: ClinicalTrials.gov, number NCT03572829. Registered 28 June 2018, https://clinicaltrials.gov/ct2/show/NCT03572829?term=NCT03572829&draw=2&rank=1.

scholarly journals Mystery of neck lump: an uncommon presentation of urachal cancer

2019 ◽  
Vol 12 (8) ◽  
pp. e230215 ◽  
Author(s):  
Kamal Kant Sahu ◽  
Deepali Pandey ◽  
Ajay Kumar Mishra ◽  
James O’Shea ◽  
Yayan Chen ◽  
...  
Keyword(s):  
Bladder Tumour ◽  
Cervical Lymphadenopathy ◽  
Unknown Origin ◽  
Excisional Biopsy ◽  
Signet Ring Cell ◽  
High Dose ◽  
Uncommon Presentation ◽  
Signet Ring ◽  
Urachal Cancer ◽  
Adenocarcinoma Of Unknown Origin

We present the case of a 55-year-old male patient who presented with palpable cervical lymphadenopathy. Excisional biopsy showed metastatic adenocarcinoma of unknown origin. Imaging showed a bladder mass following which he underwent transurethral resection of bladder tumour. Histopathological evaluation of mass confirmed a poorly differentiated adenocarcinoma with signet-ring cell features. Immunohistochemistry was suggestive of metastatic urachal cancer. He agreed for enrollment in a clinical trial, however soon after 1st cycle, he developed immune pneumonitis requiring high dose steroids. On follow-up, MRI brain was done for evaluation of headache which showed metastatic intracranial disease. He completed radiotherapy following which he was started on FOLFOX chemo regimen (folinic acid, 5-fluorouracil and oxaliplatin).

Adults with Acute Lymphoblastic Leukemia and T(1;19) Abnormality Have a Favorable Outcome with Hyper-CVAD Chemotherapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3955-3955
Author(s):  
Ravin Jain Garg ◽  
Hagop M Kantarjian ◽  
D. A Thomas ◽  
Stefan Faderl ◽  
Farhad Ravandi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Response Duration ◽  
Complete Response ◽  
Cancer Center ◽  
P Value ◽  
Small Subset ◽  
High Dose ◽  
Cytogenetic Abnormalities

Abstract Among the well-described cytogenetic abnormalities in adults with acute lymphoblastic leukemia (ALL), a translocation involving chromosomes 1 and 19 [t(1;19) (q23;p13)] occurs in a small subset but has varyingly been associated with a good or bad prognosis in different studies. Adults with ALL and t(1;19) treated at M.D. Anderson Cancer Center were reviewed. Their clinical features and outcome were compared to those with other cytogenetic abnormalities. Endpoints included complete remission rate (CR), complete response duration (CRD) and overall survival (OS). Of 411 adults with pre-BALL, 12 patients had t(1;19). Ten of the 12 patients with t(1;19) received Hyper-CVAD (Cyclophosphamide, Vincristine, Adriamycin, Dexamethasone alternating with Methotrexate and high-dose Cytarabine); the other 2 were treated with VAD (Vincristine, Adriamycin, Dexamethasone). All 12 patients achieved CR; the 3-year survival rate was 73%. Patients with t(1;19) had significantly better CRD and OS when compared to all other patients combined as well as individually to patients with Ph+, t(4;11), and lymphoma-like abnormalities [6q(−), 14q+, t(11;14), t(14;18)]. Adults with ALL and t(1;19) have an excellent prognosis when treated with the Hyper-CVAD regimen. Outcome of patients by cytogenetic group: t(1;19) vs. individual cytogenetic groups OVERALL SURVIVAL N Fail 3-Year % Median (weeks) P-value T(1,19) 12 3 73 Not recorded Diploid 138 72 52 179 0.09 Lymphoma-like 20 17 35 54 0.008 Ph+ 117 88 23 68 0.0002 Miscellaneous 112 56 56 236 0.17 T(4,11) 12 10 0 58 0.002 COMPLETE RESPONSE DURATION (CRD) N Fail 3-Year % Median (weeks) P-value T(1,19) 12 2 80 Not recorded Diploid 133 59 54 177 0.06 Lymphoma-like 16 13 34 89 0.009 Ph+ 102 52 42 63 0.006 Miscellaneous 100 41 59 401 0.16 T(4,11) 11 7 NR 45 0.018

Long-Term Disease Control in Patients with Primary Central Nervous System Lymphoma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3600-3600
Author(s):  
Ingo Schmidt-Wolf ◽  
Hendrik Pels ◽  
Annika Jürgens ◽  
Sabine Rogowski ◽  
Axel Glasmacher ◽  
...  
Keyword(s):  
Overall Survival ◽  
Central Nervous System Lymphoma ◽  
Response Duration ◽  
Complete Response ◽  
High Dose ◽  
Survival Fraction ◽  
Median Response ◽  
Kaplan Meier ◽  
Time To Treatment Failure

Abstract Objectives: A pilot phase II trial was performed to evaluate response rate, response duration, overall survival, and toxicity in primary central nervous system lymphoma (PCNSL) after systemic and intraventricular chemotherapy with deferred radiotherapy. Patients and Methods: From 09/1995 to 12/2002, 65 patients with PCNSL (median age 62 years) were enrolled into a pilot/phase II study evaluating chemotherapy without radiotherapy. A high-dose methotrexate (MTX) (cycles 1,2,4,5) and cytarabine (ara-C) (cycles 3,6) based systemic therapy (including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide) was combined with intraventricular MTX, prednisolone and ara-C. Primary endpoint was time to treatment failure (TTF), secondary endpoints were response, overall survival, response duration, 5-year-survival fraction and (neuro)toxicity. Results: 34 patients were male, 31 female. Sixty-one of 65 patients were evaluable for response. Of these, 37 (61%) achieved a complete response (CR), 6 (10%) complete response/unconfirmed, and 12 (20%) progressed under therapy. Overall response rate was 71% for all patients and 86% for patients younger than 61 years. Six (9%) out of 65 patients died due to treatment-related complications. Follow-up time is 78 to 151 months in surviving patients (median 100 months). Kaplan Meier estimates for median time to treatment failure (TTF), median overall survival and median response duration are 22 months, 54 months and 37 months, respectively. For patients aged 60 years or older, the respective numbers were 7 months, 34 months and 30 months; in patients younger than 60 years, the Kaplan Meier estimate for TTF is 49 months, median overall survival and median response duration have not yet been reached. The 5-year survival fraction is 72% in patients < 60 years and 24% in older patients. Systemic toxicity was mainly hematologic. Ommaya reservoir infection occurred in 19% of the patients. At present, 17/30 (57%) of younger and 4/35 (9%) elderly patients are still alive. Only 5/30 (17%) of younger, but 19/35 (54%) of elderly patients received radiation salvage therapy at relapse. In 2/65 (3%), secondary cancers developed. In the subgroup of patients with long-term survival (n=17/30 under 61 years), 12 had an ongoing response, 1 an isolated CNS relapse (resolved by radiation), 1 an isolated ocular relapse (resolved by ocular radiation) and 3 a pure systemic relapse without CNS involvement (all resolved by systemic chemotherapy). Eleven of these 17 patients could be investigated by comprehensive neuropsychological testing, which revealed normal cognitive function in all of them. Conclusions: Primary chemotherapy based on high-dose MTX and ara-C is highly efficient in PCNSL. A substantial fraction of patients < 60 years can obviously be cured with this regimen.

Neoadjuvant denosumab treatment of locally advanced giant cell tumor of bone (GCTB).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11026-11026 ◽  
Author(s):  
Piotr Rutkowski ◽  
Louie Gaston ◽  
Aneta Borkowska ◽  
Silvia Stacchiotti ◽  
Giacomo Giulio Baldi ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Progression Free Survival ◽  
Axial Skeleton ◽  
En Bloc Resection ◽  
Preoperative Treatment ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Primary Tumors ◽  
Locally Advanced Tumors ◽  
Advanced Tumors

11026 Background: Retrospective study on locally advanced GCTB patients (pts) treated with neoadjuvant Denosumab (Db) outside clinical trials in 6 European reference centers. Methods: From 138 pts (median age 30yrs) with histologically confirmed advanced GCTB treated with Db(2011-2016), we included into analysis 87pts who underwent surgery after preoperative Db. All 87 patients had locally advanced tumors with extensive soft tissue involvement(54) or penetration to joint, not amenable to limb-sparing surgery/primary curettage or with high risk of recurrence. In 39/42(93%) cases diagnosis was confirmed by H3F3Agene mutation. Median follow-up time -22 months. Results: Primary tumor was located in lower limb(54%; n = 47) -mostly in tibia(25%) and femur(23%), upper limb(33%; n = 29), and pelvis/axial skeleton/ribs(13%; n = 11). 68(78%) patients had primary tumors, 19(22%) recurrent tumors after surgery (+/-radiotherapy). Median Db duration was 7months (range 1.5-35months), 17pts received also Db postoperatively. 39(45%) had wide en-bloc resection -WE (+17 implantation of prosthesis), 48(55%) cases had intralesional curettage -C, no extremity amputation. Pts who underwent prosthetic replacement had longer median preoperative Db therapy as compared to pts without prosthesis. All pts demonstrated a response to Db Progression after surgical treatment was observed in 15 pts -13 of them after intralesional curettage (13/48, 27%); 9 patients underwent D re-challenge -all responded. Two-year progression-free survival (PFS; from Db start) rate was 80%, 91% in WE group vs 73% in C group (p = 0.04), one-year PFS (from operation date) rate was 84%: 92% in WE and 79% in C group(p = 0.01). Treatment was well tolerated with only 1 grade 3 toxicity. Conclusions: Our study confirms that Db is active in a neoadjuvant setting with excellent efficacy and short-term tolerability. It implies that neoadjuvant therapy with Db is the option for treatment of initially locally advanced tumors to facilitate complete surgical resection or avoid mutilating surgery. The risk of recurrences after curettage of GCTB following Db raises questions about the optimal duration of preoperative treatment and if Db is indicated postoperatively.

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