Outcomes of oxaliplatin-based adjuvant chemotherapy in pathologically lymph node positive (ypN+) rectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14664-e14664
Author(s):  
Ahmad Al Zahrani ◽  
James D. Brierley ◽  
Erin Diane Kennedy ◽  
Monika Krzyzanowska
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Distant Metastasis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Rank Test ◽  
Lymph Node Status ◽  
Curative Surgery ◽  
Group 2 ◽  
Group 1

e14664 Background: Standard therapy for locally advanced rectal cancer( LARC) with pre-operative chemoradiation(CRT) followed by curative surgery and adjuvant 5-flourouracil (5-FU) has resulted in a 5-year local relapse (LR) rate of less than 10% and incidence of distant metastases of about 36%. Accumulating data suggests that pathological lymph node status post CRT (ypN) is a major prognostic factor for long term outcomes in LARC .The role of adjuvant oxaliplatin-based therapy has not yet been well defined in ypN+ patients and is the focus of this study. Methods: Patients with ypN+ rectal cancer who underwent fluoropyrimidine-based preoperative CRT followed by curative surgery and received adjuvant oxaliplatin- (group 1) or fluoropyrimidine-based (group 2) chemotherapy at Princess Margaret Hospital were retrospectively reviewed.The study end point was comparison of three year disease free survival(DFS) and freedom from distant metastasis (FDM) in group 1 vs 2 using log-rank test. Results: Between 2003 and 2010, 25 pts in group 1 (adjuvant FOLFOX, n=23 and FOLFOX/bevacizumab, n=2) and 38 pts in group 2 ( adjuvant 5-FU/LV, n =37; capecitabine, n=1) were reviewed. Baseline characteristics were similar in both groups except more pts in group 2 had < 12 lymph nodes (LNs) retrieved (p=0.02), whereas more pts in group 1 were female (p=0.03)and had ypN2 vs ypN1 (p=0.01). Median follow-up was 33 months in group 1 and 38 months in group 2 (range: 3-86). Median age: 58 years. Male: 51, 80%. Five pts (8%) in the entire cohort experienced LR and 20 pts (31.7%) had distant metastasis. A trend toward better three-year DFS was observed in favour of oxaliplatin-based therapy (76% in group 1 vs. 51% in group 2; HR=0.4, 95%CI = 0.1-1.0; P=0.05). Corresponding three-year FDM rates were 83% and 58%, respectively (HR=0.23; 95% CI = 0.6-0.8; p= 0.01). In multivariate analysis, number of LNs retrieved of ≥12 and adjuvant oxaliplatin-based therapy were independent prognostic factors for improved DFS and FDM, respectively. Conclusions: Our analysis suggests that in ypN+ rectal cancer, addition of oxaliplatin to adjuvant therapy is associated with better outcomes. A prospective confirmatory randomized trial would be informative.

Oncologic outcome of lateral pelvic lymph node metastasis in locally advanced rectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 661-661 ◽  
Author(s):  
HyungJin Kim ◽  
Gun Kim ◽  
Ri Na Yoo ◽  
Bong-Hyeon Kye ◽  
Hyeon-Min Cho
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Rectal Cancer Patient ◽  
Locally Advanced ◽  
Oncologic Outcome ◽  
Pelvic Lymph Node ◽  
Lateral Pelvic Lymph Node ◽  
The Mean ◽  
Group 2 ◽  
Group 1

661 Background: Lateral pelvic lymph node (LPLN) metastasis is a major cause of recurrence in patients with rectal cancer. This study investigates the oncologic outcome based on LPLN status after neoadjuvant chemoradiotherapy (nCRT). Methods: Between January 2009 and February 2013, 141 patients with rectal cancer received nCRT followed by curative radical surgery in our hospital. 16 patients were identified with LPLN before nCRT. These patients were categorized to two groups according to nCRT response evidenced by post-nCRT imaging studies with 5mm criteria. Group 1 included 7 patients who showed disappearance of LPLN after nCRT. Group 2 consisted of the patients identified with LPLN after nCRT. Results: The mean follow-up period was 35.6 ± 12.8 months. The mean overall survival (OS) period and 3-year OS rate for the patient with LPLN before nCRT was 56.0 ± 2.6 months and 93.3%, respectively. The mean relapse free survival period and 3-year RFS rate for the patient with LPLN before nCRT was 32.6 ± 5.7 months and 47.1%, respectively. The risk factors associated with RFS were ypN stage (P = 0.031), tumor location (P = 0.002), and postoperative CEA level (P = 0.022). Comparing RFS between Group 1 and 2, Group 1 tended to demonstrate longer RFS (P = 0.058). Analyzing oncologic outcome of two groups compared to the cohort population, group 1 showed similar oncologic outcome with ypTNM stage II. Group 2 demonstrated a tendency of worse oncologic outcome than ypTNM stage III (Group 1 vs. ypII P = 0.761 and Group 2 vs. ypIII P = 0.135). Conclusions: Preoperative LPLN status after nCRT seems to influence oncologic outcome in rectal cancer patient. If patients with LPLN metastasis before nCRT exhibit persistent LPLN metastasis after nCRT, they may require additional treatment.

Distant metastasis in head and neck cancer: Baseline factors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Rahul Krishnatry ◽  
Tejpal Gupta ◽  
Vedang Murthy ◽  
Sudhir Vasudevan Nair ◽  
Deepa Nair ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Rank Test ◽  
Advanced Tumor

e16021 Background: Loco-regional relapse is predominant pattern of failure in locally advanced head & neck squamous cell cancer (HNSCC). Distant metastasis (DM) is increasingly detected on follow-up. this study attempts to identify baseline patient, tumor & treatment characteristics which determine poor survival in radically treated HNSCC patients developing DM. Methods: Clinical outcome audit of HNSCC receiving radical treatment from 1990-2010 in a single HNCC radiotherapy (RT) clinic who developed DM, using electronic search of a prospectively maintained database. The Disease free survival (DFS) & overall survival (OS) were calculated using Kaplan Meier method. The Log rank test & Cox regression (p< 0.05 significant) were used for univariate & multivariate analysis respectively. Results: 104 HNC patients developed DM, baseline characteristics are shown in table 1. DM was detected at a median of 7(IQR 3-14) months from treatment completion & median survival after diagnosis of DM was 2.6 (0-6) months. The median DFS & OS were 19(13-26), 21.5(16-29) months respectively. On univariate analysis, factors affecting DFS & OS were advanced tumor and nodal stage, perinodal extension & treatment factors (surgery & RT gap >30 days). On multivariate analysis stage and PNE remained significant for DFS while only stage showed significance for OS. Conclusions: Locally advanced stage of presentation (stage IV, T4, N2+) is the most important baseline factor determining poor outcome in HNC patients developing DM. Trials for aggressive primary systemic treatment (chemotherapy, targeted agents) are needed. [Table: see text]

Laser carbon dioxide cordectomy versus open surgery in the treatment of glottic carcinoma: Our results

2005 ◽  
Vol 132 (6) ◽  
pp. 857-861 ◽  
Author(s):  
Maurizio Maurizi ◽  
Giovanni Almadori ◽  
Gaetano Plaudetti ◽  
De Corso Eugenio ◽  
Jacopo Galli
Keyword(s):  
Total Laryngectomy ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Rank Test ◽  
Glottic Carcinoma ◽  
Local Recurrences ◽  
Specific Disease ◽  
Log Rank Test ◽  
Group 2 ◽  
Group 1

OBJECTIVE: To analyze oncologic results in patients with glottic cancers treated respectively, by laser CO2 or open surgery, taking into account specific-disease survival, rate of locoregional recurrences, and their salvageability. STUDY DESIGN: Retrospective study of 198 patients treated from January 1993 to June 2002 in the department of otorhinolaryngology at a Catholic university in Rome. METHODS: Glottic carcinoma were treated by laser CO2 cordectomy in 132 patients (group 1) and by open surgery in 66 patients (group 2). The statistical analysis was performed by Kaplan Meyer method, log rank test, and x 2 , test. RESULTS: The log-rank test points out significant differences between the 2 groups regarding specific-disease survival; no differences were found for disease-free survival. Within group 1, 16 patients developed local failure, which was retreated in 6 cases with laser surgery; in 9 (6.8%) with total laryngectomy, only 1 case was inoperable. In this group, 10 patients (62.5%) were salvaged. Within group 2, 18 patients developed local recurrences, which was retreated in 14 (21.21%) cases with total laryngectomy; the other 4 cases were not suitable for surgery. Of these 18, 8 patients (44.5%) were salvaged. CONCLUSIONS AND SIGNIFICANCE: Our results show significant differences between the 2 groups concerning the specific-disease survival and the salvageability of local recurrences. In fact, in group 1 we found a higher salvage rate and a lower incidence of total laryngectomy. As already suggested, laser therapy leaves the laryngeal cartilaginous framework intact, avoiding the spread of the tumor out of laryngeal organ and resulting in a more favorable oncologic outcome.

338. Correlation Between Lymph Node Status and Tumour Regression After Neoadyuvant Chemoradiation in Locally Advanced Rectal Cancer

2012 ◽  
Vol 38 (9) ◽  
pp. 836-837
Author(s):  
A. Frunza ◽  
L.J. García Flórez ◽  
M.M. Camaces ◽  
G. Gómez Álvarez ◽  
C. Martínez Alonso ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Lymph Node Status ◽  
Tumour Regression ◽  
Node Status

scholarly journals Neoadjuvant chemotherapy in the combination treatment for locally advanced rectal cancer: currently available options

2018 ◽  
Vol 8 (3) ◽  
pp. 36-41
Author(s):  
D. V. Kuzmichev ◽  
Z. Z. Mamedli ◽  
A. V. Polynovskiy ◽  
Zh. M. Madyarov ◽  
S. I. Tkachev ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Complete Clinical Response ◽  
Consolidation Chemotherapy ◽  
Group 3 ◽  
Group 2 ◽  
Grade Iii ◽  
Group 1

Objective:to analyze treatment outcomes in patients with locally advanced rectal cancer that received various combinations of neoadjuvant chemotherapy and chemoradiotherapy.Materials and methods. In this retrospective study, we analyzed a cohort of prospectively recruited patients with stage mrT3(CRM+)/ T4N0–2M0 locally advanced rectal cancer. Participants were divided into three groups. Patients in Group 1 received preoperative longcourse radiotherapy given concurrently with capecitabine, followed by 2–6 cycles of consolidation chemotherapy with capecitabine and oxaliplatin (CapOx). In Group 2, patients initially received 1–2 cycles of induction chemotherapy with CapOx, followed by radiotherapy + capecitabine, and then consolidation chemotherapy with CapOx (“sandwich” method). Participants in Group 3 were treated with 1–3 cycles of induction CapOx chemotherapy with subsequent long-course chemoradiotherapy. After the combination treatment, all patients underwent surgery. The primary endpoint of this study was therapeutic pathomorphosis. Secondary endpoints included complete clinical response, toxicity, local recurrence, distant metastasis, and relapse-free survival.Results.This study included 155 patients (98 in Group 1, 44 in Group 2, and 13 in Group 3). Grade III toxicity was documented in 6.12 %, 4.55 %, and 23.08 % of cases in Groups 1, 2, and 3 respectively. None of the patients had grade IV toxicity. Grade III therapeutic pathomorphosis was achieved in 33.7 %, 22.7 %, and 23.1 % of patients in Groups 1, 2, and 3 respectively. Grade IV therapeutic pathomorphosis was observed in 14.3 %, 15.9 %, and 7.69 % of patients in Groups 1, 2, and 3 respectively. Complete clinical response was registered in 16.3 %, 11.4 %, and 0 % of cases in Groups 1, 2, and 3 respectively. Median follow-up was 47.2 months with no signs of progression. Relapses were observed in 1.02 % and 2.27 % of patients from Group 1 and Group 2 respectively, whereas Group 3 demonstrated no relapses. A total of 11.22 %, 13.64 %, and 23.1 % of participants from Groups 1, 2, and 3 respectively developed distant metastasis.Conclusion.Polychemotherapy used within the consolidation and «sandwich» treatment regimens is a promising option for the treatment of locally advanced rectal cancer. The efficacy of induction chemotherapy should be further studied with a larger sample.

scholarly journals Disease-free Survival of Patients with Differentiated Thyroid Cancer: A Study from a Tertiary Center in Oman

2021 ◽  
Vol 36 (2) ◽  
pp. e246-e246
Author(s):  
Fathimabeebi P. Kunjumohamed ◽  
Abdulhakeem Al Rawahi ◽  
Noor B. Al Busaidi ◽  
Hilal N. Al Musalhi
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Distant Metastasis ◽  
Differentiated Thyroid Cancer ◽  
Disease Free Survival ◽  
Lymph Node Status ◽  
Free Survival ◽  
Disease Free

Objectives: As with global trends, the prevalence of differentiated thyroid cancer (DTC) has increased in recent years in Oman. However, to the best of our knowledge, no local studies have yet been published evaluating the prognosis of DTC cases in Oman. This study aimed to assess disease-free survival (DFS) and prognostic factors related to DTC among Omani patients attending a tertiary care center. Methods: This retrospective, observational cohort study was conducted between January 2006 and May 2016 at the National Diabetes and Endocrine Center in Oman. Data related to DFS and prognostic factors were obtained from the electronic medical records of all ≥ 18-year-old patients diagnosed with DTC during the study period. Results: A total of 346 DTC cases were identified. Overall, 82.7% of patients were disease-free at their last follow-up appointment. Univariate analysis indicated that various tumor characteristics including histological subtype (i.e., papillary carcinoma, Hurthle cell cancer, and minimally invasive follicular thyroid carcinoma), lymph node status, number of lymph node metastases, distant metastasis status, and TNM status (primary tumor (T), regional lymph node (N), distant metastasis (M) stage) were strong prognostic factors for DFS (p < 0.050). According to multivariate regression analysis, lymph node status, extrathyroidal extension, and angiovascular invasion were independent predictors of DFS (p < 0.050). Conclusions: The overall prognosis of DTC among Omani patients was excellent. Treatment and follow-up strategies for patients with DTC should be tailored based on the individual’s risk factor profile.

Is greater downstaging achieved if surgery is delayed beyond 8 weeks in patients with locally advanced (LA) rectal cancer?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 660-660 ◽  
Author(s):  
Shailesh V. Shrikhande ◽  
Bhawna Sirohi ◽  
Alok Gupta ◽  
Vipul Sheth ◽  
Mukta Ramadvar ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Randomised Trial ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Timing Of Surgery ◽  
Tumour Regression ◽  
R0 Resection ◽  
Tumour Regression Grade ◽  
Group 2 ◽  
Group 1

660 Background: Neoadjuvant Chemoradiotherapy (NACTRT) improves local recurrence rate in LA rectal cancer with no survival benefit. Pathological complete response (pCR) and better tumour regression grade (TRG) is associated with improved outcome. Debate is ongoing as to what is the best time to operate—if greater downstaging can be achieved by a longer interval to surgery and have an impact on sphincter saving surgery rates. In this study, we have correlated the pCR rate and TRG post completion of NACTRT with timing of surgery (TD). Methods: This is a retrospective study of prospective database of patients with LA adenocarcinoma of rectum treated from Jan 2012 to May 2013. 89 pts who completed NACTRT (50Gy/25 fractions with capecitabine 825 mg/m2BD) followed by surgical resection were included. For response evaluation patients were divided into two groups, group 1 (TD < 60 days, n=34) and 2 (TD > 60 days, n=55). Results: Of 89 pts (median age 48 y (22-76), 64 M/25F; 16/89 (18%) had signet ring histology) 93% pts underwent R0 resection; 7% R1 resection. Response to NACTRT was CR in 8 pts, PR in 65 (73%) pts and 15 SD, 1 not assessed. Median time from completion of NACTRT to surgery was 64 d (32-141). Median number LN resected were 11 (1-50). Overall, 25 (28%) pts achieved pCR; 6/89 (7%) pts had positive circumferential resection margin. 25 (74%) patients in group 1 compared to 28 (51%) pts in group 2 underwent sphincter preserving surgery (P=0.045). Eight (24%) pts in group 1 and 17 (31%) in group 2 achieved pCR (P=0.479). The median TRG in group 1 was 2.5 and in group 2 was 2 (P=NS). In pts who achieved pCR, median TD was 67 d compared to 63 d in pts who did not achieve pCR. Of the 16 pts with signet histology 4(25%) had pCR compared to 21(29%) in those with non-signet histology (P=NS). Conclusions: We conclude that the timing of surgery is not an important variable post completion of NACTRT and our data suggests that it's possible that earlier surgery may be better for organ conservation. There is no incremental benefit of delaying the surgery though this needs to be confirmed in a prospective randomised trial.

Long-term experience with oral fluoropyrimidines and oxaliplatin-based long-course chemoradiotherapy in locally advanced rectal cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15159-e15159
Author(s):  
Robert Diaz Beveridge ◽  
Dilara Akhoundova ◽  
Gema Bruixola ◽  
Juan Antonio Mendez ◽  
Maria Eugenia Medina ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Lymph Node Staging ◽  
Long Course

e15159 Background: Neoadjuvant radiotherapy (RT) previous to surgery (S), both as short-course RT (SCRT) and as long-course RT with 5-FU-based chemotherapy (LCRCT), is used in locally advanced rectal cancer (LARC), with consistent benefits in the local relapse (LR) risk. However, survival benefits have been elusive to find, especially with the use of total mesorectal excision (TME). Concerns about over-treating patients (pts) and long-term side effects have also cast more doubts in a blanket approach of treating all pts with neoadjuvant RT, especially with LCRCT. Methods: Retrospective review of cT3-T4 and/or N+ rectal cancer pts (1999-2014) treated with LCRCT and oral 5-FU and oxaliplatin (65% of pts), followed by TME and 5-FU-based CT. Clinical, radiological and pathological prognostic factors for LR, distant metastases (DM), disease-free survival (DFS) and overall survival (OS) are shown. Results: 203 pts. 98.5% proceeded to S; TME done in 89.7%. Downstaging rate: 70.4% (mainly N staging); pathological complete responses: 14.9%. LR and DM rate was 8.3% and 27%. TNM pathological data (ypTN) were better prognostic factors than tumour regression grades. Prognostic factors (multivariate): circumferential margin (CRM) and perineural invasion. No benefit seen with the addition of oxaliplatin. Compliance to adjuvant CT was poor; < 50% received the full dose. 5- and 10-year DFS and OS: 71.4% and 54.9% and 75.4% and 62.4%. Elderly pts had a worse OS, due to higher unexpected toxicity and lower treatment compliance. Mucinous tumours showed a poor response to LCRCT. Prognostic factors (multivariate) for OS and DFS: older age, CRM invasion, an unsuccessful TME and a heavy lymph node burden. Conclusions: The identification of pts with a low risk of LR where RT could be avoided is based on the premise of an exquisite imaging staging and a surgical team specialized in TME. A free CRM and a successful TME are pivotal for success. Clinical lymph node staging is problematic. The role of adjuvant CT remains undefined, and compliance rates are poor. Neoadjuvant CT is an option, especially if there is a high risk of DM. Better tolerated options, such as SCRT, should be used in elderly or frail pts.

Distant outcomes of chemoimmunotherapy with recombinant interferon-gamma for acinar-type adenocarcinoma of the lung.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20090-e20090
Author(s):  
Sergey P. Pyltsin ◽  
Yuriy N. Lazutin ◽  
Tamara G. Ayrapetova ◽  
Anna V. Chubaryan ◽  
Pavel A. Anistratov ◽  
...  
Keyword(s):  
Interferon Gamma ◽  
Disease Free Survival ◽  
Long Term Results ◽  
Rank Test ◽  
Recombinant Interferon ◽  
Adenocarcinoma Of The Lung ◽  
Results Of Treatment ◽  
Kaplan Meier ◽  
Group 2 ◽  
Group 1

e20090 Background: We performed a comparative analysis of disease-free survival (DFS) after adjuvant chemoimmunotherapy (ACIT) with recombinant interferon-gamma in combination therapy and standard adjuvant chemotherapy (ACT) of patients with acinar-type adenocarcinoma of the lung. Methods: The study included 63 patients who received radical surgery for stage I-IIIA adenocarcinoma in 2009-2012. Group 1: 33 patients with ACIT after radical pneumonectomy, carboplatin AUC = 5 on day 1 and etoposide 100 mg/m2 on days 1, 3 and 5; i.v. ingaron 500 000 IU/m2 but no more than 1 million IU for one injection on days 2, 4 and 6. Carboplatin was replaced by cisplatin 100 mg/m2 in ACIT after lobectomy. Group 2: 30 patients with similar ACT without ingaron. The interval between courses was 21 days. Survival was estimated by Kaplan-Meier method, and differences were compared using log-rank test. Results: Group 1: 28 (84.8%) patients received 3 ACIT courses, 5 (15.2%) – 2 courses. Group 2: 27 (90%) patients received 3 ACT courses and 3 (10%) – 2 courses. Analysis of the Kaplan-Meier curves showed a tendency to a 8% increase in 5-year DFS that was 58% in Group 1 and 50% in Group 2 (p = 0.064). Conclusions: 5-year DFS increase by 8% demonstrates the expediency of further studies involving more patients which will allow revealing statistically significant differences in long-term results of treatment.

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