Recurrence and survival outcomes following adjuvant therapy for early-stage uterine serous carcinoma (USC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16556-e16556
Author(s):  
David A. Iglesias ◽  
Laura L. Holman ◽  
Shannon Neville Westin ◽  
Bryan Fellman ◽  
Kathleen M. Schmeler ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Cumulative Incidence ◽  
Early Stage ◽  
Treatment Modalities ◽  
Serous Carcinoma ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Recurrence Rates ◽  
Stage Ia

e16556 Background: The choice of adjuvant therapy for early-stage USC remains controversial. The objective of this study was to estimate the recurrence rates of patients with surgically resected early-stage USC stratified by observation alone or adjuvant therapy. Methods: A retrospective review of women with surgically-staged stage IA-II USC followed at M.D. Anderson Cancer Center between January 2000 and December 2011. Descriptive statistics were used to summarize the demographic and clinical characteristics of patients. We estimated the cumulative incidence of disease recurrence, overall survival (OS), and recurrence-free survival (RFS) as a function of adjuvant therapy received. Adjuvant therapy groups listed in the Table. Results: 80 patients included in study. 58 patients had stage IA, 14 had stage IB, and 8 had stage II disease. Mean age was 66.4 years. Median follow-up for all patients was 4.83 years (range: 0.02 – 18.16). Cumulative incidence of recurrence for the whole group was 0.18 (95% CI: 0.10 – 0.28) which was reached at 3.96 years and remained at this rate until rising to 0.23 (95% CI: 0.12 – 0.36) at 11.12 years. Adjuvant treatment was not significantly associated with decreased risk of recurrence (Table). RFS at 5 years for the whole population was 0.71 (95% CI: 0.59 – 0.80) and OS at 5 years was 0.76 (95% CI: 0.63 – 0.85). Adjuvant treatment was not significantly associated with RFS or OS. In a subset of stage IA patients, 4 of 27 patients in the observation or cuff alone group recurred compared with 1 of 16 patients in the chemotherapy +/- cuff group (HR 0.48, CI: 0.05 – 4.27, p=0.511). Conclusions: In this study, there were no observed differences between observation and adjuvant treatment modalities in recurrence rates or survival outcomes for patients with early-stage USC. The addition of adjuvant chemotherapy may reduce risk for recurrence in stage IA patients, but further study is needed. [Table: see text]

A comparison of adjuvant therapy approaches for patients with early-stage uterine serous carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5517-5517
Author(s):  
Katherine Kurnit ◽  
Silvana Pedra Nobre ◽  
Bryan M. Fellman ◽  
David A Iglesias ◽  
Kristina Lindemann ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Figo Stage ◽  
Serous Carcinoma ◽  
Stage Ia ◽  
Multivariable Analyses ◽  
Uterine Serous Carcinoma

5517 Background: Uterine serous carcinoma is a less common subtype of endometrial cancer that is associated with poorer survival. The optimal post-operative adjuvant treatment strategy for these patients remains uncertain. Methods: This multi-institutional, retrospective cohort study evaluated patients with early stage uterine serous carcinoma. Patients with FIGO Stage IA-II disease after surgery, whose tumors had serous or mixed serous/non-serous histology were included. Patients with carcinosarcoma were excluded. Clinical data were abstracted from local medical records. Summary statistics, Fisher’s exact, and Kruskal-Wallis tests were used to analyze demographic and clinical characteristics. Univariable and multivariable analyses were performed for recurrence-free survival (RFS) and overall survival (OS). Results: 634 patients were included. 77% of patients had Stage IA disease, 42% showed no myometrial invasion. The majority had pure serous histology (72%) and LVSI (76%). Adjuvant treatment varied: 12% received no adjuvant therapy, 7% had chemotherapy alone, 51% had cuff brachytherapy, 12% had cuff brachytherapy with chemotherapy (cuff/chemo), and 19% underwent pelvic radiation (EBRT). Complete RFS and OS data were available for 607 and 609 patients, respectively, and the median follow-up time was 58 months. As compared with patients who received no adjuvant therapy, patients who received cuff or cuff/chemo had improved RFS (cuff: HR 0.70, p = 0.02; cuff/chemo HR 0.53, p = 0.01) and OS (cuff HR 0.56, p = 0.001; cuff/chemo HR 0.48, p = 0.01). In a direct comparison, patients with cuff/chemo had better RFS and OS than those with chemotherapy alone (RFS HR 0.52, p = 0.03; OS HR 0.50, p = 0.05). There were no differences in RFS or OS for women who received chemotherapy alone or EBRT. Improved survival with cuff and cuff/chemo persisted on multivariable analyses (included age, stage, LVSI, adjuvant therapy type); additionally, EBRT was also associated with improved OS. In analyses limited to patients without myometrial invasion, patients with cuff or cuff/chemo had improved RFS and OS compared with observation alone. Conclusions: The use of adjuvant cuff brachytherapy with and without chemotherapy was associated with improved RFS and OS in patients with early stage uterine serous carcinoma.

Micro-RNA Profiling as a Predictor of Clinical Outcomes for Head and Neck Cancer Patients

2017 ◽  
Vol 23 (32) ◽  
pp. 4729-4744 ◽  
Author(s):  
Tatyana Isayeva ◽  
Margaret Brandwein-Gensler ◽  
Maheshika Somarathna ◽  
Lakisha D. Moore-Smith ◽  
Timmy Lee
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Advanced Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Micro Rna ◽  
Treatment Modalities ◽  
Survival Outcomes ◽  
Recurrence Rates

Head and neck cancer is one of the leading malignancies worldwide. Due to the lack of symptoms in the early stage of the disease, about two thirds of patients present with locally advanced disease at the time of diagnosis. Even with significantly improved survival rates over the past two decades due to advanced imaging and treatment modalities, locoregional recurrence rates in patients with advanced disease ranges from 16% to 35%. Alternative therapeutic targets are being developed to improve survival outcomes. MicroRNAs (miRNA or miRs) are a family of small non-coding RNA species that have been demonstrated to regulate all cellular, physiological and developmental processes. Recently, there has been an exponential increase in the number of studies suggesting that miRNA is involved in regulating tumor metastasis, chemoresistance, radioresistance and survival outcomes. MiRNA candidates have been identified as potential prognostic biomarkers to diagnose cancer stages and progression, as well as to monitor follow-up treatment. In this review, we will discuss the miRNA profile in each stage of head and neck patients' therapy, with an emphasis on its application to clinical outcome prognosis.

scholarly journals A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study

10.2196/27576 ◽  
2021 ◽  
Vol 23 (9) ◽  
pp. e27576
Author(s):  
Jing Yu ◽  
Jiayi Wu ◽  
Ou Huang ◽  
Xiaosong Chen ◽  
Kunwei Shen
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Endocrine Therapy ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Compliance Rate ◽  
Multidisciplinary Treatment ◽  
Significant Difference ◽  
Noncompliance Rate

Background Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

Recurrent disease in patients with stage III melanoma in the era of adjuvant immune and targeted therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21570-e21570
Author(s):  
Victor Lo ◽  
Valerie Francescutti ◽  
Elaine McWhirter ◽  
Forough Farrokhyar ◽  
Linda May Lee
Keyword(s):  
Targeted Therapy ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Systemic Therapy ◽  
Recurrent Disease ◽  
Stage Iii ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Stage Iii Melanoma

e21570 Background: Advancements in systemic therapy have reduced recurrence, and the adoption of nodal surveillance in place of dissection has reduced morbidity for patients with Stage III melanoma. The objective of this study was to describe the timing and pattern of recurrence in stage III melanoma patients and evaluate the impact of adjuvant treatment and nodal surveillance. Methods: A multicenter retrospective chart review of patients with pathologically confirmed Stage III cutaneous melanoma seen at either the Juravinski Cancer Centre or Walker Family Cancer Centre in Ontario, Canada from January 1, 2017 to December 31, 2019. Results: There were 137 patients with Stage III melanoma: 18% IIIA, 22% IIIB, 52% IIIC, and 8% Stage IIID as per the 8th American Joint Committee on Cancer (AJCC) 2018 staging system. 103 (75%) patients had sentinel lymph node biopsy (SLNB) only as part of initial surgical therapy, 6 (4%) had SLNB with completion dissection, and 25 (18%) had upfront radical nodal dissection. 67 (49%) patients received adjuvant therapy, of which 50 (74%) had immunotherapy, 17 (25%) received BRAF-targeted therapy, and 1 (1%) had interferon. 54 (39%) patients developed recurrent disease, with a median time to recurrence of 8.5 months (IQR: 4.3-14.9). The recurrence rates were 63% in patients who did not have adjuvant treatment and 37% in those who had adjuvant therapy, with a median time-to-recurrence of 7.5 and 9.0 months respectively. There were 30 (56%) loco-regional recurrences and 24 (44%) distant recurrences. Of the patients with loco-regional recurrence, 26 (87%) had SLNB only compared to 4 (13%) who had upfront or completion dissection. 12 (24%) patients recurred while on adjuvant treatment (7 distant recurrences and 5 loco-regional recurrences), and 8 (13%) patients recurred following completion of adjuvant treatment (5 distant recurrences and 3 loco-regional recurrences). Recurrences were detected by patients, clinicians, CT and nodal US surveillance in 43%, 20%, 28% and 9% of cases, respectively. The majority of loco-regional recurrence was detected clinically (67%) rather than by radiologic surveillance (33%). Of the 30 loco-regional recurrences, 24 underwent surgical resection of the recurrence, 4 had subsequent systemic therapy without surgery, 1 had intra-tumoral injections and 1 had no treatment. Conclusions: Recurrences in Stage III melanoma occur early, often within a year, with higher rates of loco-regional rather than distant disease. Recurrence rates were lower in those who received adjuvant therapy, but the majority of recurrences were detected by patients or clinicians, including loco-regional recurrences in patients who had SLNB only despite surveillance nodal US.

Recurrence rates in patients with uterine papillary serous cancer with and without breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16529-e16529
Author(s):  
Jessica E. Stine ◽  
Stuart Pierce ◽  
Paola A. Gehrig ◽  
John Nakayama ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Recurrence Rate ◽  
Late Stage ◽  
Early Stage ◽  
Disease Stage ◽  
Serous Carcinoma ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Risk Patients ◽  
Papillary Serous Carcinoma

e16529 Background: Women with uterine papillary serous carcinoma (UPSC) are at increased risk for breast cancer and the converse is true. A genetic association between breast cancer and UPSC was recently described and counseling women faced with more than one cancer diagnosis can be difficult. Our objective was to evaluate recurrence rates of women with UPSC to those with UPSC and a personal history of breast cancer (UPSCBR). Methods: Data was collected for UPSCBR patients at two academic institutions between 7/1990 and 7/2012. Patient demographics, pathology, disease stage, and treatments were recorded. A UPSC literature review was performed focusing on recurrences per number of at-risk patients by stage. We used the fixed effect Mantel-Haenszel method to estimate the common pooled effect (recurrence rate) for the UPSC studies and compared these to UPSCBR patients. Results: Forty-three UPSCBR patients were identified. Median age at diagnosis was 72 (49-93). Twenty-six patients were Caucasian, 14 African-American and 3 other. Twenty-four (56%) had early stage at diagnosis (IA-IC) and 19 (44%) had late stage (III-IV). All but one underwent surgical staging/debulking; 36 (90%) were optimally debulked. Twelve (50%) early stage and 17 (89.5%) late stage patients underwent adjuvant therapy with radiation and/or chemotherapy. Nine studies were identified with available recurrence data for early stage UPSC; 8 for late stage. The recurrence rate for stage IA UPSCBR patients was 2/11 (18%) [95% CI: 2 to 52%] compared to 11% [95% CI: 9.8 to 13%] in the UPSC literature. In IB/IC UPSCBR patients we had 3/13 (23%) [95% CI: 5 to 54%] recur versus 21% [95% CI: 19 to 23%]. In later stages III/IV, 7/19 (37%) [95% CI:16 to 62%] UPSCBR patients had recurrences compared to 58% [95% CI: 56 to 60%] of UPSC patients. Conclusions: There is an association between breast cancer and UPSC with regard to incidence. We failed to find evidence of an appreciable difference in recurrence rates between our UPSCBR patients and UPSC patient groups from other reported studies. While diagnosis with two primary malignancies can be challenging for patients, this does not appear to impact their risk of recurrence.

Impact of inaccurate clinical staging for gastric cancer on patient survival outcomes.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 345-345
Author(s):  
Michelle Ju ◽  
Matthew R. Porembka
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Patient Survival ◽  
Early Stage ◽  
Tumor Location ◽  
Clinical Staging ◽  
Survival Outcomes ◽  
Adjuvant Therapies ◽  
Pathologic Staging ◽  
The Impact

345 Background: Accurate clinical staging (CS) in gastric cancer is critical for appropriate treatment selection and prognostication, but CS remains highly ineffective. Our study aims to evaluate the factors associated with inaccurate CS, the impact of inaccurate CS on patient outcomes, and effect of adjuvant therapy in patients with inaccurate CS. Methods: We conducted a retrospective review of the NCDB of patients diagnosed with clinical early-stage gastric adenocarcinoma based on AJCC 8th edition (cT1-2, N0, M0) between 2004-2016. Those who did not undergo upfront surgery or had missing pathologic staging data were excluded. Patients were classified into 3 groups: accurately staged (AS) if pathologic staging confirmed early-stage cancer, inaccurately staged with receipt of adjuvant therapy (IS+), and inaccurately staged with no receipt of adjuvant therapy (IS-). Logistic regression using stepwise selection was utilized to assess the impact of factors on CS accuracy and receipt of adjuvant therapies. Kaplan-Meier and Cox Proportional Hazard methods were used to compare survival outcomes. Results: Approximately 39% of patients (2841/7199) were understaged. T2 tumors, non-well differentiated tumors, and diffuse type histology were associated with increased likelihood of inaccurate CS. Age >60, female sex, Asian/Black race, and non-cardia tumor location were associated with decreased likelihood of inaccurate CS. Only 44% of patients who were inaccurately staged received adjuvant chemotherapy/radiation. Age >75 and fundus/body tumor location were associated with decreased likelihood of receiving adjuvant therapies, while more advanced pT and pN stage were associated with increased likelihood. Treatment facility type (community vs. academic) had no impact on likelihood of accurate CS or receipt of adjuvant treatment after inaccurate CS. 5-year overall survival was significantly different between groups (71.7% AS, 48.3% IS+, 51.1% AS-; p<0.001). Conclusions: CS is inadequate, and understaging has detrimental effects on patient survival outcomes. Novel strategies for improved CS are needed to improve patient care.

Impact of adjuvant therapy on survival of patients with early-stage uterine papillary serous carcinoma

2005 ◽  
Vol 63 (3) ◽  
pp. 839-844 ◽  
Author(s):  
Chad A. Hamilton ◽  
Wen-Shiung Liou ◽  
Kathryn Osann ◽  
Michael L. Berman ◽  
Amreen Husain ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Early Stage ◽  
Serous Carcinoma ◽  
Uterine Papillary Serous Carcinoma ◽  
Papillary Serous Carcinoma

Low-dose adjuvant vaginal cylinder brachytherapy for early-stage non-endometrioid endometrial cancer: recurrence risk and survival outcomes

2020 ◽  
Vol 30 (12) ◽  
pp. 1908-1914
Author(s):  
Alicia Smart ◽  
Daniela Buscariollo ◽  
Gabriela Alban ◽  
Ivan Buzurovic ◽  
Teresa Cheng ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymphovascular Invasion ◽  
Low Dose ◽  
Early Stage ◽  
Pelvic Recurrence ◽  
High Dose ◽  
Recurrence Rates ◽  
Stage Ia ◽  
Endometrioid Endometrial Cancer

ObjectiveThe aim of this study was to evaluate recurrence patterns and survival outcomes for patients with early-stage non-endometrioid endometrial adenocarcinoma treated with adjuvant high-dose rate vaginal brachytherapy with a low-dose scheme.MethodsA retrospective review was performed of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II non-endometrioid endometrial cancer who received adjuvant vaginal brachytherapy with a low-dose regimen of 24 Gy in six fractions from November 2005 to May 2017. All patients had >6 months of follow-up. Rates of recurrence-free survival, overall survival, vaginal, pelvic, and distant recurrence were calculated by the Kaplan–Meier method. Prognostic factors for recurrence and survival were evaluated by Cox proportional hazards modeling.ResultsA total of 106 patients were analyzed. Median follow-up was 49 months (range 9–119). Histologic subtypes were serous (47%, n=50), clear cell (10%, n=11), mixed (27%, n=29), and carcinosarcoma (15%, n=16). Most patients (79%) had stage IA disease, 94% had surgical nodal assessment, and 13% had lymphovascular invasion. Adjuvant chemotherapy was delivered to 75%. The 5-year recurrence-free and overall survival rates were 74% and 83%, respectively. By histology, 5-year recurrence-free/overall survival rates were: serous 73%/78%, clear cell 68%/88%, mixed 88%/100%, and carcinosarcoma 56%/60% (p=0.046 and p<0.01). On multivariate analysis, lymphovascular invasion was significantly associated with recurrence (HR 3.3, p<0.01). The 5-year vaginal, pelvic, and distant recurrence rates were 7%, 8%, and 21%, respectively. Vaginal and pelvic recurrence rates were highest for patients with carcinosarcoma, lymphovascular invasion and/or FIGO stage IB/II disease. At 5 years, vaginal and pelvic recurrence rates for patients with lymphovascular invasion were 33% and 40%, respectively. Patients with stage IA disease or no lymphovascular invasion had 5-year vaginal recurrence rates of 4% and pelvic recurrence rates of 6% and 3%, respectively.ConclusionsAdjuvant high-dose rate brachytherapy with a low-dose scheme is effective for most patients with early-stage non-endometrioid endometrial cancer, particularly stage IA disease and no lymphovascular invasion. Pelvic radiation therapy should be considered for those with carcinosarcoma, lymphovascular invasion and/or stage IB/II disease.

Association of adjuvant therapy in early-stage low-risk endometrial cancer with increased mortality: A statewide cancer registry analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5095-5095
Author(s):  
Michael R. Milam ◽  
Bin Huang ◽  
Mana Moghadamfalahi ◽  
Lynn Parker ◽  
Daniel Metzinger ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
Cancer Registry ◽  
Cox Regression ◽  
Early Stage ◽  
Low Risk ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Stage Ia ◽  
Registry Analysis

5095 Background: National Comprehensive Cancer Network (NCCN) guidelines state that patients with early stage low risk endometrial cancer (defined with 2009 criteria as stage IA endometrioid endometrial cancer) may be managed with observation with consideration of adjuvant therapy.The premise of this study is to review the patterns of care of those patients who received adjuvant therapy and its impact on survival. Methods: This is a retrospective cohort analysis of 1044 women from 2004-2008 in the Kentucky Cancer Registry (KCR) one of the affiliates utilized in the Surveillance, Epidemiology and End Results (SEER) Program database. Inclusion criteria for the patients in this analysis were those women with 2009 Stage IA uterine cancer of endometrioid histology, moderate and well differentiated tumor grade, who received definitive primary surgery. Adjuvant therapy was defined as any postoperative radiotherapy and/or chemotherapy after definitive surgical treatment. Patients with adjuvant therapy after surgery (AT) were compared to those patients who underwent surgery only (SO). Chi-square tests were used to identify associations between type of treatment and clinical/demographic factors. K-M plots and Cox regression models were used to examine survival between the two treatment groups. Results: 5.3% (55/1044) of patients with early stage low risk endometrial cancer were treated with AT compared to 94.7% (989/1044) of SO patients.No statistical differences in mean age, race, tumor size, smoking status, insurance status, lymph node dissection and gynecologic oncology care were found among the AT or SO groups. Five year survival was significantly better in the SO cohort compared to the AT cohort (92% alive at 5 years for SO vs. 66% alive at 5 years; p<0.0001). Controlling for other confounders in the multivariate Cox regression analysis, SO patients had substantially less risk for death compared to the AT groups (HR: 0.21; 95%CI 0.12-0.38; p<0.0001). Conclusions: In this statewide cancer registry analysis, adjuvant therapy after surgery in early stage low risk endometrial cancer patients is uncommon and is associated with an increased risk of mortality.

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