Prognostic factor and outcome of 32 patients with classic and iatrogenic Kaposi sarcoma: A monoinstitutional experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e21500-e21500
Author(s):  
Pasquale Rescigno ◽  
Giovannella Palmieri ◽  
Lucia Nappi ◽  
Carlo Buonerba ◽  
Piera Federico ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Immunosuppressive Agents ◽  
Kaposi Sarcoma ◽  
Complete Response ◽  
Response To Treatment ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Nodular Lesions ◽  
Classic Kaposi Sarcoma ◽  
Hiv 1

e21500 Background: Classic Kaposi Sarcoma (CKS) is a rare and mild form of the disease that primarily affects men, older than 50 years in the endemic areas. Iatrogenic KS (IKS) is associated with the use of steroids, immunosuppressive agents in patients with autoimmune diseases, inflammatory disorders, or organ transplantation. We have conducted a retrospective analysis from January 2008 to December 2012 for CKS and IKS to evaluated outcomes and potential prognostic factors in this rare disease. Methods: Patients with histologically proven KS lesions of the skin and negative HIV-1/2 were enrolled. In some cases diagnosis was completed by immunohistochemical tests for HHV-8 staining. Eligible patients received different systemic chemotherapy for disease at stage IIb and in all variants of stage III and IV, according Mediterranean KS staging. Results: 32 cases of non-AIDS KS were identified in this study. Mean age at diagnosis of the group was 70 year-old. Approximate male/female ratio was 2:1. 78.2% of cases was classic KS. All patients received systemic chemotherapy containing one of this agent: alkaloid of vinca, taxane, pegylated lyposomial doxorubicin. Ten patients (31.5%) experienced a partial response, a complete response was achieved in 4 patients (12.4%) and stability in 16 cases (50%). Two patients (6.2%) developed multiple local recurrences. PFS was 11.7 months while OS resulted 28.5 months. At multivariate analysis nodular lesions were related to lower PFS compared to macular lesions (HR: 2,5817, 95% CI 1,2911 to 5,1624; p: 0,0049), and HHV8 status (positive vs. negative) had a statistically significant correlation with a worse response to treatment (HR: 5,0289 95% CI 1,6540 to 15,2901; p: 0,0046). Conclusions: Classic and iatrogenic KS patients appears less aggressive, mostly limited to the skin and well-responsive on local or systemic therapeutic strategies. Our data show as positivity to HHV8 and nodular lesions correlate with a worse response to treatment.

Liposomal Cytarabine (DepoCyte®) for the Prophylaxis and Treatment of Central Nervous System Involvement In Adult Acute Lymphoblastic Leukemia (ALL) - A Retrospective Analysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2122-2122
Author(s):  
Beata Piatkowska-Jakubas ◽  
Wojciech Jurczak ◽  
Sebastian Giebel ◽  
Aleksandra Holowiecka-Goral ◽  
Maria Adamczyk-Cioch ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Systemic Chemotherapy ◽  
Lymphoblastic Leukemia ◽  
Central Nervous System Involvement ◽  
Concomitant Administration ◽  
Liposomal Cytarabine ◽  
Female Ratio ◽  
Cns Relapse ◽  
Male Female Ratio

Abstract Abstract 2122 Background: Central nervous system involvement in Acute Lymphoblastic Leukemia can be either primary, present at diagnosis or associated with relapse of the disease. Prevention and treatment of CNS relapse is an essential component of all ALL chemotherapy regimens. Liposomal cytarabine (DepoCyte) is a sustained release formulation of Ara-C with a homogeneous distribution throughout the neuroaxis and a prolonged half-life maintaining cytotoxic concentrations in the CSF for more than 14 days. DepoCyte obtained superior response rates, improved patient quality of life and improved the time to neurological progression compared to standard cytarabine in a randomized clinical trial (Glantz et al 1999). Materials and Methods: A retrospective analysis was carried out to evaluate feasibility, safety and efficacy of DepoCyte in the prophylaxis and treatment of ALL patients. 45 patients who received 50mg liposomal cytarabine either as a prophylaxis (N=24) or treatment (N=21) between March 2006 – December 2009 in 4 centers in Poland were included in the analysis. Baseline characteristics of patients who completed CNS prophylaxis with DepoCyte: median age 34 (range: 18–67 years), male/female ratio 16/8, B-cell ALL (n=17), T-cell ALL (n=4), Ph-positive ALL (n=3). In the treatment group median age was 35 (range 18–60), male/female ratio 12/9, B-cell ALL (n=15), T-cell ALL (n=3) and Ph-positive ALL (n=3). Results: In the prophylaxis group the average number of DepoCyte administrations was 2.6 (range 2–4). Oral or IV Dexamethasone for 5 days was given to all patients to prevent symptoms of arachnoiditis. With a median follow-up of 12 months (range: 3–27) only 1 pt developed combined systemic and CNS relapse. 25% of patients (6/24) experienced mild and transitory adverse events: headache (n=3), brain edema during methotrexate-containing consolidation (n=1) and post-puncture syndrome (n=2). In the treatment group 8 pts were in first isolated CNS relapse and 13 pts were in combined CNS and systemic relapse. All patients had neurological symptoms and blast cells identified in the cerebrospinal fluid with average cellularity 713/μL (range 20–2500/μL). In 2 patients CNS disease was confirmed by computed tomography. DepoCyte was administered intrathecally together with systemic chemotherapy in 18 patients. The treatment was planned to avoid concomitant administration of DepoCyte and other cytotoxic agents that cross the BBB. All patients received concurrent dexamethasone for prophylaxis of arachnoiditis. Neurological and cytological responses were obtained in all 21 pts (16 CRs and 5 PRs). No serious adverse events with DepoCyte were reported. Mild headache was the most commonly reported toxicity (10/21pts, 47.6%). 2 out of 21 (9.5%) heavily pretreated patients developed transient sacral radiculopathy. Conclusions: 1) Implementation of liposomal cytarabine as IT prophylaxis in ALL patients reduces the total number of IT injections, is feasible and effective and has a favorable tolerance profile. 2) DepoCyte used for the treatment of leukaemic meningitis with concurrent systemic chemotherapy is a highly effective and feasible treatment in isolated and combined CNS relapse in ALL. 3) DepoCyte is generally well tolerated when concurrent dexamethasone is administered to alleviate symptoms of arachnoiditis and concomitant administration of agents that cross the BBB is avoided. Reference: Glantz M et al. Randomized trial of a slow release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis. J Clin Oncol 1999; 17: 3110-17. Disclosures: No relevant conflicts of interest to declare.

A comparison of doublet versus triplet chemotherapy regimens for esophagogastric adenocarcinoma (EGC): Is more always better?

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 124-124
Author(s):  
Tiago Felismino ◽  
Ana Caroline Alves ◽  
Audrey Oliveira ◽  
Wilson Luiz da Costa ◽  
Felipe José Fernandez Coimbra ◽  
...  
Keyword(s):  
Cox Model ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Clinical Staging ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Relapse Free Survival ◽  
Female Ratio ◽  
Free Survival ◽  
Male Female Ratio

124 Background: Recent data showed that a taxane-containing triplet regimen (FLOT) was superior to an anthracycline-containing regimen (ECX/ECF). However, there is no comparison between more costly and toxic triplet (T) regimens versus doublets (D) in the perioperative setting (periCT) of EGC. Methods: A retrospective analysis of patients (pts) with newly diagnosed EGC was carried out at AC Camargo Cancer Center from 2007 to 2015. Pts received either a D with a fluopyrimidine and platin or T with addition of epirubicin or docetaxel. Variables used in the Cox model were age, site, TNM, Lauren subtype and periCT (T versus D). The selection between T and D was at physician's choice. Endpoints were Relapse Free Survival (RFS) and Overall Survival (OS). Results: A total of 128 pts were included. Median age was 59.5y (56.5y for T and 67y for D, respectively). Male/female ratio was 82/46. Sixty-six received T (DCF 26 pts, EOX 28, ECX 8, 4 others) and 62 received D (FOLFOX 47 pts, CF 13, 2 others). Primary site: gastric in 93 pts and 35 EGJ. Main clinical staging cT3 N = 81 (63.3%), cN+ 84 (65.4%). Lauren subtype: intestinal N = 48, diffuse N = 54. Regarding surgery: 114 pts were resected and median lymph nodes removed 30. Pathologic complete response was seen in N = 9 (14.5%) and N = 4 (6.1%) considering D and T regimens, respectively (p = 0.14). In multivariate analysis there was no advantage of T over D regarding RFS (HR = 1.65, 0.87 – 3.11, p = 0.12) or OS (HR = 1.29, 0.65 – 2.57, p = 0.45). The 3y RFS rate was 63.2% for D and 40.6% for T and the 3y OS was 69.4% for D and 56.1% for T. Conclusions: In our analysis outcomes of pts treated with T regimen was not superior to D. Our main T was DCF and D was FOLFOX. We consider that doublet regimens may still have a role in periCT in EGC and could be an option for frail or elderly pts. Future trials are needed to confirm our data.

The Age of Mexican Patients with Chronic Myeloid Leukemia (CML) Ph+ Is Quite Younger Than the Reported in USA and European Series.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4291-4291
Author(s):  
Pablo Vargas-Viveros ◽  
Rafael Hurtado Monroy ◽  
Eduardo Cervera ◽  
Carlos Best ◽  
Alvaro Aguayo ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Age Distribution ◽  
Age At Diagnosis ◽  
Response To Treatment ◽  
Female Ratio ◽  
Male Predominance ◽  
Younger Age ◽  
Male Female Ratio ◽  
Long Term Observation ◽  
Mexican Patients

Abstract Abstract 4291 CML accounts for approximately 15 percent of the cases of leukemia in adults. It has an annual incidence of 1 to 2 cases per 100000, with a slight male predominance. The median age at presentation is about 60 years and the incidence increases as a function of age, as reported in North American, Australian and European series. However, in our country we found a younger age at diagnosis. Herein we report our analysis of the age distribution of the patients included in the Mexican Cooperative Leukemia Group. We analyzed 356 patients with diagnosis of CML Ph+, from January 2001 to December 2008. The data analysis showed a median age at diagnosis of 37 years (range 16 to 64 years), with a male: female ratio of 1.1:1. There is a clear difference of age between Mexican patients with CML and those reported in the referred series (37 vs. 60 years) highlighting a geographical and/or ethnical pattern that may play a role as prognostic factor and response to treatment. Moreover, challenge the multistep theory of carcinogenesis in CML, inspired by the observation that cancer incidence increases as a higher order function of age, explained by an increasing somatic mutations rate with age. Further analysis and long term observation is required. Disclosures: No relevant conflicts of interest to declare.

Results of Radiation Therapy for Treatment of Classic Kaposi Sarcoma

2009 ◽  
Vol 13 (1) ◽  
pp. 18-21 ◽  
Author(s):  
David Hauerstock ◽  
William Gerstein ◽  
Te Vuong
Keyword(s):  
Radiation Therapy ◽  
Response Rate ◽  
Kaposi Sarcoma ◽  
Surgical Excision ◽  
Complete Response ◽  
Interferon Α ◽  
Effective Treatment Modality ◽  
Choice Of Treatment ◽  
Classic Kaposi Sarcoma ◽  
Jewish Descent

Background: Classic Kaposi sarcoma (CKS) is a vascular neoplasm that primarily affects men of Mediterranean and Ashkenazi Jewish descent. A variety of therapeutic options exist, and choice of treatment depends on clinical form and stage, as well as lesion location and size; options include surgical excision, intralesional interferon α-2b, local or extended field radiotherapy, and chemotherapy. Objective: The aim of this study was to review the outcome of radiation therapy in the treatment of CKS at a single institution. Methods: This retrospective study reviewed patients who receive radiation therapy for histologically confirmed CKS between 1994 and 2006. Results: Sixteen patients were reviewed; the mean age at diagnosis was 74 years, and 13 patients were male. Fifteen patients (94%) presented with leg lesions, and two patients (12.5%) presented with arm lesions. The most commonly prescribed radiation dose was 30 Gy in 15 daily fractions of 2 Gy. All lesions responded to treatment, with a complete response rate of 88% and a partial response rate of 12%. Toxicity was limited to grade I dermatitis (four patients) and grade II dermatitis (two patients). Conclusion: Radiation therapy is an effective treatment modality for CKS and is associated with minimal toxicity.

Neoadjuvant capecitabine and oxaliplatin (CAPOX) followed by chemoradiation (CRT) in high-risk rectal cancer: A single-institution experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14100-e14100
Author(s):  
Saif Ahmad ◽  
Deepak Parashar ◽  
Catherine Rachel Jephcott ◽  
Hugo Ford ◽  
Charles Wilson
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Standard Of Care ◽  
Complete Response ◽  
Outcome Data ◽  
R0 Resection ◽  
Chemotherapy Response ◽  
Female Ratio ◽  
High Risk Disease ◽  
Male Female Ratio

e14100 Background: Total Mesorectal Excision (TME) is standard of care in early rectal cancer. Pre-operative CRT facilitates microscopic complete resection (R0), improving outcome in high risk disease. Recent Phase 2 studies investigated the role of neoadjuvant CAPOX chemotherapy pre-CRT with promising results. We have adopted this strategy in high risk cancers with threatened circumferential resection margin (CRM) on MRI, and report our institution’s early outcome data. Methods: Retrospective data was collected on 37 patients with high risk disease treated March 2007 to December 2011. Patients received 12 weeks oxaliplatin (130mg/m2) and capecitabine (1000mg/m2 BD for 14 days) every 3 weeks, followed by CRT (45 Gy/ 25 #) with concurrent capecitabine (800mg/m2 BD). 11/37 patients had a 5.4 Gy/ 3 # boost with CRT. 4 patients were in a clinical trial, 2 of whom had cetuximab in addition to CAPOX. Patients deemed operable on repeat MRI had TME and 4 cycles of adjuvant CAPOX. Results: Median age was 64 (33-78) and male: female ratio 2.1:1. Median follow-up was 22 months (1.9-53.7). 2 patients did not complete 4 cycles neoadjuvant CAPOX due to toxicity. Median time to surgery post CRT was 6.6 weeks (4.7-10 weeks). 1 patient had an embolic event and femoral embolectomy. 7/31 (23%) patients had no post-operative chemotherapy (4 wound; 2 previous toxicity; 1 comorbidity). Radiological response rates post CRT were 26/34 (76%). 2 patients progressed and were unable to have radical surgery. 1 further patient was found to have unsuspected metastatic disease (liver) at time of surgery. 28/35 (80%) patients had R0 resection and pathological complete response (pCR) was 6/37 (16%). 2 year DFS and OS was 89% and 91.3%. Conclusions: Our outcomes, within an unselected cohort, reflect outcomes consistent with published trial data and support routine use of pre-operative CAPOX and CRT in high risk rectal cancers. This strategy is feasible in a non-trial population, and offers the benefit of early sterilisation of micrometastases, better prediction of chemotherapy response and facilitates the incorporation of novel agents within neoadjuvant window studies.

Achievement of Complete Response Is Important for Longer Overall Survival in Patients with Newly Diagnosed Myeloma: A Single-Institutional Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5115-5115
Author(s):  
Kanichi Iwama ◽  
Tomotaka Ugai ◽  
Hiroki Sugihara ◽  
Masayuki Yamakura ◽  
Masami Takeuchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Partial Response ◽  
Complete Response ◽  
Novel Agents ◽  
Response To Treatment ◽  
Prognostic Impact ◽  
Female Ratio ◽  
Best Response ◽  
The Impact

Abstract Abstract 5115 INTRODUCTION. Even with the introduction of novel therapeutic agents, including thalidomide, bortezomib, and lenalidomide, multiple myeloma (MM) is an incurable disease. Deeper responses, such as complete response (CR) and very good partial response (VGPR), are major goals of treatment to obtain long-term overall response (OS) and progression-free response (PSF) in patients with MM. Recent large randomized retrospective studies also suggested improved OS and PFS in patients who achieved deeper responses. However, the prognostic impact of achieving CR or VGPR remains controversial. In addition, these studies included selected patients that may not be representative of the general population. Therefore, we analyzed cases in our database to evaluate the impact of treatment response on the outcome of consecutive patients with symptomatic MM who were treated with chemotherapeutic regimens containing novel agents over the past 6 years at our institution in Kamogawa City, Japan. PATIENTS AND METHODS. We included 97 consecutive patients treated at our institution between April 2005 and May 2011. The study population consisted of 56 male and 41 female patients with a median age of 70 years old (range: 45 −90). Due to the rapid changes in treatment modality and government approval of novel agents in myeloma during this period, initial treatment could not be uniformly categorized, but all patients received chemotherapy regimens containing at least one novel agent, including thalidomide, bortezomib, and lenalidomide. These patients were thought to be more representative of the general myeloma population. Seventy-seven (79.4%), 27 (38.6%), and 55 (56.7%) patients received bortezomib-, lenalidomide-, and thalidomide-containing regimens, respectively. Treatment responses were assessed using the International Myeloma Working Group (IMWG) criteria with minor modifications, and the best response to treatment during the course of disease was evaluated. Immunofixation test and serum free light chain measurements were performed for confirmation of CR and stringent CR. OS was calculated from the time of diagnosis until the date of death from any cause or the date on which the patient was last known to be alive. Univariate and multivariate analyses were performed for the following variables: age at diagnosis, International Staging System (ISS), and best response achieved. RESULT. The median age of patients was 71 y.o. (range: 49 −90 y.o.), and the male to female ratio was 56:41. The best responses to treatment were as follows: CR was obtained in 19 cases (19.6%), VGPR in 29 (29.9%), partial response (PR) in 34 (35.0%), and stable disease (SD) or less in 15 (15.4%). Baseline characteristics according to best response achieved in patients who achieved CR, VGPR, PR, and SD or less were similar among the patients ≥70 y.o. vs. ≤70 y.o. Patients' age has no impact on the response to treatment. With a median follow-up of 25 months, Kaplan–Meier estimated 3-year and 5-year overall survival (OS) rates were 67.2% and 35.0%, respectively. The 3- and 5-year OS were 100% in patients with CR, which were significantly superior in patients with VGPR (3-y 70%, 5-y 55.0%) and PR (3-y 60%, 5-y 23.0%). The 3- and 5-year OS were not significantly different between patients with VGPR and PR. Normalization of FLC kappa/Lambda ratio was observed in 15 of 19 (80%) patients with CR, 15 of 29 (51%) with VGPR, 4 of 34 (6.6%) in PR, and in none of 15 (0%) in SD or less. Patients who showed normalization of FLC kappa/Lambda ratio had significant OS benefit compared to those who did not. Proportional hazard Cox models showed that patients with ISS stage I/II had better 5-year OS rate compared to patients with stage III (51%; 20%, P = 0.005). However, there was no association between ISS stage and achievement of CR. CONCLUSION. The results of the present study highlighted the importance of achieving CR, not PR or VGPR, and normalization of FLC kappa/Lambda ratio for obtaining long-term OS in patients with MM regardless of age or ISS stage. Disclosures: No relevant conflicts of interest to declare.

Treatment outcomes of primary mediastinal and intrathoracic great vessels sarcoma: Royal Marsden Hospital experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10060-10060
Author(s):  
Shir Kiong Lu ◽  
Charlotte Benson ◽  
Sushila Ganguli ◽  
Michelle R. Scurr ◽  
Cyril Fisher ◽  
...  
Keyword(s):  
Case Series ◽  
Palliative Radiotherapy ◽  
Complete Response ◽  
Disease Recurrence ◽  
High Recurrence Rate ◽  
Spindle Cell Sarcoma ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Great Vessels ◽  
Localised Disease

10060 Background: Sarcoma of the mediastinum and great vessels remain a rare subgroup of soft tissue sarcoma and prognosis remains poor with patients (pts) often presenting with advanced disease. There is no standard treatment due to paucity of data hence its management relies on case series. To date this is the largest series of pts reported. Methods: Retrospective analysis of pts identified anonymously from a prospectively maintained database of the sarcoma unit. Results: 46 pts were included in the analysis. The median age at diagnosis was 45.9 with a male: female ratio of 1.2: 1. 60% of pts presented with localised disease. The most common histological subtype was spindle cell sarcoma followed by angiosarcoma. The heart (n=21), majority in the atria, was the commonest primary site. 28 pts presented with localised disease of which 21 had surgery and 16 received chemotherapy (CT). 4 pts received multi-modality treatment. 83% of pts with metastases had CT. 6 of them attained stable disease, 1 had partial response and 4 (Ewing’s, rhabdomyosarcoma and angiosarcoma) had complete response. 31 pts developed disease recurrence of which 58% had initial localised disease. 6 pts had metastectomy, 19 received palliative CT and 11 had palliative radiotherapy (RT). RT of 50-60Gy to the heart or mediastinum was delivered to 61% of pts with initial localized disease and 33% of pts with metastases. 2 pts had documented post-treatment cardiac complication. After a median follow up of 2.16 years, the median event-free survival was 0.97 years (95%CI 0.65-1.30), median overall survival (OS) was 1.7 years (95% CI 0.70-2.71) and 5 year OS was 17.9%. Conclusions: The optimal management in this disease is unclear. In this study, surgery was frequently implemented in both localised and metastatic settings but challenges remain in achieving clear margins. Chemotherapy has a role and it is key to identify chemosensitive subtypes. RT is offered as an adjunct following suboptimal resection. Despite aggressive treatments, this group of young pts had high recurrence rate and poor prognosis. Multi-modality treatment may have a role in selected pts but its efficacy and long-term cardiac sequelae need to be evaluated prospectively.

Suicide in Nógrád County, Hungary, 1970-1994

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Tamás Zonda
Keyword(s):  
High Risk ◽  
Psychiatric Disorders ◽  
Suicide Rate ◽  
Risk Groups ◽  
The Elderly ◽  
Female Ratio ◽  
Suicide Notes ◽  
Suicidal Intention ◽  
Male Female Ratio

The author examined completed suicides occurring over a period of 25 years in a county of Hungary with a traditionally low (relatively speaking) suicide rate of 25.8. The rates are clearly higher in villages than in the towns. The male/female ratio was close to 4:1, among elderly though only 1.5:1. The high risk groups are the elderly, divorced, and widowed. Violent methods are chosen in 66.4% of the cases. The rates are particularly high in the period April-July. Prior communication of suicidal intention was revealed in 16.3% of all cases. Previous attempts had been undertaken by 17%, which in turn means that 83% of suicides were first attempts. In our material 10% the victims left suicide notes. Psychiatric disorders were present in 60.1% of the cases, and severe, multiple somatic illnesses (including malignomas) were present in 8.8%. The majority of the data resemble those found in the literature.

Sign in / Sign up

Export Citation Format

Share Document