Fifteen-year experience of all patients (pts) with small bowel adenocarcinoma (SBA), treated in a specialized gastrointestinal (GI) oncology unit: Royal Marsden (RM) experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 316-316
Author(s):  
Khurum Hayat Khan ◽  
Clare Peckitt ◽  
Francesco Sclafani ◽  
Sachin Trivedi ◽  
Vikram Kumar Jain ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Advanced Disease ◽  
Early Stage ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Small Bowel Adenocarcinoma ◽  
Early Stage Disease ◽  
Free Survival ◽  
Resectable Disease

316 Background: Small bowel adenocarcinoma (SBA) is a rare tumour with poor prognosis. There is paucity of published literature due to rarity of disease; we conducted this retrospective study to determine the clinical course and outcome along with prognostic factors in both early and later stage SBA. Methods: Clinical characteristics and outcomes of all pts treated consecutively in the GI Unit RM, 1996-2011 were recorded. The study endpoints were relapse free survival (RFS), progression free survival (PFS), and overall survival (OS), in early stage pts (G1) and in pts with advanced disease (presentation or relapse with un-resectable disease=G2). In G2 response rate (RR) to chemotherapy was determined. In both groups association to baseline prognostic factors were sought by performing Cox regression univariate analysis (UVA). Results: Eighty four pts with SBA were treated 1996-2011. A total of 48 presented with early stage disease (G1). In G1 (58.3% males; mean age, 57 years), 44/48 pts underwent R0 resection; 21 received adjuvant chemotherapy. RFS, PFS and OS in this group were 29.6 [95% confidence interval (CI) 3.3-55.9], 31.1 (CI=8.0-54.3) and 42.9 (CI=0-94.9) months (m), with median follow up of 76.4 m. Poor histological differentiation (p=0.025), abnormal CEA at presentation (P=0.082), and lymphovascular invasion (p=0.003) were prognostic of OS. G2 comprised of 36 pts with un-resectable disease along with 23 from G1 who subsequently relapsed [G2 (n=59); 52.5% males; mean age, 59 years]; 54 pts with metastatic and 5 with locally advanced disease; 78% received first-line chemotherapy. Overall RR of pts who received chemotherapy was 50%. OS and PFS were 12.8 (CI =8.4-17.2) and 8.8 (CI=5.5-12.3) m respectively; 1-year survival was 60.9% vs. 27.3% (no chemotherapy) (p=0.042). Abnormal albumin (0.041), platelet count (p=0.007) and CEA (p=0.025) were prognostic of OS in the chemotherapy group; doublet (18/41) versus triplet (23/41) chemotherapy were not prognostic (p=0.185). Conclusions: Pts with SBA and metastatic disease may derive benefit from systemic chemotherapy; prospective clinical trials are required to evaluate this further.

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.

Small bowel adenocarcinoma treatment: A single centre experience.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 451-451
Author(s):  
Philip Bredin ◽  
Joseph J McKendrick ◽  
Prasad Cooray ◽  
Rachel Wong
Keyword(s):  
Small Bowel ◽  
Early Stage ◽  
Eastern Health ◽  
Small Bowel Adenocarcinoma ◽  
Curative Intent ◽  
Early Stage Disease ◽  
Gastrointestinal Malignancies ◽  
Free Survival ◽  
Line Chemotherapy

451 Background: Small bowel adenocarcinoma (SBA) has a high mortality. Randomised controlled trials are not feasible due to its rarity, therefore there is no gold standard treatment approach. Surgical resection for early stage disease is the only potentially curative option. Systemic therapeutic options are generally extrapolated from oesophagogastric and colorectal chemotherapy regimens. Methods: This is a retrospective review of treatment and outcomes for SBA patients who attended Eastern Health between 1st January 2010 and 30thJune 2015. Approval was obtained from the Eastern Health Human Research and Ethics Committee. Results: Thirty-six patients with SBA were identified: 16 (44%) duodenal, 12 (33%) ampullary, 6 (17%) jejunal, 2 (6%) terminal ileum, 1 not specified. Median age was 72 and 25 (69%) were male. Stage at diagnosis was as follows: Stage 1 = 4 (11%), Stage 2 = 8 (22%), Stage 3 = 9 (25%) and Stage 4 = 10 (28%). Surgery with curative intent occurred in 19 patients (Whipple’s = 13, wide local excision = 6) of whom 6 received adjuvant (predominantly fluoropyrimidine-based) chemotherapy. One patient died from post-operative complications. At last follow-up, 8 patients remained in complete remission; 11 had relapsed; 3 were lost to follow-up. Three patients had died due to disease. Median relapse-free survival in the curative-intent group was 21.4 months. Median overall survival (OS) has not been reached. Sixteen patients were initially treated with palliative intent. Ten underwent palliative surgery (bypass = 7; resection = 3). Overall, 16 patients commenced palliative chemotherapy, including 8 from the curative-intent group post-relapse. The most commonly used regimen was oxaliplatin plus fluoropyrimidine. Best responses to chemotherapy were partial response = 5 (31%) and stable disease = 4 (25%). Six patients received second-line chemotherapy. Median progression-free survival on first-line chemotherapy was 4.8 months. Median OS was 9.4 months. Conclusions: SBA has a poor prognosis. Although 56% of advanced SBA patients had disease control using chemotherapy extrapolated from other gastrointestinal malignancies, responses were not durable.

Impact of tumor site on the prognosis of small bowel adenocarcinoma

2019 ◽  
Vol 105 (6) ◽  
pp. 524-528 ◽  
Author(s):  
Rosa Falcone ◽  
Adriana Romiti ◽  
Marco Filetti ◽  
Michela Roberto ◽  
Riccardo Righini ◽  
...  
Keyword(s):  
Small Bowel ◽  
Clinical Outcome ◽  
Primary Tumor ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Rank Test ◽  
Small Bowel Adenocarcinoma ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Early Stage Disease

Background: Because of a lack of large-scale prospective studies there is no clear indication about the management of patients with small bowel adenocarcinoma (SBA). This study evaluated clinical outcome of patients diagnosed with SBA at our institution. Methods: Clinicopathologic features, treatments, and clinical outcome of patients diagnosed with SBA between 2006 and 2017 were retrospectively analyzed. Median time of survival was calculated and compared using the log-rank test. Multivariate Cox regression was used to test independence of significant factors in univariate analysis. Results: Forty patients were included in the study; the majority (82.5%) had a tumor in the duodenum (including ampulla of Vater) and an early stage disease at the diagnosis. Median overall survival (OS) in the whole study population was 26.5 months. Patients with a tumor of the lower part of the small intestine (jejunum, ileum, and appendix) showed a better OS compared with that of patients with upper SBA (40 months vs 26 months, respectively; P=0.09). Primary tumor site and stage were independent predictors of OS. Conclusions: Our results suggest a prognostic role for the primary tumor site. This finding deserves to be further investigated to ensure better classification as well as more effective management strategies for SBA.

A phase II study of 5-FU/l-LV/oxaliplatin (mFOLFOX6) in patients with metastatic or unresectable small bowel adenocarcinoma: A post hoc analysis.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 430-430
Author(s):  
Taro Funakoshi ◽  
Takahiro Horimatsu ◽  
Norisuke Nakayama ◽  
Toshikazu Moriwaki ◽  
Yoshinori Hirashima ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Primary Tumor ◽  
Performance Status ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Primary Site ◽  
Small Bowel Adenocarcinoma ◽  
Serum Cea ◽  
Post Hoc

430 Background: Small bowel adenocarcinoma (SBA) is a rare disease. Previous studies suggested several prognostic factors of unresectable SBA, including age, performance status (PS), primary site, resection of primary tumor, histology, and tumor marker (CEA and CA19–9) levels. However, prognostic factors of the patients treated with oxaliplatin–fluoropyrimidine combination therapy were unknown, while these drugs were reported as a promising chemotherapy regimen for SBA. Methods: Previously untreated SBA patients were treated with an mFOLFOX6 regimen, and a post hoc analyses for prognostic factors were performed. Results: Between April 2010 and November 2012, 24 patients were included in this study. The overall response rate was 45% (9/20). The median progression-free survival and overall survival (OS) were 5.4 months (95% CI, 4.8–6.0) and 17.3 months (95% CI, 11.7–19.0), respectively. Univariate analysis revealed that lower PS (HR= 0.27; 95% CI, 0.10–0.77; p= 0.014), primary disease of the jejunum (HR= 0.35; 95% CI, 0.11–1.12; p=0.077), and serum CEA in the normal range (HR= 0.40; 95% CI, 0.14–1.11; p= 0.079) were potential prognostic factors of longer OS (threshold, p< 0.10). Although resection of the primary tumor was not a predictive factor of survival in this study, 54% and 21% of the patients needed surgery (primary resection or bypass) because of stenosis before and during chemotherapy, respectively. It is considered that bowel obstruction should be addressed before and during treatment. Conclusions: PS, primary site, and serum CEA levels are potential prognostic factors of unresectable SBA. There is a higher incidence of bowel stenosis or obstruction caused by the primary tumor before and during the treatment of SBA.

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]

Primary adenocarcinoma of the ileum causing obstruction in an 84-year-old patient – a case report

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Krzysztof Łampika ◽  
Paweł Dutkiewicz ◽  
Przemysław Ciesielski
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Early Stage ◽  
Tumour Progression ◽  
Correct Diagnosis ◽  
Primary Adenocarcinoma ◽  
Intestinal Fistula ◽  
Small Bowel Adenocarcinoma ◽  
Early Stage Disease ◽  
Stage Disease

Although small bowel adenocarcinoma is a rare cancer, with estimated incidence rate of 4 cases per million persons it is the most common small bowel tumour. Diagnosis of early-stage disease is difficult due to non-specific symptoms. Patients are usually treated on an emergency basis due to gastrointestinal obstruction or bleeding. The paper presents a case report of an 84-year-old female who underwent surgical treatment due to bowel obstruction caused by ileum cancer, and in whom diagnostic imaging did not allow for a correct diagnosis. The surgery was complicated by intestinal fistula. Histopathology confirmed local tumour progression. After treatment completion, the patient was referred for further anti-cancer treatment.

Prognostic factors for overall survival and distant metastasis free survival in cervical cancer patients with locally advanced disease and the role of consolidation chemotherapy.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e17004-e17004
Author(s):  
Ana Carolina Matos Queiroz ◽  
Solange Moraes Sanches ◽  
Andrea Paiva Guimaraes ◽  
Adriana Regina G. Ribeiro ◽  
Glauco Baiocchi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Consolidation Chemotherapy ◽  
Free Survival ◽  
Distant Metastasis Free Survival

scholarly journals Natural history and prognostic factors for localised small bowel adenocarcinoma

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000960
Author(s):  
Andreina Colina ◽  
Hyunsoo Hwang ◽  
Huamin Wang ◽  
Matthew H G Katz ◽  
Ryan Sun ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Mismatch Repair ◽  
Recurrence Rate ◽  
Univariate Analysis ◽  
Histologic Grade ◽  
Small Bowel Adenocarcinoma ◽  
Perioperative Treatment ◽  
Increased Risk ◽  
Significant Difference

ObjectiveSmall bowel adenocarcinoma (SBA) is a rare malignancy with limited evidence regarding outcomes after curative resection of localised disease. We aimed to evaluate presentation and prognostic factors affecting overall survival (OS), relapse-free survival (RFS) and recurrence of SBA.MethodsConsecutive patients with completely resected localised SBA (1979–2019) were retrospectively reviewed for presentation, patient and tumour characteristics, perioperative treatment, recurrence, outcomes, and prognostic factors.ResultsAmong 257 total patients, median age was 58 years. Primary location was in the duodenum, jejunum and ileum in 52%, 29%, and 19% of patients, respectively. Median OS was 57.5 months and median follow-up was 40 months. In multivariate analysis, lymph node involvement, lymphovascular invasion, histologic grade and race were independent predictors of RFS, while race, stage and histologic grade were independent predictors of OS. No significant difference in OS or RFS was seen when evaluating the role of perioperative treatment. Median time to diagnosis from first medical evaluation was 31 days and did not change over time. Overall recurrence rate was 56%. Recurrence rate was higher in ileal (77%), than duodenal (54%) and jejunal (65%) SBA (p=0.01). Recurrence presented most commonly as distant metastasis (71%). Proficient mismatch repair was associated with decreased risk of locoregional recurrence (LR) but increased risk of distant recurrence (DR) when compared with deficient mismatch repair (dMMR) in univariate analysis.ConclusionsDespite advances in diagnostic modalities, this study did not show any improvement in earlier diagnosis of SBA over the course of the past three decades. The predominant pattern of disease recurrence was distant across all SBA locations, but dMMR status demonstrated a robust predilection for LR as opposed to DR. Perioperative treatment did not improve outcomes; however, a lower stage disease was seen in patients that received neoadjuvant therapy, suggesting further exploration of this approach.

scholarly journals Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular

2017 ◽  
Vol 3 (6) ◽  
pp. 757-764 ◽  
Author(s):  
Nancy Reynoso-Noverón ◽  
Cynthia Villarreal-Garza ◽  
Enrique Soto-Perez-de-Celis ◽  
Claudia Arce-Salinas ◽  
Juan Matus-Santos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Social Protection ◽  
Advanced Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Cancer Center ◽  
Seguro Popular ◽  
Early Stage Disease ◽  
Locally Advanced Disease

Purpose One half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular. Materials and Methods This was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed. Results A total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%). Conclusion This represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

Construction and Validation of a Nomogram for Predicting Progression-Free Survival in Patients with Early-Stage Testicular Germ Cell Tumor

2021 ◽  
Vol 16 ◽  
Author(s):  
Jin-Guo Chen ◽  
Jing-Quan Wang ◽  
Tian-Wen Peng ◽  
Zhe-Sheng Chen ◽  
Shan-Chao Zhao
Keyword(s):  
Prognostic Factors ◽  
Validation Cohort ◽  
Early Stage ◽  
Predictive Ability ◽  
Testicular Germ Cell Tumor ◽  
Progression Free Survival ◽  
Cell Tumor ◽  
Testicular Germ Cell ◽  
Free Survival ◽  
Training Cohort

Background: Testicular Germ Cell Tumor (TGCT) is the most common malignant tumor in young men, but there is a lack of prediction model to evaluate prognosis of patients with TGCT. Objective: To explore the prognostic factors for Progression-Free Survival (PFS) and construct a nomogram model for patients with early-stage TGCT after radical orchiectomy. Methods: Patients with TGCT from The Cancer Genome Atlas (TCGA) database were used as the training cohort; univariate and multivariate cox analysis were performed. A nomogram was constructed based on the independent prognostic factors. Patients from the Nanfang Hospital affiliated with Southern Medical University were used as the cohort to validate the predictive ability using the nomogram model. Harrell's concordance index (C-index) and calibration plots were used to evaluate the nomogram. Results: A total of 110 and 62 patients with TGCT were included in training cohort and validation cohort, respectively. Lymphatic Vascular Invasion (LVI), American Joint Committee on Cancer (AJCC) stage and adjuvant therapy were independent prognostic factors in multivariate regression analyses and were included to establish a nomogram. The C-index in the training cohort for 1-, 3-, and 5-year PFS were 0.768, 0.74 and 0.689, respectively. While the C-index for 1-, 3-, and 5-year PFS in the external validation cohort were 0.853, 0.663 and 0.609, respectively. The calibration plots for 1-, 3-, and 5-year PFS in the training and validation cohort showed satisfactory consistency between predicted and actual outcomes. The nomogram revealed a better predictive ability for PFS than AJCC staging system. Conclusion: The nomogram as a simple and visual tool to predict individual PFS in patients with TGCT could guide clinicians and clinical pharmacists in therapeutic strategy.

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