Distance from the anal verge as an indirect measure to predict response to anti-EGFR therapy in left side metastatic colon cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15153-e15153
Author(s):  
Daniela Pezzutti DOMINGUES Armentano ◽  
Mariana Ribeiro Monteiro ◽  
Raphael Araujo ◽  
Renata Arakelian ◽  
Paula Freire Cardoso ◽  
...  
Keyword(s):  
Anal Verge ◽  
Tumor Location ◽  
Response To Therapy ◽  
Rank Test ◽  
Metastatic Colon Cancer ◽  
Indirect Measure ◽  
Colon Cancers ◽  
Significant Difference ◽  
Group A ◽  
Group B

e15153 Background: Right and left sided colon cancers (RC, LC) differ with respect to biology and response to therapy. Several retrospective analyses have assessed the clinical effect of epidermal growth fator receptor (EGFR) targeted agents in patients with metastatic CRC (mCRC) according to the primary tumor location. Differentiating only right from left. But can in the LC responses differ according to the distance from the anal verge (DAV)? Methods: Exploratory retrospective analyses was planned to evaluate if LC responses differ according to the DAV. LC was defined as tumors originating anywhere from the distal rectum to the left colic flexure (splenic flexure). DAV was describe in cm measured by previous to surgery or treatment, colonoscopy, CT or MRI. Patients were divided for analysis purposes in two groups: Group A (tumors above 12cm from de anal verge), Group B (tumors below 12cm from the anal verge). Results: We retrospectively evaluated 29 patients with left metastatic colorectal cancer treated with anti-EGFR therapy as part of their treatment at the Paulistano Hospital -São Paulo from 2011 to 2018. Median population age 51.8 years (48.5-62.3). Median DAV 14.5 (4.6-25 cm). Median follow-up 12.8 months. No significant difference on stable and partial response rate was detected (Group A 43.7% vs Gropup B 56.3%), p=0.211. Long-rank test with a median pFS 8,5 meses and a PFS at 6 months of 66.7 vs 78,8 (Group A and Group B respectively ), p=0.901. Two-year OS was 58.4 % in Group A and 100% in Group B, p=0.17. Conclusions: Although no significant diferences were detected, responses rates were numerically higher in patients with tumors located below 12 cm from the anal verge. Further studies are needed to evaluate the association between response and DAV.

scholarly journals Cisplatin, Cetuximab, and Radiation in Locally Advanced Head and Neck Squamous Cell Cancer: A Retrospective Review

2015 ◽  
Vol 9 ◽  
pp. CMO.S18682 ◽  
Author(s):  
Prakash Peddi ◽  
Runhua Shi ◽  
Binu Nair ◽  
Fred Ampil ◽  
Glenn M. Mills ◽  
...  
Keyword(s):  
Head And Neck ◽  
Performance Status ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Rank Test ◽  
Advanced Head ◽  
Significant Difference ◽  
Group A ◽  
Group B

Efficacy of cisplatin versus cetuximab with radiation in locally advanced head and neck cancer (LAHNC) was evaluated. A total of 96 patients with newly diagnosed LAHNC treated at our institution between 2006 and 2011 with concurrent radiation and cisplatin (group A, n = 45), cetuximab (group B, n = 24), or started with cisplatin but switched to cetuximab because of toxicity (group C, n = 27) were reviewed. Chi-square test, analysis of variance, and log-rank test were used for analysis. The three groups had similar baseline characteristics, except for median age, T stage, albumin levels, hemoglobin levels, performance status, and comorbidities. A complete response (CR) was seen in 77%, 17%, and 67% of patients ( P < 0.001), respectively. There was no significant difference in median overall survival (OS) between groups A and C. The median OS for groups A and C was not reached (>65 months), even though it was significantly longer than median OS for group B (11.6 months; P ≤ 0.001). The 2-year OS in groups A and C is significantly higher than that in group B (70% for groups A and C, 22% for group B). There is no significant difference in progression-free survival (PFS) between groups A and C. The median PFS for these groups was not reached (>62 months), and is significantly longer than that for group B (4.3 months; P ≤ 0.001). The 2-year PFS of group A (67%) and group C (76%) was significantly longer than that of group B (20%). Cisplatin with radiation appears to be more efficacious even in suboptimal dosing than cetuximab with radiation in LAHNC but the two groups were not well matched.

scholarly journals Induction chemotherapy for the individualised treatment of hypopharyngeal carcinoma with cervical oesophageal invasion: a retrospective cohort study

2020 ◽  
Author(s):  
Tian-qiao Huang ◽  
Ru Wang ◽  
Ju-gao Fang ◽  
Shi-zhi He ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Retention Rates ◽  
Rank Test ◽  
Hypopharyngeal Carcinoma ◽  
First Choice ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Individualised Treatment

Abstract Background: The aim of this study was to evaluate the potential of induction chemotherapy as an indicator of the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion. Methods: Sixty-eight patients admitted to our hospital between February 2003 and November 2016 with stage IVB hypopharyngeal carcinoma with cervical oesophageal invasion were retrospectively analysed. Patients were divided into two groups according to the treatment they selected following an explanation of the different treatments available. Patients in Group A received induction chemotherapy and had (1) complete/partial remission following chemotherapy and radiotherapy/concurrent chemoradiotherapy or (2) stable disease following chemotherapy and surgery. Patients in Group B underwent surgery followed by adjuvant radiotherapy/concurrent chemoradiotherapy. Survival analyses were performed using the Kaplan–Meier method, and differences between the groups were evaluated using the log-rank test. Laryngeal and oesophageal retention rates were compared using the cross-tabulation test. Results: The 3- and 5-year overall survival rates were 22.86% and 11.43% in Group A and 24.25% and 6.06% in Group B, respectively (all P > 0.05). The laryngeal and oesophageal retention rates were 40.0% and 74.3% in Group A and 0.0% and 27.3% in Group B, respectively (all P < 0.01). There was no statistically significant difference in the incidence of post-operative complications between the two groups (Group A: 8.6%, Group B: 12.1%; P > 0.05). Conclusions: Induction chemotherapy may be an appropriate first choice to ensure laryngeal and oesophageal preservation in the individualised treatment of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.

Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shigeru Fujimoto ◽  
Masato Osaki ◽  
Masaya Kumamoto ◽  
Makoto Kanazawa ◽  
Naoki Tagawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Arch ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact

Background & Purpose: In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death. Methods: Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.

Fistula first, graft on arterialized vein second

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 265-269
Author(s):  
Giuseppe Galzerano ◽  
Michele Giubbolini ◽  
Francesco Setacci ◽  
Gianmarco de Donato ◽  
Pasqualino Sirignano ◽  
...  
Keyword(s):  
Patency Rate ◽  
Rank Test ◽  
P Value ◽  
Secondary Patency ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Vein Stenosis

Objectives Arterovenous grafts (AVGs) present a feasible solution for creating a vascular access in patients who are unsuitable for autogenous fistula (AVF). The aim of this study is to assess the prevention rate of vein stenosis, placing a graft on an arterialized vein (GAV) instead of an anastomized AVG in a native vein (GNV). Methods This was a cohort study conducted from January 2009 to November 2012. All consecutive patients who underwent AVG in our institution were included. All patients requiring a secondary intervention were also referred to our centre. Patients underwent ultrasound follow up at first and the every month. A Kaplan–Meier method was used; a Log-rank test was used to identify whether significant difference existed between GAV and GNV ( p < 0.05). Results Forty-six grafts were placed. Twenty patients had arterialized receiving veins (group A), while 26 patients received an AVG immediately because they lacked autogenous veins suitable for fistula (group B).The average follow-up period was 16.1 months (range 0–41). The group A 41 months-patency rate was 84.3%, while group B was 43.7% ( p = 0.06). Secondary patency was similar in the two groups. Conclusions Vein arterialization seems to prevent venous stenosis improving AVG-patency rate. More data are needed; however, the borderline p value encourages new studies.

scholarly journals Induction chemotherapy for the individualised treatment of hypopharyngeal carcinoma with cervical oesophageal invasion: a retrospective cohort study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Tian-Qiao Huang ◽  
Ru Wang ◽  
Ju-Gao Fang ◽  
Shi-Zhi He ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Retention Rates ◽  
Rank Test ◽  
Hypopharyngeal Carcinoma ◽  
First Choice ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Individualised Treatment

Abstract Background This study aimed to evaluate the potential of induction chemotherapy as an indicator of the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion. Methods Sixty-eight patients admitted to our hospital between February 2003 and November 2016 with stage IVB hypopharyngeal carcinoma with cervical oesophageal invasion were retrospectively analysed. Patients were divided into two groups according to the treatment they selected following an explanation of the different treatments available. Patients in group A received induction chemotherapy and had (1) complete/partial remission following chemotherapy and radiotherapy/concurrent chemoradiotherapy or (2) stable disease following chemotherapy and surgery. Patients in group B underwent surgery followed by adjuvant radiotherapy/concurrent chemoradiotherapy. Survival analyses were performed using the Kaplan–Meier method, and differences between the groups were evaluated using the log-rank test. Laryngeal and oesophageal retention rates were compared using the cross-tabulation test. Results The 3- and 5-year overall survival rates were 22.86% and 11.43% in group A and 24.25% and 6.06% in group B, respectively (all P > 0.05). The laryngeal and oesophageal retention rates were 40.0% and 74.3% in group A and 0.0% and 27.3% in group B, respectively (all P < 0.01). There was no statistically significant difference in the incidence of post-operative complications between the two groups (group A 8.6%, group B 12.1%; P > 0.05). Conclusions Induction chemotherapy may be an appropriate first choice to ensure laryngeal and oesophageal preservation in the individualised treatment of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.

Treatment Strategy for Patients with HR-Positive HER2-Negative Metastatic Breast Cancer That Progressed on CDK4/6 Inhibitors

Breast Care ◽  
2021 ◽  
pp. 1-8
Author(s):  
Shouko Hayama ◽  
Rikiya Nakamura ◽  
Toshiko Miyaki ◽  
Makiko Itami ◽  
Naohito Yamamoto
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Treatment Option ◽  
Metastatic Breast ◽  
Mtor Inhibitors ◽  
Subsequent Treatment ◽  
Rank Test ◽  
Significant Difference ◽  
Group A ◽  
Group B

<b><i>Background/Aims:</i></b> The study aim was to evaluate if mTOR inhibitors can be considered as a treatment option for HR+ HER2− metastatic breast cancer (MBC) after progression on CDK4/6 inhibitors in clinical practice. <b><i>Methods:</i></b> We retrospectively collected the clinicopathological data of patients with HR+ HER2− MBC treated with CDK4/6 inhibitors and subsequent therapies at our institution between 2014 and 2020. The patients were divided into 3 groups according to the type of subsequent treatment: (A) exemestane plus everolimus, (B) endocrine monotherapy, and (C) chemotherapy. Overall survival (OS) was estimated by using the Kaplan-Meier method and compared by using the log-rank test. The efficacy and adverse events (AEs) of each subsequent treatment were assessed by using Fisher’s exact tests. <b><i>Results:</i></b> Eighty-six patients (34 in group A, 20 in group B, 32 in group C) were included. The most common endocrine therapy in group B was fulvestrant (40%). The major chemotherapy regimen in group C was eribulin (25%). The median OS times after stopping CDK4/6 inhibitors were 34.5 months (95% confidence interval, 17.2 to NA), 13.6 months (3.9 to NA), and 19.5 months (18.8 to NA) in group A, group B, and group C, respectively. The only significant difference in OS was observed between group A and group B (20.9 months; <i>p</i> = 0.003). There was no difference in the incidence of grade 3 AEs between groups A and C or in the frequency of treatment discontinuation because of AEs among the 3 groups. <b><i>Conclusion:</i></b> Our study shows that mTOR inhibitors might be an effective treatment option for patients with HR+ HER2− MBC previously treated with CDK4/6 inhibitors.

scholarly journals Comparative study of closed versus open lateral internal sphincterotomy in the management of chronic anal fissure

2020 ◽  
Vol 7 (4) ◽  
pp. 1158
Author(s):  
Anand R. Bansal ◽  
Manish Bansal ◽  
Ankit Bhardwaj
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Anal Verge ◽  
Dentate Line ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Significant Difference ◽  
Delayed Healing ◽  
Group A ◽  
Group B

Background: Anal fissure is a painful tear in distal anal canal extending from just below the dentate line to anal verge. Patient presents with pain during or after defecation and passage of bright red blood per anus. Various studies investigating chronic anal fissures show a large variation in healing rates for different modalities. The present study was carried out to evaluate effectiveness of closed versus open lateral internal sphincterotomy in treatment of patients with chronic anal fissure.Methods: A prospective study was conducted in the Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak. Group A and group B included 20 patients each with chronic anal fissure and managed by closed and open lateral internal sphincterotomy respectively and effectiveness was evaluated with regards to fissure healing, pain reduction, recurrence and incontinence after surgical treatment.Results: The mean pain scores on visual analogue scale at end of 1 week in group A and group B was not found to be statistically significant, whereas it was found to be statistically significant at 3 week and at 6 weeks. Delayed healing was seen in 1 patient of group B, whereas no patient in group A had delayed healing or absence of healing postoperatively.Conclusions:There was a significant difference between closed and open methods of lateral internal sphincterotomy in terms of relief in post-operative pain but as a whole both techniques did not show any statistically significant difference in terms of fissure healing, postoperative complications or recurrence at 3 months.  

scholarly journals Induction Chemotherapy for the Individualized Treatment of Hypopharyngeal Cancer with Oesophageal Invasion: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Tian-qiao Huang ◽  
Ru Wang ◽  
Ju-gao Fang ◽  
Shi-zhi He ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Hypopharyngeal Cancer ◽  
Individualized Treatment ◽  
Retention Rates ◽  
Rank Test ◽  
First Choice ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: This study aimed to evaluate the potential for induction chemotherapy to be an indicator for the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.Methods: Sixty-eight patients (admitted to our department between February 2003 and November 2016) with stage IVB hypopharyngeal cancer with cervical oesophageal invasion were retrospectively analysed. Patients were divided into two groups depending on the treatment they selected following an explanation they received on the different treatments. Group A patients received induction chemotherapy and had (1) complete or partial remission following chemotherapy combined with radiotherapy or concurrent chemoradiotherapy or (2) stable disease following chemotherapy combined with surgery. Group B patients underwent surgery and received adjuvant radiotherapy or concurrent chemoradiotherapy following surgery. Survival analyses were performed using the Kaplan–Meier method, differences between the two groups were tested using the log-rank test, and the laryngeal and oesophageal retention rates were compared using the cross-tabulation test. Results: The 3- and 5-year overall survival rates of patients in Group A were 22.86% and 11.43%, respectively; in Group B, the rates were 24.25% and 6.06%, respectively (P > 0.05 for all). The laryngeal retention rates in Group A and B patients were 40% and 0%, respectively, whereas the oesophageal retention rates in Group A and B patients were 74.3% and 27.3%, respectively (P < 0.01 for all). There was no statistically significant difference in the incidence of postoperative complications between the two groups (Group A: 8.6%, Group B: 12.1%, P > 0.05). Conclusions: For patients with advanced hypopharyngeal cancer with cervical oesophageal invasion, induction chemotherapy could be the appropriate first choice for individualized treatment to ensure laryngeal and oesophageal cancer preservation.

scholarly journals Induction chemotherapy for the individualised treatment of hypopharyngeal carcinoma with cervical oesophageal invasion: a retrospective cohort study

2020 ◽  
Author(s):  
Tian-qiao Huang ◽  
Ru Wang ◽  
Ju-gao Fang ◽  
Shi-zhi He ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Retention Rates ◽  
Rank Test ◽  
Hypopharyngeal Carcinoma ◽  
First Choice ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Individualised Treatment

Abstract Background: This study aimed to evaluate the potential of induction chemotherapy as an indicator of the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.Methods: Sixty-eight patients admitted to our hospital between February 2003 and November 2016 with stage IVB hypopharyngeal carcinoma with cervical oesophageal invasion were retrospectively analysed. Patients were divided into two groups according to the treatment they selected following an explanation of the different treatments available. Patients in Group A received induction chemotherapy and had (1) complete/partial remission following chemotherapy and radiotherapy/concurrent chemoradiotherapy or (2) stable disease following chemotherapy and surgery. Patients in Group B underwent surgery followed by adjuvant radiotherapy/concurrent chemoradiotherapy. Survival analyses were performed using the Kaplan–Meier method, and differences between the groups were evaluated using the log-rank test. Laryngeal and oesophageal retention rates were compared using the cross-tabulation test.Results: The 3- and 5-year overall survival rates were 22.86% and 11.43% in Group A and 24.25% and 6.06% in Group B, respectively (all P > 0.05). The laryngeal and oesophageal retention rates were 40.0% and 74.3% in Group A and 0.0% and 27.3% in Group B, respectively (all P < 0.01). There was no statistically significant difference in the incidence of post-operative complications between the two groups (Group A: 8.6%, Group B: 12.1%; P > 0.05).Conclusions: Induction chemotherapy may be an appropriate first choice to ensure laryngeal and oesophageal preservation in the individualised treatment of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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