Adjuvant chemotherapy with CAV/IE for malignant transformation of teratoma to primitive neuroectodermal tumor (PNET): An institutional analysis from Indiana University.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5026-5026
Author(s):  
Cynthia Wei ◽  
Clint Cary ◽  
Timothy A. Masterson ◽  
Richard Foster ◽  
Ryan Ashkar ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Malignant Transformation ◽  
Indiana University ◽  
Primary Tumor Site ◽  
Disease Biology ◽  
Alive With Disease ◽  
Poor Outcomes ◽  
Disease Free

5026 Background: Malignant transformation of teratoma to PNET has an aggressive disease biology and generally poor outcomes when metastasis occurs. The optimal management of patients (pts) with PNET who have complete surgical extirpation is unknown. Most pts who are monitored with surveillance will relapse. We report results from pts with metastatic PNET who had complete surgical resection to NED status followed by adjuvant chemotherapy, most commonly cyclophosphamide + doxorubicin + vincristine alternating with ifosfamide + etoposide (CAV/IE) for 4 cycles. Methods: We reviewed records for pts with histologically confirmed malignant transformation of teratoma at Indiana University from 1990 to 2020. We identified 13 pts with PNET who underwent resection of metastatic disease to NED status followed by treatment with adjuvant chemotherapy, most commonly CAV/IE comprising of cyclophosphamide (1200 mg/m2), doxorubicin (75 mg/m2), and vincristine (2 mg/m2) alternating with ifosfamide (1.8 g/m2) plus etoposide (100 mg/m2). Treatment was delivered every 3 weeks for 4 cycles or until unacceptable toxicity. Results: Thirteen pts with metastatic PNET resected to NED status and received adjuvant chemotherapy were identified. Median age at diagnosis was 29 (range, 20 to 55). Primary tumor site was testis in 11 pts, retroperitoneum in 1 pt, and mediastinum in 1 pt. Metastasis site was retroperitoneal lymph nodes in 11 pts, mediastinal lymph nodes in 1 pt, and local mediastinal recurrence in 1 pt. After resection to NED status, all 13 pts were treated with adjuvant chemotherapy: 11 pts were treated with CAV/IE and 2 received etoposide-ifosfamide-cisplatin (VIP) x 2. Among the 11 pts who received CAV/IE: 3 pts received < 4 cycles due to toxicity and 8 completed 4 cycles. With a median follow-up of 16.3 months, 3 of 13 pts relapsed (23%) and 10 of 13 remained continuously disease free (77%). Of those who relapsed, median time to relapse was 9.3 months, 2 remained alive with disease at follow up and one patient died of disease progression. Conclusions: Adjuvant CAV/IE improves the outcomes of pts with malignant transformation of teratoma to PNET and who had resection of metastasis to NED status. Most pts who received adjuvant therapy remain continuously disease-free in comparison to historically high relapse rates in pts with resected PNET monitored with surveillance.

Radiofrequency Ablation of Hepatic Metastases from Colorectal Cancer: Are Newer Generation Probes Better?

2006 ◽  
Vol 72 (10) ◽  
pp. 875-879 ◽  
Author(s):  
Aziz Ahmad ◽  
Steven L. Chen ◽  
Maihgan A. Kavanagh ◽  
David P. Allegra ◽  
Anton J. Bilchik
Keyword(s):  
Colorectal Cancer ◽  
Radiofrequency Ablation ◽  
First Generation ◽  
Hepatic Metastases ◽  
Disease Free Survival ◽  
Cancer Center ◽  
Free Survival ◽  
Alive With Disease ◽  
Disease Free

Second-generation radiofrequency ablation (RFA) probes and their successors have more power, shorter ablation times, and an increased area of ablation compared with the first-generation probes used before 2000. We examined whether the use of the newer probes has improved the clinical outcome of RFA for hepatic metastases of colorectal cancer at our tertiary cancer center. Of 160 patients who underwent RFA between 1997 and 2003, 52 had metastases confined to the liver: 21 patients underwent 46 ablations with the first-generation probes and 31 patients underwent 58 ablations with the newer probes. The two groups had similar demographic characteristics. At a median follow-up of 26.2 months, patients treated with the newer probes had a longer median disease-free survival (16 months vs 8 months, P < 0.01) and a lower rate of margin recurrence (5.2% vs 17.4%); eight patients had no evidence of disease and one patient was alive with disease. By contrast, of the 46 patients treated with the first-generation probes, 2 patients had no evidence of disease and 1 patient was alive with disease. Newer-generation probes are associated with lower rates of margin recurrence and higher rates of disease-free survival after RFA of hepatic metastases from colorectal cancer.

Expression of A9 Antigen and Loss of Blood Group Antigens as Determinants of Survival in Patients with Head and Neck Squamous Carcinoma

1987 ◽  
Vol 96 (3) ◽  
pp. 221-230 ◽  
Author(s):  
Thomas E. Carey ◽  
Gregory T. Wolf ◽  
S. Hsu ◽  
J. Poore ◽  
K. Peterson ◽  
...  
Keyword(s):  
Head And Neck ◽  
Blood Group ◽  
Squamous Cell ◽  
Primary Tumor ◽  
Primary Tumor Site ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free

The murine monoclonal antibody (A9), raised to the human squamous cell carcinoma (SCC) cell-line UM-SCC-1, defines a squamous cell antigen associated with aggressive biologic behavior of SCC cell lines in vivo and in vitro. In the present investigation, A9 antigen was detected in tissue sections from 37 consecutive, previously untreated patients with SCC of the head and nack. All tumors were positive for A9 binding, although three distinct patterns (reflecting different intensities of A9 expression) were identified. The intensity of A9 expression was independent of primary tumor site, tumor differentiation, keratinization, or growth pattern. The frequency of high expression (Pattern 1) grew with increasing T class, N class, and tumor stage, and was associated with loss of blood group expression in the tumor and with low levels of lymphocyte infiltration In the tumor. Strong A9 expression had a statistically signification association with low nuclear grade (i.e., tumors with more mature and fewer enlarged nuclei, P = 0.019), low vascular/stromal response (i.e., patchy response rather than continuous, P = 0.014), and impaired in vitro lymphokine production by peripheral blood leukocytes ( P = 0.0011). Of greatest interest, however, was the strong association of high A9 expression with shortened disease-free interval (DFI) ( P = 0.085) and survival ( P = 0.081) relative to patients with weak A9 tumor staining (Patterns 2 and 3). Similarly, the loss of blood group antigen expression was strongly associated with decreased DFI ( P = 0.038) and survival ( P = 0.062). While neither Pattern 1 A 9 expression nor loss of blood group reach statistical significance in prediction of survival, the combination of Pattern 1 A 9 expression and loss of blood group expression in primary tumors was significantly associated, both with decreased disease-free interval ( P = 0.017) and with decreased overall survival ( P = 0.011) (median length of follow-up = 22 months). The length of follow-up (LFU) ranged from 2 to 38 months, with a median LFU of 22 months. While the number of patients (37) is small, the significant association between the expression of these cell-surface markers with relapse and survival indicates that immunohistologic staining of the primary tumor will be an important prognostic indicator useful in identification of individual patients at greatest risk of recurrence or early death from head and neck cancer, independent of tumor size, site, or stage at presentation. These markers may thus provide means of selecting patients who should receive adjuvant therapy and more intensive monitoring for the early detection of recurrent disease.

Adjuvant chemotherapy for patients with high-grade soft-tissue sarcomas of the extremity.

1988 ◽  
Vol 6 (9) ◽  
pp. 1491-1500 ◽  
Author(s):  
A E Chang ◽  
T Kinsella ◽  
E Glatstein ◽  
A R Baker ◽  
W F Sindelar ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Dose Regimen ◽  
Soft Tissue Sarcomas ◽  
Disease Free Survival ◽  
High Dose ◽  
Free Survival ◽  
High Dose Regimen ◽  
Disease Free

We have previously reported the results of a randomized trial that demonstrated the survival benefit of adjuvant chemotherapy in the treatment of patients with high-grade extremity sarcomas compared with no chemotherapy. This regimen included doxorubicin, cyclophosphamide, and methotrexate. This report updates and extends our experience. The median follow-up of this trial is now 7.1 years and reveals a 5-year disease-free survival of 75% and 54% for chemotherapy and no chemotherapy groups, respectively (two-sided P [P2] = .037). The 5-year overall survival for patients in this trial was 83% and 60% for the chemotherapy and no chemotherapy groups, respectively, with a trend towards improved survival in the chemotherapy arm (P2 = .124). Because of doxorubicin-induced cardiomyopathy we performed a subsequent randomized trial comparing this high-dose regimen to reduced cumulative doses of doxorubicin and cyclophosphamide without methotrexate. Eighty-eight patients were entered into this trial which has a median follow-up of 4.4 years. The 5-year disease-free and overall survival for patients treated with the reduced doses of chemotherapy was 72% and 75%, respectively, and was not significantly different from the high-dose regimen. No patients developed congestive heart failure on this study. We conclude that adjuvant chemotherapy improves disease-free survival in patients with extremity soft-tissue sarcomas. The overall survival advantage in patients receiving adjuvant chemotherapy in our initial randomized high-dose chemotherapy trial has diminished though it continues to favor the chemotherapy group. A reduced-dose chemotherapy regimen was found to be comparable to the high-dose regimen.

5-Year Results of Dose-Intensive Sequential Adjuvant Chemotherapy for Women With High-Risk Node-Positive Breast Cancer: A Phase II Study

1999 ◽  
Vol 17 (4) ◽  
pp. 1118-1118 ◽  
Author(s):  
C. Hudis ◽  
M. Fornier ◽  
L. Riccio ◽  
D. Lebwohl ◽  
J. Crown ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Pilot Study ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Dose Dense ◽  
Disease Free

PURPOSE: We conducted a phase II pilot study of dose-intensive adjuvant chemotherapy with doxorubicin followed sequentially by high-dose cyclophosphamide to determine the safety and feasibility of this dose-dense treatment and to estimate the disease-free and overall survival in breast cancer patients with four or more involved axillary lymph nodes. PATIENTS AND METHODS: Seventy-three patients received adjuvant treatment with four cycles of doxorubicin 75 mg/m2 as an intravenous bolus every 21 days, followed by three cycles of cyclophosphamide 3,000 mg/m2 every 14 days with granulocyte colony-stimulating factor support. RESULTS: Seventy-one patients were assessable, and all but two completed all planned chemotherapy. There was no treatment-related mortality. The most common toxicity was neutropenic fever, which occurred in 39% of patients. Median disease-free survival is 66 months (95% confidence interval, 34 to 98 months), and median overall survival has not yet been reached. At 5 years of follow-up, the disease-free survival is 51.7%, and overall survival is 60.0%. There is no long-term treatment-related toxicity, and no cases of acute myelogenous leukemia or myelodysplastic syndrome have been observed. CONCLUSION: Our pilot study of doxorubicin followed by cyclophosphamide demonstrates the safety and feasibility of the sequential dose-dense plan. Long-term follow-up, although noncomparative, is promising. However, this regimen is associated with a higher incidence of toxicity (and also higher costs) than the standard dose and schedule of doxorubicin and cyclophosphamide, and therefore it should not be used as conventional therapy in the absence of demonstrated improvement of outcome. Randomized trials testing the dose-dense approach have been completed but not yet reported. Because the sequential plan can decrease overlapping toxicities, it is an appropriate platform for the addition of newer active agents, such as taxanes or monoclonal antibodies.

Risk-Adapted Treatment in Clinical Stage I Testicular Seminoma: The Third Spanish Germ Cell Cancer Group Study

2011 ◽  
Vol 29 (35) ◽  
pp. 4677-4681 ◽  
Author(s):  
Jorge Aparicio ◽  
Pablo Maroto ◽  
Xavier García del Muro ◽  
Josep Gumà ◽  
Alfonso Sánchez-Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Clinical Stage ◽  
Cell Cancer ◽  
Stage I ◽  
Adequate Treatment ◽  
Local Risk ◽  
Stage I Seminoma ◽  
Disease Free

Purpose To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate. Patients and Methods From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance. Results After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%. Conclusion With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model.

Accelerated hypofractionated hemithoracic intensity modulated radiation therapy (IMRT) followed by extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM): Results of a phase I/II study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7526-7526
Author(s):  
Marc de Perrot ◽  
Ronald Feld ◽  
Natasha B. Leighl ◽  
Isabelle Opitz ◽  
Masaki Anraku ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Stage Iii ◽  
Extrapleural Pneumonectomy ◽  
Final Pathology ◽  
Concomitant Boost ◽  
Short Period ◽  
Disease Free

7526 Background: We developed a protocol with accelerated hypofractionated hemithoracic IMRT followed by EPP for MPM. Advantages include optimal delivery of radiation to the whole tumor bed in a short period limiting the risk of viable tumor cell spread during surgery. Methods: Patients with resectable clinical T1-3N0M0 histology proven MPM were eligible for the study. 25 Gy in 5 daily fractions over 1 week was delivered to the entire ipsilateral hemithorax by IMRT with concomitant boost of 5 Gy to volumes at high risk based on CT and PET scan findings. EPP was performed one week after the end of radiation. Adjuvant chemotherapy was offered to patients with ypN2 on final pathology. The primary end-point was treatment related mortality. Secondary endpoint included overall survival and disease-free survival (DFS). Initial sites of recurrence were also recorded. Results: Twenty five patients were accrued between 11/2008 and 10/2012. Patients had a median age of 64 years (range, 45-75), 76% were males, 64% had epithelioid histology. All patients completed IMRT and EPP. IMRT was well tolerated with no grade 3-5 toxicity. EPP was performed 6±2 days after completion of IMRT. Surgical complications occurred in 18 patients. One patient died from empyema at 88 days. All but one patient (stage IB) had stage III (n=11) or IV (n=13) disease on final pathology. Five out of 13 patients with ypN2 disease underwent adjuvant chemotherapy. After a median follow-up of 19 months (range, 3-51), the estimated 3-year survival reached 62%. Survival was significantly better in epithelioid compared to biphasic pathologic subtypes (83% survival at 3 years vs 19%, respectively; p=0.004). 14 patients remain disease free after a median follow-up of 17 months (range, 3-37). 2-year DFS was 85% in stage III and 37% in stage IV disease (p=0.03). Recurrences occurred in the ipsilateral chest only (n=2), ipsilateral chest and distant sites (n=2), and distant sites only (n=6). Conclusions: Accelerated hypofractionated hemithoracic IMRT followed by EPP is feasible. This treatment could improve survival in selected patients with epithelial subtype. Clinical trial information: NCT00797719.

Phase I study of chemoradiation with nedaplatin and ifosfamide in patients with advanced squamous cell carcinoma of the uterine cervix

2008 ◽  
Vol 18 (6) ◽  
pp. 1300-1304 ◽  
Author(s):  
J. Kodama ◽  
M. Takemoto ◽  
N. Seki ◽  
K. Nakamura ◽  
A. Hongo ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Uterine Cervix ◽  
Complete Response ◽  
Advanced Squamous Cell Carcinoma ◽  
Alive With Disease ◽  
Disease Free ◽  
Dose Limiting Toxicity

Cisplatin and ifosfamide are considered among the most active drugs in both neoadjuvant and salvage treatments for patients with cervical cancer. Nedaplatin is an analog of cisplatin and it exhibits lesser nephrotoxicity, neurotoxicity, and gastrointestinal toxicity than cisplatin. This study aimed to determine the recommended dosage of nedaplatin plus ifosfamide chemoradiotherapy for advanced squamous cell carcinoma (SCC) of the uterine cervix. Beginning with a dose of 65 mg/m2, nedaplatin (day 1) combined with ifosfamide 1 g/m2 (days 1–5) was designed to be administered for three cycles (minimum: two cycles); its dose was gradually escalated up to 80 mg/m2. Dose-limiting toxicity (DLT) was defined as a more than 7-day delay in the planned radiation therapy and/or planned chemotherapy (prior to the completion of two cycles) due to toxicity. Chemotherapy was not interrupted prior to the completion of two cycles in any patients. Of the 12 patients, 11 received three cycles of chemotherapy. DLT did not occur in any patient. We confirmed a clinical complete response (CR) in ten and partial response (PR) in two patients. The median follow-up period was 39 months (range: 18–57 months). Ten patients (83%) were alive and disease free, one patient was alive with disease, and only one patient died due to the disease. Nedaplatin and ifosfamide combination chemotherapy is a feasible and active chemoradiation strategy for patients with advanced SCC of the uterine cervix. With the ifosfamide dose fixed to 1 g/m2, the recommended nedaplatin dosage was determined to be 80 mg/m2 to be administered for three cycles.

FIGO stage IIIC endometrial carcinoma: Resection of macroscopic nodal disease and other determinants of survival

2003 ◽  
Vol 13 (5) ◽  
pp. 664-672 ◽  
Author(s):  
R. E. Bristow ◽  
M. L. Zahurak ◽  
C. J. Alexander ◽  
R. C. Zellars ◽  
F. J. Montz
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Endometrial Carcinoma ◽  
Figo Stage ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Nodal Disease ◽  
Stage Iiic

The objective of this study was to evaluate the potential survival benefit of debulking macroscopic adenopathy and other clinical prognostic factors among patients with node-positive endometrial carcinoma. Demographic, operative, pathologic, & follow-up data were abstracted retrospectively for 41 eligible patients with FIGO stage IIIC endometrial cancer. Survival curves were generated using the Kaplan-Meier method and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. All patients had positive pelvic lymph nodes and 20 patients (48.8%) had positive para-aortic lymph nodes. Postoperatively, all patients received whole pelvic radiation therapy, 17 received extended-field radiation therapy, and 15 patients received chemotherapy. The median disease-specific survival (DSS) time for all patients was 30.6 months (median follow-up 34. 0 months). Patients with completely resected macroscopic lymphadenopathy had a significantly longer median DSS time (37.5 months), compared to patients left with gross residual nodal disease (8.8 months, P = 0.006). On multivariate analysis, independent predictors of DSS were gross residual nodal disease (HR 7.96, 95% CI 2.54–24.97, P < 0. 001), age ≥ 65 years (HR 6.22, 95% CI 2.05–18.87, P = 0.001), and the administration of adjuvant chemotherapy (HR 0.22, 95% CI 0.07–0.76, P = 0.016). We conclude that in patients with stage IIIC endometrial carcinoma, complete resection of macroscopic nodal disease and the administration of adjuvant chemotherapy, in addition to directed radiation therapy, are associated with improved survival.

Bronchial-Associated Lymphoid Tissue (BALT) Lymphoma: Characteristics and Treatment Outcome of 19 Cases.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4564-4564
Author(s):  
Kathryn P. Beal ◽  
Carol Portlock ◽  
Joachim Yahalom
Keyword(s):  
Treatment Outcome ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphoid Tissue ◽  
B Cell Lymphoma ◽  
Mediastinal Lymph Nodes ◽  
Cervical Lymph Nodes ◽  
Balt Lymphoma ◽  
Disease Free

Abstract Background: Bronchial-associated lymphoid tissue (BALT) lymphoma, an indolent marginal zone lymphoma, is a rare clinical entity with only few published reports on its optimal management and treatment outcome. In the absence of a well established standard of care, different treatment options are available including surgery, radiation, chemotherapy, immunotherapy or merely observation. We analyzed a large cancer center’s experience with the management of BALT lymphoma patients during the last 12 years. Patients and Methods: Nineteen cases of BALT lymphoma were identified from a database of 175 cases of MALT lymphoma pathologically confirmed at our center. We retrospectively reviewed the clinical data and treatment results. Results: There were 12 (63%) men and 7 (37%) women with a median age of 68 years (range 37–81 years). Seven (37%) patients were asymptomatic at diagnosis and were diagnosed after radiologic studies ordered either for routine evaluation or for pre-operative clearance showed unexpected abnormalities. The 12 (63%) symptomatic patients had non-specific pulmonary complaints such as cough, shortness of breath, or dyspnea on exertion. One patient had B symptoms (significant unintentional weight loss). Twelve patients (63%) had unilateral lung involvement and 7 (37%) had bilateral involvement on chest CT. Twelve patients had FDG-PET scans at the time of diagnosis and all had FDG uptake in pathologically confirmed sites of disease with a median SUV of 3.2 (range 1.3–26). Five patients (26%) had radiographically enlarged hilar or mediastinal lymph nodes including 1 with pathologically confirmed transformation to diffuse large B-cell lymphoma in a mediastinal lymph node and 1 with progression to a supraclavicular lymph node. Fifteen patients (79%) had stage I or II disease limited to their thorax. One patient had previously treated MALT of the bilateral orbits, 1 patient was also found to have MALT involving her small bowel, 1 patient also had bone marrow involvement, and 1 patient had extensive disease involving not only lung parenchyma but also mediastinal lymph nodes, and bilateral axillary, supraclavicular, and cervical lymph nodes. Ten patients were treated with surgery alone (8 had wedge resections, 2 had lobectomies). Six received chemotherapy alone and 2 had rituximab alone. One received radiation (RT) alone. With a median follow-up of 28 months (range 11–146 months), no patients were lost to follow-up. At 5 years, overall survival was 91% and disease free survival was 42%. At latest follow-up all patients were alive with the exception of one patient who died of his disease (the patient who had extensive lung parenchymal disease and lymphadenopathy) and 8 patients (42%) were without evidence of any disease after RT(1), chemotherapy(2), or surgery(5). Conclusion: In one of the largest series of BALT lymphoma patients with complete follow-up, we document good response to local treatment and overall excellent prognosis. Of interest, BALT lymphoma lesions are PET-positive and thus are similar to lung cancer lesions. Limited lesions may be safely resected and patients remain disease-free, but even some patients with unresectable disease respond to chemotherapy and are rendered disease-free or stable.

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