scholarly journals Long-term Outcomes from Proton Therapy for Sinonasal Cancers

2021 ◽  
Vol 8 (1) ◽  
pp. 200-212
Author(s):  
Roi Dagan ◽  
Haruka Uezono ◽  
Curtis Bryant ◽  
Adam L. Holtzman ◽  
Christopher G. Morris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Proton Therapy ◽  
Concurrent Chemotherapy ◽  
Gross Total Resection ◽  
High Grade ◽  
Total Resection ◽  
Sinonasal Cancer ◽  
Regional Control ◽  
Local Regional Control

Abstract Purpose To report long-term disease control, survival, and toxicity after proton therapy for sinonasal cancer. Patients and Methods We reviewed 143 cases of adults with nonmetastatic sinonasal cancers treated with primary (18%; n = 26) or adjuvant (82%; n = 117) proton therapy. The most common histologies were squamous cell carcinoma (29%; n = 42), olfactory neuroblastoma (23%; n = 33), and adenoid cystic carcinoma (16%; n = 23). Patients had predominantly advanced-stage disease (T3, 24%, n = 35; T4, 66%, n = 94) and high-grade histology (52%; n = 74). Surgery included endoscopic resection alone (50%) with craniotomy (10%) or open resection (40%), and 31% had gross disease present at radiotherapy. Most (91%) received high-dose (median, 73.6 Gy radiobiological equivalent [GyRBE]; 84% >70 GyRBE) passive-scatter proton therapy using accelerated hyperfractionation (1.2 GyRBE twice daily) and concurrent chemotherapy (70%). Univariate and multivariate models assessed prognostic factors. Grade 3+ toxicities were recorded per Common Terminology Criteria, version 4. Median follow-up was 3.4 years (range, 0.1–12.5 years) overall and 4.9 years (range, 0.9–12.5 years) for living patients. Results The 5-year outcomes were as follows: local control (LC), 80%; neck control, 96%; local-regional control, 78%; freedom from distant metastases, 71%; and disease-free survival, 62%; cause-specific survival, 64%; and overall survival, 59%. Surgery improved LC, but only with gross total resection (5-year LC 87% versus subtotal resection 62.9%, and biopsy alone 55% (P < 0.001). Gross residual disease was the only significant prognostic factor for local-regional control on multivariate analysis. High-grade, T4, and local recurrence were associated with decreased overall survival. Late (G3+) toxicity occurred in 22% (32 of 143), including central nervous system necrosis and vision loss in 6% (9 of 143) and 3.5% (5 of 143), respectively. Conclusion Proton therapy after gross-total resection provides excellent long-term LC in patients with locally advanced, high-grade sinonasal cancer. Moreover, LC remains strongly associated with long-term survival. With gross disease, about 60% of patients had long-term LC with proton therapy and induction or concurrent chemotherapy.

scholarly journals Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience

2021 ◽  
Vol 8 (1) ◽  
pp. 108-118
Author(s):  
G. Brandon Gunn ◽  
Adam S. Garden ◽  
Rong Ye ◽  
Noveen Ausat ◽  
Kristina R. Dahlstrom ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Proton Therapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Regional Control ◽  
Grade 5 ◽  
Grade 3 ◽  
Local Regional Control ◽  
Disease Free

Abstract Purpose To characterize our experience and the disease control and toxicity of proton therapy (PT) for patients with head and neck cancer (HNC). Patients and Methods Clinical outcomes for patients with HNC treated with PT at our institution were prospectively collected in 2 institutional review board–approved prospective studies. Descriptive statistics were used to summarize patient characteristics and outcomes. Overall survival, local-regional control, and disease-free survival were estimated by the Kaplan-Meier method. Treatment-related toxicities were recorded according to the Common Terminology Criteria for Adverse Events (version 4.03) scale. Results The cohort consisted of 573 patients treated from February 2006 to June 2018. Median patient age was 61 years. Oropharynx (33.3%; n = 191), paranasal sinus (11%; n = 63), and periorbital tissues (11%; n = 62) were the most common primary sites. Patients with T3/T4 or recurrent disease comprised 46% (n = 262) of the cohort. The intent of PT was definitive in 53% (n = 303), postoperative in 37% (n = 211), and reirradiation in 10% (n = 59). Median dose was 66 Gy (radiobiological equivalent). Regarding systemic therapy, 43% had received concurrent (n = 244), 3% induction (n = 19), and 15% (n = 86) had both. At a median follow-up of 2.4 years, 88 patients (15%) had died and 127 (22%) developed disease recurrence. The overall survival, local-regional control, and disease-free survival at 2 and 5 years were, respectively, 87% and 75%, 87% and 78%, and 74% and 63%. Maximum toxicity (acute or late) was grade 3 in 293 patients (51%), grade 2 in 234 patients (41%), and grade 1 in 31 patients (5%). There were 381 acute grade 3 and 190 late grade 3 unique toxicities across 212 (37%) and 150 (26%) patients, respectively. There were 3 late-grade 4 events across 2 patients (0.3%), 2 (0.3%) acute-grade 5, and no (0%) late-grade 5 events. Conclusions The overall results from this prospective study of our initial decade of experience with PT for HNC show favorable disease control and toxicity outcomes in a multidisease-site cohort and provide a reference benchmark for future comparison and study.

Letter to the Editor Regarding “Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection”

2020 ◽  
Vol 142 ◽  
pp. 537
Author(s):  
Gustavo Correa Lordelo ◽  
Victor Salviato Nespoli ◽  
Iuri Santana Neville ◽  
Wellingson Silva Paiva
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Letter To The Editor ◽  
Grade Ii

Combined Immunoscore of CD103 and CD3 Identifies Long-Term Survivors in High-Grade Serous Ovarian Cancer

2016 ◽  
Vol 26 (4) ◽  
pp. 671-679 ◽  
Author(s):  
Hans-Christian Bösmüller ◽  
Philipp Wagner ◽  
Janet Kerstin Peper ◽  
Heiko Schuster ◽  
Deborah Lam Pham ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Prognostic Value ◽  
Intraepithelial Lymphocytes ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Term Survival ◽  
Cell Counts

ObjectiveIncreased numbers of tumor-infiltrating lymphocytes (TILs) in high-grade serous ovarian cancer (HGSC) are associated with improved clinical outcome. Intraepithelial localization of TILs might be regulated by specific homing receptors, such as CD103, which is widely expressed by intraepithelial lymphocytes. Given the emerging role of CD103+ TILs, we aimed to assess their contribution to the prognostic value of immunoscoring in HGSC.MethodsThe density of intratumoral CD3+ and CD103+ lymphocytes was examined by immunohistochemistry on a tissue microarray of a series of 135 patients with advanced HGSC and correlated with CD4+, CD8+, CD56+, FoxP3+, and TCRγ+ T-cell counts, as well as E-cadherin staining and conventional prognostic parameters and clinical outcome.ResultsBoth the presence of CD103+ cells, as well as high numbers of intraepithelial CD3+ lymphocytes (CD3E), showed a significant correlation with overall survival, in the complete series, as well as in patients with optimal debulking and/or platinum sensitivity. Combining CD3 and CD103 counts improved prognostication and identified 3 major subgroups with respect to overall survival. The most pronounced effect was demonstrated for patients with optimally resected and platinum-sensitive tumors. Patients with CD3high/CD103high tumors showed a 5-year survival rate at 90%, CD3low/CD103high at 63%, and CD3low/CD103low at 0% (P < 0.001).ConclusionsThese results suggest that combined assessment of CD103 and CD3 counts improves the prognostic value of TIL counts in HGSC and might identify patients with early relapse or long-term survival based on the type and extent of the immune response.

scholarly journals P01.064 Correlation with MGMT pyrosequencing-based methylation levels and overall survival in glioblastoma patients with gross total resection and concomitant chemio and radiotherapy

2018 ◽  
Vol 20 (suppl_3) ◽  
pp. iii244-iii244
Author(s):  
A Parlangeli ◽  
E Pirola ◽  
M Caroli ◽  
C Pesenti ◽  
S Buonamassa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection

scholarly journals Low rates of recurrence and slow progression of pediatric pilocytic astrocytoma after gross-total resection: justification for reducing surveillance imaging

2016 ◽  
Vol 17 (5) ◽  
pp. 569-572 ◽  
Author(s):  
Andrew J. Dodgshun ◽  
Wirginia J. Maixner ◽  
Jordan R. Hansford ◽  
Michael J. Sullivan
Keyword(s):  
Overall Survival ◽  
Cost Savings ◽  
Tumor Location ◽  
Gross Total Resection ◽  
Total Resection ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Pilocytic Astrocytomas ◽  
Mri Scans ◽  
Mri Surveillance

OBJECTIVE Pilocytic astrocytomas (PAs) are common brain tumors in children. Optimal management of PA is gross-total resection (GTR), after which event-free survival (EFS) is excellent. The tempo of recurrences, when they do occur, is relatively sparsely reported, and there is no agreed upon surveillance recommendation for patients in this category. It has been suggested that surveillance MRI is performed too frequently and could be safely reduced in both frequency and duration. The authors conducted a retrospective review of pediatric patients with PA who underwent GTR at a single institution over an 18-year period and who had documented recurrences. METHODS All patients under 18 years of age who had undergone GTR of a PA between 1996 and 2013 were included in the study. Clinical, radiological, and tumor characteristics were recorded. RESULTS Sixty-seven patients met the criteria for GTR over the period studied. The 5-year EFS rate was 95% (95% CI 89%–100%) and overall survival was 100%. Recurrences showed a nonsignificant trend of occurring more commonly in patients with persistent nonenhancing FLAIR abnormalities after surgery, but there was no difference with regard to tumor location. All recurrences occurred before 3 years postresection, all were asymptomatic, and all patients were observed for at least one additional scan after the initial detection during routine surveillance MRI before further therapy was undertaken. CONCLUSIONS EFS and overall survival are excellent after GTR in this population with PAs. Progression after recurrence occurs slowly and is asymptomatic. A less intensive schedule of MRI surveillance in this group of patients would result in time and cost savings, without compromising safety. The authors suggest a schedule of 6 MRI scans to be obtained postoperatively, at 3–6 months, then at 1, 2, 3.5, and 5 years.

Preoperative survivin, ERCC1, and PTEN expression in stage III non-small cell lung cancer (NSCLC) patients (pts) treated with neoadjuvant and definitive chemoradiation and association with overall survival (OS).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7067-7067
Author(s):  
Marta Batus ◽  
Mary J. Fidler ◽  
Kelly Kaiser Walters ◽  
Mark Pool ◽  
Brett Mahon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Dna Repair ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Stage Iii ◽  
Term Survival ◽  
Modest Improvement ◽  
Thoracic Radiation ◽  
Nsclc Patients

7067 Background: Thoracic radiation and concurrent chemotherapy consisting of platinum based doublets has produced modest improvement in long term survival for patient with locally advanced (LA) NSCLC. There is relatively little information regarding molecular profiles and outcome in LA-NSCLC patients (pts) treated with chemoradiation. The objective of this retrospective study is to evaluate potential relationships between expression of DNA repair enzyme ERCC1 and enzymes involved in cell survival – survivin and PTEN. Methods: Stage III NSCLC pts who were treated with chest radiation (40-60Gy) and concurrently with platinum doublet and who had sufficient pretreatment tissue were included in this study. Immunohistochemistry was used to detect nuclear and cytoplasmic expression (frequency 0-4 and intensity 0-4) of survivin, and PTEN, and for nuclear expression of ERCC1. Product of intensity and frequency was calculated for all markers and correlated with overall survival (OS). Results: 97 pts had adequate tumor samples for analysis. 53 women, median age 67. 48 pts with ERCC1 prod <=6 had longer OS than 41 pts with ERCC1 prod >6 (19.6 vs 1.0 months, p=0.034). 16 pts with ERCC1 prod >6, PETN prod <=6 and survivin prod >4 had significantly lower OS than 68 pts with ERCC1<=6, PETN >6 and survivin <=4 (17.2 vs 40.2 months, p<0.001). Conclusions: The association of inferior survival in LA-NSCLC pts whose tumors express high survivin, low PTEN, and high ERCC1, suggests that combining inhibitors of survivin and or of PI3KCA with chemoradiation and developing strategies to inhibit DNA repair might improve outcomes in this group of pts.

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