scholarly journals Local treatment for focal progression in metastatic neuroendocrine tumors

2019 ◽  
Vol 26 (4) ◽  
pp. 405-409 ◽  
Author(s):  
Taymeyah Al-Toubah ◽  
Stefano Partelli ◽  
Mauro Cives ◽  
Valentina Andreasi ◽  
Franco Silvestris ◽  
...  
Keyword(s):  
Median Time ◽  
Neuroendocrine Tumors ◽  
Systemic Treatment ◽  
Local Treatment ◽  
Arterial Embolization ◽  
External Beam Radiation ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Beam Radiation ◽  
Additional Intervention ◽  
Systemic Treatments

New systemic treatments have improved the therapeutic landscape for patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). While drugs such as everolimus, sunitinib, temozolomide and 177Lutetium-dotatate are appropriate for patients with widespread disease progression, local treatment approaches may be more appropriate for patients with unifocal progression. Surgical resection, radiofrequency ablation (RFA), hepatic arterial embolization (HAE) or radiation, can control discrete sites of progression, allowing patients to continue their existing therapy and sparing them toxicities of a new systemic treatment. We identified 69 patients with metastatic GEP-NETs who underwent a local treatment for focal progression in the setting of widespread metastases. Twenty-six percent underwent resection, 27% RFA, 23% external beam radiation and 23% selective HAE. With a median follow-up of 25 months, 42 (61%) patients subsequently progressed to the point of requiring additional intervention (12 locoregional, 30 systemic) for disease control. Median time to new systemic treatment was 32 months (95% CI, 16.5–47.5 months). Median time to any additional intervention was 19 months (95% CI, 8.7–25.3 months). Control of local sites of progression enabled the majority of patients to remain on their existing systemic treatment and avoid potential toxicities associated with salvage systemic therapy.

Outcomes of locoregional treatment for unifocal progression in widespread metastatic gastroenteropancreatic neuroendocrine tumors.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 472-472
Author(s):  
Taymeyah E. Al-Toubah ◽  
Mauro Cives ◽  
Daniel A. Anaya ◽  
Heloisa P. Soares ◽  
Jonathan R. Strosberg
Keyword(s):  
Median Time ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Local Treatment ◽  
External Beam Radiation ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Beam Radiation ◽  
Additional Intervention ◽  
Local Progression ◽  
Systemic Treatments

472 Background: New systemic treatments have improved the therapeutic landscape for patients with progressive, metastatic GEP-NETs. While drugs such as everolimus are appropriate for patients with widespread disease progression, local treatment approaches may be more appropriate for patients with unifocal progression. Surgical resection, radiofrequency ablation (RFA), hepatic arterial embolization (HAE), or radiation, can control discrete sites of progression, allowing patients to continue their existing therapy, and sparing them toxicities of a new systemic treatment. Methods: We reviewed records of patients treated at a large referral center to identify patients seen between 1/2014 and 5/2017 with metastatic GEP-NETs who underwent a local treatment for focal progression. Patients undergoing lobar HAE or cytoreductive hepatic surgery were not included. The primary endpoint was time to new systemic therapy. Secondary endpoints included time to any additional intervention (systemic or local), progression free survival, and side effects of treatment. Results: 59 patients were identified who underwent a form of local treatment for a progressive metastatic tumor in the setting of widespread metastases. 27% underwent resection, 29% RFA, 25% external beam radiation, and 19% selective HAE. With a median follow-up of 17 months, 19 patients (32.2%) eventually progressed to the extent that they received salvage systemic treatment. 6 patients (10.2%) progressed and received further local treatment. Median time to new systemic treatment was 42 months (95% CI, 9.7-74.3 months). Median time to any additional intervention was 21 months (95% CI, 11.4-30.6 months). 4 patients died, all of whom had progressed and received further systemic treatment. Conclusions: We identified a large cohort of patients with metastatic GEP-NETs who underwent a local treatment for unifocal progression in the setting of widespread metastases. Control of local sites of progression enabled the majority of patients to remain on their existing systemic treatment and avoid potential toxicities associated with salvage systemic therapy.

Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment

The Prostate ◽  
2017 ◽  
Vol 77 (6) ◽  
pp. 686-693 ◽  
Author(s):  
Raisa S. Pompe ◽  
Helen Davis-Bondarenko ◽  
Emanuele Zaffuto ◽  
Zhe Tian ◽  
Shahrokh F. Shariat ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Local Treatment ◽  
Population Based ◽  
External Beam Radiation ◽  
Gleason Grade ◽  
External Beam ◽  
Beam Radiation ◽  
Grade Groups

Regional Therapies for Extremity Sarcoma

2018 ◽  
Author(s):  
Chiara Colombo ◽  
Sandro Pasquali
Keyword(s):  
Local Recurrence ◽  
Local Treatment ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
External Beam Radiation ◽  
Resection Margins ◽  
Beam Radiation ◽  
Limb Perfusion

Several regional therapies are used for the local treatment of patients with soft tissue sarcomas (STS), especially for tumors at high risk for local recurrence. Surgery with negative tumor resection margins is the main treatment for primary STS. External-beam radiation therapy is considered for deeply seated, large, and high-grade disease to lower the risk of local recurrence. A combination of preoperative chemo-radiation is associated with improved local control. TNF-α-based isolated limb perfusion is another regional chemotherapy strategy available at specialized surgical oncology units for unresectable STS. Other strategies suitable for management of advanced STS include cryoablation and radiofrequency. This review discusses these and other current regional treatment strategies.  This review contains 10 figures, 6 tables and 64 references Key words: cryoablation, extremity, hyperthermia, isolated limb perfusion, limb infusion, radiotherapy, regional therapy, sarcoma

Improved control of invasive cervical cancer in Sweden over six decades by earlier clinical detection and better treatment.

1995 ◽  
Vol 13 (3) ◽  
pp. 715-725 ◽  
Author(s):  
P Sparén ◽  
L Gustafsson ◽  
L G Friberg ◽  
J Pontén ◽  
R Bergström ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Invasive Cervical Cancer ◽  
Local Treatment ◽  
Substantial Reduction ◽  
External Beam Radiation ◽  
Cervix Uteri ◽  
Beam Radiation ◽  
Clinical Detection ◽  
Cancer Of The Cervix ◽  
Incident Cases

PURPOSE Cancer of the cervix uteri can be controlled by cytologic screening for the detection of precursor lesions, but such intervention remains unrealistic in many countries in which this cancer is common. The possibility of reducing mortality by earlier clinical detection, followed by basic therapy, has never been properly assessed. PATIENTS AND METHODS We compiled records of incident cases of invasive cancer of the cervix diagnosed in a defined area of Sweden from 1930 through 1990. In a cohort of 6,044 women, we analyzed temporal trends in incidence and survival by clinical stage and age at diagnosis. Generalized proportional hazards models were used to study several factors simultaneously and quantify the overall reduction in mortality. RESULTS For each successive stage at diagnosis, the overall risk of dying increased 2.5-fold (95% confidence interval [CI], 2.4 to 2.7). From 1930, a marked improvement in stage distribution was accompanied by increasing survival rates in stages I and II disease. These changes largely took place before the introduction of screening and external-beam radiation. The 10-year relative survival rate increased from 33% in the 1930s to approximately 55% in the 1950s and thereafter. CONCLUSION Improvements in public and professional awareness of cervical cancer resulted in diagnoses at earlier clinical stages. The rate of cure in early stages improved when basic local treatment was introduced, but only little of the progress was attributable to the introduction of more advanced treatment technologies. These findings offer considerable hope for a substantial reduction in the mortality of cervical cancer without cytologic screening, even in countries with limited resources.

Clinical benefit and toxicity of nivolumab plus ipilimumab in patients with advanced melanoma previously treated with checkpoint blockade inhibitors.

2017 ◽  
Vol 35 (7_suppl) ◽  
pp. 100-100
Author(s):  
Claire Frances Friedman ◽  
Jedd D. Wolchok ◽  
Michael Andrew Postow ◽  
Alexander Noor Shoushtari ◽  
Margaret K. Callahan ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Median Time ◽  
Systemic Treatment ◽  
Immune Therapy ◽  
Progression Free Survival ◽  
Advanced Melanoma ◽  
Checkpoint Blockade ◽  
Systemic Treatments ◽  
Previously Treated

100 Background: The combination of nivolumab and ipilimumab (nivo+ipi) prolongs progression-free survival in treatment-naïve patients (pts) with advanced melanoma. However, the efficacy and tolerability of nivo+ipi in pts previously treated with checkpoint blockade inhibitors (CPI) are unknown. Methods: 19 pts previously treated with CPI (ipi or anti-PD-1 as single agents) were treated with nivo+ipi at MSKCC. Ipi (3mg/kg) and nivo (1mg/kg) were administered q3 weeks for 4 doses with the option to continue anti-PD1 maintenance. Pts were followed for time to treatment failure (TTF), defined as the time from the date of first nivo+ipi infusion to the date of one of the following: clinical progression, new locally-directed treatment (ie surgery or radiotherapy), new systemic treatment other than anti-PD-1 monotherapy, or death. Results: 15 pts (79%) had stage M1c disease and 12 (63%) had a cutaneous primary. Pts had received a median of 2 prior systemic treatments (range 1-7). 10 pts (53%) had received prior ipi and 17 pts (89%) had received prior anti-PD-1 treatment; 8 pts (42%) had received both. The median time between anti-PD-1 monotherapy and nivo+ipi was 51 days (range 20-385). Pts received a median of 3 doses of combination therapy; 9 of 19 pts (47%) received all 4 doses. With a median follow-up time of 210 days, 8 pts (42.1%) remained on combination immune therapy, 9 pts (47%) switched systemic treatments or had a local procedure and 6 pts (31.6%) died. Median time on immunotherapy for those still alive and without treatment failure was 105 days (range 26-343). The median TTF was 78 days (range 42-220). The most common systemic treatment after nivo+ipi failure was BRAF-targeted therapy (5/9 or 56.3%). The median number of immune related adverse events (irAEs) was 1 (range 0-3). Rash (26%), Hepatitis (16%) and Colitis (16%) were the most common irAEs. Conclusions: With a short median follow-up, administration of nivo+ipi in CPI-experienced patients with advanced melanoma was associated with a short TTF. 58% of patients died or had treatment failure within the follow-up period. More research is needed to guide the utilization of combination immunotherapy in this setting.

Testosterone recovery as biomarker for overall and cause-specific survival in combined treated patients with high-risk and locally advanced prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 188-188
Author(s):  
Mathew Deek ◽  
Victoria Vaage ◽  
Knut H. Hole ◽  
Theodore L. DeWeese ◽  
Andreas Stensvold ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Median Time ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Cause Specific Survival

188 Background: Androgen deprivation therapy (ADT) can cause considerable toxicity and may influence outcome. The study assessed the impact of testosterone recovery (TR) on survival after ADT and definitive radiotherapy in two independent cohorts. Methods: Two hundred and forty-four patients (high risk JHH cohort N=106, T1c-T3N0M0 [A], locally advanced OUH cohort N=138, T1c-T4N0-1M0 [B]) with adenocarcinoma of the prostate were included in this retrospective analysis. Short and long-term ADT was given (median 12 months A, 24 months B, respectively,) and along with conformal external beam radiation 76-80 Gy given to the prostate in cohort A, 74 Gy prescribed in cohort B and 46-50 Gy to the whole pelvis. Testosterone levels were measured at the end of ADT and at biochemical relapse. TR was defined as ≥ 9 nmol/L. Kaplan Meier plots were generated for overall survival (OS) and cause-specific survival (CSS) stratified by TR, in addition to patient characteristics median time to TR and FU were calculated. Results: The median age in the A cohort was 66.7 years and 64.7 years in the B group. FU was 6 years for A and 8 years in B. Patients in group A received median ADT of 12 months and 24 months in group B. The median time to TR was 1.6 yr in A and 2.5 yrs in B, respectively. Patients in group A stratified to TR showed no difference in overall survival (p=0.92)), on contrary, patients in group B showed improved overall survival depending on TR (Fig. 1, KM plot, 10 year OS 75.3% vs 59.9% p=0.034). CSS was seemed to trend towards improvement with TR for cohort A (p=0.19) and was improved in cohort B (p=0.022). The Univariate ADT length, age, and RT dose was associated with time to TR, but on multivariate analysis only longer ADT time (p = 0.03) was significantly associated with time to TR. Conclusions: TR was associated with improved OS in patients with unfavorable locally advanced disease a finding not seen in patients with high-risk disease.

Prostate cancer (PC) follow-up and treatment by race in an equal access health system: A pilot study.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 177-177
Author(s):  
Nirupama Devi Mitikiri ◽  
Anitha Nallu ◽  
C. Daniel Mullins ◽  
Ebere Onukwugha ◽  
Arif Hussain
Keyword(s):  
Pilot Study ◽  
Health System ◽  
Racial Disparities ◽  
Median Time ◽  
Initial Treatment ◽  
Specific Antigen ◽  
Equal Access ◽  
External Beam Radiation ◽  
Beam Radiation

177 Background: There are known racial disparities in the incidence and outcomes of PC as well as in receipt of treatment. Although some studies in the Veterans Affairs Health System (VA) suggest that utilization and outcomes are as good, if not better, for African Americans (AA) as for Whites (WH), race appears to have mixed impact on stage-specific PC survival in the VA population. This pilot study aims to identify racial disparities in PC care in an equal access health system such as the VA. Methods: A retrospective cohort study was conducted of 109 consecutive patients with newly diagnosed PC in the year 2010 at the Baltimore VA Medical Center (BVAMC). Baseline characteristics (age, prostate specific antigen (PSA) at diagnosis, Gleason score (GS), stage, race) were extracted from the electronic medical records. Patterns of treatment and follow-up care, including specialist (urologist, medical oncologist, radiation oncologist) visits, time to first treatment, and primary treatment in the first year of diagnosis were examined. Results: Of 109 patients, 32 (30%) were WH, 69 (63%) AA and 8 (7%) other racial groups. AA and WH had similar median age (62, 64), GS (7, 7) and PSA (8.06, 7.46) at diagnosis. More AA were diagnosed with stage IV PC compared to WH (13% vs. 3%). Median time to first follow-up specialist visit since diagnosis was 15 (0-140) and 19.5 (2-169) days for AA and WH, respectively. Median time to initial treatment was 99.5 (1-306) and 146 (6-345) days for AA and WH, respectively. For localized PC, 30% AA received prostatectomy (RP) and 70% external beam radiation therapy (EBRT); in WH it was 19% and 76%, respectively. Conclusions: In an equal access health system such as the BVAMC, there did not appear to be racial differences in PC follow-up with specialists and time to initial treatment. AA had more advanced disease at diagnosis. Interestingly, although both AA and WH received EBRT more often than RP for localized PC, AA underwent RP more frequently than WH. It will be of interest to determine whether these patterns hold for other years and in other equal access health systems.

New and recurrent tumor foci following local treatment as well as external beam radiation in eyes of patients with hereditary retinoblastoma

1990 ◽  
Vol 228 (5) ◽  
pp. 426-431 ◽  
Author(s):  
Elmar P. Messmer ◽  
Wolfgang Sauerwein ◽  
Thomas Heinrich ◽  
Wolfgang H�pping ◽  
Doris Klueter-Reckmann ◽  
...  
Keyword(s):  
Local Treatment ◽  
External Beam Radiation ◽  
External Beam ◽  
Recurrent Tumor ◽  
Beam Radiation

Biology and Systemic Treatment of Advanced Gastroenteropancreatic Neuroendocrine Tumors

2018 ◽  
pp. 292-299 ◽  
Author(s):  
Nitya Raj ◽  
Nicola Fazio ◽  
Jonathan Strosberg
Keyword(s):  
Neuroendocrine Tumors ◽  
Systemic Treatment ◽  
Future Research ◽  
Neuroendocrine Neoplasms ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Treatment Approaches ◽  
Biologic Characterization ◽  
Scientific Advances

In recent years, there have been important scientific advances in the biologic characterization of neuroendocrine neoplasms and in their treatment. This review will describe these scientific advances, the evolving systemic treatment approaches, and important topics to be addressed in future research.

scholarly journals External Beam Radiation and Brachytherapy for Prostate Cancer: Is It a Possible Trigger of Large Cell Neuroendocrine Carcinoma of the Urinary Bladder?

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ali Zakaria ◽  
Bayan Al Share ◽  
Sri Kollepara ◽  
Cynthia Vakhariya
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Neuroendocrine Tumors ◽  
Neuroendocrine Carcinoma ◽  
Large Cell ◽  
External Beam Radiation Therapy ◽  
Large Cell Neuroendocrine Carcinoma ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

Neuroendocrine tumors commonly involve the respiratory and gastrointestinal systems. Primary genitourinary neuroendocrine tumors are rare, accounting for less than 1% of all bladder carcinomas. Four histopathologic subtypes have been described. Among those, large cell neuroendocrine carcinoma (LCNEC) is the least common, is more aggressive, and generally presents in an advanced stage with poor prognosis compared to transitional cell bladder carcinoma. There is no standardized treatment regimen because of the rarity of the disease. Herein, we present a case of 72-year-old male patient with previously treated prostate cancer, who received external beam radiation therapy and high dose brachytherapy, presenting with intermittent hematuria. Cystoscopy and transurethral resection of bladder tumor (TURBT) were performed. The histopathology and immunohistochemistry were consistent with large cell neuroendocrine carcinoma (LCNEC). Further studies are required to proof the higher risk of neuroendocrine carcinoma of the bladder in patients treated with external beam radiation therapy and brachytherapy for prostate cancer.

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