scholarly journals A Novel Nomogram Containing Acute Radiation Esophagitis Predicting Radiation Pneumonitis in Thoracic Cancer Receiving Radiotherapy

2020 ◽  
Author(s):  
Wenjie Tang ◽  
Xiaolin Li ◽  
Haining Yu ◽  
Xiaoyang Yin ◽  
Bing Zou ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Acute Radiation ◽  
Ipsilateral Lung ◽  
Thoracic Radiation ◽  
Thoracic Cancer ◽  
Life Threatening ◽  
Radiation Induced ◽  
Mean Lung Dose ◽  
Grade 3

Abstract BackgroundRadiation-induced pneumonitis (RP) is a non-negligible and sometimes life-threatening complication in patients with thoracic radiation. We initially aimed to ascertain the predict value of acute radiation-induced esophagitis (SARE, grade≥2) to symptomatic RP (SRP, grade≥2) among thoracic cancer patients receiving radiotherapy. Based on that, we also established a novel nomogram model to provide individualized risk assessment for SRP.MethodsPatients with thoracic cancer who were treated with thoracic radiation from Jan 2018 to Jan 2019 in Shandong Cancer Hospital and Institute were enrolled prospectively. All patients were followed up during and after radiotherapy (RT) to observe the appearance of esophagitis and pneumonitis. Variables were analyzed by univariate and multivariate analysis using the logistic regression model, and a nomogram model was established to predict SRP by "R" version 3.6.0.ResultsA total of 123 patients were enrolled (64 esophageal cancer, 57 lung cancer and 2 mediastinal cancer) in this study prospectively. RP grades of 0, 1, 2, 3, 4 and 5 occurred in 29, 57, 31, 0, 3 and 3 patients, respectively. SRP appeared in 37 patients (30.1%). In univariate analysis, SARE was shown to be a significant predictive factor for SRP (P < 0.001), with the sensitivity 91.9% and the negative predictive value 93.5%. The incidence of SRP in different grades of ARE were as follows: Grade 0-1: 6.5%; Grade 2: 36.9%; Grade 3: 80.0%; Grade 4: 100%. Besides that, the dosimetric factors considering total lung mean dose, total lung V5, V20, ipsilateral lung mean dose, ipsilateral lung V5, and mean esophagus dose were correlated with SRP (all P < 0.005) by univariate analysis. The incidence of SRP was significantly higher in patients whose symptoms of RP appeared early. SARE (HR 34.408, P = 0.001), mean esophagus dose and ipsilateral mean lung dose were still significant in multivariate analysis, and they were included to build a predictive nomogram model for SRP.ConclusionsSARE was an easy index that can reflect patients’ radiosensitivity visually, which could be an applicable predictor for SRP in patients receiving thoracic radiation. And the nomogram could assist in accurate prediction to SRP in clinic.

scholarly journals A novel nomogram containing acute radiation esophagitis predicting radiation pneumonitis in thoracic cancer receiving radiotherapy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjie Tang ◽  
Xiaolin Li ◽  
Haining Yu ◽  
Xiaoyang Yin ◽  
Bing Zou ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cancer Patients ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Clinical Work ◽  
Acute Radiation ◽  
Ipsilateral Lung ◽  
Thoracic Radiation ◽  
Thoracic Cancer ◽  
Radiation Induced

Abstract Background Radiation-induced pneumonitis (RP) is a non-negligible and sometimes life-threatening complication among patients with thoracic radiation. We initially aimed to ascertain the predictive value of acute radiation-induced esophagitis (SARE, grade ≥ 2) to symptomatic RP (SRP, grade ≥ 2) among thoracic cancer patients receiving radiotherapy. Based on that, we established a novel nomogram model to provide individualized risk assessment for SRP. Methods Thoracic cancer patients who were treated with thoracic radiation from Jan 2018 to Jan 2019 in Shandong Cancer Hospital and Institute were enrolled prospectively. All patients were followed up during and after radiotherapy (RT) to observe the development of esophagitis as well as pneumonitis. Variables were analyzed by univariate and multivariate analysis using the logistic regression model, and a nomogram model was established to predict SRP by “R” version 3.6.0. Results A total of 123 patients were enrolled (64 esophageal cancer, 57 lung cancer and 2 mediastinal cancer) in this study prospectively. RP grades of 0, 1, 2, 3, 4 and 5 occurred in 29, 57, 31, 0, 3 and 3 patients, respectively. SRP appeared in 37 patients (30.1%). In univariate analysis, SARE was shown to be a significant predictive factor for SRP (P < 0.001), with the sensitivity 91.9% and the negative predictive value 93.5%. The incidence of SRP in different grades of ARE were as follows: Grade 0–1: 6.5%; Grade 2: 36.9%; Grade 3: 80.0%; Grade 4: 100%. Besides that, the dosimetric factors considering total lung mean dose, total lung V5, V20, ipsilateral lung mean dose, ipsilateral lung V5, and mean esophagus dose were correlated with SRP (all P < 0.05) by univariate analysis. The incidence of SRP was significantly higher in patients whose symptoms of RP appeared early. SARE, mean esophagus dose and ipsilateral mean lung dose were still significant in multivariate analysis, and they were included to build a predictive nomogram model for SRP. Conclusions As an early index that can reflect the tissue’s radiosensitivity visually, SARE can be used as a predictor for SRP in patients receiving thoracic radiation. And the nomogram containing SARE may be fully applied in future’s clinical work.

Do pathological parameters of primary tumor correlate with overall survival (OS) of metastatic clear-cell renal cell carcinoma (ccRCC)?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 549-549
Author(s):  
Umberto Basso ◽  
Marco Maruzzo ◽  
Anna Paola Fraccon ◽  
Teodoro Sava ◽  
Francesco Massari ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Clinical Laboratory ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Fuhrman Grade ◽  
Metastatic Setting ◽  
N Stage ◽  
Grade 3

549 Background: T and N stage, Fuhrman grade, necrosis and sarcomatoid features in the primary tumor are key prognostic factors for relapse of ccRCC, but they are not part of Heng's algorithm applied to predict OS in the metastatic setting, which instead is based on 6 clinical/laboratory items. Methods: Retrospective analysis on correlation between pathological parameters and OS (from start of first-line targeted therapy) and Heng's prognostic factors in a multicenter cohort of pts with advanced ccRCC, all of whom had undergone surgery on the kidney. Results: From 2006 to 2012, data of 903 eligible metastatic pts were collected from 33 Italian Oncology Institutions, median age 66 years, 72.6% males, 36.4 metastatic at diagnosis. After a median observation of 42 mo, 70,5% of pts died, estimated OS is 28.5 mo. Heng good prognosis pts were 14.45%, intermediate 69.1% and poor 16.45%. Univariate analysis showed that all pathological parameters significantly correlated with OS: T stage 3-4 vs 1-2 (HR 1.3), N1 vs N0 (1.3), Fuhrman grade 3-4 vs 1-2 (1.7) presence of necrosis (1.5) and sarcomatoid features (1,6). All pathological parameters had a strong correlation with a time to metastases < 1 year, while only weak correlations were found with the other clinical prognostic items of Heng's model. At multivariate analysis only N stage showed an independent impact on OS (table). Conclusions: T3-4 stage, N1, Fuhrman grade 3-4, presence of necrosis and sarcomatoid features negatively affect OS of metastatic ccRCC, but clinical items of Heng's model confirm to have a more robust prognostic significance at multivariate analysis. [Table: see text]

CT findings of acute radiation-induced pneumonitis in breast cancer

2021 ◽  
pp. 20200997
Author(s):  
Wonguen Jung ◽  
Sung Shine Shim ◽  
Kyubo Kim
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Postoperative Radiotherapy ◽  
Acute Radiation ◽  
Breast Cancer Patients ◽  
Ct Findings ◽  
Dose Volume ◽  
Radiation Induced ◽  
Grade 3

Objectives: To evaluate the computed tomography (CT) findings of acute radiation pneumonitis (RP) in breast cancer patients undergoing postoperative radiotherapy, and to analyze clinico-dosimetric factors associated with acute RP. Methods: Between 2015 and 2017, 61 patients with breast cancer who underwent follow-up chest CT at 3 months after radiotherapy were analyzed. The degree of acute RP on CT was evaluated by the change of extent and scoring system (grade 0, no RP; Grade 1, ground-glass opacities (GGOs); Grade 2, GGOs and/or consolidations; Grade 3, clear focal consolidation; Grade 4, dense consolidation). The dosimetric parameters were calculated from the dose-volume histogram of RT. Results: The acute RP on CT was scored as follows: grade 0, in 37.7%, Grade 1 in 13.1%, Grade 2 in 44.3%, and Grade 3 in 4.9%. The median extent of RP in patients with Grades 1 to 3 was 6.2 ml (range, 0.2–95.9). There were no clinico-dosimetric factors significantly associated with the presence of RP or its severity. One patient developed symptomatic RP. Conclusions: This study showed no correlation between acute RP and clinico-dosimetric factors, and acute RP based on CT findings were much more common than symptomatic RP. Advances in knowledge: CT findings of acute RP or extent of RP were not significantly related to clinico-dosimetric factors in breast cancer patients.

Antithymocyte Globulins (ATG) as Part of the Myeloablative Conditioning (MAC) Regimen Can Reduce the Risk of Severe Graft-Vs.-Host Disease (GVHD) after Allogeneic Stem Cell Transplantation (allo-SCT) from Matched-Unrelated Donors (MUD).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1151-1151
Author(s):  
Mohamad Mohty ◽  
Marie- Lorraine Balere ◽  
Gerard Socie ◽  
Noel-Jean Milpied ◽  
Norbert Ifrah ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
Beneficial Effect ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Univariate Analysis ◽  
Hla Typing ◽  
High Dose ◽  
Increased Risk ◽  
Grade 3

Abstract The use of ATG in the setting of standard MAC allo-SCT is still controversial. Some studies, however, suggested a beneficial effect of ATG in preventing acute GVHD. Here, we report the results of a large multicenter retrospective study analyzing the effect of ATG, incorporated within the MAC regimen for MUD-transplants in leukemic patients compared to patients not receiving ATG. The purpose of the study was to compare the incidence and severity of acute and chronic GVHD as well as non-relapse mortality (NRM), leukemiafree and overall survivals (LFS, OS). The study included 171 adult patients with acute leukemia and MDS (73% standard risk and 27% more advanced disease) reported to the registry of the SFGM-TC between 1998 and 2004, and for whom detailed allelic HLA typing (4 digits) for the recipient and the donor was available. Patients’ characteristics were as follow: median age: 33 (range, 15–67), 57% male recipients, 35% female donors, 44% AML, 43% ALL, 11% MDS and 2% unclassified leukemia. The stem cell source was bone marrow in 72.5% of patients, while PBSCs were used in 27.5% of cases. 81% of patients were transplanted from 10/10 allelic MUD, and 19% from a MUD with at least one allelic difference. A high dose TBI-based MAC regimen was used in 84% of cases, while 16% received a high-dose chemotherapy containing MAC regimen. 85% of the patients received the classical CsA and short course methotrexate GVHD prophylaxis regimen. In this series, 120 patients (70%) did not receive ATG (“no-ATG” group), while 51 patients received ATG (“ATG” group; Thymoglobuline*-Genzyme in all cases; total ATG dose: ≤5 mg/Kg, n=13; &gt;5 and &lt;10 mg/Kg, n=17; ≥10 mg/Kg, n=21) as part of the MAC regimen. Except for a significantly higher number of allelic differences between recipient and donor (33% vs. 13%; P=0.002), the “no-ATG” and “ATG” groups were strictly comparable as for patients, disease and transplant characteristics. 95% of patients had a sustained engraftment at a median of 20 (range, 9–41) days after allo-SCT with no significant differences between the 2 groups. With a median followup of 30.3 (range, 2.6–68.1) months after allo-SCT, grade 0–1 and 2–4 acute GVHD occurred in 74 (46%) and 88 patients (54%) respectively, with grade 3–4 acute GVHD being significantly lower in the “ATG” group as compared to the “no-ATG” group (18% vs. 32%; P=0.04). In this series, 142 patients (83%) were evaluable for chronic GVHD. Limited and extensive chronic GVHD were observed in 22 and 25% of assessable patients respectively, with extensive chronic GVHD being significantly lower in the “ATG” group as compared to the “no-ATG” group (5% vs. 33%; P=0.001). Interestingly, patients from the “ATG” group had a higher incidence of limited chronic GVHD (33% vs. 18%; P=0.06). The use of ATG was not associated with a higher risk of infections: infection-related mortality was comparable between both groups (23% vs. 27%, P=NS). Also, NRM was comparable between both groups (30% vs. 29%; P=NS). In multivariate analysis including all relevant risk factors tested in the univariate analysis, we found that an HLA allelic mismatch and the non-use of ATG were associated with an increased risk of severe grade 3–4 acute GVHD (RR=2.80, 95%CI, 1.5–5.3), P=0.001; and RR=2.4, 95%CI, 1.1–5.0, P=0.02 respectively). Similarly, multivariate analysis showed that the absence of use of ATG was the unique and strongest parameter associated with an increased risk of extensive chronic GVHD (RR=6.9; 95%CI, 1.7–29.0, P=0.008). Finally, LFS and OS at 2 years were not significantly different between the “no-ATG” and “ATG” group (48.8% vs. 41.3%, P=NS; and 53.6% vs. 54.3%, P=NS; respectively) Despite its retrospective nature, these results strongly indicate a global long-term beneficial effect of ATG when used as part of the MAC regimen prior to allo-SCT from MUD (especially in the HLA mismatch setting). Though prospective studies are needed to assess the optimal ATG dosing and administration schedule, such protective effect of ATG against severe acute and chronic GVHD, can be likely achieved without an increased risk of infections or leukemia recurrence.

Allogeneic Stem Cell Transplantation (alloSCT) and Donor Lymphocyte Infusion (DLI) In Patients with Non-Hodgkin Lymphoma (NHL) Who Experienced Relapse or Progression After Autologous Stem Cell Transplantation (autoSCT): Retrospective Analysis From the Korean Society of Blood and Marrow Transplantation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3536-3536 ◽  
Author(s):  
Ji-Won Kim ◽  
Byung-Su Kim ◽  
Soo-Mee Bang ◽  
Inho Kim ◽  
Dong Hwan Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Serum Albumin ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Grade 3 ◽  
Ecog Ps ◽  
Significant Factors

Abstract Abstract 3536 Prognosis of patients with NHL who underwent relapse or progression after autoSCT is generally dismal and treatment option is limited. AlloSCT has been performed to overcome this problem and long term survivors have been reported. However, substantial transplant-related mortality (TRM) is a significant problem. We report clinical outcomes of alloSCT in these patients and DLI after failure of alloSCT along with analysis of risk factors for treatment results and adverse events. This retrospective study was performed in 7 hospitals in Korea. Candidate risk factors were age, sex, histology, Ann Arbor stage at diagnosis, number of prior treatments, time to progression (TTP) after autoSCT, bone marrow involvement, Eastern Cooperative Oncology Group (ECOG) performance status (PS), donor type, stem cell source, conditioning regimens of alloSCT, serum lactate dehydrogenase (above 250 IU/L), serum albumin (above 3.0 g/dL), and acute graft-versus-host disease (aGvHD). Between August 1998 and March 2009, 38 patients received alloSCT. Median age was 37 (range, 17–54) years. Male to female ratio was 26:12. Eighteen patients (47.4%) had B-cell lymphoma and 20 patients (52.6%), T/NK-cell lymphoma. Before alloSCT, patients had received median 4 (range, 2–7) prior treatments including autoSCT. Median TTP after autoSCT was 5.9 (range, 0.8–35.8) months. Twenty four patients (63.2%) received stem cells from related donors and 14 patients (36.8%) from unrelated donors. Median number of CD34+ cells infused was 5.41 × 106 (range, 0.86 × 106-16.60 × 106) /kg. Eighteen patients (47.4%) underwent a myeloablative conditioning and 20 patients (52.6%), a reduced intensity conditioning. During a median follow-up of 45.2 (range, 1.3–137.1) months, 24 patients (63.2%) experienced treatment failure and 22 patients (57.9%) died. Median event-free survival (EFS) was 6.3 (95% confidence interval (CI), 4.3–8.4) months. Median overall survival (OS) was 19.0 (95% CI, 3.8–34.2) months. Estimated 5-year survival rate was 35.0% (Figure). Treatment response was evaluable in 30 patients. Response rate was 73.3%; complete remission (CR) was achieved in 20 patients (66.7%) and partial response in 2 patients (6.7%). Grade 3 or 4 renal toxicity developed in 6 patients (15.8%), grade 3 or 4 hepatic toxicity in 15 patients (39.5%) including veno-occlusive disease (VOD) in 6 patients (15.8%), aGvHD in 13 patients (34.2%), and neutropenic fever in 34 patients (89.5%) including documented sepsis in 11 patients (28.9%). TRM was reported in 8 patients (21.1%). Causes of TRM were infection in 7 patients and VOD in 1 patient. In univariate analysis, no significant association was found with treatment response. By contrast, EFS was related to stage (p=0.039), TTP after autoSCT (p=0.033), and PS (p<0.001). OS was associated with stage (p=0.037), number of prior treatments (p=0.049), TTP after autoSCT (p=0.032), PS (p<0.001), and serum albumin (p=0.016). On the other hand, aGvHD was not associated with EFS (p=0.545) and OS (p=0.476). Multivariate analysis demonstrated that stage IV (hazard ratio (HR) 2.85 (95% CI, 1.13–7.22); p=0.027) and ECOG PS 2 (HR 3.94 (95% CI, 2.08–7.47); p<0.001) were significant factors for EFS and that stage IV (HR 3.28 (95% CI, 1.19–9.04); p=0.022), ECOG PS 2 (HR 5.26 (95% CI, 2.22–12.48); p<0.001), and serum albumin above 3.0 g/dL (HR 0.15 (95% CI, 0.03–0.63); p=0.010) were significant factors for OS. TRM was associated with PS (p=0.010) and serum albumin (p=0.040) by univariate analysis. Multivariate analysis showed that ECOG PS 2 was the only significant factor for TRM (relative risk (RR) 11.77 (95% CI, 1.43–97.01); p=0.022). ECOG PS 2 was also a significant factor for documented sepsis (RR 7.14 (95% CI, 1.08–47.42); p=0.042). DLI was performed in 8 patients who failed alloSCT. After median 1.5 (range, 1–6) cycles of DLI, 2 patients achieved CR. Grade III or IV aGvHD developed in these patients. By contrast, among 6 patients who failed to achieve CR, aGvHD developed in 2 patients. In conclusion, alloSCT is a viable option for patients with NHL who failed autoSCT despite high TRM. Stage and PS were significant factors for EFS and OS. Serum albumin was a significant factor for OS. In patients with ECOG PS 2, alloSCT should be avoided and novel treatment approaches should be offered due to high risk of TRM. DLI after failure of alloSCT showed promising results, which supports the presence of graft-versus-lymphoma effect. Disclosures: No relevant conflicts of interest to declare.

LACE - an Effective Conditioning Regimen for Lymphoma Patients Undergoing Autologous Transplant- Analysis of Outcomes and Prognostic Factors

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3979-3979
Author(s):  
Deepan Rajamanickam ◽  
Anant Gokarn ◽  
Alok Gupta ◽  
Sachin Punatar ◽  
Ravi Thippeswamy ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
Prognostic Factors ◽  
Median Duration ◽  
Univariate Analysis ◽  
Conditioning Regimen ◽  
Salvage Chemotherapy ◽  
Pet Ct ◽  
First Relapse ◽  
Grade 3

Abstract Background: High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed and refractory lymphomas. BEAM (BCNU, etoposide, cytarabine, melphalan) and CBV (cyclophosphamide, BCNU , VP-16) are most widely used conditioning regimens prior to ASCT in lymphomas. LACE has been found to be an effective regimen though outcome data is sparse.As BCNU was difficult to procure in India, we began using this regimen since November 2007. This study is a retrospective analysis to evaluate outcomes and possible prognostic factors in this cohort of patients. Methods: All patients between November 2007- January 2014 who received LACE regimen for primary progressive, chemotherapy sensitive relapse or relapsed-refractory Hodgkin’s (HL) and non- Hodgkin’s lymphoma (NHL) were included.Patients received salvage chemotherapy with either GDP, ICE, MINE or DHAP with or without rituximab (NHL patients). PET-CT was performed in all patients after 2-3 cycles of salvage chemotherapy. Response assessment was performed according to Cheson’s criteria. Patients underwent peripheral blood stem cell collection after 3rd or 4th cycle of salvage chemotherapy.Conditioning regimen used was LACE (lomustine-200 mg/m2 d-7, etoposide 1000mg/m2 d-7, ara-c 2000 mg/m2 d-6, d-5 and cyclophosphamide 1800 mg/m2 d-4 to d-2). PET-CT was done on day 100, 1 year post transplant and then yearly for next 4 years. Incidence and grade of treatment related toxicity was recorded according to CTCAE V-3. Prognostic factors evaluated for overall survival (OS) and progression-free survival (PFS) included time between diagnosis – transplant; time between CR1 - first relapse; baseline, presalvage and pretransplant serum albumin,LDH and B2 microglobulin; PET positivity pretransplant, at day 100 and day 360; remission status at time of transplant; IPI (NHL) and IPS (HL) at baseline and at relapse; stage at diagnosis and at relapse. Probabilities of OS and PFS were estimated using the Kaplan–Meier method. Univariate comparisons of survival times for potential prognostic factors were made using the log-rank test. Multivariate analysis of significant factors was performed by Cox –regression analysis. Results: Seventy patients had HL while 30 NHL (Male-73, Female-27) with median age at transplant of 23 years. In NHL cohort, 19 were DLBCL, 6 were T-cell lymphomas, 4 mantle cell lymphoma and 1 Burkitt’s lymphoma.The median time from complete remission (CR) to first relapse and time from diagnosis to transplant were 1.4 and 1.9 years respectively. The median number of lines of chemotherapy pre transplant was 2. GDP (53 patients) was the most commonly used salvage chemotherapy. At the time of transplant, 68% were in CR, 29% in partial remission (PR) and 3% had refractory state. The incidence of grade 3-4 oral mucositis was 8% with a median duration of 3.5 days. The incidence of grade 3-4 diarrhea was 4% with median duration of 3 days. Median days to myeloid and platelet engraftment were 10 and 13 respectively. The median follow-up was 2.9 years. The probability of OS and PFS at 5 years was 67% and 57% for the whole group, 73% and 62% in HL group and 51% and 46% in NHL group. Seven patients died due to transplant related causes which included 6 due to sepsis and 1 due to herpes simplex encephalitis. In univariate analysis for OS, PET negativity pre transplant (P= 0.03), at day 100 (P= 0.019) and at day 360 (P= 0.01) were associated with better OS. Similarly, HL patients with IPS 0-2 (P=0.002) at time of relapse had better OS. Univariate analysis for PFS showed that PET negativity pre transplant (P=0.002), at day 100 (P= 0.0001) and at day 360 (P=0.00) was associated with better PFS. HL patients with IPS 0-2 (P=0.000) and NHL patients with IPI 0-2 at time of relapse (P=0.007) had better PFS. Patients in CR at the time of transplant had better PFS than those in not in CR (P=0.008). Overall HL patients had better OS (P=0.037) and PFS (P=0.097) compared to NHL group. Multivariate analysis for OS (P= 0.021) and PFS (P=0.001) revealed PET negativity at day 100 as the only significant prognostic factor. Conclusions: This is the largest reported cohort of lymphoma patients transplanted with LACE regimen. LACE is effective and well tolerated conditioning regimen in lymphoma transplant. PET negativity at various time points pre and post transplant prognosticates for better survival. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk factors for radiation pneumonitis in lung cancer patients with subclinical interstitial lung disease after thoracic radiation therapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fangjuan Li ◽  
Hui Liu ◽  
Hongyu Wu ◽  
Shixiong Liang ◽  
Yaping Xu
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Significant Risk ◽  
Intensity Modulated Radiation Therapy ◽  
Significant Risk Factor ◽  
Lung Cancer Patients ◽  
Thoracic Radiation ◽  
Mean Lung Dose ◽  
Grade 3

Abstract Background Previous studies have found that patients with subclinical interstitial lung disease (ILD) are highly susceptible to developing radiation pneumonitis (RP) after thoracic radiation therapy. In the present study we aimed to evaluate the incidence of and risk factors for RP after thoracic intensity-modulated radiation therapy in lung cancer patients with subclinical ILD. Methods We retrospectively analyzed data from lung cancer patients with subclinical ILD who were treated with thoracic intensity-modulated radiation therapy with a prescribed dose of ≥ 50 Gy in our institution between January 2016 and December 2017. Results Eighty-seven consecutive lung cancer patients with subclinical ILD were selected for the study. The median follow-up period was 14.0 months. The cumulative incidence of grades ≥ 2 and ≥ 3 RP at one year was 51.0% and 20.9%, respectively. In the multivariate analysis, a mean lung dose ≥ 12 Gy was a significant risk factor for grade ≥ 2 RP (p = 0.049). Chemotherapy with gemcitabine in the past, V5 ≥ 50%, and subclinical ILD involving ≥ 25% of the lung volume were significantly associated with grade ≥ 3 RP (p = 0.046, p = 0.040, and p = 0.024, respectively). Conclusion Mean lung dose is a significant risk factor for grade ≥ 2 RP. Lung cancer patients who have received chemotherapy with gemcitabine in the past, V5 ≥ 50%, and those with subclinical ILD involving ≥ 25% of lung volume have an increased risk of grade ≥ 3 RP in lung cancer patients with subclinical ILD.

Prognostic significance of p53 immunostaining in epithelial ovarian cancer.

1994 ◽  
Vol 12 (1) ◽  
pp. 64-69 ◽  
Author(s):  
L C Hartmann ◽  
K C Podratz ◽  
G L Keeney ◽  
N A Kamel ◽  
J H Edmonson ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Multivariate Analysis ◽  
Epithelial Ovarian Cancer ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Stage I ◽  
Stage Iii ◽  
P53 Expression ◽  
Independent Prognostic Significance ◽  
Grade 3

PURPOSE To evaluate the prognostic significance of p53 expression in epithelial ovarian cancer, including a subset of stage I patients, and to look for correlations between p53 expression and other disease parameters, including stage, grade, age, histologic subtype, second-look results, ploidy, and percent S phase. PATIENTS AND METHODS We analyzed p53 expression in 284 patients with epithelial ovarian cancer using immunohistochemical techniques in paraffin-embedded specimens. There were 36 patients with stage I disease, 20 with stage II disease, 186 with stage III disease, and 42 with stage IV disease. RESULTS p53 immunoreactivity was present in 177 cases (62%). p53 expression was associated with grade 3 to 4 disease (P = .003). The following factors were associated with a decrease in overall survival in a univarate analysis: stage III or IV disease (P = .0001), grade 3 or 4 disease (P = .0001), age above the median (P = .0002), and p53 reactivity (P = .04). In a multivariate analysis, stage, grade, and age retained independent prognostic significance. In the subset of 36 stage I patients, p53 positively approached statistical significance (P = .10) as a negative prognostic factor in a univariate analysis. CONCLUSION Abnormalities of p53 expression occur commonly in epithelial ovarian cancer. Although associated with decreased survival in a univariate analysis, this biologic marker did not retain independent prognostic significance in a multivariate analysis. p53 expression should be studied in a larger cohort of early-stage patients, where accurate prognostic information is needed to direct therapy.

scholarly journals Clinical outcomes of patients with nasopharyngeal carcinoma treated with antibiotics for radiation-induced mucositis: a retrospective study

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051987489
Author(s):  
JingJin Weng ◽  
Jiazhang Wei ◽  
Min Li ◽  
Jinlong Lu ◽  
Yangda Qin ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Nasopharyngeal Carcinoma ◽  
Disease Free Survival ◽  
Survival Curves ◽  
Free Survival ◽  
Factors Affecting ◽  
Radiation Induced ◽  
N Stage ◽  
Grade 3 ◽  
Disease Free

Objective To examine the effects of antibiotic administration on radiation-induced oral and oropharyngeal mucositis, and on the prognosis of patients with nasopharyngeal carcinoma (NPC). Methods We retrospectively analyzed data for patients with NPC with grade 1/2 or 3/4 mucositis. Forty-two patients with grade 3/4 mucositis received antibiotics. Univariate survival analysis was assessed by Kaplan–Meier survival curves, survival curves were compared using log-rank tests, and multivariate analysis was carried out by Cox regression. Results A total of 463 patients with NPC were included in the study (194 grade 1/2 mucositis, 269 grade 3/4 mucositis). Univariate analyses identified T-stage, N-stage, clinical stage, type of treatment, and antibiotic use as factors affecting overall and disease-free survival. Multivariate analysis also determined that T-stage, N-stage stage, type of treatment, and antibiotic usage were independent factors affecting overall and disease-free survival. Mucositis improved in 32 of the 42 patients who received antibiotics (76.19%). However, red blood cell count and hemoglobin levels decreased in all patients after antibiotic treatment. Conclusions Antibiotics may be effective for the treatment of severe radiation-induced mucositis (grade 3/4) during chemoradiotherapy, but may potentially adversely affect the prognosis of patients with NPC.

Converting borderline-resectable, locally-advanced esophageal carcinoma to resectability with neoadjuvant chemoradiotherapy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 160-160
Author(s):  
Zachary D. Horne ◽  
Weijing Sun ◽  
Michael K. Gibson ◽  
Arjun Pennathur ◽  
James D. Luketich ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Multivariate Analysis ◽  
Median Survival ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Significant Proportion ◽  
Borderline Resectable ◽  
N Stage ◽  
Grade 3

160 Background: Treatment of T3-4/N+ esophageal cancer is challenging. Outcomes are suboptimal and patterns of care are not well defined for borderline-resectable esophageal cancer (BREC). We present our institutional experience using preoperative chemoradiotherapy (CRT) in the management of BREC. Methods: We identified 67 patients with T3-4/N+ BREC who were treated with concurrent CRT between 2009 and 2014. Survival was calculated with Kaplan-Meier curves and cohort comparisons were made with log-rank test and Cox regression. Results: We treated 67 patients (81% males, median age 61 years, and KPS of 80), primarily with T3N2 disease. Median follow-up was 16 months. The most common CRT regimen was 58.8Gy in 28 fractions with carboplatin and paclitaxel. Median survival was 16.5 months. Forty two (62.7%) patients underwent minimally invasive Ivor-Lewis esophagectomy within 100 days of CRT. Resected patients had a median survival of 30.6 vs. 6.4 months without surgery (p<.001). Pathologic complete response and pN0 was 30.0% and 59.5%, respectively. Acute grade 3+ toxicity was seen in 34.3% and late grade 3+ toxicity in 49.3%. Three patients (4.5%) died during CRT or before surgery. Predictors of overall survival (OS) on univariate analysis included age, KPS, male gender, absence of radiographic progression and surgical resection (all p<.05). Surgery remained significant on multivariate analysis (HR 0.215 [95%CI .114-.408, p<.001]). For resected patients, survival was predicted by positive margins, pathologic N stage, and number of positive nodes (all p<.05). The only predictor of OS on multivariate analysis was pathologic N stage, with actuarial 1- and 2-year OS for pN0 vs. pN+ of 96.2%/73.1% vs 53.3%/40.0% (p=.001). pN+ patients receiving adjuvant chemotherapy (53.3%) had improved survival of 26.7 vs 8.3 months without (p=.023). Conclusions: Preoperative CRT enabled a significant proportion of patients with BREC to proceed with a potentially curative resection. Further investigation with careful patient selection is warranted in incorporating a trimodality strategy to optimize outcomes and better define a treatment algorithm for this complex cohort of patients.

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