scholarly journals Complete response induced by concurrent chemoradiotherapy in a patient with NUT carcinoma: a case report

2021 ◽  
Author(s):  
Joji Muramatsu ◽  
Kohichi Takada ◽  
Shintaro Sugita ◽  
Takaaki Tsuchiya ◽  
Keisuke Yamamoto ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Concurrent Chemoradiotherapy ◽  
Vision Loss ◽  
Locally Advanced ◽  
Complete Response ◽  
Adolescent And Young Adult ◽  
Pathological Examination ◽  
Positive Staining ◽  
Dismal Prognosis ◽  
Nut Carcinoma

Abstract BackgroundNUT carcinoma (NC) is a rare and extremely aggressive carcinoma that occurs in young individuals. Although NC has a dismal prognosis, recommended therapies have not been established.Case presentationAn 18-year-old man presented with sudden vision loss in his left eye. Magnetic resonance imaging revealed a rapidly growing tumor, which had directly invaded the left optic nerve and epidural space, originating from the left posterior ethmoid sinus. A pathological examination of the tumor revealed a dense proliferation of polygonal-to-round tumor cells with enlarged round nuclei and conspicuous nucleoli, and positive staining for NUT protein in the nuclei of tumor cells. The patient was diagnosed with locally advanced NC. We initiated concurrent chemoradiotherapy (CCRT), consisting of chemotherapy with vincristine, doxorubicin, and cyclophosphamide (VDC), alternating with ifosphamide and etoposide (IE) according to a regimen for Ewing sarcoma, plus radiation therapy (70 Gy/35 Fr). The patient completed CCRT and achieved a complete response.ConclusionsCCRT, comprising a VDC–IE regimen, can be a useful treatment option for adolescent and young adult patients with NC, even when the cancer is at a locally advanced unresectable stage.

scholarly journals Prognostic value of PD-L1 expression on tumor cells combined with CD8+ TIL density in patients with locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Kathrin Gennen ◽  
Lukas Käsmann ◽  
Julian Taugner ◽  
Chukwuka Eze ◽  
Monika Karin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tumor Cell ◽  
Small Cell Lung Cancer ◽  
Tumor Cells ◽  
Local Control ◽  
Prognostic Value ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung

Abstract Background/aim mmune checkpoint inhibition (CPI) has an increasing impact in the multimodal treatment of locally advanced non-small cell lung cancer (LA-NSCLC). Increasing evidence suggests treatment outcome depending on tumor cell PD-L1 expression. The purpose of this retrospective study was to investigate the prognostic value of PD-L1 expression on tumor cells in combination with CD8+ tumor stroma-infiltrating lymphocyte (TIL) density in inoperable LA-NSCLC treated with concurrent chemoradiotherapy (CRT). Patients and method We retrospectively assessed clinical characteristics and initial tumor biopsy samples of 31 inoperable LA-NSCLC patients treated with concurrent CRT. Prognostic impact of tumor cell PD-L1 expression (0% versus ≥1%) and CD8+ TIL density (0–40% vs. 41–100%) for local control, progression-free (PFS) and overall survival (OS) as well as correlations with clinicopathological features were evaluated. Results Median OS was 14 months (range: 3–167 months). The OS rates at 1- and 2 years were 68 and 20%. Local control of the entire cohort at 1 and 2 years were 74 and 61%. Median PFS, 1-year and 2-year PFS were 13 ± 1.4 months, 58 and 19%. PD-L1 expression < 1% on tumor cells was associated with improved OS, PFS and local control in patients treated with concurrent CRT. Univariate analysis showed a trend towards improved OS and local control in patients with low CD8+ TIL density. Evaluation of Tumor Immunity in the MicroEnvironment (TIME) appears to be an independent prognostic factor for local control, PFS and OS. The longest and shortest OS were achieved in patients with type I (PD-L1neg/CD8low) and type IV (PD-L1pos/CD8low) tumors (median OS: 57 ± 37 vs. 10 ± 5 months, p = 0.05), respectively. Conclusion Assessment of PD-L1 expression on tumor cells in combination with CD8+ TIL density can be a predictive biomarker in patients with inoperable LA-NSCLC treated with concurrent CRT.

scholarly journals Molecular and Kinetic Analyses of Circulating Tumor Cells as Predictive Markers of Treatment Response in Locally Advanced Rectal Cancer Patients

Cells ◽  
2019 ◽  
Vol 8 (7) ◽  
pp. 641 ◽  
Author(s):  
Bianca C. Troncarelli Flores ◽  
Virgilio Souza e Silva ◽  
Emne Ali Abdallah ◽  
Celso A.L. Mello ◽  
Maria Letícia Gobo Silva ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Protein Expression ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Excision Repair ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Neoadjuvant chemoradiation (NCRT) followed by total mesorectal excision is the standard treatment for locally advanced rectal cancer (LARC). To justify a non-surgical approach, identification of pathologic complete response (pCR) is required. Analysis of circulating tumor cells (CTCs) can be used to evaluate pCR. We hypothesize that monitoring of thymidylate synthase (TYMS) and excision repair protein, RAD23 homolog B (RAD23B), can be used to predict resistance to chemotherapy/radiotherapy. Therefore, the aims of this study were to analyze CTCs from patients with LARC who underwent NCRT plus surgery for expression of TYMS/RAD23B and to evaluate their predictive value. Blood samples from 30 patients were collected prior to NCRT (S1) and prior to surgery (S2). CTCs were isolated and quantified by ISET®, proteins were analyzed by immunocytochemistry, and TYMS mRNA was detected by chromogenic in situ hybridization. CTC counts decreased between S1 and S2 in patients exhibiting pCR (p = 0.02) or partial response (p = 0.01). Regarding protein expression, TYMS was absent in 100% of CTCs from patients with pCR (p = 0.001) yet was expressed in 83% of non-responders at S2 (p < 0.001). Meanwhile, RAD23B was expressed in CTCs from 75% of non-responders at S1 (p = 0.01) and in 100% of non-responders at S2 (p = 0.001). Surprisingly, 100% of non-responders expressed TYMS mRNA at both timepoints (p = 0.001). In addition, TYMS/RAD23B was not detected in the CTCs of patients exhibiting pCR (p = 0.001). We found 83.3% of sensitivity for TYMS mRNA at S1 (p = 0.001) and 100% for TYMS (p = 0.064) and RAD23B (p = 0.01) protein expression at S2. Thus, TYMS mRNA and/or TYMS/RAD23B expression in CTCs, as well as CTC kinetics, have the potential to predict non-response to NCRT and avoid unnecessary radical surgery for LARC patients with pCR.

Radio-Chemotherapy of Vulvar Cancer

1998 ◽  
Vol 84 (2) ◽  
pp. 250-251 ◽  
Author(s):  
Roberto Zucali ◽  
Francesco Raspagliesi ◽  
Rado Kenda ◽  
Laura Lozza ◽  
Silvia Tana ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Pathological Examination ◽  
Locally Advanced Tumors ◽  
Cure Rates ◽  
Radio Chemotherapy ◽  
Advanced Tumors

Surgery alone, more or less demolitive, is the treatment of choice of vulvar cancers. Cure rates are high for early cancers only, while locally advanced tumors with or without inguinal adenopathies and recurrences have a bad prognosis. The excellent results of concurrent chemo-radiotherapy of anal cancers suggested to adopt the same approach for locally advanced vulvar cancers. The shrinkage of the tumor allowed surgery, often less demolitive than usual, and the pathological examination demonstrated an overall complete response in 40% of cases. Survival has been improved through this multidisciplinary approach. Patients not suitable for surgery obtained important remissions and an improved quality of life. Clinical experience at the Istituto Tumori of Milano is presented.

scholarly journals Poorly differentiated neuroendocrine rectal carcinoma with uncommon immune-histochemical features and clinical presentation with a subcutaneous metastasis, treated with first line intensive triplet chemotherapy plus bevacizumab FIr-B/FOx regimen: an experience of multidisciplinary management in clinical practice

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gemma Bruera ◽  
◽  
Antonio Giuliani ◽  
Lucia Romano ◽  
Alessandro Chiominto ◽  
...  
Keyword(s):  
Rectal Carcinoma ◽  
Neuroendocrine Carcinoma ◽  
Locally Advanced ◽  
Complete Response ◽  
Neuroendocrine Cells ◽  
Perineal Pain ◽  
Pathological Examination ◽  
First Line ◽  
Triplet Chemotherapy ◽  
Poorly Differentiated

Abstract Background Neuroendocrine tumors (NETs) are heterogeneous, widely distributed tumors arising from neuroendocrine cells. Gastrointestinal (GI)-NETs are the most common and NETs of the rectum represent 15, 2% of gastrointestinal malignancies. Poorly differentiated neuroendocrine carcinomas of the GI tract are uncommon. We report a rare case of poorly differentiated locally advanced rectal neuroendocrine carcinoma with nodal and a subcutaneous metastasis, with a cytoplasmic staining positive for Synaptophysin and Thyroid Transcription Factor-1. Case presentation A 72-year-old male presented to hospital, due to lumbar, abdominal, perineal pain, and severe constipation. A whole-body computed tomography scan showed a mass of the right lateral wall of the rectum, determining significant reduction of lumen caliber. It also showed a subcutaneous metastasis of the posterior abdominal wall. Patient underwent a multidisciplinary evaluation, diagnostic and therapeutic plan was shared and defined. The pathological examination of rectal biopsy and subcutaneous nodule revealed features consistent with small-cell poorly differentiated neuroendocrine carcinoma. First line medical treatment with triplet chemotherapy and bevacizumab, according to FIr-B/FOx intensive regimen, administered for the first time in this young elderly patient affected by metastatic rectal NEC was highly active and tolerable, as previously reported in metastatic colo-rectal carcinoma (MCRC). A consistent rapid improvement in clinical conditions were observed during treatment. After 6 cycles of treatment, CT scan and endoscopic evaluation showed clinical complete response of rectal mass and lymph nodes; patient underwent curative surgery confirming the pathologic complete response at PFS 9 months. Discussion and conclusions This case report of a locally advanced rectal NEC with an unusual subcutaneous metastasis deserves further investigation of triplet chemotherapy-based intensive regimens in metastatic GEP NEC.

Concurrent chemoradiotherapy with cetuximab plus twice-weekly paclitaxel and cisplatin followed by esophagectomy for locally advanced esophageal squamous cell carcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 79-79
Author(s):  
C. Lin ◽  
C. Hsu ◽  
J. C. Cheng ◽  
C. Yen ◽  
H. Shiah ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Radiation Dose ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Complete Response ◽  
Weekly Paclitaxel ◽  
One Year

79 Background: We investigated the efficacy and safety of adding cetuximab into twice-weekly paclitaxel/cisplatin-based concurrent chemoradiotherapy (CCRT), followed by surgery, for patients with locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Patients with operable ESCC (T3N0-1M0 or T1-3N1M0 or M1a) were treated with paclitaxel (35 mg/m2 1 h on days 1 and 4/week), cisplatin (15 mg/m2 1 h on days 2 and 5/week), cetuximab (400 mg/m2 2 h on day -5, then 250 mg/m2 2 h on day 3/week) and radiotherapy (2 Gy on days 1-5/week). When the accumulated radiation dose reached 40 Gy, the feasibility of esophagectomy was evaluated for all patients. In patients for whom esophagectomy was not feasible, CCRT was continued to a radiation dose of 60-66 Gy. Results: Sixty-two patients with ESCC were enrolled, and the majority had T3N1M0 or M1a tumors by endoscopic ultrasonographic staging (94%). All patients received CCRT to 40 Gy. Forty-three patients underwent surgery, and 17 patients continued definitive CCRT to 60-66 Gy. Of the scheduled doses of paclitaxel, cisplatin, and cetuximab, 80%, 79%, and 99% were given, respectively. The intent-to-treat pathological complete response rate was 24% (15/62) (95% confidence interval: 13-35%). At the median follow-up of 13.3 months, the one-year progression-free and overall survivals were 76% and 63%, respectively. The most common grade 3/4 toxic effects were leukopenia (51%), neutropenia (15%), esophagitis (19%), and infection (12%). Grade 1, 2, and 3 skin rash occurred in 59%, 36%, and 2% of patients, respectively. Grade 1, 2, 3, and 4 hypomagnesemia occurred in 14%, 5%, 0%, and 5% of patients, respectively. Conclusions: Adding cetuximab to twice-weekly paclitaxel/cisplatin-based CCRT prior to esophagectomy is an active and tolerable treatment for locally advanced ESCC. No significant financial relationships to disclose.

Nimotuzumab in combination with preoperative concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma: A prospective trial.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 101-101
Author(s):  
Xiaoyuan Wu ◽  
Yongshun Chen ◽  
Yuanyuan Yang ◽  
Daxuan Hao ◽  
Xue Li ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Response Rate ◽  
Pathological Complete Response ◽  
Complete Response Rate ◽  
Locally Advanced ◽  
Complete Response ◽  
Clinical Response Rate

101 Background: Preoperative chemoradiotherapy is an accepted standard treatment for patients with locally advanced esophageal cancer. Nimotuzumab is a monoclonal antihuman EGFR IgG1 antibody that has demonstrated synergistic activity with both radiotherapy and platinum-based chemotherapy in some solid tumors. The aim of this study is to investigate the safety and efficacy of nimotuzumab in combination with preoperative concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Previously untreated patients with stage II-III ESCC received nimotuzumab (200mg per week in weeks1-5), paclitaxel(45 mg/m2 per week in weeks 2-5), cisplatin(20 mg/m2 per week in weeks 2-5) and radiotherapy at a total dose of 40 Gy (2.0Gy/d,5 days per week in weeks 2-5). Esophagectomy was performed 4 weeks after the completion of preoperative strategies. Results: Eighteen eligible patients were enrolled. All patients completed the preoperative regimen, and seventeen patients underwent surgery. The clinical response rate was 94.4% (17/18). The most frequent Grade 1/2 toxicities were esophagitis(12/17), leukocytopenia(14/17), nausea/vomiting(8/17) and fatigue(4/17). Grade 3 leukocytopenia was observed in 11.8 % of patients (3/17). The rate of radical resection was 100%, and the pathological complete response rate was 41.2%(7/17). Downstaging occurred in 15/17 (88.2 %) patients by T stage and 8/17 (47.1%) by N stage. The incidences of postoperative anastomotic leak, pulmonary infection, hoarseness and arrhythmia were 11.8%, 11.8%, 5.9%, and 5.9%, respectively. No perioperative deaths occurred in the study. Conclusions: The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy is safe for locally advanced ESCC. The preoperative strategy is able to achieve substantially high clinical response rate and pathological complete response rate.

Outcomes of concurrent chemoradiotherapy for anal cancer in Brazil.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15073-e15073
Author(s):  
Andressa Cardoso Azeredo ◽  
Bruna Castilhos Silva
Keyword(s):  
Anal Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Demographic Data ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Real Life ◽  
Complete Response ◽  
Definitive Treatment ◽  
Lymph Node Status ◽  
Anal Canal Cancer

e15073 Background: The incidence of anal cancer has increased in the last 30 years and concurrent chemoradiotherapy has been the standard treatment for anal cancer for many decades, since it is a curative treatment in most cases. Although, data from real life outcomes in brazilian patients is lacking. Methods: From October 2001 to November 2016, all the pacientes who were treated with concomitant 5-FU and mitomycin or more recently cisplatin plus radiation at Hospital de Clínicas de Porto Alegre, an academic hospital from South Brazil were identified by electronic database. Medical records were reviewed and demographic data, tumor and treatment characteristics were collected. OS and PFS were estimated by Kaplan-Meier curves. Statistical analysis was performed with SPSS 22. Results: Fifty one patients were analysed for this review. Patient characteristics revealed a mean age of 53 ± 9.03 years, 69% female, with predominantly histology being squamous cell carcinoma (90%). 92% (47) received chemoradiotherapy as a definitive treatment. The chemoterapy regimen used was 5-FU and mitomycin in 69% (35) of the patients and 5-FU plus cisplatin was used in 16 patients (31%). The standard chemoterapy regimen was changed because of lack of supply of mitomycin in our country. Approximately 66% of the patients achieved a complete response while 4 patients (7%) had persistent disease after treatment and 7% had disease progression during treatment. On multivariable analysis, the lymph node status and the size of the tumor were independently associated with worst results. The estimated median PFS was 78 months and the median OS was 92 months. Conclusions: To our knowledge, this is the first report of patients from Brazil treated with concurrent chemoradiation for anal canal cancer. Although we have a delay in the diagnosis and many patients present with locally advanced disease, the CR rate and prognosis are consistent with data from previous studies. We need a longer follow-up to confirm these data and also verify if there will be different outcomes because of the change in the chemoterapy regimen.

scholarly journals Road to organ preservation in locally advanced rectal cancer

2017 ◽  
Vol 145 (7-8) ◽  
pp. 415-420
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Branko Brankovic
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Operative Management ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Pathological Examination ◽  
Diagnostic Tools ◽  
Non Operative Management

Introduction. In the past 20 years there has been significant change in the treatment of rectal cancer, especially in terms of multimodal approach. Surgery is, at least for now, the mainstay treatment for resectable rectal cancer. Preoperative chemoradiotherapy is, regardless of its modality, short or long course, different chemotherapeutic regiments, widely recommended for locally advanced rectal cancer. After neoadjuvant treatment, 15?27% of patients experience pathological complete response (pCR). These patients could benefit from non-operative management, thus avoiding potential surgical complications and possible reduction in the quality of life. Unfortunately, one cannot precisely define, while omitting surgery, which patients have pCR. For this reason Habr-Gama, a pioneer in the ?watch-and-wait? strategy, developed a new endpoint for non-operative management ? clinical complete response. To measure the response, in the absence of pathological examination, same diagnostic tools are used as in initial staging, but none is reliable enough to be used alone. This article is focusing on critical points in the reassessment of response to preoperative chemoradiotherapy for advanced rectal cancer, which is mandatory for appropriate selection of patients who might benefit from non-operative management.

scholarly journals High throughput proteomic analysis and machine learning algorithm identifies DUOX2 (dual oxidase 2) as a novel biomarker for response prediction of concurrent chemoradiotherapy for locally advanced rectal cancer.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 71-71
Author(s):  
Hyebin Lee
Keyword(s):  
Machine Learning ◽  
Rectal Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Response Prediction ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Machine Learning Algorithms ◽  
Dual Oxidase

71 Background: Although many efforts to predict treatment response of concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer (LARC) have been made, no molecular has proved to be a robust biomarker. Methods: We performed mass spectrometry-based quantitative proteomic analysis of pretreatment Formalin-fixed, Paraffin-embedded (FFPE) biopsy samples of 13 patients with LARC, who were treated with CCRT followed by curative surgery. Based on pathologic report of surgical specimens, we divided thirteen patients as two response groups: complete response (CR) and non-complete response (nCR) groups. Results: A total of 3,637 proteins were identified and 498 proteins were confirmed as expressed at significantly different levels (DEPs; differently expressed proteins) between these two groups. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were also performed: the result showed that up-regulated DEPs enriched in biological processes (BP) were significantly different between two groups; immune response, cell migration & motility, protein transport in CR group; amide/peptide biosynthetic process, translation, posttranscriptional regulation of gene expression and detoxification in nCR group. To identify the best classifier to evaluate predictive power of signatures, we employed for different machine learning algorithms to classify samples between CR and nCR groups. As a result, we identified the predictive relevance of dual oxidase 2 (DUOX2) as the strongest predictive biomarker. Conclusions: This study identified a new biomarker, DUOX2, applicable to discrimination between CR and nCR after NACRT for LARC. To our knowledge, the present study provides the first identification of a clinical biomarker for response prediction based on in-depth proteomics and machine learning algorithms.

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