scholarly journals Early Axonal Dysfunction of the Peripheral Nervous System Influences Disease Progression of ALS: Evidences From Clinical Neuroelectrophysiology

2020 ◽  
Author(s):  
Huiyan Yu ◽  
Lu Chen ◽  
Shuo Zhang ◽  
Jing He ◽  
Dongsheng Fan
Keyword(s):  
Overall Survival ◽  
Nervous System ◽  
Disease Progression ◽  
Peripheral Nervous System ◽  
Compound Muscle Action Potential ◽  
Age At Onset ◽  
Prognostic Indicator ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Axonal Dysfunction

Abstract Background:Studies have indicated that more axonal dysfunction in early ALS predictive of more aggressive phenotypes. However, as an important electrophysiological index to detect motor axonal damage, the prognostic value of compound muscle action potential (CMAP) in ALS remains unclear. We aimed to determine if CMAP could be a prognostic indicator of disease progression in early ALS.Methods: Patients were stratified into 4 groups according to the decrement of the CMAP amplitude within 12 months of symptom onset (CMAP-12 amplitudes): normal (≥the lower limit of normal, LLN), mild (<LLN but ≥50% of LLN), moderate (<50% but ≥30% of LLN) and severe (<30% of LLN). All patients were followed up every 3 months. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression.Results: A total of 149 patients included in the analysis [90 male (60.4%); mean age at onset, 50.7 years]. The decrement of CMAP-12 amplitudes was normal in 24.2%, mildly in 22.1%, moderately in 15.4% and severely in 38.3%. Kaplan-Meier analysis showed there was a significant difference in the overall survival across the 4 groups (p<0.05). Further pairwise comparison found there were significant differences in survival between the normal vs. the moderately groups (p<0.05), and the normal vs. the severely groups (p<0.01). There was a significant inverse correlation between the CMAP-12 amplitude and overall survival. Compared to the normal group, survival in the moderately and severely decreased groups were significantly shorter (HR 3.394, 95%CI 1.292-8.917, p=0.013; and HR 4.732, 95%CI 2.032-11.017; p=0.000, respectively).Conclusions: Our results suggested that CMAP-12 amplitude could be a prognostic indicator of disease progression in ALS. More importantly, it provided clinical evidences to the viewpoint that early axonal dysfunction of peripheral nervous system accelerates disease progression of ALS.

scholarly journals Early Axonal Dysfunction of the Peripheral Nervous System Influences Disease Progression of ALS: Evidence From Clinical Neuroelectrophysiology

2021 ◽  
Vol 12 ◽  
Author(s):  
Huiyan Yu ◽  
Lu Chen ◽  
Shuo Zhang ◽  
Jing He ◽  
Dongsheng Fan
Keyword(s):  
Overall Survival ◽  
Nervous System ◽  
Disease Progression ◽  
Peripheral Nervous System ◽  
Compound Muscle Action Potential ◽  
Age At Onset ◽  
Cox Proportional Hazards ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Axonal Dysfunction

Objective: To assess the prognostic value of the decrement in compound muscle action potential amplitude within 12 months of symptom onset (CMAP-12 amplitude) for the survival of patients with amyotrophic lateral sclerosis (ALS).Methods: Patients were stratified into 4 groups according to the decrement of the CMAP-12 amplitudes: normal (≥the lower limit of normal, LLN), mild (&lt;LLN but ≥50% of LLN), moderate (&lt;50% but ≥30% of LLN) and severe (&lt;30% of LLN). All patients were followed up every 3 months. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression.Results: A total of 149 patients were included in the analysis [90 males (60.4%); mean age at onset, 50.7 years]. The decrement of CMAP-12 amplitudes was normal in 24.2% of patients, mild in 22.1%, moderate in 15.4% and severe in 38.3%. Kaplan–Meier analysis showed there was a significant difference in the overall survival across the 4 groups (p &lt; 0.05). Further pairwise comparisons identified significant differences in survival between the normal vs. the moderate group (p &lt; 0.05) and the normal vs. the severe group (p &lt; 0.01). There was a significant inverse correlation between the CMAP-12 amplitude and overall survival. Compared to that in the normal group, survival in the moderately and severely decreased groups was significantly shorter (HR 3.394, 95% CI 1.292–8.917, p = 0.013; and HR 4.732, 95% CI 2.032–11.017; p = 0.000, respectively).Conclusions: Our results suggest that CMAP-12 amplitude could be a prognostic indicator of disease progression in ALS. More importantly, our findings provide clinical evidence for the viewpoint that early axonal dysfunction of the peripheral nervous system accelerates disease progression of ALS.

scholarly journals Evaluation of The Effectiveness and Side Effects of Radiotherapy in Patients With Primary Nervous System Lymphoma. A Single Center Experience

2020 ◽  
Vol 7 ◽  
Author(s):  
Timur Koca ◽  
Aylin Fidan Korcum ◽  
Yasemin Şengün ◽  
Melek Gamze Aksu ◽  
Mine Genç
Keyword(s):  
Central Nervous System ◽  
Overall Survival ◽  
Nervous System ◽  
Side Effects ◽  
Disease Free Survival ◽  
Central Nervous System Lymphoma ◽  
Field Size ◽  
High Dose ◽  
Free Survival ◽  
Significant Difference

Aim: In this study, we aimed to evaluate the overall and progression-free survival, the radiotherapy process and the early and late adverse effects in patients who underwent radiotherapy (RT) for primary nervous system lymphoma in our clinic.Method: Between January 2010 and September 2019, 16 patients who received radiotherapy due to primary central nervous system lymphoma in our clinic were examined according to their statistically significant differences in terms of survival and side effects.Results: The median disease-free survival of the patients was 6 months, and the median overall survival was 12.5 months. 18.75% of the patients could not receive chemotherapy but only radiotherapy. Radiotherapy doses were range from 2600 to 5000 cGy. When patients were evaluated in terms of radiotherapy dose, field size and chemotherapy, no statistically significant difference in overall survival was detected. Cognitive disorders were observed as the most common late side effects while the most common acute side effects in patients were headaches.Conclusion: In the treatment of primary central nervous system lymphoma, changes in radiotherapy portals and radiotherapy doses can be predicted in patients who received high-dose methotrexate chemotherapy or not. Furthermore, it has been considered that more comprehensive studies are needed to increase the success of treatment and provide standardization in treatment, especially in patients with elderly and comorbid diseases.

scholarly journals Impact of Treatment Facility Chracteristics on Patient (Pt) Outcomes in Acute Myeloid Leukemia (AML) Using Data from the National Cancer Database (NCDB)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-22
Author(s):  
Allison Taylor ◽  
Kimberley Doucette ◽  
Bryan Chan ◽  
Xiaoyang Ma ◽  
Jaeil Ahn ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hazard Analysis ◽  
Treatment Options ◽  
Academic Research ◽  
High Volume ◽  
Rank Test ◽  
Rural Residence ◽  
Integrated Network ◽  
Kaplan Meier ◽  
Significant Difference

Introduction The literature suggests a widespread reduction in the availability and accessibility of newer treatment options among marginalized groups in AML. Studies from large national databases point to lower socio-economic status, Hispanic and African American race, Medicare or no insurance, being unmarried, treatment at non-academic centers, and rural residence as negatively impacting overall survival (OS) and rates of chemotherapy utilization in AML patients (Patel et al. 2015, Jaco et al. 2017, Bhatt et al. 2018, Master et al. 2016). We hypothesized that facility affiliation and pt volume would also have important effects on time to treatment (TTT) and OS in AML, even when these socioeconomic disparities were accounted for. Methods For this retrospective analysis, we used NCDB data that included 124,988 pts over the age of 18 with AML between the years 2004-2016. Variables analyzed included facility types described as community cancer programs (CP), comprehensive community cancer programs (CCP), academic/research center cancer programs (AC) and integrated network cancer programs (IN), and volume of facilities defined as high volume (HV) and low volume (LV). HV facilities had case volumes of ≥ 99th percentile and all other facilities were classified as LV. Multivariate analyses (MVA) included demographic and socioeconomic covariables. We used Cox proportional hazard analysis for both TTT and OS MVA. The Kaplan-Meier method was used to estimate median TTT and OS, and the log rank test used to compare TTT and OS across predictor variables. Results The median age of AML patients was 63 yrs (range 18-90) with 54% males, and 86% Caucasian. Five percent of patients were treated at CP, 30% at CCP, 44% at AC, and 10% at IN. 21% at HV facilities and 79% at LV facilities. Median TTT in days at CP facilities was 7, compared to 5 days in CCP and AC facilities versus 4 days at IN (p&lt;0.0001). TTT was 5 days at HV facilities versus 4 days at LV facilities (p&lt;0.0001). Kaplan-Meier curves showed that TTT was similar between HV and LV facilities(figure 1). The median OS was 3.25 months in CP compared to 4.34 months at CCP, 5.06 months at IN and 9.53 months at AC (p&lt;0.0001). For facility volume, the median OS was 13.11 months in HV facilities compared to 6.93 months in LV facilities (p&lt;0.0001). When sex, race, age, Hispanic Origin, education, urban/rural residence, Charlson-Deyo Comorbidity score and Great Circle Distance were adjusted for in MVA (table 1), the OS was higher in AC versus CP facilities (hazard ratio [HR] of 0.90 (0.87-0.93, p&lt;0.0001), and there was no statistically significant difference with comparison of other facility types to CP. Similarly, there was a lower OS at LV versus HV facilities with a HR of 1.14 (1.12-1.16, p&lt;0.0001). CCP facilities had a shorter TTT compared to CP with a HR of 1.21 (1.17-1.26, p&lt;0.0001). AC had a shorter TTT than CP with a HR of 1.17 (1.13-1.22, p&lt;0.0001), and IN had a shorter TTT compared to CP with a HR of 1.29 (1.24-1.34, p&lt;0.0001). Additionally, TTT in the MVA for facility volume was shorter in LV facilities compared to HV facilities with HR of 1.05 (1.04-1.07, p&lt;0.0001) [table 1]. Conclusion When adjusting for various socioeconomic factors, we found that TTT was longest in CP compared to CCP, AC, and IN. Treatment at a LV facility resulted in a decreased overall survival. LV facilities may be less familiar with treatment regimens for AML, less likely to use novel treatment options, and be less familiar with the disease. We showed that treatment at an AC compared to CP, CCP and IN facilities improved survival. Given poor outcomes for AML, these results show the importance of going to AC and HV facilities with more experience in treating AML for improved outcomes. Disclosures Lai: Astellas: Speakers Bureau; Jazz: Speakers Bureau; Abbvie: Consultancy; Agios: Consultancy; Macrogenics: Consultancy.

Efficacy of PD-1 or PD-L1 inhibitors and central nervous system metastases in advanced cancer: a meta-analysis

2021 ◽  
Vol 21 ◽  
Author(s):  
Minyong Peng ◽  
Shan Li ◽  
Hui Xiang ◽  
Wen Huang ◽  
Weiling Mao ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Overall Survival ◽  
Cell Death ◽  
Nervous System ◽  
Programmed Cell Death ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Cns Metastases ◽  
Hazard Ratios ◽  
Significant Difference

<P>Background: Little is known about the efficacy of programmed cell death protein-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) inhibitors in patients with central nervous system (CNS) metastases. <P> Objective: Assess the difference in efficacy of PD-1 or PD-L1 inhibitors in patients with and without CNS metastases. <P> Methods: From inception to March 2020, PubMed and Embase were searched for randomized controlled trials (RCTs) about PD-1 or PD-L1 inhibitors. Only trails with available hazard ratios (HRs) for overall survival (OS) of patients with and without CNS metastases simultaneously would be included. Overall survival hazard ratios and their 95% confidence interval (CI) were calculated, and the efficacy difference between these two groups was assessed in the meantime. <P> Results: 4988 patients (559 patients with CNS metastases and 4429 patients without CNS metastases) from 8 RCTs were included. In patients with CNS metastases, the pooled HR was 0.76 (95%CI, 0.62 to 0.93), while in patients without CNS metastases, the pooled HR was 0.74 (95%CI, 0.68 to 0.79). There was no significant difference in efficacy between these two groups (Χ=0.06 P=0.80). <P> Conclusion: With no significant heterogeneity observed between patients with or without CNS metastases, patients with CNS metastases should not be excluded from PD-1 or PD-L1 blockade therapy. Future research should permit more patients with CNS metastases to engage in PD-1 or PD-L1 blockade therapy and explore the safety of PD-1 or PD-L1 inhibitors in patients with CNS metastases.</P>

scholarly journals P14.56 Recurrent Glioblastomas: Should we operate a second and even a third time

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii80-iii80
Author(s):  
M Yahia-Cherif ◽  
O De Witte ◽  
C Mélot ◽  
F Lefranc
Keyword(s):  
Overall Survival ◽  
Survival Benefit ◽  
Standard Of Care ◽  
Recurrent Glioblastoma ◽  
Kaplan Meier ◽  
Significant Survival ◽  
Significant Difference ◽  
Second Surgery ◽  
Second Resection ◽  
Initial Resection

Abstract BACKGROUND The aim of this study was i) to analyse the effect of repeat surgeries on the survival of patients with focally recurrent glioblastoma who have benefited from temozolomide treatment and ii) to identify potential prognostic factors for survival. MATERIAL AND METHODS Cases from 2005 to 2014 in the glioblastoma database of our department were retrospectively reviewed. The Kaplan-Meier method was used to estimate overall survival (OS) as a function of time after one, two and three surgical resections. All patients received the standard of care after the first surgery (temozolomide during and after radiotherapy) and adjuvant treatment after repeat surgeries. RESULTS One hundred-thirty-two glioblastoma patients (median age: 57 years) were included in the study. Among them, 68, 53 and 11 patients underwent one, two and three surgical resections, respectively. The median OS was 11, 16 and 18 months, respectively, for patients who underwent one, two and three surgical resections. Patients who underwent two (p<0.001) or three (p<0.01) surgeries survived significantly longer than patients who underwent only one. No significant difference was observed between patients who underwent two versus three surgeries (p=0.76). A second resection performed more than 6 months after the initial resection was the only factor associated with prolonged survival (p=0.008). CONCLUSION Glioblastoma patients who benefited from temozolomide treatment and underwent surgery for recurrent glioblastoma exhibited a significant increase in survival compared with patients who did not undergo a second surgery. By contrast, a third surgery for a second recurrence did not contribute to any significant survival benefit.

Dose Intensive Induction Chemotherapy Does Not Decrease Tumor Contamination of Autograft or Improve Survival for Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplant.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2932-2932
Author(s):  
Farzana A. Sayani ◽  
Nizar J. Bahlis ◽  
Peter Faris ◽  
Mary Lynn Savoie ◽  
Ahsan Chaudhry ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Small Sample ◽  
Cell Transplant ◽  
Intensive Chemotherapy ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Time To Relapse

Abstract Multiple dose intensive chemotherapy regimens have been used for induction/mobilization of stem cells for autologous stem cell transplantation (ASCT) in multiple myeloma. However, the exact role and regimens of such dose intensive chemotherapy has not been clearly defined. We therefore did a retrospective study to determine if dose intensive cyclophosphamide (Cyclo) 5.25 g/m2, etoposide 1.05 g/m2 and cisplatin 105 mg/m2 (DICEP) results in improved relapse rate and survival compared to standard mobilization with only Cyclo 2 g/m2. Between January 1998 and March 2004, a consecutive series of 57 newly diagnosed multiple myeloma patients receiving DICEP (38) or Cyclo (19) for in-vivo purging/mobilization were analyzed. Both groups were similar in regards to age and sex. There were no significant differences in IPI score, Durie-Salmon stage, B2 microglobulin, calcium, creatinine and albumin levels between treatment groups. Outcomes included time to relapse and time to death. Median follow up time was 799 days. Kaplan-Meier plots for time to relapse showed no significant difference (p=0.0992). Median relapse time in the DICEP group was 905 days (95% CI 580–1604) compared to 1112 days (95% CI 742-infinity) in the Cyclo group. Kaplan-Meier plots for overall survival showed no significant difference between both groups (p=0.8664). The median survival times have not yet been reached in either group and are not reported. Analysis revealed no discernable confounding risk factors. Effects of treatment on outcomes were not altered after adjusting for IPI score and Durie-Salmon staging using the stratified log-rank test. Small sample size and short duration of followup are potential limiting factors for this study, however, preliminary analysis of a larger sample of 91 multiple myeloma patients receiving either DICEP or a less intense induction/mobilization regimen, also revealed no significant difference in disease free or overall survival. Monoclonal plasma cell contamination of stem cell products was not significantly different between both groups (DICEP 42.9%, Cyclo 56.3%, p=0.5573). This study therefore suggests that the very intense DICEP induction/mobilization regimen results in no significant difference in survival outcomes. The more intense regimen does not significantly decrease tumor contamination of autograft stem cells. Overall, our experience suggests that novel induction therapies such as bortezomib, lenolidomide etc. should be pursued in preference to any further study of high dose cytotoxic chemotherapy induction. Figure Figure

Management of Hyperleukocytosis in Acute Myelogenous Leukemia Using Hydroxyurea Rather Than Leukopheresis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2007-2007 ◽  
Author(s):  
Kevin H.M. Kuo ◽  
Jeannie Callum ◽  
Joseph Brandwein ◽  
Michael Crump ◽  
John E. Curtis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Early Death ◽  
Prognostic Indicator ◽  
Pulmonary Involvement ◽  
Early Mortality ◽  
Myelogenous Leukemia ◽  
Princess Margaret Hospital ◽  
Kaplan Meier ◽  
Retrospective Comparison ◽  
Median Cumulative Dose

Abstract Patients with AML presenting with hyperleukocytosis (WBC >100x109/L) experience higher early mortality due to leukostasis. A retrospective comparison of 2 cohorts of patients managed in 2 different institutions either by leukapheresis (Princess Margaret Hospital n=42) or hydroxyurea (HU) (Toronto General Hospital n=47) demonstrated equivalent survival on days 8 (p=1.0000) and 28 (p=0.4784) after presentation. Based on this observation a policy was established to manage patients with HU rather than leukapheresis. The current study was designed to validate this policy. 1146 consecutive AML patients presented between 1998 and 2006 to the Princess Margaret Hospital at diagnosis. 105 of these patients had a WBC >100x109/L. According to the policy 85 were treated with a median cumulative dose of 18 gm HU within the first 4 days, 5 died before initiating treatment with HU and 15 underwent induction therapy without initial cytoreduction using HU. 35/105 patients (33%) died within the first 28 days. Patients presenting with symptoms of leukostasis, particularly with pulmonary involvement, were more likely to die within the first 28 days compared to patients without symptoms (p=0.0492). The death rate of 33% at 28 days was similar to those observed in the previous study (31% for the cohort undergoing leukapheresis and 23% for the cohort being treated with HU, p=0.5048). This rate was significantly higher when compared to 54/1041 (5%) patients dying before day 28 that presented with <100x109/L (p< 0.0001). Patients of both groups that survived more than 28 days (n=70 and n=987 respectively) demonstrated a similar overall survival. The 5 year overall survival amounted to 27% and 33% respectively (p=0.2023) and was influenced by the cytogenetic risk of patients at diagnosis (54 and 67% for patients with favourable, 28 and 30% with intermediate and 0 and 15% with unfavourable risk). In conclusion, hyperleukocytosis continues to be an adverse prognostic indicator affecting early mortality of patients with AML. Particularly patients that present with symptoms secondary to leukostasis are at risk for early death. The overall survival of patients surviving the first 28 days after presentation is not different. A treatment policy to use HU rather than leukapheresis in the immediate management of these patients confirmed a previous observation of equivalency. Kaplan Meier plots of Overall Survival in AML Patients with and without Hyberleukocytosis (P< 0.001) (1998 to 2006 cohort) Kaplan Meier plots of Overall Survival in AML Patients with and without Hyberleukocytosis (P< 0.001) (1998 to 2006 cohort) Kaplan Meier plots of Overall Survival in AML Patients with and without Hyberleukocytosis Surviving 28 Days after Presentation (p = 0.2023) (1998 to 2006 cohort) Kaplan Meier plots of Overall Survival in AML Patients with and without Hyberleukocytosis Surviving 28 Days after Presentation (p = 0.2023) (1998 to 2006 cohort)

Sites of Extranodal Involvement Are Prognostic in Patients with Stage 1 Follicular Lymphoma: An Analysis of the Surveillance, Epidemiology and End Results Database

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1670-1670
Author(s):  
Aditi Shastri ◽  
Yiting Yu ◽  
Amit Verma ◽  
Stefan Klaus Barta
Keyword(s):  
Overall Survival ◽  
Nervous System ◽  
Multivariate Analysis ◽  
Lymph Node ◽  
Musculoskeletal System ◽  
Primary Site ◽  
Stage I ◽  
Aggressive Treatment ◽  
Primary Disease ◽  
Kaplan Meier

Abstract Background: Follicular lymphoma (FL) is the most common indolent B cell lymphoma with a rising incidence. Approximately 26% of patients with FL present with stage I disease. Although international consensus guidelines recommend radiotherapy for these patients, a recent survey of the National Lymphocare Study demonstrated that adherence to the standard is low with less than one third of patients treated with radiotherapy, whereas the rest were only observed, received single-agent rituximab, or a combination of rituximab with chemotherapy +/- subsequent radiotherapy. There is evidence to suggest that extranodal sites of involvement are associated with better/worse outcomes in other lymphomas (DLBCL, MCL). Hence, we examined the association between primary site of disease and survival in patients with Stage I FL to identify subgroups of patients that have distinct characteristics and could potentially benefit from early and/or more aggressive treatment. Methods: We analyzed the United States SEER database from 1983 to 2011. Direct case listings were extracted by SEER*Stat software, version 8.1.5, released March 31,2014. All histologically confirmed, Stage I FL cases, age > 18 years, with active follow-up and only a single primary tumor were included in the analysis. Overall survival (OS) estimates for each primary site were calculated using the Kaplan-Meier method and log rank test. We assessed the impact of primary disease site on OS using Cox proportional hazards models adjusted for age, sex, race, radiotherapy, surgery and era of diagnosis (pre-rituximab era: Õ83-Õ98 vs. rituximab era: Õ99-Õ11). Calculations were performed using SAS, version 9.3. Results: We analyzed 9931 total patients, 25% of patients presented with an extranodal primary site. The most common extranodal primary sites were the integumentary system (8%), GI tract (6.4%) and the head & neck region (5.6%). In univariate analysis, Stage I FL of the integumentary system was associated with better OS than lymph node (LN) primary disease (HR 0.74, 95% CI 0.63 to 0.59). Primary site FL of the respiratory system (HR 1.69, CI 1.18 to 2.4), musculoskeletal system (HR 2, CI 1.37 to 3) and nervous system (HR 1.9, CI 1.37 to 2.68) were significantly associated with worse overall survival than lymph node primary disease. In multivariate analysis, only integumentary disease was associated with better OS (HR 0.77, CI 0.66 to 0.9) while primary site FL of the nervous system (HR 2.4, CI 1.72 to 3.38) and the musculoskeletal system (HR 2.14, CI 1.44 to 3.18) were associated with worse overall survival than lymph node primary disease. Patients treated in the rituximab era had a better OS on multivariate analysis than if treated in the pre-rituximab era (p<0.0001). Female sex was associated with better survival while older age at diagnosis was associated with worse survival (p<0.0001). In multivariate analysis, patients who received surgery or radiation had better survival than those that did not receive any therapy and Whites had better survival than Blacks (both p<0.0001). Conclusions: Primary site of disease may be an important prognostic factor for patients with early stage FL as demonstrated by this population-based study. Patients with Stage I FL of the integumentary system had a significantly better outcome than primary nodal disease. Musculoskeletal and nervous system primary sites had a significantly worse survival than primary nodal sites. These subsets of patients may benefit from early, aggressive treatment. Primary site may correlate with certain biological characteristics associated with disease behavior and pathogenesis and needs further evaluation. Overall survival was significantly better in the rituximab era. Figure 1. Kaplan Meier Curve demonstrating OS of integumentary system vs. lymph node primary site (180 months vs. 170 months, p <0.0001), nervous system vs. lymph node primary site (95 months vs. 170 months, p <0.0001) and musculoskeletal system vs. lymph node primary site (96 months vs. 170 months, p <0.0001). Figure 1. Kaplan Meier Curve demonstrating OS of integumentary system vs. lymph node primary site (180 months vs. 170 months, p <0.0001), nervous system vs. lymph node primary site (95 months vs. 170 months, p <0.0001) and musculoskeletal system vs. lymph node primary site (96 months vs. 170 months, p <0.0001). Disclosures No relevant conflicts of interest to declare.

Overall survival trends in pediatric osteosarcoma patients over the past three decades

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10041-10041
Author(s):  
R. van Schie ◽  
M. Hagleitner ◽  
P. Hoogerbrugge ◽  
U. Flucke ◽  
H. Schreuder ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Rank Test ◽  
Histological Response ◽  
Treatment Protocols ◽  
Treatment Regimens ◽  
The Past ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Pediatric Osteosarcoma

10041 Background: In the late seventies, the combination of chemotherapy and surgery, significantly improved survival of osteosarcoma patients. However, the chemotherapeutic drugs used for treatment of osteosarcoma patients has not significantly changed since then although surgery clearly improved further and adjuvant chemotherapy have been added. In this study, we retrospectively evaluated, whether after the introduction of neoadjuvant chemotherapy in the late seventies, further improvement in outcome of pediatric osteosarcoma patients was achieved. Methods: Since 1978 and 2008, 54 previously untreated pediatric patients with osteosarcoma were enrolled in six consecutive regimens of different agents and intensity. The main difference between the treatment protocols is the addition of either methothrexate or ifosfamide. Overall survival (OS) and event free survival (EFS) in relationship to the different treatment regimens was calculated using the Kaplan-Meier method. Significance of difference in outcome were calculated using the log rank test. Results: The 5-year EFS and OS of the whole group was 54.7% and 61.1%, respectively. There was no significant difference in outcome in patients treated between 1978 and 1993 (n = 18), as compared to patients treated after 1993 (n = 36, OS 47.1% vs 69.4%, p = 0.34). Of all treatment regimens used, OS was the highest in patients treated with cisplatin, doxorubicin, and methotrexate (OS after 5 year 70%). Multivariate analysis showed that EFS and OS significantly correlated with the histological response but not with one of the treatment regimens used. Conclusions: No significant improvement in overall survival has been accomplished in pediatric osteosarcoma patients during the past thirty years. Histological response after neoadjuvant chemotherapy was the most important prognostic factor. No significant financial relationships to disclose.

Survival among cancer patients undergoing opioid rotation to methadone as compared to other opioids.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 183-183
Author(s):  
Akhila Sunkepally Reddy ◽  
Sriram Yennu ◽  
Ulrich S. Schuler ◽  
Maxine Grace De la Cruz ◽  
Jimin Wu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
The Other ◽  
Pain Response ◽  
Opioid Rotation ◽  
Kaplan Meier ◽  
Methadone Group ◽  
Significant Difference ◽  
Edmonton Symptom Assessment Scale ◽  
Strong Opioids

183 Background: Recent studies have reported that methadone has antineoplastic activity. Other studies have associated methadone with lower overall survival in patients with chronic pain. Methadone is the most frequent opioid chosen for purpose of opioid rotation (OR) in cancer patients experiencing refractory pain or opioid induced neurotoxicity. There is no data available on the association of methadone with overall survival in cancer patients. Our aim was to compare the characteristics and overall survival in cancer patients in methadone group with other strong opioid group. Methods: In this ad hoc analysis, we reviewed 2471 consecutive patient visits to the supportive care center of a tertiary cancer center in 2008 for ORs from strong opioids to methadone or other strong opioids with a follow-up visit within 6 weeks. Information regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and morphine equivalent daily dose (MEDD) were collected. Successful pain response was defined as 2-point or 30% reduction in pain score. Kaplan-Meier curves were used to evaluate survival. Results: Of the 102 eligible patients, 54 underwent OR to methadone and 48 to other strong opioids. The median age was 56 years, 56% were male, and 81% had advanced cancer. There were no significant differences between the methadone group and the other opioid group in patient characteristics, performance status, MEDD, and ESAS scores. Although both the groups showed significant pain response, methadone group (72%) had a significantly higher pain response as compared to the other opioid group (65%; P = 0.04). The Kaplan-Meier curves revealed no significant difference in overall survival (OS) between the methadone group and the other opioid group [median OS: 5.2 months (95% CI 3.64-7.41) vs. 5.9 months (95% CI 2.6-9.2); P = 0.89]. Conclusions: We observed no significant difference in overall survival in cancer patients in methadone group as compared to other opioids. Further validation studies in a larger sample are warranted.

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