scholarly journals Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

2020 ◽  
Author(s):  
Masashi Utsumi ◽  
Hideki Aoki ◽  
Seichi Nagahisa ◽  
Yuta Une ◽  
Yuji Kimura ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Survival Rates ◽  
The Elderly ◽  
Elderly Group ◽  
Rank Test ◽  
Elderly Age ◽  
Nutritional Factors ◽  
Log Rank Test

Abstract Background Conflicting data on the safety of pancreaticoduodenectomy (PD) for elderly patients exist. Therefore, this study aimed to evaluate and compare the nutritional factors and clinical outcomes of PD between elderly and non-elderly patients.Methods A retrospective study of 122 consecutive patients who underwent PD from April 2008 to April 2020 was conducted. Preoperative and postoperative nutritional factors (prognostic nutritional index [PNI]), complication rates, and survival rates were compared between the elderly (age ≥80 years) and non-elderly (age <80 years) patient groups. Furthermore, changes in nutrition markers were evaluated before surgery to 1 year after surgery. Data were analyzed using unpaired Student’s t-test, chi-squared test with Fisher’s exact test, and log-rank test.Results A total of 20 elderly patients (16.4%) and 102 non-elderly patients (83.6%) underwent PD. With respect to preoperative factors, elderly patients had a significantly lower PNI than non-elderly patients. The duration of operation, amount of blood loss, postoperative complication rate, and incidence rate of pancreatic fistula were similar between the two groups. At 3 months postoperatively, elderly patients had a lower albumin level and PNI than non-elderly patients. The median length of hospital stay was significantly longer in the elderly group than in the non-elderly group (39.9 vs. 27 days, P=0.004). The rate of death due to other diseases was relatively higher in the elderly group than in the non-elderly group. Elderly patients had a significantly lower overall survival rate than non-elderly patients (1-/3-/5-year overall survival rates: 78.1%/26.7%/13.3% vs. 87.1%/54.4%/46.7%; log-rank test, P=0.008).Conclusions Elderly patients had a lower nutritional status and lower survival rate than non-elderly patients. Careful patient selection and optimal perioperative care are necessary to determine whether PD is indicated for elderly patients.

scholarly journals Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mitsuro Kanda ◽  
Masahiko Koike ◽  
Chie Tanaka ◽  
Daisuke Kobayashi ◽  
Masamichi Hayashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Neoadjuvant Treatment ◽  
The Elderly ◽  
Elderly Group ◽  
Elderly Age ◽  
Subtotal Esophagectomy

Abstract Background The global increase in elderly populations is accompanied by an increasing number of candidates for esophagectomy. Here we aimed to determine the postoperative outcomes after subtotal esophagectomy in elderly patients with esophageal cancer. Methods Patients (n = 432) with who underwent curative-intent transthoracic subtotal esophagectomy with 2- or 3-field lymphadenectomies for thoracic esophageal cancer were classified as follows: non-elderly (age < 75 years, n = 373) and elderly (age ≥ 75 years, n = 59) and groups. To balance the essential variables including neoadjuvant treatment and stage of progression, we conducted propensity score analysis, and clinical characteristics, perioperative course and prognosis were compared. Results After two-to-one propensity score matching, 100 and 50 patients were classified in the non-elderly and elderly groups. The elderly group had more comorbidities and lower preoperative cholinesterase activities and prognostic nutrition indexes. Although incidences of postoperative pneumonia, arrhythmia and delirium were slightly increased in the elderly group, no significant differences were observed in overall incidence of postoperative complications, rates of repeat surgery and death caused by surgery, and length of postoperative hospital stay between the two groups. There were no significant differences in disease-free and disease-specific survival as well as overall survival between the two groups. Conclusion Older age (≥75 years) had limited impact on morbidity, disease recurrence, and survival after subtotal esophagectomy. Therefore, age should not prevent older patients from benefitting from surgery.

Liver resection in elderly patients over the age of 70 with primary liver cancer: A retrospective analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15647-e15647 ◽  
Author(s):  
Elinor Tan ◽  
Charbel Sandroussi
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Elderly Patients ◽  
Liver Surgery ◽  
Vascular Invasion ◽  
The Elderly ◽  
Elderly Group ◽  
Poor Survival ◽  
Major Complications ◽  
Liver Cancers

e15647 Background: Liver surgery in the elderly remains controversial amidst growing incidence in developed countries. This study compares perioperative outcomes of elderly with non-elderly patients undergoing curative hepatectomy for primary liver malignancies. Methods: 310 patients underwent liver resection for primary tumours between 2000 and 2018. There were 71 elderly (≥70 years) and 239 non-elderly patients ( < 70 years). Survival analyses, stratified according to pathology (Hepatocellular carcinoma (HCC), n = 262 and Cholangiocarcinoma (CC) n = 48), were compared between the elderly and non-elderly group. Multiple regression analyses were performed to evaluate independent predictors of major complications and overall survival. Results: Elderly patients had higher frailty score (modified Frailty Index, mean, 1.14 v 0.51, p < 0.001), more comorbidities (Comorbidities ≥4: 28% v 14%, p = 0.005), had non viral-induced primary liver cancers (Non-Hep B Non-Hep C: 65% v 19%, p < 0.001) with lower AST (p = 0.014) and ALT (p = 0.004) levels. 46% of patients underwent major hepatectomy and were similar between both groups (p = 0.502). The overall complication rate and duration of stay were comparable (p > 0.05). Post-Hepatectomy Liver Failure occurred in 10 (3%) patients with no difference between both groups (p > 0.05). There were 11 (4%) postoperative deaths with higher mortality in the elderly group (8% v 2%, p = 0.011). Multiple logistic regression revealed that MELD ≥11 (OR 2.415, p = 0.480) and a positive surgical margin (OR 2.549, p = 0.024) were independent predictors for major complications. The overall survival (OS) and disease free survival (DFS) for both HCC and CC were similar between elderly and non-elderly group respectively (HCC: 5-yr OS, 62% v 68.5%, p = 0.712; 5-yr DFS, 30.4% v 38.8%, p = 0.323; CC: 5-yr OS, 62.2% v 48.3%, p = 0.919; 5-yr DFS, 43.6% v 28.2%, p = 0.618). Multiple Cox regression revealed that albumin < 40g/L (HR 2.533, p = 0.002) and the presence of vascular invasion (HR 2.417, p = 0.004) were independent predictors of poor survival. Conclusions: Long-term survivals were comparable between the elderly and non-elderly patients following surgical treatment for primary liver cancers. Low albumin and vascular invasion predicted poor survival. Age alone should not be a contraindication to liver surgery. Major complications may be minimised by carefully selecting patient and paying particular attention to the MELD score in elderly patients with primary liver disease. Further prospective studies are required to confirm the findings here.

Efficacy and Safety of Autologus Hematopoietic Cell Transplantation in Elderly Patients with Multiple Myeloma: A Retrospective Israeli Multi-Site Cohort Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3989-3989
Author(s):  
Yael C Cohen ◽  
Tsila Zuckerman ◽  
Moshe Yeshurun ◽  
Galit Perez ◽  
Hila Magen ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Elderly Patients ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Progression Free Survival ◽  
Disease Status ◽  
The Elderly ◽  
Elderly Group ◽  
Free Survival

Abstract Background: High-dose therapy (HDT) with melphalan 200 mg/m2 (MEL200) followed by autologous hematopoietic cell transplantation (HCT) after an induction therapy is considered the standard of care for patients with newly diagnosed multiple myeloma younger than 65 years. Data are limited for patients above the age of 65 years. We aimed to test the feasibility, efficacy and toxicity of HDT/HCT in patients > 65 years. Methods: We included all consecutive patients with multiple myeloma aged 60 and above who underwent an upfront first HCT within 9 months of diagnosis, at 4 Israeli bone marrow transplantation centers. We recorded and compared transplantation-associated toxicity and outcomes between patients >65 years (elderly group) and patients 60-65 years (younger group). Results: 220 patients fulfilling the above inclusion criteria underwent HCT between the years 2000 – 2014. Median age of the younger and the elderly group were 62 (range, 60-65) and 68 (range, 66-75), respectively. There were no differences in patient characteristics between the 2 cohorts except of the status of disease at HCT, Table. As expected, higher percentage of patients in the younger group received melphalan 200 mg/m^2 compared to the older group (77% vs. 57%, p=.002). There were no differences in the median day of neutrophil engraftment, the incidence of documented infections, the percentage of patients with grade 3-4 mucositis and the occurrence of cardiovascular events, between the two groups. Within a median follow up of 18 months, 136 patients are alive. There was no difference in non-relapse mortality at 100 days post HCT (4.7%, vs. 5%, p=.9). There was no difference in the percentage of patients with improvement in disease status after HCT, per the IMWG criteria, between the 2 groups in all patients (36%, vs. 35%, p=.87) and among sub-group of patients who failed to reach VGPR pre-transplant (p=.18). At 3 year post HCT progression-free survival was higher in the younger group, compared to patients in the elderly group (42% vs. 29% , p=.04), however this was no longer true after adjustment for disease status prior to HCT (p=.49). In the elderly group, melphalan 200 mg/m^2 compared to lower doses were not associated with improved progression-free survival (p=.69), Figure. Multivariate analysis identified only lambda chain myeloma and no improvement in disease response after HCT to predict a worse progression-free survival (HR 1.7, p=.045 and HR=2.9, p=.021, respectively), while melphalan doses and the age of patients did not predict progression-free survival. There was no difference in overall survival between the younger and the elderly groups (p=.2). Conclusions: Toxicity profile, response rate, progression-free and overall survival of HCT in elderly patients with myeloma is similar to younger patients. Lower melphalan doses given as a preparative regimen do not hamper efficacy of HCT. Randomized controlled trials are needed to confirm the feasibility and outcomes of HCT in patients older than 65 years. Table Patients’, collection and preparative regimen’s characteristics Datum Young group (N=133) Older group (N=87) P value Age (median, range) years 62 (60-65) 68 (66-75) <.001 Female (%) 47 46 1 ISS 2-3 (%) 54 45 .65 Novel-agents-based induction (%) 86 78 .18 > 1 line prior to HCT 76 70 .41 Status prior to auto >PR (%) 68 54 .08 Collection at steady state (%) 44 35 .32 Pleriixafor (%) 6 6 1 Total collected cells (median, range) CD34/kg 6.85 (1.9-33.6) 6.25 (2.6-20) .06 MEL 200 (%) 77 57 .002 Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Outcomes of Autologous Stem Cell Transplantation (ASCT) in Elderly Multiple Myeloma (MM) Patients Aged ≥ 65 Years: A Multi-Centre Australian Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3441-3441
Author(s):  
Jeremy An Ke Er ◽  
David Routledge ◽  
Jennifer Hempton ◽  
Colin Wood ◽  
Trish Joyce ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Induction Chemotherapy ◽  
Significant Proportion ◽  
Essential Element ◽  
The Elderly ◽  
Elderly Group ◽  
University Hospital ◽  
Novel Agents ◽  
Rank Test ◽  
High Dose

Abstract Background: MM is a disease of the elderly, with a median age at diagnosis of approximately 65-70 years. Induction chemotherapy followed by high-dose melphalan ASCT is considered the standard of care in younger patients (< 65 years). Historically, transplant eligibility has been determined according to age, based on clinical trials of young MM patients and the potential increased toxicity and mortality in the elderly. However, numerous studies have demonstrated the efficacy and safety in elderly MM patients. Here, we present the largest cohort of elderly MM patients aged ≥ 65 years from Australia and their outcomes based on our multi-centre experience. Methods: A retrospective case note audit identified 426 MM patients who underwent a single ASCT at the Peter MacCallum Cancer Centre and University Hospital Geelong, Australia, between 2008 and 2016. Patients were analysed based on age at ASCT and divided into the "elderly group" (aged ≥ 65 years) and the "younger group" (aged < 65 years). Patient characteristics including ISS stage, cytogenetics, pre and post transplant response, and engraftment duration were collected. Response assessment included overall response rate (ORR), transplant-related mortality (TRM), progression-free survival (PFS) and overall survival (OS). The Kaplan-Meier method was used to estimate OS and PFS and compared using the log-rank test. Results: There were 123 patients in the elderly group (median age 67 years; range 65-79,) and 303 the younger group (median age 56 years; range 31-64). Median follow-up time was 74 months. There were no differences in gender and cytogenetic risk status between the 2 groups. The younger group had a higher proportion of ISS stage 3 disease (25% vs 13%, p=0.031), while the elderly group had a higher proportion of ISS stage 1 disease (53% vs 38%, p=0.024). More patients in the younger group received full dose melphalan conditioning (200mg/m2) compared to the elderly group (89% vs 76%) while the elderly group had a higher percentage receiving a reduced dose between <100-180mg/m2 (22% vs 9% younger group). A significant proportion of elderly patients received bortezomib based induction chemotherapy (72% vs 48%, p= <0.001) while the younger cohort had more patients receiving DNA damaging agents (e.g. cyclophosphamide and doxorubicin) likely reflecting the increased availability and tolerability of novel agents in elderly patients. ORR pre (≥PR = 87% vs 88% younger group) and post-ASCT (≥PR = 88% vs 87% younger group) were comparable between the 2 groups. Mean time to neutrophil (11 vs 11 days younger group) and platelet (13 vs 12 days) engraftment were similar and TRM was low (2%) in both groups. The median PFS for the elderly group was 37 months compared to the younger group of 49 months which was statistically significant (p=0.042) while the median OS was not reached in both groups [Figure 1]. Conclusion: The findings of this retrospective study suggest that ASCT is both well tolerated and effective in MM patients aged ≥ 65 years. Therefore despite the increased availability of novel agents, ASCT should still be an essential element of treatment in elderly MM patients who are fit enough for the procedure. Figure 1. Figure 1. Disclosures Routledge: BMS: Honoraria; Celgene: Honoraria. Harrison:Janssen-Cilag: Other: Scientific advisory board.

PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 115-115
Author(s):  
Yusuke Muneoka ◽  
Yasuyuki Kawachi ◽  
Shigeto Makino ◽  
Yu Sato ◽  
Chie Kitami ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Survival Rates ◽  
The Elderly ◽  
Elderly Group ◽  
Transthoracic Esophagectomy ◽  
Long Term Outcomes ◽  
Short And Long Term

Abstract Background Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated. Methods We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups. Results There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively. Conclusion MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease. Disclosure All authors have declared no conflicts of interest.

scholarly journals Clinical Outcome in Elderly Patients on Chronic Peritoneal Dialysis: A Retrospective Study from a Single Center in China

2014 ◽  
Vol 34 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Upendra Joshi ◽  
Qunying Guo ◽  
Chunyan Yi ◽  
Rong Huang ◽  
Zhijian Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Serum Albumin ◽  
Patient Survival ◽  
Survival Rates ◽  
The Elderly ◽  
Elderly Group ◽  
Chronic Peritoneal Dialysis ◽  
Lower Serum ◽  
Technique Survival

ObjectivesWe aimed to evaluate clinical outcomes and identify the predictors of mortality in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodsThis retrospective cohort study included all incident CAPD patients treated at our center from 2006 to 2009. Demographic and clinical data on initiation of CAPD and clinical events during the study period were collected. Survival probabilities were generated using the Kaplan–Meier method, and risk factors for mortality were evaluated using Cox proportional hazards models.ResultsOf 805 patients on CAPD, the elderly group (≥65 years; mean age: 71.3 ± 4.3 years) consisted of 148 patients, and the younger group (<65 years; mean age: 43.1 ± 12.2years) consisted of 657 patients. The 1-, 2-, 3-, and 5-year patient survival rates were 97%, 92%, 88%, and 73% for the younger group, and 79%, 67%, 56%, and 30% for elderly group. The patient survival rates were significantly lower for the elderly group than for the younger group ( p = 0.000). However, technique survival did not significantly differ between the groups ( p = 0.559). In the patients overall, the independent predictors of death were old age ( p = 0.003), diabetes ( p = 0.000), cardiovascular disease ( p = 0.006), lower hemoglobin ( p = 0.010), and lower serum albumin ( p = 0.024). Mortality in the elderly patients was associated with advanced age [relative risk (RR): 1.088; 95% confidence interval (CI): 1.027 to 1.153; p = 0.004], diabetes (RR: 2.064; 95% CI: 1.236 to 3.445; p = 0.006), and lower serum albumin (RR: 0.940; 95% CI: 0.897 to 0.985; p = 0.010).ConclusionsThe elderly patients on CAPD experienced technique survival comparable with that of younger patients, but their patient survival was lower. In elderly patients, mortality was determined predominantly by greater age, diabetes, and lower serum albumin. Our results indicate that chronic peritoneal dialysis is a viable dialysis option for elderly patients with end-stage renal disease. Better management of hypoalbuminemia and comorbid conditions might improve survival in elderly PD patients.

scholarly journals Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

2017 ◽  
Vol 99 (4) ◽  
pp. 325-331 ◽  
Author(s):  
A Tandon ◽  
I Rajendran ◽  
M Aziz ◽  
R Kolamunnage-Dona ◽  
QM Nunes ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Complications ◽  
Univariate Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Elderly Group ◽  
Rank Test ◽  
Log Rank Test ◽  
Number Of Patients ◽  
Significant Difference

BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

scholarly journals Gamma Knife surgery for intracranial chordoma and chondrosarcoma: radiosurgical perspectives and treatment outcomes

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 188-197 ◽  
Author(s):  
Ji Hee Kim ◽  
Hyun Ho Jung ◽  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gamma Knife ◽  
Volume Change ◽  
Tumor Volume ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Rank Test ◽  
Tumor Control ◽  
Free Survival ◽  
Log Rank Test

ObjectIntracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that are reported to be similar in terms of anatomical location, clinical presentation, and radiological findings but different in terms of behavior and outcomes. The purpose of this study was to investigate and compare clinical outcomes after Gamma Knife surgery (GKS) for the treatment of intracranial chordoma and chondrosarcoma.MethodsThe authors conducted a retrospective review of the results of radiosurgical treatment of intracranial chordomas and chondrosarcomas. They enrolled patients who had undergone GKS for intracranial chordoma or chondrosarcoma at the Yonsei Gamma Knife Center, Yonsei University College of Medicine, from October 2000 through June 2007. Analyses included only patients for whom the disease was pathologically diagnosed before GKS and for whom more than 5 years of follow-up data after GKS were available. Rates of progression-free survival and overall survival were analyzed and compared according to tumor pathology. Moreover, the association between tumor control and the margin radiation dose to the tumor was analyzed, and the rate of tumor volume change after GKS was quantified.ResultsA total of 10 patients were enrolled in this study. Of these, 5 patients underwent a total of 8 sessions of GKS for chordoma, and the other 5 patients underwent a total of 7 sessions of GKS for chondrosarcoma. The 2- and 5-year progression-free survival rates for patients in the chordoma group were 70% and 35%, respectively, and rates for patients in the chondrosarcoma group were 100% and 80%, respectively (log-rank test, p = 0.04). The 2- and 5-year overall survival rates after GKS for patients in the chordoma group were 87.5% and 72.9%, respectively, and rates for patients in the chondrosarcoma group were 100% and 100%, respectively (log-rank test, p = 0.03). The mean rates of tumor volume change 2 years after radiosurgery were 79.64% and 39.91% for chordoma and chondrosarcoma, respectively (p = 0.05). No tumor progression was observed when margin doses greater than 16 Gy for chordoma and 14 Gy for chondrosarcoma were prescribed.ConclusionsOutcomes after GKS were more favorable for patients with chondrosarcoma than for those with chordoma. The data also indicated that at 2 years after GKS, the rate of volume change is significantly higher for chordomas than for chondrosarcomas. The authors conclude that radiosurgery with a margin dose of more than 16 Gy for chordomas and more than 14 Gy for chondrosarcomas seems to enhance local tumor control with relatively few complications. Further studies are needed to determine the optimal dose of GKS for patients with intracranial chordoma or chondrosarcoma.

Clinical Characteristics and Outcomes in Patients with t(8;21) Acute Myeloid Leukemia in Japan.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4269-4269
Author(s):  
Hiroto Narimatsu ◽  
Toshiya Yokozawa ◽  
Hiroatsu Iida ◽  
Motohiro Tsuzuki ◽  
Masaya Hayakawa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Myeloid Leukemia ◽  
Clinical Characteristics ◽  
Survival Rates ◽  
Japanese Patients ◽  
Rank Test ◽  
High Dose ◽  
Log Rank Test ◽  
High Dose Cytarabine ◽  
Acute Myeloid

Abstract Clinical characteristics of Japanese patients with t(8;21) acute myeloid leukemia (AML) have not been well described. From January 2000 to December 2005, a total of 147 Japanese adult de novo AML (FAB: M2) patients were newly diagnosed with t(8;21) AML (n=46) or without t(8;21) AML (n=101) in collaborating hospitals. Patients with t(8;21) (median age, 49.5 years; range, 18–86 years) were significantly younger than AML(M2) patients without t(8;21) (median age, 60 years; range 17–90 years) (p<0.001). Three-year overall survival rate in patients with t(8;21) was 70% (95% confidence interval (CI), 51–83%), significantly better than that in AML (M2) patients without t(8;21) (log-rank test, p=0.005) (Figure). Among patients <60-years-old, overall survival rates of patients with t(8;21) AML and patients with non-t(8;21) AML(M2) were 71% (95%CI, 47–86%) and 58% (95%CI, 41–72%), respectively (log-rank test, p=0.28). Of the 40 patients who achieved complete remission, 21 patients received high-dose cytarabine-containing consolidation therapy. Event-free survival rates at 3 years after diagnosis in patients with and without high-dose cytarabine were 60% (95%CI, 36–78%) and 57% (95%CI, 26–79%), respectively (log-rank, p=0.87). In multivariate analysis, age and white blood cell count at diagnosis represented significant predictors of overall survival. For the 147 AML(M2) patients, presence of t(8;21) was not a significant predictor of overall survival after adjusting for age (hazard ratio, 0.65; 95%CI, 0.34–1.24; p=0.19). Japanese patients with t(8;21) AML display more favorable survival rates than those in Western countries. Efficacy of high-dose cytarabine might differ between Japanese and Western patients. Clinicians must be aware of potential differences among different ethnicities. Figure Figure

Hepatitis C Treatment Differences in Elderly Patients: Single-Center Retrospective Study

2019 ◽  
Vol 54 (2) ◽  
pp. 113-121 ◽  
Author(s):  
Kamran Qureshi ◽  
Tess Petersen ◽  
Jennifer Andres
Keyword(s):  
Hepatitis C ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Binary Logistic Regression ◽  
The Elderly ◽  
Elderly Group ◽  
Success Rates ◽  
Elderly Age ◽  
Cirrhotic Patients ◽  
Direct Acting

Background: Clinical studies evaluating direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment show sustained virological response at 12 weeks (SVR12) rates >90%. However, there are few elderly patients included in these studies; thus, generalizability of high success rates to patients >70 years old cannot be assumed. Objective: To identify treatment differences between elderly and nonelderly patients. Methods: This is a retrospective cohort study of all patients who were treated with DAAs between June 2014 and September 2016 at our institution. Patients were divided into 2 groups: elderly, age ≥70 years at the time of initiation of DAAs, and nonelderly, <70 years. The primary outcome was achievement of SVR12. Results: Among the 551 patients, 60 with age range 70 to 86 years comprised the elderly group. SVR12 rates were significantly lower in the elderly population, especially in those with liver cirrhosis. SVR12 was achieved in 81% of the elderly group as compared with 95% in the nonelderly group. Among cirrhotic patients, 69.4% in the elderly group, and 94.1% in the nonelderly group achieved SVR12. Binary logistic regression modeling showed age >70 years to be the strongest predictor of treatment failure (odds ratio = 3.4), along with diagnosis of cirrhosis (odds ratio = 2.4), when corrected for gender, race, prior treatment experience, genotype, and presence of hepatocellular carcinoma. Conclusion and Relevance: Lower SVR12 was seen in elderly cirrhotic patients (69.4%), who are at higher risk of complications related to advanced liver disease and untreated HCV infection, highlighting the need to treat patients before cirrhosis develops.

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