scholarly journals Response to Trans-arterial Radioembolization Therapy for Liver Cancer According to Voxel-Based Dosimetry: A Retrospective Study

2020 ◽  
Author(s):  
Min Young Yoo ◽  
Jin Chul Paeng ◽  
Hyo-Cheol Kim ◽  
Min Sun Lee ◽  
Jae Sung Lee ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Local Control ◽  
Tumor Size ◽  
Transaminase Level ◽  
Absorbed Dose ◽  
Post Treatment ◽  
Independent Predictive Factor ◽  
Large Tumor ◽  
Simple Method ◽  
Cutoff Value

Abstract BackgroundUsual clinical dosimetry models for trans-arterial radioembolization (TARE) is based on assumption of uniform dose distribution in each tissue compartment. We performed a simple voxel-based dosimetry using post-treatment yttrium-90 (90Y) microsphere PET in TARE and investigated the prognostic value of dosimetry parameters from the voxel-based dosimetry.MethodTwenty-eight patients with hepatocellular carcinoma who underwent TARE using 90Y-microsphere were retrospectively included. Mean absorbed dose of each lesion (TDv) was analyzed using voxel-based dose maps derived from posttreatment 90Y-microsphere PET and voxel-wise S-value kernels. Heterogeneity of intra-tumoral absorbed dose was investigated using standard deviation and coefficient of variation of voxel doses in a tumor. The response of each lesion was classified as local control success (LCS) and local control failure (LCF) based on follow-up MRI or CT. Prognostic values of dosimetry parameters and clinicopathologic factors were evaluated using survival analysis for progression-free survival. ResultsFourteen lesions from 10 patients were analyzed. The LCS and LCF groups showed significant differences in TDv and intra-tumoral absorbed dose heterogeneity, but not in the tumor size. Univariate survival analysis identified high serum aspartate transaminase level (> 40 IU/L), large tumor size (> 66 mm), and low TDv (< 81 Gy) as significant prognostic factors. However, on multivariate analysis, only low TDv was identified as an independent predictive factor (P = 0.022; HR, 21.018; 95% CI: 1.549–258.204), with a cutoff value of 80–120 Gy. Spearman’s correlation analysis also showed a significant correlation between TDv and PFS (P = 0.009, r = 0.669). ConclusionsIn TARE using 90Y-microspheres, voxel-wise absorbed dose can be easily estimated on post-treatment 90Y PET using a simple method. The TDv calculated by the voxel-based dosimetry is an effective prognostic factor for PFS with a cutoff value of 80–120 Gy.

scholarly journals Indications of Lymph Node Metastasis and Survival Analysis in T1N+M0 Gastric Cancer: a Population-Based Study

2020 ◽  
Author(s):  
Peng Jin ◽  
Yang Li ◽  
Shuai Ma ◽  
Wenzhe Kang ◽  
Hao Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Survival Analysis ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Multivariate Analyses ◽  
Invasion Depth ◽  
Node Metastasis ◽  
Definition Of

Abstract Background Since the definition of early gastric cancer (EGC) was first proposed in 1971, the treatment of gastric cancer with or without lymph node metastasis (LNM) has changed a lot. The present study aims to identify risk factors for LNM and prognosis, and to further evaluate the indications for adjuvant chemotherapy (AC) in T1N + M0 gastric cancer. Methods A total of 1291 patients with T1N + M0 gastric cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to identify risk factors for LNM. The effect of LNM on overall survival (OS) and cancer-specific survival (CSS) was compared with patients grouped into T1N0-1 and T1N2-3, as the indications for AC. Results The rate of LNM was 19.52%. Multivariate analyses showed age, tumor size, invasion depth, and type of differentiation and retrieved LNs were associated with LNM (p < 0.05). Cox multivariate analyses indicated age, sex, tumor size, N stage were independent predictors of OS and CSS (p < 0.05), while race was indicator for OS (HR 0.866; 95%CI 0.750–0.999, p = 0.049), but not for CSS (HR 0.878; 95% CI 0.723–1.065, p = 0.187). In addition, survival analysis showed the proportion of patients in N+/N0 was better distributed than N0-1/N2-3b. There were statistically significant differences in OS and CSS between patients with and without chemotherapy in pT1N1M0 patients (p༜0.05). Conclusions Both tumor size and invasion depth are associated with LNM and prognosis. LNM is an important predictor of prognosis. pT1N + M0 may be appropriate candidates for AC. Currently, the treatment and prognosis of T1N0M0/T1N + M0 are completely different. An updated definition of EGC, taking into tumor size, invasion depth and LNM, may be more appropriate in an era of precision medicine.

The Implication of Lymph Node Metastasis on Survival in Patients with Well-Differentiated Thyroid Cancer

2005 ◽  
Vol 71 (9) ◽  
pp. 731-734 ◽  
Author(s):  
Yale D. Podnos ◽  
David Smith ◽  
Lawrence D. Wagman ◽  
Joshua D.I. Ellenhorn
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Large Scale ◽  
Differentiated Thyroid Cancer ◽  
Lymph Node Status ◽  
Large Tumor ◽  
Node Metastasis ◽  
Well Differentiated

Though survival for well-differentiated thyroid cancer is very good, specific populations suffer greater recurrence and mortality. Defining these cohorts can significantly influence prognosis and extent of treatment. This study, using a large, multi-institutional database, seeks to determine how the presence of lymph node disease in patients with well-differentiated thyroid cancer affects outcome. The Surveillance, Epidemiology, and End Results (SEER) database is a large-scale sample of 14 per cent of the U.S. population. It was used to identify patients with papillary and follicular thyroid carcinomas and identify the prognostic implications of lymph node metastasis. Additional factors, including presence of metastasis, age, and tumor size, were compared using multivariate and χ2 analyses. Of 19,918 patients identified, lymph node status was known for 9,904 (49.7%). On multivariate analysis, age >45 years, presence of distant metastasis, large tumor size, and lymph node involvement significantly predicted poor outcome. Overall survival at 14 years was 82 per cent for node negative and 79 per cent for node positive patients ( P < 0.05). This study shows that the survival of patients with well-differentiated thyroid cancer is adversely affected by lymph node metastases. The optimum treatment for this cohort needs further delineation, as particular populations are at greater risk of recurrence and death.

Intraocular retinoblastoma group V: an analysis of prognostic factors.

1985 ◽  
Vol 3 (5) ◽  
pp. 680-685 ◽  
Author(s):  
C M Rubin ◽  
L L Robison ◽  
J D Cameron ◽  
W G Woods ◽  
M E Nesbit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Optic Nerve ◽  
Life Table ◽  
Tumor Size ◽  
Large Tumor ◽  
Group V ◽  
Large Tumor Size ◽  
Poor Risk ◽  
Undifferentiated Histology

A retrospective analysis of the University of Minnesota (Minneapolis) experience with retinoblastoma is presented. Seventy-five patients were diagnosed with retinoblastoma between 1958 and 1983, of which 53 (71%) had at least one Reese-Ellsworth group V eye. Nineteen group V patients and one group II patient developed extraocular disease recurrence. The cumulative actuarial rate of recurrence at 12 years was 36% for patients with group V disease. The median time from diagnosis to recurrence for unilateral patients was seven months and for bilateral patients 28 months (P = .001). Patients developing extraocular disease had a 10-year actuarial survival rate postrecurrence of 34%. The four long-term survivors of extraocular recurrences had had isolated orbital or local soft tissue recurrences only. Features of group V patients associated with extraocular recurrences were identified by univariate life table analyses. Clinical poor-risk factors included the nongenetic form of the disease (P = .03) and male sex (P = .02). Pathologic poor risk factors included rubeosis (P = .01), undifferentiated histology (P = .03), large tumor size (P = .05), and intraocular extension to the anterior segment (P = .02), retinal pigment epithelium (P = .03), choroid (P less than .001), and optic nerve beyond the lamina cribrosa (P = .02). Treatment-associated poor-risk factors included an optic nerve length of less than 5 mm removed at enucleation (P = .003). Multivariate life table analyses demonstrated the following parameters to be independent poor-prognostic factors: optic nerve length of less than 5 mm removed at enucleation (P = .001), optic nerve involvement (P = .004), and large tumor size (P = .01). These results will help to identify patients with retinoblastoma who are at greatest risk for extraocular recurrence.

Evaluation of local control in patients with non-metastatic Ewing sarcoma of the bone: A report from the Children's Oncology Group

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10013-10013
Author(s):  
S. G. DuBois ◽  
M. D. Krailo ◽  
E. F. Cook ◽  
N. J. Tarbell ◽  
C. J. Fryer ◽  
...  
Keyword(s):  
Disease Progression ◽  
Local Control ◽  
Ewing Sarcoma ◽  
Tumor Size ◽  
Cumulative Incidence ◽  
Hazard Ratio ◽  
Local Failure ◽  
Control Mode ◽  
Distant Failure ◽  
Risk Of Disease

10013 Background: Options for local control in patients (pts) with Ewing sarcoma (EWS) include surgery (S), radiation (R), or surgery plus radiation (S+R). The choice of local control depends on factors that also impact outcome in EWS, including tumor site, tumor size, and age. Our objective was to determine if risk of disease progression differs between local control methods, after controlling for potential confounders. Methods: We analyzed the cohort of pts with non-metastatic EWS of the bone treated on Intergroup Study-0091 (Grier et al, NEJM, 2003). Local control decisions were made on an individual basis. We excluded pts with tumors of the skull/face, progression prior to end of local control, or incomplete local control data. Disease progression was recorded from end of local control. Cumulative incidence of disease progression was determined using a competing risks approach. We constructed a Cox proportional hazards model of progression free survival incorporating local control mode and potential confounders into the model. Secondary analyses evaluated overall survival, local failure, and distant failure. Results: 329 pts met eligibility criteria for analysis. 122 pts received S, 142 received R, and 65 received S+R. The cumulative incidence of disease progression at 5 years was 22.1% (95% CI 15.1–29.9%) for S, 36.9% (29.0–44.9%) for R, and 48.1% (35.5- 59.7%) for S+R. Using R as the reference group and controlling for age, tumor size, tumor location, and chemotherapy regimen, the hazard ratio for progression was 0.66 (95% CI 0.38–1.13) for S and 1.55 (0.96–2.49) for S+R. The hazard ratio for death was 0.77 (95% CI 0.44–1.34) for S and 1.46 (0.88–2.42) for S+R. The hazard ratio for local failure was 0.38 (95% CI 0.15–0.98; p=0.04) for S and 0.77 (0.34–1.75) for S+R. The hazard ratio for distant failure was 0.78 (0.42–1.46) for S and 1.60 (0.91–2.82) for S+R. Conclusions: Observed differences in outcome between local control groups are largely due to confounding factors that affect outcome and local control choice. Risk of disease progression, distant failure, or death does not differ between pts who receive S or R. Pts who receive S have a decreased risk of local failure compared to pts who receive R. No significant financial relationships to disclose.

Bevacizumab (Bev) to reduce the negative impact of glioblastoma (GBM) tumor size on survival from first recurrence.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2052-2052
Author(s):  
Huy Tram N. Nguyen ◽  
Liang Yen Liu ◽  
Nhung T Nguyen ◽  
Daniel Lenchner ◽  
Laura Dovek ◽  
...  
Keyword(s):  
Tumor Size ◽  
Negative Impact ◽  
Performance Status ◽  
High Rate ◽  
Control Group ◽  
Kaiser Permanente ◽  
Large Tumor ◽  
Kaplan Meier ◽  
First Recurrence ◽  
2D And 3D

2052 Background: Bev was FDA approved for recurrent GBM in 2009. However, the survival benefit from Bev in GBM remains to be demonstrated. Methods: We retrospectively identified 168 primary GBM patients diagnosed between 2001-2015 at UCLA and Kaiser Permanente LA, who received upfront radio-chemotherapy, followed with Bev and/or Lomustine (CCNU) at 1st recurrence. We measured tumor size at 1st recurrent treatment initiation, using bi-dimensional (2D) and volumetric (3D) techniques. We analyzed overall survival (OS) from 1st recurrence by Kaplan-Meier analysis. Results: Three groups of patients diagnosed from 2009-2015 were identified: patients treated with Bev alone (n = 49), CCNU alone (n = 36), and concurrent Bev/CCNU (n = 53). Patients were statistically different in performance status at 1st recurrence and tumor size; the CCNU alone group had smaller tumor sizes at diagnosis compared to the Bev groups. The CCNU group showed substantially greater survival (median OS (mOS) = 14.1 mo) compared to the Bev and Bev/CCNU groups (mOS = 6.9 and 7.1 mo, respectively), which may be explained by the imbalance in tumor sizes among the groups, and high rate of crossover (69%) to Bev in subsequent recurrences. To minimize selection bias, we identified another control group (n = 30) diagnosed from 2001-2004 who received CCNU only (CCNU 01-04). These patients had tumor size and KPS more comparable to both Bev groups, and a low rate of crossover (7%). OS for CCNU 01-04 (mOS = 5.7 mo) was similar to the Bev groups. Across all patients, we observed poor OS associated with larger 2D size vs. those with small tumors (mOS = 6.7 vs. 8.8 mo; p = 0.003). In separate stratification of each treatment group by tumor size, this association was retained in the CCNU 01-04 group (mOS = 4.0 vs. 8.4 mo, p < 0.001), but not in either Bev (mOS = 6.7 vs. 7.3 mo) or BEV/CCNU (mOS = 7.0 vs. 8.8 mo). Analysis of effect of tumor size by 3D measurement yielded similar results. Conclusions: Bev appears to reduce the negative impact of large tumor size on GBM patient survival from 1st recurrence. 2D and 3D measurements were correlated, suggesting the adequacy of use of conventional tumor bi-dimensional measurement to predict benefit of Bev in patients based on tumor size.

Quantitative PET-MRI for early treatment response assessment in pancreatic ductal adenocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 520-520
Author(s):  
Martin Valera Consunji ◽  
Spencer Behr ◽  
Andrew H. Ko ◽  
Margaret A. Tempero ◽  
Pelin Cinar ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Treatment Response ◽  
Early Treatment ◽  
Tumor Size ◽  
Treatment Initiation ◽  
Post Treatment ◽  
Ductal Adenocarcinoma ◽  
Imaging Biomarkers ◽  
Early Assessment ◽  
Early Treatment Response

520 Background: There is an unmet need for improved non-invasive markers to assess early treatment response in pancreatic ductal adenocarcinoma (PDAC). Assessing early treatment response using tumor size on anatomic imaging or serum carbohydrate antigen 19-9 (CA19-9) level is unreliable. In contrast, metabolic and functional imaging is a promising new tool that may differentiate responders from non-responders early on during therapy. Therefore, the objective of this pilot study was to explore the potential of integrated positron emission tomography-magnetic resonance imaging (PET-MRI) to provide imaging biomarkers of early (4 weeks post treatment initiation) response in patients with advanced PDAC. Methods: 13 patients with biopsy-proven locally advanced or metastatic PDAC underwent integrated 18F-fluorodeoxyglucose PET-MRI through the abdomen prior to, and again at 4 weeks post, treatment initiation. Patients also had computed tomography (CT) imaging of the chest, abdomen, and pelvis and serum CA19-9 levels measured, as per standard of care. Patients were classified as responders or non-responders according to RECIST (Response Evaluation Criteria In Solid Tumors) on delayed CT, at 8-12 weeks interval post treatment initiation. Changes in metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from PET, and apparent diffusion coefficient (ADC) from diffusion-weighted MRI at 4 weeks were compared between responders and non-responders. Results: Of the 13 patients, there were 7 responders (partial response by RECIST) and 6 non-responders (progressive or stable disease by RECIST). After 4 weeks of therapy, responders had a significantly greater decrease in MTV (p = 0.003) and TLG (p = 0.006) compared to non-responders. Responders also had a significantly greater increase in mean and minimum ADC (p = 0.004 and p = 0.024, respectively) compared to non-responders. Change in tumor size at 4 weeks was not significantly different between responders and non-responders (p = 0.11). Conclusions: Integrated PET-MRI can provide early assessment of treatment response in patients with advanced PDAC.

Impact of Large Tumor Size on Survival After Resection of Pathologically Node Negative (pN0) Non–Small Cell Lung Cancer

2005 ◽  
Vol 79 (4) ◽  
pp. 1142-1146 ◽  
Author(s):  
Shin-ichi Takeda ◽  
Shimao Fukai ◽  
Hikotaro Komatsu ◽  
Etsuo Nemoto ◽  
Kenji Nakamura ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Tumor Size ◽  
Small Cell ◽  
Small Cell Lung ◽  
Large Tumor ◽  
Node Negative ◽  
Large Tumor Size

scholarly journals Tumor Size-Dependent Anticancer Efficacy of Chlorin Derivatives for Photodynamic Therapy

2018 ◽  
Author(s):  
Ji-Eun Chang ◽  
Yang Liu ◽  
Woo Kyoung Lee ◽  
Il Yoon ◽  
Kwhanmien Kim
Keyword(s):  
Photodynamic Therapy ◽  
Tumor Size ◽  
Tumor Volume ◽  
Irradiation Time ◽  
Tunel Staining ◽  
Large Tumor ◽  
Anticancer Efficacy ◽  
Anticancer Treatment

Photodynamic therapy (PDT) with a suitable photosensitizer molecule is a promising anticancer treatment. We evaluated two chlorin molecules as potential photosensitizers, methyl pyropheophorbide a (MPPa) and N-methoxyl purpurinimide (NMPi), against A549 human lung adenocarcinoma cells in vitro as well as in A549 tumor-bearing mice in vivo. Cell viability, microscopy, and FACS analyses were performed for the in vitro studies. MPPa and NMPi showed high phototoxicity in vitro, which was dependent on the concentration of the photosensitizers as well as the light irradiation time. In the animal study, tumor volume change, tumor surface alterations, and H&amp;E and TUNEL staining analyses were performed and compared between small (tumor volume of &lt;50 mm3) and large (tumor volume of &gt;50 mm3) size of initial tumors. MPPa and NMPi showed high anticancer efficacy against small-size tumors, indicating that early treatment with PDT is effective. Especially, repeated two times PDT with NMPi allowed almost complete eradication against small-size tumors. However, MPPa and NMPi were not effective against large-size tumors. In conclusion, the two chlorin derivatives, MPPa and NMPi, show good anticancer efficacy as promising photosensitizers for PDT in vitro and in vivo. Moreover, their activity in vivo was significantly dependent on the initial tumor size in mice, which confirms the importance of early cancer treatment.

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