scholarly journals A Retrospective Analysis of the Palliative Surgical Treatment in Patients with Malignant Pleural Effusion

2021 ◽  
Vol 21 (1) ◽  
pp. 13-20
Author(s):  
G Krajnakova ◽  
A Dzian ◽  
M Skalicanova ◽  
L Hamada ◽  
M Malik ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Median Survival ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
University Hospital ◽  
Talc Pleurodesis ◽  
Term Survival ◽  
Advanced Malignancy ◽  
Surgical Interventions

Abstract Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea. Material and Methods: Clinical data from patients who were hospitalized at the Clinic of Thoracic Surgery, JFMED CU and Martin University Hospital, in the years 2015–2019 were retrospectively explored and statistically analyzed based on their medical records. Results: From the group of patients with proven MPE (n=67), 32 patients were male (48%) and 35 were female (52%). The mean age was 62.3 years (65.4 for males and 59.4 for females). The three most common primary malignancies were lung cancer (n=24), breast cancer (n=14), and kidney cancer (n=6). In 38 patients with MPE a talc pleurodesis via VATS was performed, with a median survival of 341 days (95% CI 256–859). Drainage following the talc slurry pleurodesis was performed in 10 patients with a median survival of 91.5 days (95% CI 64-NA). Ten patients with MPE underwent drainage only. The overall median survival time after all types of surgical interventions was 301 days (95% CI 207-389 days). Conclusion: Management of MPE depends on the patient´s prognosis. A definitive intervention is required in patients with a long-term survival, while in patients with a short life expectancy procedures leading to the shortest hospital stay are preferred. Videothoracoscopic procedures with pleurodesis represent an effective treatment for patients with symptomatic MPE with a good performance status, presence of lung re-expansion following pleural drainage or expected survival.

Prognostic factors in metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9051-9051
Author(s):  
D. R. Minor ◽  
M. Kashani-Sabet ◽  
D. Moore ◽  
C. Kim ◽  
S. S. Venna ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Metastatic Melanoma ◽  
Median Survival ◽  
Performance Status ◽  
Intensive Therapy ◽  
Stage Iv ◽  
Treatment Center ◽  
Term Survival ◽  
Melanoma Patients

9051 Background: Patients with stage IV metastatic melanoma are usually felt to be incurable with a median survival of 6.4 months and a 5-year survival of only 2%. Biochemotherapy has shown promise with long-term survival in selected patients. We felt the study of prognostic factors would determine which patients might benefit the most from this intensive therapy. Methods: 135 consecutive patients with stage IV melanoma treated with decrescendo biochemotherapy followed by maintenance immunotherapy at one melanoma treatment center were studied to determine the most important prognostic factors; these factors were then validated by analysis of 133 patients treated in a multi-center trial at other institutions. Patients were treated using the inpatient regimen of O'Day (JCO23:710s,2005 abstract). Results: Median overall survival (OS) was 16.6 months with 1-year survival of 70% and 5-year survival of 28%. Median progression-free survival (PFS) was 7.6 months with 15% progression-free at 5 years. PFS curves showed no relapses after 30 months, so remissions were durable. For OS performance status 0, normal LDH, stage M1a, and non-visceral sites of metastases were favorable prognostic factors. For PFS performance status 0, normal LDH, female sex, age <50 and stage M1a were favorable prognostic factors Multivariate analysis demonstrated two important prognostic factors for survival: normal serum LDH and the presence of either skin or nodes as one of the sites of metastatic disease. The group with normal LDH and skin or node metastases had a relatively good prognosis with median survival of 44 months and a 5-year survival of 38%. Conversely patients with elevated LDH without any skin or nodal metastases had a poor prognosis, with no long-term survivors. Conclusions: Metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy that have either a normal LDH or skin or nodes as one of their metastatic sites may have durable remissions of their disease, and this therapy should be studied further in these groups. [Table: see text]

Risk of Thromboembolic Disease and Hemorrhage in Patients with Multiform Glioblastoma

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Iris DLR ◽  
◽  
Sánchez JP ◽  
Keyword(s):  
Survival Analysis ◽  
Predictive Model ◽  
Performance Status ◽  
Cerebral Haemorrhage ◽  
University Hospital ◽  
Term Survival ◽  
Risk Patients ◽  
The Moment ◽  
Prophylactic Anticoagulation

Introduction: Glioblastoma Multiforme (GBM) is the most frequent malignant brain tumor, with an aggressive course and a short life expectancy despite standard treatment (chemotherapy and radiotherapy). The possibility of the development of Thrombotic Events (VTE) with this type of cancer is frequent. We designed this study to determine the risk of presenting VTE and hemorrhagic events in patients affected by GBM. Methods: Observational retrospective study of patients with GBM diagnosis at the General University Hospital of Ciudad Real between 2012 and 2015. The demographic characteristics of patients were studied, predictive models were compared, and a survival analysis was performed. Results: 77 patients were studied, 42 (55.3%)/34 (44.7%), men and women respectively, with an average age of 66.42 years. 13 (16.9%) presented VTE; of which 10 (61.54%) in the form of Deep Venous Thrombosis (DVT), 3 (23.08%) Pulmonary Embolism (PE) and 2 (15.38%) mixed events. The quality of life according to the performance status ECOG scale at the moment of diagnosis was 1 in 42 (15.38%) patients, and at the time of VTE, 5 (41.7%) had a value of 2, and 4 (33.3.3 %) registered 3. In the group that developed VTE according to the predictive model of risk for thrombosis in Khorana 5 (38.5%) had low risk and 8 (61.5%) intermediate; on the ASCO 2013 modified scale 5 (38.5%) had an Intermediate risk and 8 (61.5%) high. With a median, 1 year follow-up, 64 (84.2%) patients died, with an average time after the diagnosis of 279.09 days (216.6-341.6) (SE 31,8). 2 (2.6%) of the patients presented a greater haemorrhagic event and 7 (7.9%) cerebral haemorrhage, of which 4 (44.4%) had prophylactic Low Molecular Weight Heparins (LMWHs). In the survival analysis of Kaplan Meyer, patients who received prophylactic treatment with LMWHs had a higher survival rate with an average of 298.5 days compared to 239.3 of those who did not (p >0.05). There were no significant variables in the multivariate analysis for thrombotic or haemorrhagic events. Conclusion and Discussion: The demographic and clinical characteristics of our patients were similar to those reported in other international publications. The predictive scale of Khorana was not validated in our study, in contrast, the modified ASCO 2013 scale was closer to our results. The creation of a precise predictive model would help to delineate the benefit of prophylactic anticoagulation in high-risk patients. Long-term prophylaxis with LMWHs has demonstrated a reduction of thrombotic events without significantly increasing the fatal haemorrhagic episodes, also demonstrating greater long-term survival, independent of thrombotic events. Randomized prospective studies are needed to demonstrate its benefits.

scholarly journals P1-145: Predictors of “long term" survival following surgical treatment of malignant pleural effusion

2007 ◽  
Vol 2 (8) ◽  
pp. S608-S609
Author(s):  
John Pilling ◽  
Michael Dusmet ◽  
George Ladas ◽  
Peter Goldstraw
Keyword(s):  
Surgical Treatment ◽  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Etiology and prognostic evaluation of malignant pleural effusion

2020 ◽  
Vol 7 (4) ◽  
pp. 1405
Author(s):  
Sadhana Ramesh ◽  
Basanta Hazarika ◽  
Jogesh Sarma ◽  
Rahul Karwa
Keyword(s):  
High Risk ◽  
Pleural Effusion ◽  
Survival Time ◽  
Pleural Fluid ◽  
Median Survival ◽  
Median Survival Time ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Medical Problem

Background: Malignant pleural effusion is a common medical problem in patients with cancer. The survival of patients with malignant pleural effusion is generally poor. The objectives of our study were to reveal possible prognostic factors of malignant pleural effusion.Methods: Fifty-three consecutive patients, 34 male and 19 female patients of malignant pleural effusion diagnosed by pleural fluid positive for malignant cytology and/or pleural tissue positive for malignancy by thoracoscopy biopsy. Performance status by the Eastern Cooperative Oncology Group (ECOG) score and LENT score was calculated at the time of diagnosis. Median survival time was calculated using Kaplan-Meier analysis curve. Survival time was defined as the time from diagnosis to death or the last follow-up.Results: Most common cause of malignant pleural effusion was lung carcinoma 46 (86.79%). Adenocarcinoma was the most common 31 (58.5%) followed by NSCLC 10 (18.0%). Low, moderate and high-risk LENT score was found in 3 (5.7%), 35 (66%) and 15 (28.3%) respectively.  The median survival time of pleural fluid sugar less than 20 were 3 months. The median survival time of LENT low, medium and high risk was 12 months, 5.2 months and 2.5 months respectively. The median survival time of patients with ECOG score of 1 and 4 was 6.5 months and 1 month respectively. Patients with bilateral pleural fluid had a mean survival time of 2 months.Conclusions: Adenocarcinoma lung is the most common etiology of malignant pleural effusion. The median overall survival time was 4 months. Higher ECOG score and LENT score are associated with shorter survival time.

Long-term follow-up of patients with low-grade malignant lymphomas treated with doxorubicin-based chemotherapy or chemoimmunotherapy.

1993 ◽  
Vol 11 (4) ◽  
pp. 644-651 ◽  
Author(s):  
B W Dana ◽  
S Dahlberg ◽  
B N Nathwani ◽  
E Chase ◽  
C Coltman ◽  
...  
Keyword(s):  
Median Survival ◽  
Survival Data ◽  
Survival Curve ◽  
Performance Status ◽  
Survival Duration ◽  
Low Grade ◽  
Term Survival ◽  
Symptom Status

PURPOSE We reviewed survival data of patients with low-grade lymphoma entered on Southwest Oncology Group (SWOG) lymphoma trials in 1972 to 1983 to determine the utility of doxorubicin-containing therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]) in such patients. PATIENTS AND METHODS We identified all patients with low-grade lymphoma, no prior therapy, and stage III or IV disease who were treated with full-dose CHOP induction therapy on any arm of SWOG studies 7204, 7426, or 7713. Survival data for this group of patients were correlated with pretreatment prognostic factors, including histology, patient age, sex, symptom status, performance status, bone marrow or extranodal involvement, and the number of disease sites. The effect of maintenance treatment was also assessed. RESULTS Four hundred fifteen patients met criteria for inclusion in the study group. With median follow-up periods of 12.8 years (maximum, 19.8 years), the median survival duration was 6.9 years. Survival was significantly shorter in patients with follicular mixed or small lymphocytic histology, age greater than 40 years, male sex, B-symptom status, and SWOG performance status greater than 1. Multivariate regression analysis showed histology, age, and sex to be independent predictors of survival. There was no definite survival plateau of cured patients in any subgroup, although the survival curve for follicular mixed histology patients showed long-term survival of approximately 25%. Maintenance therapy did not prolong survival. CONCLUSION Doxorubicin-containing treatment did not prolong the overall median survival of low-grade lymphoma patients compared with results with less-aggressive programs.

scholarly journals Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

2021 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Maged Hassan ◽  
Elinor Harriss ◽  
Rachel M. Mercer ◽  
Najib M. Rahman
Keyword(s):  
Systematic Review ◽  
Pleural Effusion ◽  
Survival Benefit ◽  
Malignant Pleural Effusion ◽  
Risk Of Bias ◽  
Common Condition ◽  
Survival Difference ◽  
Range Difference ◽  
Simple Drainage

Abstract Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5–5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing pleurodesis are required to ascertain this effect.

scholarly journals Technique of pressurized intrathoracic aerosol chemotherapy (PITAC) for malignant pleural effusion

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Gabrielle Drevet ◽  
Jean-Michel Maury ◽  
Naoual Bakrin ◽  
François Tronc
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Vital Signs ◽  
Bronchial Tube ◽  
Intrathoracic Pressure ◽  
Intercostal Space ◽  
Novel Therapy ◽  
Apical Position ◽  
Surgical Smoke

AbstractObjectivesMalignant pleural effusion (MPE) is a devastating evolution of several malignancies. Pressurized intrathoracic aerosol chemotherapy (PITAC) might be a novel therapy option in MPE.MethodsPITAC is considered for patients with MPE with a performance status <2 and without other metastatic sites. General anesthesia is administered and a double-lumen bronchial tube is inserted. The patient is placed in a lateral decubitus position, and the operation is performed after ipsilateral lung exclusion. Two 12-mm balloon trocars are inserted—one in the seventh intercostal space in the mid-axillary line and one in the fifth intercostal space in the anterior axillary line. Extent of pleural disease and volume of MPE are documented. MPE is removed and parietal pleural biopsy are performed. An intrathoracic pressure of 12 mmHg CO2 is established, and a combination of Cisplatin (10.5 mg/m2 in a total volume of 150 cc NaCl 0.9%) and Doxorubicin (2.1 mg/m2 in a total volume of 50 cc NaCl 0.9%) are aerosolized via nebulizer in the pleural cavity. Vital signs and nebulization are remote-controlled. After 30 min, the remaining toxic aerosol is exhausted using a closed surgical smoke evacuation system. A 24Fr chest tube is inserted in postero-apical position with continuous negative pressure of 20 cm H2O. When needed, PITAC may be repeated every six weeks in alternate with systemic chemotherapy.ResultsIn our hands, the technique above has shown to be feasible and safe.ConclusionsFurther studies are needed to assess the potential symptomatic and oncological benefits of PITAC in MPE.

EXTH-13. LOCAL DELIVERY OF AN IL-15 SUPERAGONIST USING A REPLICATING RETROVIRUS SIGNIFICANTLY IMPROVES SURVIVAL AND LYMPHOCYTE INFILTRATION IN POORLY IMMUNOGENIC MURINE GLIOBLASTOMA MODELS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi166-vi166
Author(s):  
Alexander Haddad ◽  
Jordan Spatz ◽  
Megan Montoya ◽  
Sara Collins ◽  
Sabraj Gill ◽  
...  
Keyword(s):  
T Cell ◽  
Median Survival ◽  
T Cell Activation ◽  
Term Survival ◽  
Long Term Survival ◽  
Immunosuppressive Cell ◽  
Imaging Results ◽  
Local Immunosuppression ◽  
Inflammatory Changes

Abstract Glioblastoma (GBM) leads to severe systemic and local immunosuppression, and immunotherapies have had limited clinical success. Here, we evaluated the treatment efficacy of RLI, a superagonist of T-cell activator IL-15, delivered to tumor cells using a tumor-selective retroviral replicating vector (RRV) in the syngeneic murine SB28 and Tu2449 GBM models, which are both engineered to be poorly immunogenic with low-mutational burden and known resistance to immunotherapy, and hence more accurate biomimetic models of human GBM. RRV-RLI replicated and spread effectively in cultured murine GBM cells with robust production of functional RLI (165.4 ± 5.3 ng/mL). Stereotactic injection of RRV-RLI into pre-established intracerebral SB28 tumors significantly reduced tumor growth on bioluminescent imaging, and increased median survival compared to control mice (55 vs. 19 days, p=0.002), leading to long-term survival in 12% of treated mice. In the Tu2449 model, imaging results showed complete eradication of intracerebral tumors after RRV-RLI treatment, with long-term survival (median not reached) in &gt; 85% of treated mice, compared to a median survival of 12.5 days in control mice (p=0.001). RRV-RLI treated tumors showed significantly increased CD8 T-cell infiltration, without altering immunosuppressive cell populations. Similarly, broad anti-tumor inflammatory changes, including increased expression of genes involved in T-cell activation and killing, were observed in the NanoString nCounter platform using a 770-gene panel representing various immune cell types. Notably, RLI was not detected in the blood of treated mice, and tumor-localized RRV-RLI gene delivery showed no adverse systemic immune effects in either model. In summary, RRV-mediated RLI immunotherapy results in immunostimulatory and pro-inflammatory changes to the tumor microenvironment and achieves a significant survival benefit in two poorly immunogenic syngeneic murine models of GBM. This tumor-localized immunomodulatory gene therapy has the potential to safely reverse the T-cell depleted immunophenotype of GBM.

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