scholarly journals Intraspinal mesenchymal chondrosarcoma: An argument for aggressive local resection and adjuvant therapy based on review of the literature

2020 ◽  
Vol 11 ◽  
pp. 95
Author(s):  
Sricharan Gopakumar ◽  
William J. Steele ◽  
Matthew Muir ◽  
Zain Bhogani ◽  
Gavin Britz
Keyword(s):  
Adjuvant Therapy ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Axial Skeleton ◽  
Local Resection ◽  
Mesenchymal Chondrosarcoma ◽  
Review Of The Literature ◽  
Free Survival ◽  
Intradural Extramedullary ◽  
Mesenchymal Chondrosarcomas

Background: Mesenchymal chondrosarcoma is a rare cartilaginous neoplasm that typically involves the axial skeleton. Despite a well-circumscribed appearance, this tumor has a tendency to recur both locally and with distant metastases. Case Description: A 17-year-old patient presented with numbness and paresthesias in the lower extremities attributed to a T10-T11 intradural extramedullary mesenchymal chondrosarcoma. The patient was treated with aggressive local resection and adjuvant therapy. Here, this case and present literature are appropriately reviewed. Conclusion: Although uncommon, intraspinal mesenchymal chondrosarcomas warrant both radical local resection and aggressive adjuvant therapy with chemoradiation to provide the greatest chance of progression-free survival.

A clinical comparison between dedifferentiated low-grade osteosarcoma and conventional osteosarcoma

2019 ◽  
Vol 101-B (6) ◽  
pp. 745-752 ◽  
Author(s):  
S. Toki ◽  
E. Kobayashi ◽  
A. Yoshida ◽  
K. Ogura ◽  
S. Wakai ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Poor Response ◽  
Distant Metastases ◽  
Histological Evaluation ◽  
Low Grade ◽  
Cyclin Dependent Kinase ◽  
Free Survival ◽  
Standard Chemotherapy Regimen ◽  
Conventional Osteosarcoma ◽  
High Grade Osteosarcoma

Aims The purpose of this study was to clarify the clinical behaviour, prognosis, and optimum treatment of dedifferentiated low-grade osteosarcoma (DLOS) diagnosed based on molecular pathology. Patients and Methods We retrospectively reviewed 13 DLOS patients (six men, seven women; median age 32 years (interquartile range (IQR) 27 to 38)) diagnosed using the following criteria: the histological coexistence of low-grade and high-grade osteosarcoma components in the lesion, and positive immunohistochemistry of mouse double minute 2 homolog (MDM2) and cyclin-dependent kinase 4 (CDK4) associated with MDM2 amplification. These patients were then compared with 51 age-matched consecutive conventional osteosarcoma (COS) patients (33 men, 18 women; median age 25 years (IQR 20 to 38)) regarding their clinicopathological features. Results The five-year overall survival (OAS) rates in the DLOS and COS patients were 85.7% and 77.1% (p = 0.728), respectively, and the five-year progression-free survival (PFS) rates were 57.7% and 44.9% (p = 0.368), respectively. A total of 12 DLOS patients received chemotherapy largely according to regimens for COS. Among the nine cases with a histological evaluation after chemotherapy, eight showed a poor response, and seven of these had a necrosis rate of < 50%. One DLOS patient developed local recurrence and five developed distant metastases. Conclusion Based on our study of 13 DLOS cases that were strictly defined by histological and molecular means, DLOS showed a poorer response to a standard chemotherapy regimen than COS, while the clinical outcomes were not markedly different. Cite this article: Bone Joint J 2019;101-B:745–752.

scholarly journals SURG-29. LASER INTERSTITIAL THERMAL THERAPY COMPARED TO CRANIOTOMY FOR TREATMENT OF RECURRENT GLIOBLASTOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi245-vi245
Author(s):  
Ali Palejwala ◽  
Kyle O’connor ◽  
Chad Glenn ◽  
Michael Sughrue
Keyword(s):  
Overall Survival ◽  
Adjuvant Therapy ◽  
Perioperative Complications ◽  
Progression Free Survival ◽  
Senior Author ◽  
Thermal Therapy ◽  
Free Survival ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference ◽  
Recurrent Gbm

Abstract There have been publications that propose the use of laser interstitial thermal therapy (LITT) as a viable alternative to craniotomy for the treatment of glioblastoma (GBM). The aim of this study was to retrospectively compare outcomes after LITT versus craniotomy for patients with recurrent GBM. To adequately match the cohorts, we included only pre-treatment tumor volumes of under 15 cc. We retrospectively collected data on all patients presenting with recurrent GBM, with a recurrence volume under 15 cc. These patients were either treated with LITT or craniotomy by the senior author. Data included demographics, tumor location and volume, tumor markers, perioperative complications, re-initiation of adjuvant chemotherapy, and long-term follow up data. We performed 23 LITT treatments and 34 craniotomies for recurrent GBM in patients that met selection criteria. There was no significant difference in the patients’ age, tumor volume (6.38 for craniotomy versus 5.765 cc for LITT), location, and post-procedure KPS. Patients that underwent LITT had significantly reduced inpatient stays in comparison to craniotomy (1.7 versus 4.2 days). They also had less perioperative complications (13.0% versus 32.3% for craniotomy). It was found that 28 out of the 34 patients that underwent craniotomy were able to undergo adjuvant therapy; in comparison, 15 out of the 23 patients who underwent LITT had undergone adjuvant therapy. Of these patient’s that underwent adjuvant therapy, 87% of patients were able to receive bevacizumab or a clinical trial versus 42% after craniotomy. Progression-free survival (PFS) and overall survival (OS) after procedure were similar for LITT versus craniotomy, respectively: % PFS-survival at 6 months = 23.5% versus 21.7%. Overall survival did not significantly differ at 9 months versus 9.9 months respectively. LITT appears to be safe and may be as efficacious as craniotomy in achieving progression free survival for small to moderate volume recurrent GBM.

Postoperative concurrent radiochemotherapy versus radiotherapy in high-risk SCCA of the head and neck: Results of the German phase III trial ARO 96–3

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5507-5507 ◽  
Author(s):  
R. Fietkau ◽  
C. Lautenschläger ◽  
R. Sauer ◽  
J. Dunst ◽  
A. Becker ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Phase Iii ◽  
Phase Iii Trial ◽  
Free Survival ◽  
Tumor Bed ◽  
Grade 3

5507 Background: Despite resection and postoperative irradiation high-risk (3 or more involved lymph nodes, extra-capsular disease and/or microscopically involved mucosal margins of resection) squamous cell carcinomas (SCCAs) of the head and neck frequently recur in the tumor bed. Postoperatively radiochemotherapy (RCT) with cis-Platin (CDDP)/5-FU versus radiotherapy (RT) alone was compared in a randomized trial. Methods: Between 5/97 and 12/04, 440 patients who had high-risk SCCAs of the head and neck were enrolled in this prospectively randomized phase III trial. Following resection and neck dissection, 214 patients were randomly assigned to RT (66 Gy/33 Fx/6.6 weeks) and 226 patients to identical RT plus CDDP (20 mg/m2 on day 1–5, 29–33) and 5-FU (600 mg/m2 on day 1–5, 29–33). Results: The 5 year local-regional control rate is 72.2 ± 3.7% following RT and 88.6 ± 2.4% for the RCT group (p = 0.00259; 5-year progression free survival 50.1 ± 4.0% and 62.4 ± 4.4% (p = 0.024) and 5-year overall survival 48.6 ± 4.4% vs. 58.1 ± 4.6% (p = 0.11). There was no difference in the 5 year incidence of distant metastases (19.3 ± 3.6% vs 25.5 ± 4.6%; p = 0.45). The incidence of grade 3+ acute toxicity was higher during RCT: mucositis 12.6% vs. 20.8% (p = 0.04), leucopenia 0% vs. 4.4% (p = 0.007). Conclusions: Acute toxicity is increased to an acceptable level by RCT. Postoperative RCT compared to RT improves locoregional control and progression free survival; thus survival as a trend is improved by 10% after 5 years. Supported by Deutsche Krebshilfe 70–2140. No significant financial relationships to disclose.

A phase II trial of pazopanib in relapsed/refractory small cell lung cancer (SCLC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7099-7099 ◽  
Author(s):  
Leena Gandhi ◽  
Rebecca Suk Heist ◽  
Joan Vern Lucca ◽  
Jennifer S. Temel ◽  
Panos Fidias ◽  
...  
Keyword(s):  
Phase Ii ◽  
Single Agent ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Competitive Inhibitor ◽  
Initial Therapy ◽  
Therapeutic Benefit ◽  
Free Survival ◽  
Median Progression Free Survival ◽  
Grade 3

7099 Background: Despite response to initial therapy, SCLC has high rates of relapse or distant metastasis and limited 2nd-line therapeutic options. Angiogenesis is an essential part of cell invasion, dissemination, and outgrowth of distant metastases and therefore is a potential therapeutic target in SCLC. Pazopanib (Votrient, GSK) is a potent, competitive inhibitor of the tyrosine kinase activity of VEGFR-1, VEGFR-2, VEGFR-3, PDGF, and c-kit. We initiated a phase II single-arm trial of pazopanib in relapsed or refractory SCLC to determine impact on disease progression. Methods: Patients were eligible if they had progressive disease following up to two lines of prior therapy. Patients were treated at the FDA-approved dose of 800 mg pazopanib once daily. The primary endpoint was progression-free rate (PFR) at 8 weeks. Secondary endpoints included median progression-free survival, overall survival, and safety. The trial followed a Simon 2-stage design to limit accrual if no therapeutic benefit was observed. Results: To date, 27 of 30 planned subjects have been enrolled since October 2010. Two did not complete cycle 1 and were considered inevaluable for response. Major toxicities (mostly grade 1/2) were those previously described including nausea, fatigue, hypertension, electrolyte abnormalities, and AST/ALT elevations (grade 3 in 4 subjects). Three subjects were removed from study due to toxicity: 1 with grade 3 nausea, 1 with grade 3 drop in the cardiac ejection fraction, and 1 with multiple grade 2 toxicities including diarrhea, fatigue, and nausea. A fourth was removed due to grade 1 hemoptysis despite clinical response. The PFR at 8 weeks of 21 subjects evaluable for response to date was 52%; 4 of these 11 subjects had chemo-refractory disease. There were no confirmed responses, but tumor regressions ranged from 2-20%. Median progression-free survival is 14.1 weeks. Conclusions: In patients with SCLC, single-agent pazopanib demonstrated a notable rate of stable disease (including among chemo-refractory patients) and a median PFS that exceeds that of historical PFS rates of < 2 months on ineffective 2nd-line therapies. These data suggest that the potential for pazopanib in SCLC treatment should be further investigated.

SPARTAN, a phase 3 double-blind, randomized study of apalutamide (APA) versus placebo (PBO) in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Eric Jay Small ◽  
Fred Saad ◽  
Simon Chowdhury ◽  
Boris A. Hadaschik ◽  
Julie Nicole Graff ◽  
...  
Keyword(s):  
Distant Metastasis ◽  
Randomized Study ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Abiraterone Acetate ◽  
Castration Resistant Prostate Cancer ◽  
Double Blind ◽  
End Points ◽  
Free Survival

161 Background: Pts with nmCRPC are at risk for developing metastatic disease and cancer-specific mortality. There are no approved treatments for nmCRPC. APA is an orally administered next-generation androgen receptor inhibitor with antitumor activity in CRPC. SPARTAN evaluated the effects of APA on metastasis-free survival (MFS) in men with nmCRPC. Methods: Pts with nmCRPC and prostate-specific antigen doubling time (PSADT) of ≤ 10 mos were randomized 2:1 to APA (240 mg QD) or PBO. The primary end point was MFS, defined as the time from randomization to first radiographic distant metastasis (per blinded central review) or death. Secondary end points included time to metastasis (TTM), progression-free survival (PFS), time to symptomatic progression (SymProg), and overall survival (OS). Pts were eligible to receive study-provided abiraterone acetate plus prednisone after developing distant metastases. Second progression-free survival (PFS2, the time from randomization to disease progression or death after first treatment for metastatic CRPC) was also evaluated. Results: 1207 pts were randomized. Baseline PSADT was < 5 mos in both groups. APA decreased the risk of distant metastasis or death by 72% (HR = 0.28; 95% CI, 0.23-0.35; p < 0.0001), with a median MFS of 40.5 vs 16.2 mos in the PBO group. Secondary end points (TTM, PFS, and SymProg) were all significantly improved. At an interim analysis for OS, there was a trend favoring APA. At a median follow-up of 20.3 mos, 61% of APA and 30% of PBO pts were still on treatment. Rates of discontinuation due to adverse events were low in both groups (10.7% APA, 6.3% PBO). Mean baseline health-related quality of life scores were maintained with treatment, with no difference between groups over time. Of those whose disease progressed, 80% of PBO and 56% of APA pts received therapy for metastatic CRPC. PFS2 was significantly longer for APA vs PBO. Conclusions: APA significantly improved median MFS by 2 years in men with nmCRPC. APA also significantly increased TTM, PFS, SymProg, and PFS2. APA was associated with improved OS. These results support the addition of APA to androgen deprivation therapy in men with nmCRPC. Clinical trial information: NCT01946204.

Present-day management of uterine leiomyosarcoma: Evaluation of treatment sequencing and other prognostic factors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18035-e18035
Author(s):  
Emily Hinchcliff ◽  
Jennifer Rumpf ◽  
Ravin Ratan ◽  
Nicole D. Fleming ◽  
Amir A. Jazaeri ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Early Stage ◽  
Gynecologic Oncology ◽  
Progression Free Survival ◽  
Molecular Testing ◽  
Common Mutation ◽  
Uterine Leiomyosarcoma ◽  
Free Survival ◽  
Er Positive ◽  
Grade 3

e18035 Background: Uterine leiomyosarcoma (ULMS) is a rare tumor with limited therapeutic options and no clearly established best treatment sequence strategy. Methods: Women with ULMS between 2013-2018 were identified. Clinical data was collected; descriptive statistics were performed and predictors of overall survival (OS) and progression free survival (PFS) were analyzed. Results: 189 patients were included. Median age was 53 (20-84), 91% had grade 3 tumors and 51.3% had stage IB disease. 50% underwent surgery followed by chemotherapy (n = 94, 49.7%) and 37% had surgery only (n = 70). 49 patients retained their ovaries; there was no difference in OS by oophorectomy status (p = 0.71). Estrogen and progesterone receptor (ER/PR) status, positive in 41% and 33% respectively, was not independently associated with OS (p = 0.23, p = 0.12) nor did it impact OS among those with oophorectomy and without (p = 0.70). The most common adjuvant therapy regimens were gemcitabine/docetaxel (gem/doce, 64%) or ifosphamide/doxorubicin (ifos/doxo, 19%). There were no differences in the regimens prescribed by physician specialty (gynecologic oncology vs other, p = 0.21). 147 patients (78%) experienced a recurrence or progression. For the 73 patients who received gem/doce as adjuvant therapy, 58.9% recurred and were most commonly treated with doxo containing regimens (67%). Of the 22 patients treated with ifos/doxo, only 3 recurred and each received a different second line regimen. For those not treated with adjuvant therapy (70 patients), 58.2% recurred and were treated with gem/doce (62%) and ifos/doxo (24%). In early stage patients, the majority received surgery only (45%) or surgery followed by chemotherapy (44%). There was no difference in OS in those who received adjuvant therapy and those who did not (p = 0.39). 46 (24%) had molecular testing and 37 had identified mutations. The most common mutation found was P53 (n = 25, 54%) followed by RB1 (8, 17%), PTEN (7, 15%), and BRCA (2, 4%). Conclusions: Recurrence occurred in 78% of patient despite many women undergoing adjuvant therapy after surgery. Oophorectomy did not influence OS, even though 41% of tumors were ER positive. The sequence of treatment was not associated with OS, however, the risk for recurrence in patient treated with adjuvant Ifos/Doxo was 14% compared to 59% in gem/doce. This finding warrants additional evaluation to determine the optimal adjuvant therapy for these women.

scholarly journals Pathologic and Treatment Outcomes Among a Geriatric Population of Endometrial Cancer Patients: An NRG Oncology/Gynecologic Oncology Group Ancillary Data Analysis of LAP2

2017 ◽  
Vol 27 (4) ◽  
pp. 730-737 ◽  
Author(s):  
Erin A. Bishop ◽  
James J. Java ◽  
Kathleen N. Moore ◽  
Joan L. Walker
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Gynecologic Oncology ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Gynecologic Oncology Group ◽  
Free Survival ◽  
Early Stage Endometrial Cancer

ObjectivesElderly endometrial cancer patients have worse disease-specific survival than their younger counterparts, but the cause for this discrepancy is unknown. The goal of this analysis is to compare outcomes by age in a fully staged elderly endometrial cancer population.Methods/MaterialsThis is an analysis of patients on Gynecologic Oncology Group Study (GOG) LAP2, which included clinically early stage endometrial cancer patients randomized to laparotomy versus laparoscopy for surgical staging. Patients were divided into risk groups based on criteria defined by GOG protocol 99. Differences in outcomes and adjuvant therapy were assessed within these risk groups.ResultsLAP2 included 715 patients 70 years or older. With increasing age, worse tumor characteristics were seen. Older patients received similar rates of adjuvant therapy when stratified by stage. Patients 70 years or older had significantly worse progression-free survival and overall survival, and on multivariate analysis, older age and high-risk uterine factors were predictors of progression-free survival and overall survival, whereas stage and lymph node metastases were not. When patients were divided into GOG protocol 99 risk categories, most of those who met the high-intermediate risk criteria did so based on age above 70 years and grade 2 to 3 disease. These patients had low risk of recurrence (3.3%) compared with those who met the criteria by age above 70 years and all 3 uterine factors (20.9%).ConclusionsIn early stage endometrial cancer, patients 70 years or older who undergo similar surgical management and adjuvant therapy, age and tumor characteristics independently predict recurrence. Most patients older than 70 years meet the high-intermediate risk criteria for recurrence based on age and 1 other uterine risk factor, and our results suggest that these patients are at low risk for recurrence.

scholarly journals Prognostic value of intraductal carcinoma for adjuvant radiotherapy candidates after radical prostatectomy

2020 ◽  
Author(s):  
Sedat Karakoc ◽  
Serdar Çelik ◽  
Nilhan Akbulut ◽  
Ozan Bozkurt ◽  
Hulya Ellidokuz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Radical Prostatectomy ◽  
Adjuvant Therapy ◽  
Biochemical Recurrence ◽  
Progression Free Survival ◽  
Surgical Margins ◽  
Intraductal Carcinoma ◽  
Free Survival ◽  
Group 2 ◽  
Group 1

ABSTRACT Objective: We aimed to investigate the prognostic significance of intraductal carcinoma in radical prostatectomy (RP) specimens and predictive value of IDC-P for biochemical recurrence and adjuvant therapy decision. Method: Patients who underwent RP between 2000-2014 with final pathological stage pT3a and negative surgical margins (Group 1, n=35) and pT2 with positive surgical margins (Group 2, n=32) were included. RP specimens were re-evaluated for the presence of IDC-P component and other prognostic factors. In both groups, prognostic factors were compared according to the presence of IDC-P and biochemical recurrence status. Results: In group 1, IDC-P was detected in 5 cases and biochemical recurrence was detected in 3 cases. Patients with IDC-P showed significantly higher biochemical recurrence than those without IDC-P (p=0.002). In univariate analysis, IDC-P was found to be significantly associated with worse progression free survival (p<0.001). In group 2, IDC-P was detected in 4 cases and biochemical recurrence was detected in 10 cases. Also, tumor volume was significantly higher in patients with IDC-P than those without IDC-P (p=0.02). IDC-P was also significantly associated with worse progression free survival in group 2 (p=0.033). Conclusions: In both groups, IDC-P is a prognostic factor for progression free survival and / or biochemical recurrence. Especially in these patients, presence of IDC-P might be helpful for postoperative adjuvant therapy management decision. Keywords: radical prostatectomy, intraductal carcinoma of prostate (IDC-P), prostate cancer, biochemical recurrence, progression free survival.

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