Efficacy of Whole-Ventricular Radiotherapy in Patients Undergoing Maximal Tumor Resection for Glioblastomas Involving the Ventricle

Background and PurposePatients with glioblastoma (GBM) involving the ventricles are at high risk of ventricle opening during surgery and potential ventricular tumor spread. We evaluated the effectiveness of whole-ventricular radiotherapy (WVRT) in reducing intraventricular seeding in patients with GBM and identified patients who could benefit from this approach.Methods and MaterialsWe retrospectively reviewed the data of 382 patients with GBM who underwent surgical resection and temozolomide-based chemoradiotherapy. Propensity score matching was performed to compensate for imbalances in characteristics between patients who did [WVRT (+); n=59] and did not [WVRT (–); n=323] receive WVRT. Local, outfield, intraventricular, and leptomeningeal failure rates were compared.ResultsAll patients in the WVRT (+) group had tumor ventricular involvement and ventricle opening during surgery. In the matched cohort, the WVRT (+) group exhibited a significantly lower 2-year intraventricular failure rate than the WVRT (–) group (2.1% vs. 11.8%; P=0.045), with no difference in other outcomes. Recursive partitioning analysis stratified the patients in the WVRT (–) group at higher intraventricular failure risk (2-year survival, 14.2%) due to tumor ventricular involvement, MGMT unmethylation, and ventricle opening. WVRT reduced the intraventricular failure rate only in high-risk patients (0% vs. 14.2%; P=0.054) or those with MGMT-unmethylated GBM in the matched cohort (0% vs. 17.3%; P=0.036).ConclusionsWVRT reduced the intraventricular failure rate in patients with tumor ventricular involvement and ventricle opening during surgery. The MGMT-methylation status may further stratify patients who could benefit from WVRT. Further prospective evaluation of WVRT in GBM is warranted.

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Readiness Assessment for Extubation Planning in the Intensive Care Unit: A Quality Improvement Initiative

Critical Care Nurse ◽

10.4037/ccn2021912 ◽

2021 ◽

Vol 41 (3) ◽

pp. 42-48

Author(s):

Jace D. Johnny

Keyword(s):

High Risk ◽

Failure Rate ◽

Noninvasive Ventilation ◽

Extubation Failure ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Prophylactic Measure ◽

High Risk Patients ◽

Risk Patients

Background Extubation failure is the reintubation of patients meeting criteria for weaning from mechanical ventilation. Extubation failure is correlated with mortality, prolonged mechanical ventilation, and longer hospital stays. Noninvasive ventilation or high-flow nasal cannula oxygen therapy after extubation is recommended to prevent extubation failure in high-risk patients. Local Problem The extubation failure rate is unknown. Prophylactic measures (noninvasive ventilation or high-flow nasal cannula) after extubation are not commonly used and vary among clinicians. The objective was to assess extubation planning readiness by determining extubation failure rate, identifying high-risk patients, and determining prophylactic measure compliance. Methods A quality improvement initiative included an evidence-based extubation failure risk assessment that identified high-risk patients and determined prophylactic measure compliance. A 2-year retrospective medical record review was used to determine baseline patient characteristics and extubation failure rate. Results Extubation failure rate within the retrospective cohort was 13 of 146 patients (8.9%). Extubation failure did not correlate with previously identified risk factors; however, 150 identified patients were excluded from analysis. During risk assessment integration, the extubation failure rate was 3 of 37 patients (8.1%) despite identifying 24 high-risk patients (65%). Few high-risk patients received prophylactic measures (noninvasive ventilation, 17%; high-flow nasal cannula, 12%). Conclusions Extubation failure should be routinely measured because of its effects on patient outcomes. This project reveals the multifactorial nature of extubation failure. Further research is needed to assess patients’ risk and account for acute conditions. This project used best practice guidelines for routine patient care and added transparency to a previously unmeasured event.

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Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.4.6 ◽

2004 ◽

Vol 17 (4) ◽

pp. 1-6 ◽

Cited By ~ 54

Author(s):

Michael K. Rosner ◽

Timothy R. Kuklo ◽

Rabih Tawk ◽

Ross Moquin ◽

Stephen L. Ondra

Keyword(s):

Pilot Study ◽

High Risk ◽

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Matched Cohort ◽

Filter Placement ◽

High Risk Patients ◽

Ivc Filters ◽

Risk Patients

Object The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. Methods In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. Conclusions In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.

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Hormone replacement therapy (HRT) and risk of distant recurrence in newly diagnosed ER+, node-negative (N-) breast-cancer (BC) patients: A retrospective population-based matched-cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6591 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6591-6591

Author(s):

Ariel Hammerman ◽

Ilan Feldhamer ◽

Sari Greenberg-Dotan ◽

Nicky Liebermann ◽

Rinat Yerushalmi

Keyword(s):

Breast Cancer ◽

High Risk ◽

Distant Recurrence ◽

Rank Test ◽

Matched Cohort ◽

Newly Diagnosed ◽

Chi Square ◽

Log Rank Test ◽

Chi Square Test ◽

Risk Patients

6591 Background: Observational studies have shown an increased risk of BC with use of HRT. However, data on the prognosis of BC that develop in HRT users are inconsistent. The association between HRT use and results of the 21-gene Recurrence Score (RS) assay (Oncotype DX, Genomic Health Inc.) has not been investigated. We aimed to analyze this association, and examine the actual rate of distant recurrence or death in this population. Methods: Clalit Health Services (CHS) is the largest health maintenance organization (HMO) in Israel. We identified all CHS newly diagnosed ER+, N- breast-cancer patients, aged 45-60 that performed a RS assay between 01/2006-12/2012 and that were treated for at least three months with HRT during the eight years before BC diagnosis. A 1:4 matched-cohort analysis was performed, with matching made according to age and year of BC diagnosis. Clinical and demographic data were extracted from the CHS centralized registry for all patients. RS assay scores was grouped according to the TAILORX categorization and distribution was compared using Chi-square test. Kaplan-Meier analysis with log-rank test was performed in order to compare time to a combined outcome of distant-recurrence and mortality. Results: A cohort of 259 HRT-treated patients was identified and matched with 1001 controls, not treated with HRT. The proportions of low-risk patients (RS 0-25) and high-risk patients (RS 26-100) were 76.8% and 23.2%, respectively, within HRT-treated patients, and 80.4% and 19.6% within controls. Chi square test was not found significant (χ2= 1.634, p = 0.201). The mean follow-up time was 148.4 months for the cases and 146.9 months for controls, with log-rank test not showing a significant difference between groups. Conclusions: These data did not show significant association between HRT use and higher RS assay scores, and also did not find an association between HRT use and actual distant recurrence or death. Although the proportion of patients with high risk RS appeared to be slightly higher within HRT treated patients, this difference had not reached significance and further studies are required.

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High Failure Rate of Modular Exchange With a Specific Design of a Constrained Liner in High-Risk Patients Undergoing Revision Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.02.021 ◽

2016 ◽

Vol 31 (9) ◽

pp. 1963-1969 ◽

Cited By ~ 24

Author(s):

Brian P. Chalmers ◽

Diren Arsoy ◽

Rafael J. Sierra ◽

David G. Lewallen ◽

Robert T. Trousdale

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Failure Rate ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

High Failure Rate ◽

Specific Design ◽

Total Hip ◽

Risk Patients ◽

Constrained Liner

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The Combined Masseter Muscle/Intraoral Cheek Transposition (IOCT) Flap for Primary Reconstruction of the Dorsal Oral Cavity

Otolaryngology ◽

10.1177/019459989210600402 ◽

1992 ◽

Vol 106 (4) ◽

pp. 326-331 ◽

Cited By ~ 2

Author(s):

Joachim Zöller ◽

Heinz Maier ◽

Achim Herrmann

Keyword(s):

High Risk ◽

Oral Cavity ◽

Masseter Muscle ◽

Operating Time ◽

Tumor Resection ◽

Muscle Flap ◽

Reconstruction Method ◽

Primary Reconstruction ◽

Functional Reconstruction ◽

Risk Patients

A method for primary reconstruction of the dorsal oral cavity after tumor resection of T2 or small T3 tumors is presented. By combination of the masseter muscle flap with a cranial pedicled intraoral cheek transposition (IOCT) flap, a reconstruction of the defects with two layers of tissue is possible. This easy and functional reconstruction method is especially useful for high-risk patients because of the markedly reduced operating time.

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Evaluation of global and intragenic hypomethylation in colorectal adenomas improves patient stratification and colorectal cancer risk prediction

Clinical Epigenetics ◽

10.1186/s13148-021-01135-0 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Carla Debernardi ◽

Laura Libera ◽

Enrico Berrino ◽

Nora Sahnane ◽

Anna Maria Chiaravalli ◽

...

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Cancer Risk ◽

Risk Prediction ◽

Methylation Status ◽

Low Risk ◽

Colorectal Adenomas ◽

Dna Hypomethylation ◽

High Risk Patients ◽

Risk Patients

Abstract Background Aberrant DNA hypomethylation of the long interspersed nuclear elements (LINE-1 or L1) has been recognized as an early event of colorectal transformation. Simultaneous genetic and epigenetic analysis of colorectal adenomas may be an effective and rapid strategy to identify key biological features leading to accelerated colorectal tumorigenesis. In particular, global and/or intragenic LINE-1 hypomethylation of adenomas may represent a helpful tool for improving colorectal cancer (CRC) risk stratification of patients after surgical removal of polyps. To verify this hypothesis, we analyzed a cohort of 102 adenomas derived from 40 high-risk patients (who developed CRC in a post-polypectomy of at least one year) and 43 low-risk patients (who did not develop CRC in a post-polypectomy of at least 5 years) for their main pathological features, the presence of hotspot variants in driver oncogenes (KRAS, NRAS, BRAF and PIK3CA), global (LINE-1) and intragenic (L1-MET) methylation status. Results In addition to a significantly higher adenoma size and an older patients’ age, adenomas from high-risk patients were more hypomethylated than those from low-risk patients for both global and intragenic LINE-1 assays. DNA hypomethylation, measured by pyrosequencing, was independent from other parameters, including the presence of oncogenic hotspot variants detected by mass spectrometry. Combining LINE-1 and L1-MET analyses and profiling the samples according to the presence of at least one hypomethylated assay improved the discrimination between high and low risk lesions (p = 0.005). Remarkably, adenomas with at least one hypomethylated assay identified the patients with a significantly (p < 0.001) higher risk of developing CRC. Multivariable analysis and logistic regression evaluated by the ROC curves proved that methylation status was an independent variable improving cancer risk prediction (p = 0.02). Conclusions LINE-1 and L1-MET hypomethylation in colorectal adenomas are associated with a higher risk of developing CRC. DNA global and intragenic hypomethylation are independent markers that could be used in combination to successfully improve the stratification of patients who enter a colonoscopy surveillance program. Graphic abstract

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Lymphocyte Count on Day 56 Predicts for Reduced Risk of Infection Related Mortality Following Non-Myeloablative Allogeneic Haematopoietic Stem Cell Transplantation.

Blood ◽

10.1182/blood.v108.11.5324.5324 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5324-5324

Author(s):

Caroline Alvares ◽

Samar Kulkarni ◽

Pawel Kaczmarek ◽

Radovan Saso ◽

Helena Woods ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Lymphocyte Count ◽

Recursive Partitioning ◽

Surrogate Marker ◽

Haematopoietic Stem Cell ◽

Gvhd Prophylaxis ◽

Single Antigen ◽

Risk Patients

Abstract In vivo T-cell depletion using Alemtuzumab containing conditioning regimens are commonly employed in high risk patients undergoing non-myeloablative allogeneic transplants (NMT). The effect of lymphocyte count on mortality due to infection following NMT has not been previously reported. We examined lymphocyte counts as a surrogate marker of immune reconstitution following NMT. Between August 2000 and August 2006, 70 patients (M:48, F: 22, median age:49, range: 17–63) underwent NMTs for haematological malignancies [ALL, n=6; AML, n=24; CML, n=2; HD, n=5; NHL, n=16 and MM, n=17]. Donors were matched siblings in 25 patients and 45 received matched unrelated transplants. All patients received standard induction and consolidation therapy and 39 patients had previously received autologous transplant (31 had 1 procedure and 8 had 2 procedures). Three patients received NMT as a part of tandem transplantation. Fifty two transplants were from HLA identical donors, 16 received single antigen class I mismatched grafts and 2 patients received single antigen class II mismatched transplants. Thirty two patients (32/70, 46%) and 51 donors (51/70, 73%) were CMV sero-negative. Conditioning therapy was Alemtuzumab based in 48 patients (69%), low dose TBI in 14 cases (20%) and 8 patients (11%) received other combinations. All patients received cyclosporine with or without mycophenolate as GVHD prophylaxis. At the time of transplantation 19 patients were in CR1 (27%), 26 were in subsequent CR (37%), 14 had partial remission (20%) and 11 had active disease (16%). Overall 73% patients had high risk disease. With a median follow-up of 10 months (range: 0–46), the probability of overall survival (OS) at 2 yr. was 24% (95% CI: 10.8–36.8, median OS: 10 months). Forty-three patients died and death was attributed to infection in 23/43 (54%), progressive disease in 14/43 (32%), GVHD in 5/43(12%) and secondary cancer in 1/43 (2%). Twenty-seven patients relapsed (38.6%) and the probability of relapse at 2yr. was (37%, 95% CI: 18–56). The median lymphocyte count on day 28 (L28) post transplant was significantly lower with use of Alemtuzumab (0.1 vs. 0.6, p<0.001) but this effect was not seen on the day 56 lymphocyte count (0.2 vs. 0.5, p=0.8). Recursive partitioning of L28 and L56 identified L56 count of 0.4×109/L to have a significant impact on OS. Patients with L56 >0.4 (n=26) had a significantly better survival (median OS: 15 vs. 8 months, p=0.033). This survival advantage was related to reduction in infectious deaths. There was no effect on mortality due to relapse or GVHD. The incidence of CMV reactivation within the first 100 days was independent of L56 (39% vs. 36%, p=0.7). In conclusion, this study shows that lymphocyte count >0.4 on day 56 post-NMT is associated with better overall survival due to reduction in infection related deaths. This finding warrants further investigation in a larger cohort of patients.

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MBCL-48. OUTCOMES OF TREATMENT BASED ON THE ST. JUDE MEDULLOBLASTOMA-96 REGIMEN FOR JAPANESE CHILDREN WITH MEDULLOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.518 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii398-iii398

Author(s):

Junya Fujimura ◽

Tomonari Suzuki ◽

Yuko Watanabe ◽

Hidetaka Niizuma ◽

Ryuta Saito ◽

...

Keyword(s):

High Risk ◽

Medical Center ◽

Therapeutic Option ◽

Tumor Resection ◽

University Hospital ◽

High Dose ◽

High Risk Patients ◽

Pediatric Medulloblastoma ◽

Risk Patients ◽

Standard Risk

Abstract Medulloblastoma is a type of malignant embryonal tumor in childhood that is considered to require multiagent chemotherapy followed by radical resection and craniospinal irradiation (CSI). However, the outcomes of chemotherapy for this tumor in Japan are unclear. Here, we performed a multicenter retrospective study to determine the prognosis of pediatric medulloblastoma patients in Japan treated with the St. Jude medulloblastoma-96 (SJMB96) regimen. Thirty patients with newly diagnosed medulloblastoma received treatment with the SJMB96 regimen at Juntendo University Hospital in Tokyo (n=10), Saitama Medical University International Medical Center in Saitama (n=10), and Tohoku University Hospital in Miyagi (n=10) from 2011 to 2018. All patients underwent tumor resection and CSI, with radiation doses of 23.4Gy for standard-risk patients (n=11) and 39.6Gy for high-risk patients (n=19). Six weeks after radiation therapy, patients received four cycles of high-dose chemotherapy with autologous peripheral blood stem cell transplantation according to the SJMB96 regimen. We found that 5-year overall survival was 80.8% among standard-risk patients and 74.2% among high-risk patients. No treatment-related deaths occurred. Eight patients who experienced recurrence died within 80 months of diagnosis. As these treatment outcomes are comparable to those previously reported outside of Japan, our findings indicate that this regimen is a therapeutic option for medulloblastoma patients in Japan.

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