scholarly journals Roles of Surgery in the Treatment of Patients With High-Risk Neuroblastoma in the Children Oncology Group Study: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Yingyi Qi ◽  
Jianghua Zhan
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Induction Chemotherapy ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Publication Date ◽  
Complete Tumor Resection ◽  
Full Inclusion ◽  
Review Protocol ◽  
Complete Tumor

Purpose: Neuroblastoma is the most common extracranial solid tumor in children, and most patients are at high risk when they are initially diagnosed. The roles of surgery and induction chemotherapy in patients with high-risk neuroblastoma have been a subject of much controversy and debate. The objective of the current study was to assess the roles of surgery in high-risk neuroblastoma.Method: The review protocol was prospectively registered (PROSPEROID: CRD42021253961). The PubMed, Embase, Cochrane, and CNKI databases were searched from inception to January 2020 with no restrictions on language or publication date. Clinical studies comparing the outcomes of different surgical ranges for the treatment of high-risk neuroblastoma were analyzed. The Mantel–Haenszel method and a random effects model was utilized to calculate the hazard ratio (95% CI).Results: Fourteen studies that assessed 1,915 subjects met the full inclusion criteria. Compared with the gross tumor resection (GTR) group, complete tumor resection (CTR) did not significantly improve the 5-year EFS [p = 1.0; HR = 0.95 (95% CI, 0.87–1.05); I2 = 0%], and the 5-year OS [p = 0.76; HR = 1.08 (95% CI, 0.80–1.46); I2 = 0%] of patients. GTR or CTR resection had significantly better 5-year OS [p = 0.45; HR = 0.56 (95% CI, 0.43–0.72); I2 = 0%] and 5-year EFS [p = 0.15; HR = 0.80 (95% CI, 0.71–0.90); I2 = 31%] than subtotal tumor resection (STR) or biopsy only; however, both CTR or GTR showed a trend for more intra and post-operative complications compared with the STR or biopsy only [p = 0.37; OR = 1.54 (95% CI, 1.08–2.20); I2 = 0%]. The EFS of the patients who underwent GTR or CTR at the time of diagnosis and after induction chemotherapy were similar [p = 0.24; HR = 1.53 (95% CI, 0.84–2.77); I2 = 29%].Conclusion: For patients with high-risk neuroblastoma, complete tumor resection and gross tumor resection of the primary tumor were related to improved survival, with very limited effects on reducing intraoperative and postoperative complications. It is necessary to design strong chemotherapy regimens to improve the survival rate of advanced patients.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, PROSPEROID [CRD42021253961].

Adjuvant therapy with imatinib in gastrointestinal stromal tumor (GIST) patients with intermediate or high risk: Analysis from a single-center contrast study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10556-10556
Author(s):  
J. Li ◽  
F. J. Gong ◽  
J. Li ◽  
W. A. Wu ◽  
L. Shen
Keyword(s):  
High Risk ◽  
Adjuvant Therapy ◽  
Therapy Group ◽  
Tumor Resection ◽  
Control Group ◽  
Contrast Study ◽  
Complete Tumor Resection ◽  
Free Survival ◽  
Complete Tumor

10556 Background: Imatinib benefits the patients with metastatic GIST but whether it is effective in the adjuvant setting after complete tumor resection of primary GIST is questionable. Methods: Patients who had undergone complete tumor resection with intermediate or high risk of recurrence (define) were enrolled in a single-center non-randomized open contrast study. Patients had adjuvant therapy with imatinib (400mg once a day) for 3 years commencing within 12 weeks of tumor resection, or had follow-up alone. We performed c-kit and PDGFRA mutation analysis for patients with archival tumor samples. The primary objective was recurrence-free survival (RFS) and the second objective was correlation of gene mutation profile with efficacy of adjuvant therapy. Results: One hundred and five patients were enrolled: 56 patients in adjuvant therapy group and 49 patients in control group. Median follow-up was 30 months (range 12–62); Median treatment duration in adjuvant therapy group were 20 months (range 12–36); There was relatively higher 1-year and 2-year RFS in the adjuvant therapy group compared with the control group (100% vs 89.8%,94.4% vs 60.0%) (Log-RankP< 0.001). Hazard risk was 0.13 (95% CI 0.039–0.438, P= 0.001) in Cox proportional hazard regression model. For further sub-group analysis, Log-rank and Cox regression analysis showed that adjuvant therapy could significantly decrease recurrence risk in patients with high risk disease (define)(2-year RFS: 91.5% vs 46,2%, Log-Rank: P<0.001, HR:0.107 (95%CI 0.031–0.370), P<0.001). c-kit and PDGFRA mutation were analyzed in forty-nine patients. There was a better survival benefit from adjuvant therapy for patients with c-kit exon 11 mutation. Conclusions: Adjuvant therapy with imatinib can improve 1-year and 2-year recurrence-free survival for patients with an intermediate or high risk of recurrence after complete tumor resection. No significant financial relationships to disclose.

Pituitary Adenomas with Changing Phenotype: A Systematic Review

2020 ◽  
Vol 128 (12) ◽  
pp. 835-844
Author(s):  
Fernando Guerrero-Pérez ◽  
Agustina Pia Marengo ◽  
Noemi Vidal ◽  
Carles Villabona
Keyword(s):  
Systematic Review ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cushing's Disease ◽  
Complete Tumor Resection ◽  
Null Cell ◽  
Acth Secreting ◽  
Complete Tumor

Abstract Purpose and Methods Phenotype transformation in pituitary adenomas (PA) is a little known and unexpected clinical phenomenon. We describe two illustrative cases and performed a systematic review of cases reported in literature. Results Case 1: A 24-year-old woman underwent surgery because of Cushing’s disease. A complete tumor resection and hypercortisolism resolution was achieved. Two years later, tumor recurred but clinical and hormonal hypercortisolism were absent. Case 2: A 77-year-old woman underwent surgery due to acromegaly. A complete tumor resection and GH excess remission was achieved. Four years later, tumor recurred but clinical and hormonal acromegaly was ruled out. Search of literature: From 20 patients (including our cases), 75% were female with median age 45 (19) years. Ten patients (50%) had initially functioning PA: 8 switched to NFPA (5 ACTH-secreting PA, 2 prolactinomas and 1 acromegaly) and 2 exchanged to acromegaly from TSH-secreting PA and microprolactinoma. One patient developed a pituitary carcinoma from ACTH-secreting PA. Ten patients (50%) initially had NFPA; 9 developed Cushing’s disease (4 silent corticotroph adenomas, 4 null cell PA and 1 managed conservatively). One patient with silent somatotroph PA changed to acromegaly. Treatments before transformation were surgery (80%), radiotherapy (40%), pharmacological (40%) and in 2 patients switching happened without any treatment. Median follow-up until transformation was 72 months (range 12–276). Conclusion PA can change from functioning to (NF) non-functioning (vice versa) and even exchange their hormonal expression. Clinicians should be aware and a careful lifelong follow-up is mandatory to detect it.

scholarly journals Appropriate durations of adjuvant imatinib in patients with high-risk gastrointestinal stromal tumor (GIST) the better choice, for the year 2010

2015 ◽  
Vol 5 (4S) ◽  
pp. 13-16
Author(s):  
Lucia Tozzi
Keyword(s):  
High Risk ◽  
Tumor Resection ◽  
Phase Iii ◽  
Drug Discontinuation ◽  
Imatinib Treatment ◽  
Adjuvant Imatinib ◽  
Complete Tumor Resection ◽  
Phase Iii Trial ◽  
Extended Duration ◽  
Complete Tumor

We report a case of a patient with histopathologically diagnosed GIST who had undergone complete tumor resection for primary localized lesion. The patient has received adjuvant imatinib treatment for at least two years. Studies have shown an improvement in RFS with 1 year of adjuvant imatinib, there is no consensus on the appropriate duration of adjuvant. The 2 year RFS rate in ACOSOG Z9000 was 73%, significantly lower than the 1 year RFS rate of 94%. These findings indicate that 1 year of adjuvant is likely to be insufficient, this implies that an extended duration of adjuvant prolongs RFS in patients with high risk of recurrence. The efficacy of re-challenge with imatinib in the subjects who developed recurrence after drug discontinuation indicates that it was probably due to insufficient treatment duration rather than resistence to imatinib. Waiting the results of phase III trial SSGXVIII/AIO about 3 years of treatment with imatinib we conclude that the better choice, for the year 2010, was to treat patient for at least two years.

Osteosarcoma of the jaws: a literature review

2020 ◽  
Vol 16 ◽  
Author(s):  
Francesco Ricotta ◽  
Massimo Bassi ◽  
Nicola Tomasetti ◽  
Angelo Campobassi ◽  
Vincenzo Maiolo ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
State Of The Art ◽  
Bone Erosion ◽  
Tumor Resection ◽  
Bone Destruction ◽  
Cell Type ◽  
Complete Tumor Resection ◽  
Predominant Cell Type ◽  
Bone Changes ◽  
Complete Tumor

: Osteosarcoma of the jaws (OSJ) is a relatively rare disease, accounting for between 2% and 10% of all cases of osteosarcoma, it is morphologically and radiologically identical to the trunk and extremity variant, but distinct in several crucial aspects. : The lesion is characterized by sarcomatous cells which produces a variable amount of osteoid bone. It arises centrally within the bone and can be subdivided into osteoblastic, chondroblastic and fibroblastic subtype, depending on the predominant cell type. : Radiographically, these tumors display a spectrum of bone changes from well-demarcated borders to lytic bone destruction with indefinite margins and variable cortical bone erosion or, in some cases, images of sclerotic bone. Therapeutic options for OSJ include surgery, chemotherapy and radiotherapy, which are employed according to age of the patient, histological classification and localization of the tumor. Today there is no a general consensus in the treatment guidelines for the OSJ though surgery represents the key of the treatment. The main prognostic factor deeply influencing the patient's prognosis remains the complete tumor resection with negative surgical margins. : The aim of the present review is to describe the state of the art regarding diagnostic and surgical treatment aspects of the primary osteosarcoma of the jaws.

Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

2021 ◽  
pp. 112070002199111
Author(s):  
Jacob Shapira ◽  
Mitchell J Yelton ◽  
Jeffery W Chen ◽  
Philip J Rosinsky ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Comparable Efficacy ◽  
Total Hip ◽  
High Risk Patients ◽  
Randomised Control Trials ◽  
Risk Patients

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

scholarly journals The Association of Epicardial Adipose Tissue and High Risk Plaque Characteristics: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 ◽  
pp. S272
Author(s):  
N. Nerlekar ◽  
A. Brown ◽  
R. Muthalaly ◽  
A. Talman ◽  
J. Laggoune ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adipose Tissue ◽  
High Risk ◽  
Epicardial Adipose Tissue ◽  
Meta Analysis

scholarly journals Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Julio Vaquerizo-Serrano ◽  
Gonzalo Salazar de Pablo ◽  
Jatinder Singh ◽  
Paramala Santosh
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Literature Search ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Clinical High Risk ◽  
Psychotic Experiences ◽  
Attenuated Psychosis Syndrome ◽  
The Mean ◽  
Spectrum Disorders

AbstractPsychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.

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