Could Primary Chemoradiotherapy in T2 Glottic Cancers Yield Results Comparable to Primary Radiotherapy in T1? Considerations from 531 German Early Stage Patients

T1 glottic cancer is a highly treatable disease with local control (LC) rates over 90% by either primary radiotherapy (pRT) or transoral laser microsurgery (TLM). LC of T2 glottic cancers is 15 percent points poorer on average. However, salvage after pRT entails more than 50% total laryngectomy. Therefore, there is a need for enhanced LC. Altered fractionation regimens improved LC in T1 but not in T2. For this reason, for T2, alternative strategies must be considered. In a large observational cohort study including 531 early-stage laryngeal cancers, a small number of patients were treated with primary chemoradiotherapy (pCRT). In multivariable analysis, factors associated with significantly poorer outcomes included age, comorbidities, supraglottic localization, and T category. While there was a significant difference between pRT and surgery (HR 1.79; 95%-CI: 1.15–2.79), there was none between pCRT and surgery (HR 0.70; 95%-CI: 0.33–1.51). There is evidence from the literature that pCRT in early glottic cancers could yield results that surpass the limits so far experienced in radiotherapy alone with acceptable toxicity. Thus, prospective randomized studies with larger numbers of patients are warranted.

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Organ motion in linac-based SBRT for glottic cancer

Radiation Oncology ◽

10.1186/s13014-021-01833-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Annarita Perillo ◽

Valeria Landoni ◽

Alessia Farneti ◽

Giuseppe Sanguineti

Keyword(s):

Early Stage ◽

Displacement Vector ◽

Thyroid Cartilage ◽

Three Dimensional ◽

Target Volume ◽

Glottic Cancer ◽

Organ Motion ◽

Delivery Times ◽

Significant Difference ◽

Pre Treatment

Abstract Purpose The purpose of this study is to evaluate inter- and intra-fraction organ motion as well as to quantify clinical target volume (CTV) to planning target volume (PTV) margins to be adopted in the stereotactic treatment of early stage glottic cancer. Methods and materials Stereotactic body radiotherapy (SBRT) to 36 Gy in 3 fractions was administered to 23 patients with early glottic cancer T1N0M0. Patients were irradiated with a volumetric intensity modulated arc technique delivered with 6 MV FFF energy. Each patient underwent a pre-treatment cone beam computed tomography (CBCT) to correct the setup based on the thyroid cartilage position. Imaging was repeated if displacement exceeded 2 mm in any direction. CBCT imaging was also performed after each treatment arc as well as at the end of the delivery. Swallowing was allowed only during the beam-off time between arcs. CBCT images were reviewed to evaluate inter- and intra-fraction organ motion. The relationships between selected treatment characteristics, both beam-on and delivery times as well as organ motion were investigated. Results For the population systematic (Ʃ) and random (σ) inter-fraction errors were 0.9, 1.3 and 0.6 mm and 1.1, 1.3 and 0.7 mm in the left-right (X), cranio-caudal (Y) and antero-posterior (Z) directions, respectively. From the analysis of CBCT images acquired after treatment, systematic (Ʃ) and random (σ) intra-fraction errors resulted 0.7, 1.6 and 0.7 mm and 1.0, 1.5 and 0.6 mm in the X, Y and Z directions, respectively. Margins calculated from the intra-fraction errors were 2.4, 5.1 and 2.2 mm in the X, Y and Z directions respectively. A statistically significant difference was found for the displacement in the Z direction between patients irradiated with > 2 arcs versus ≤ 2 arcs, (MW test, p = 0.038). When analyzing mean data from CBCT images for the whole treatment, a significant correlation was found between the time of delivery and the three dimensional displacement vector (r = 0.489, p = 0.055), the displacement in the Y direction (r = 0.553, p = 0.026) and the subsequent margins to be adopted (r = 0.626, p = 0.009). Finally, displacements and the subsequent margins to be adopted in Y direction were significantly greater for treatments with more than 2 arcs (MW test p = 0.037 and p = 0.019, respectively). Conclusions In the setting of controlled swallowing during treatment delivery, intra-fraction motion still needs to be taken into account when planning with estimated CTV to PTV margins of 3, 5 and 3 mm in the X, Y and Z directions, respectively. Selected treatments may require additional margins.

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Gliomatosis Cerebri: A Review of 22 Cases

Neurosurgery ◽

10.1227/01.neu.0000073527.20655.e6 ◽

2003 ◽

Vol 53 (2) ◽

pp. 261-271 ◽

Cited By ~ 72

Author(s):

G. Edward Vates ◽

Susan Chang ◽

Kathleen R. Lamborn ◽

Michael Prados ◽

Mitchel S. Berger

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

San Francisco ◽

Gliomatosis Cerebri ◽

Karnofsky Performance Scale ◽

Resonance Spectroscopy ◽

Resonance Imaging ◽

Number Of Patients ◽

Significant Difference ◽

Radiotherapy Alone

Abstract OBJECTIVE Gliomatosis cerebri is an enigmatic diffuse brain neoplasm whose prognosis is grim. We reviewed data for patients with gliomatosis who were treated at the University of California, San Francisco, during a 10-year period. Our focus was on presentation, radiological and pathological features, and outcomes. METHODS We reviewed hospital and clinic records and magnetic resonance imaging scans for 22 patients with gliomatosis. The diagnosis was based on magnetic resonance imaging findings and tissue confirmation for all patients. Seven patients also underwent magnetic resonance spectroscopy. Eleven patients were male (50%), and the median age at presentation was 49 years (range, 7–79 yr). RESULTS Kaplan-Meier analysis demonstrated median lengths of survival as follows: no treatment, 1 month (n = 4); radiotherapy alone, 28 months (95% confidence interval, 5–51 mo; n = 13); radiotherapy followed by chemotherapy, two patients, alive at 28 and 104 months; radiotherapy and chemotherapy simultaneously, three patients, one alive at 18 months and the others dead at 7 and 9 months. There was no significant difference between radiotherapy alone and radiotherapy combined with chemotherapy (P = 0.69). Karnofsky Performance Scale scores of ≥70 and grade were both significantly related to length of survival in univariate analyses (P < 0.05); these correlations were confirmed in the multivariate analysis, although the small numbers of patients and deaths precluded reliable interpretation. CONCLUSION Although the small number of patients in our study and its retrospective nature preclude definitive conclusions regarding the utility of treatment, our findings suggest that biopsies are useful not only for diagnosis but also for prediction of the length of survival.

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Surgery treatment of laryngeal carcinoma T1

Acta chirurgica iugoslavica ◽

10.2298/aci0401020m ◽

2004 ◽

Vol 51 (1) ◽

pp. 20-25

Author(s):

A. Mikic ◽

Z. Petrovic ◽

Vojko Djukic ◽

Milovan Dimitrijevic ◽

P. Stankovic ◽

...

Keyword(s):

Early Stage ◽

Maxillofacial Surgery ◽

Incidence Rates ◽

Glottic Cancer ◽

Clinical Center ◽

Regional Metastases ◽

Primary Radiotherapy ◽

European Laryngological Society

The early stage cancer of the glottis, including Tis, Tla and Tlb stages, are the most common forms with the incidence rates ranging from 25% to 85%. The therapy of early glottic cancer is usually successful for two reasons. First, true glottic cancer produces early symptoms and it is relatively easy to remove. Second, glottis is rather poor with lymph pathways so the regional metastases are rare, less than 1 %. Due to role of the larynx in phonation, respiration and swallowing, the cancer of this region and its treatment has a great impact to the quality of life. Retrospective study involved ten-year period, from January 1990 to January 2004. At the Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 858 surgical and 54 endoscopie CO2 laser-assisted resections were performed for glottic cancers of larynx of Tis-T2 stages. Glottic tumors were treated by Types III, IV and Va chordectomies according to classificaiton of endoscopie chordectomy defined by the European Laryngological Society. Analyzing the operated patients, as well as the type of the applied surgery, that is, endoscopic-laser and classic surgery, the authors attempted to clarify the dilemmas relating to the indications for one or another type of surgical intervention. The patients who had undergone primary radiotherapy were excluded from the analysis.

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Predictors of outcome following local excision for T1 rectal adenocarcinoma: A contemporary analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.35 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 35-35

Author(s):

Thejus Thayyil Jayakrishnan ◽

Stephen Abel ◽

Ari Reichstein ◽

Richard Fortunato ◽

Stanislav Nosik ◽

...

Keyword(s):

Local Excision ◽

Perineural Invasion ◽

Cox Regression ◽

Early Stage ◽

Multivariable Analysis ◽

Rectal Adenocarcinoma ◽

Predictors Of Outcome ◽

Kaplan Meier ◽

Number Of Patients ◽

Grade 3

35 Background: Local excision (LE) alone is a standard treatment option for appropriately selected early stage rectal adenocarcinoma patients. Guidelines for this therapeutic approach are based upon retrospective single institution data, some of which dates back 30 years. We thus sought to use the National Cancer Database (NCDB) to examine outcomes in a large cohort of patients with early stage rectal adenocarcinoma treated with LE and to identify/confirm predictors of outcome. Methods: We queried the NCDB for patients with pT1N0M0 rectal adenocarcinoma treated with local excision alone. Baseline characteristics were tabulated and included lymphovascular invasion (LVI), perineural invasion (PNI), grade, and size all of which have been recorded in the NCDB since 2010. Multivariable Cox regression was used to identify predictors of overall survival. Kaplan Meier curves were generated to compare survival based upon significant factors found on multivariable analysis. Results: Using the above criteria, we identified 887 patients eligible for analysis across 2010-2014. The median age was 67 and 57% of patients were male. The median tumor size was 1.5 cm (IQ range: 0.9-2.5 cm). A minority of patients had grade 3 tumors (5%), LVI (8%), or PNI ( < 1%). Median follow up was 36 months (1-83). On multivariable Cox regression, predictors of worse survival included: size > 4 cm, age > 67, higher comorbidity score, and presence of LVI. On Kaplan Meier analysis, 5 year OS was 75% vs. 74% for patients without and with LVI, respectively (p = 0.0115). In terms of size, the 5 year OS was 74% vs. 51%for size < 4cm and size > 4cm (p = 0.0138). Conclusions: Our large contemporary series demonstrates excellent survival outcomes in patients with early stage rectal adenocarcinoma treated with LE alone. LVI remains a predictor of outcome, while grade and perineural invasion were not significant in this analysis. This finding is likely due to a small number of patients with those characteristics.

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Effects of Antiacid Therapy on Granuloma after Transoral Type IV-VI Cordectomy in Patients with Early-Stage Glottic Cancer

BioMed Research International ◽

10.1155/2020/4178376 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Xiaofeng Jin ◽

Yanyan Niu ◽

Wei Gu ◽

Jian Wang

Keyword(s):

Treatment Group ◽

Early Stage ◽

Glottic Cancer ◽

Control Group ◽

Type Iv ◽

Number Of Patients ◽

The Status ◽

Postoperative Time ◽

Group Control Group ◽

Postoperative Administration

Objective. To investigate whether preventive administration of a proton pump inhibitor (PPI) can reduce the occurrence and development of traumatic granuloma (TG) following type IV-VI cordectomy. Methods. We retrospectively analyzed the status of postoperative granulomas in 37 patients who underwent type IV-VI cordectomy due to glottic cancer and determined whether postoperative administration of a PPI had any impact on granuloma formation and development. Results. The percentage and number of patients with granuloma in the PPI treatment group (experimental group) at the 1st, 2nd, 3rd, and 6th month following surgery were 81.25% (13/16), 25.00% (4/16), 18.75% (3/16), and 0.00% (0/16), respectively. The percentage and number of patients with granuloma in the no-PPI group (control group) were 95.24% (20/21), 71.43% (15/21), 52.38% (11/21), and 14.29% (3/21), respectively. The granuloma percentage of the PPI treatment group was lower than that of the control group at all postoperative time points assessed. The differences were not statistically significant at the 1st month (p=0.175) but were statistically significant at the 2nd and 3rd months after surgery (p=0.005, p=0.037). Conclusion. Preventive use of a PPI in patients after type IV-VI cordectomy can shorten the TG recovery duration and may reduce the severity of TG, but it cannot prevent TG from occurring. Our results should be confirmed by prospective randomized controlled trials with large sample sizes.

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dl-3-n-butylphthalide for alleviation of neurological deficit after combined extracranial-intracranial revascularization for moyamoya disease: a propensity score–matched analysis

Journal of Neurosurgery ◽

10.3171/2018.10.jns182152 ◽

2020 ◽

Vol 132 (2) ◽

pp. 421-433 ◽

Cited By ~ 3

Author(s):

Zongze Li ◽

Junlin Lu ◽

Li Ma ◽

Chunxue Wu ◽

Zongsheng Xu ◽

...

Keyword(s):

Propensity Score ◽

Moyamoya Disease ◽

Neurological Deficit ◽

Multivariable Analysis ◽

Neurological Function ◽

Neurological Deficits ◽

Perioperative Stroke ◽

Number Of Patients ◽

Significant Difference ◽

Revascularization Surgery

OBJECTIVEPostoperative neurological deficits impair the overall outcome of revascularization surgery for patients with moyamoya disease (MMD). dl-3-n-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in patients with MMD.METHODSThe authors studied cases in which patients underwent combined revascularization surgery for MMD at their institution, with or without NBP administration. The overall study group included 164 patients (213 surgically treated hemispheres), including 49 patients who received NBP (25 mg twice daily) for 7 postoperative days. The incidence of perioperative stroke and transient neurological deficit (TND) and the severity of neurological deficits were compared between 49 propensity score–matched case pairs with or without NBP treatment. Subgroup analyses by type of onset and preoperative neurological status were also performed to determine specific characteristics of patients who might benefit from NBP administration.RESULTSIn the overall cohort, baseline characteristics differed with respect to preoperative stroke and modified Rankin Scale (mRS) score between patients who received NBP and those who did not receive it. In the 49 propensity score–matched pairs, postoperative stroke was observed in 11 patients and TND occurred in 21 patients, with no significant difference in incidence between the 2 groups. However, the TND was less severe in the NBP-treated group (p = 0.01). At 1 month after surgery, the neurological outcome was more favorable (p = 0.001) and the disability-free recovery rate was higher in patients with NBP treatment (p < 0.001). The number of patients who experienced an improved neurological function, compared to preoperative function, as measured by mRS, was greater in the NBP group than in the no-NBP group (p < 0.001). Multivariable analysis revealed that NBP administration was associated with decreased severity of TND (OR 0.28, p = 0.02), improved neurological function (OR 65.29, p = 0.04), and lower postoperative mRS score (OR 0.06, p < 0.001). These beneficial effects of NBP remained significant in ischemic type MMD and patients with preoperative mRS scores of 2 or greater.CONCLUSIONSPostoperative administration of NBP may alleviate perioperative neurological deficits after revascularization surgery for MMD, especially in patients with ischemic MMD and unfavorable preoperative status. The results of this study suggest that randomized controlled trials to assess the potential benefit of NBP in patients with MMD may be warranted.

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Predictors of Postoperative Radiation Following Laser Resection in Early-Stage Glottic Cancer

Otolaryngology ◽

10.1177/0194599820933183 ◽

2020 ◽

Vol 163 (6) ◽

pp. 1218-1225

Author(s):

Dustin A. Silverman ◽

Kevin Y. Zhan ◽

Sidharth V. Puram ◽

Antoine Eskander ◽

Theodoros N. Teknos ◽

...

Keyword(s):

Early Stage ◽

Multivariable Analysis ◽

Glottic Cancer ◽

Glottic Carcinoma ◽

National Cancer Database ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Positive Margins ◽

Lower Volume ◽

Laser Excision

Objective Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). Study Design Retrospective observational study of the National Cancer Database. Setting National Cancer Database review from 2004 to 2014. Patients and Methods A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. Results The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. Conclusions Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.

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Identification a potential therapeutic target in castrate resistance prostate cancer by using microarray

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1416 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Massar Ibrahim Shekhan

Keyword(s):

Prostate Cancer ◽

Cell Line ◽

Lncap Cell ◽

Early Stage ◽

Cancer Cell Line ◽

Mrna Levels ◽

Line Model ◽

Cell Line Model ◽

Number Of Patients ◽

Significant Difference

The androgen receptor (AR) has a crucial role in the proliferation and progression of prostate cancer. anti-androgen therapy is used in the early stage of the disease and the patients respond well,howevera significant number of patients eventually will develop resistance,entering a castrate-resistant state,with very poor prognosis,which is a major clinical challenge at the moment. Enzalutamide,have shown potential in the treatment of CRPC patients,but response is just 50% and the development of resistance to these are challenging clinic. This study aims to investigate the whole genomic expression of LNCaP prostate cancer cell line model,compared to resistant to Enzalutamide model. TROP-2 demonstrates high expression in Enzalutamide resistant cells in our gene microarray,which mightsuggest TROP-2 may serve as a biomarker of resistance. The preliminary data reveal an increase in expression of TROP-2 in the LNCaP-Enz-R cell line model,compared with parental LNCaP cell,at both the protein and mRNA levels. siRNA againstTROP-2 led a decreases in a proliferation and cell cycle progression of the LNCaP-Enz-R cell line,whereas no significant difference was noticed in the parental,androgen sensitive LNCaP cell line. In addition,Knockdown of TROP-2 decrease migration of LNCaP-Enz-R cell line significantly,while no effect was observed in parental LNCaP cell

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Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure

Otolaryngology ◽

10.1177/0194599817728476 ◽

2017 ◽

Vol 158 (2) ◽

pp. 295-302 ◽

Cited By ~ 12

Author(s):

Philipp Wolber ◽

David Schwarz ◽

Thoralf Stange ◽

Magdalene Ortmann ◽

Matthias Balk ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Local Recurrence ◽

Cell Carcinoma ◽

Recurrence Rate ◽

Squamous Cell ◽

Early Stage ◽

Anterior Commissure ◽

Glottic Cancer ◽

Recurrence Rates ◽

Significant Difference

Objective Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design Case series with chart review. Setting Tertiary care otolaryngology clinic. Subjects and Methods Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC ( P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference ( P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates.

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High Dose Intravenous Vitamin C for Preventing The Disease Aggravation of Moderate COVID-19 Pneumonia. A Retrospective Propensity Matched Before-After Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.638556 ◽

2021 ◽

Vol 12 ◽

Author(s):

Bing Zhao ◽

Min Liu ◽

Ping Liu ◽

Yibing Peng ◽

Jun Huang ◽

...

Keyword(s):

Vitamin C ◽

Inflammatory Response ◽

Early Stage ◽

Treatment Options ◽

Control Group ◽

High Dose ◽

Protein Levels ◽

Number Of Patients ◽

Significant Difference ◽

Intravenous Vitamin

Background: Coronavirus disease 2019 (COVID-19) pandemic is continuing to impact multiple countries worldwide and effective treatment options are still being developed. In this study, we investigate the potential of high-dose intravenous vitamin C (HDIVC) in the prevention of moderate COVID-19 disease aggravation.Methods: In this retrospective before-after case-matched clinical study, we compare the outcome and clinical courses of patients with moderate COVID-19 patients who were treated with an HDIVC protocol (intravenous injection of vitamin C, 100 mg/kg/day, 1 g/h, for 7 days from admission) during a one-month period (between March 18 and april 18, 2020, HDIVC group) with a control group treated without the HDIVC protocol during the preceding two months (January 18 to March 18, 2020). Patients in the two groups were matched in a 1:1 ratio according to age and gender.Results: The HDIVC and control groups each comprised 55 patients. For the primary outcomes, there was a significant difference in the number of patients that evolved from moderate to severe type between the two groups (HDIVC: 4/55 vs. control: 12/55, relative risk [RR] = 0.28 [0.08, 0.93], P = 0.03). Compared to the control group, there was a shorter duration of systemic inflammatory response syndrome (SIRS) (P = 0.0004) during the first week and lower SIRS occurrence (2/21 vs 10/22, P = 0.0086) on Day 7 (6–7 days after admission). In addition, HDIVC group had lower C-reactive protein levels (P = 0.005) and higher number of CD4+ T cells from Day 0 (on admission) to Day 7 (P = 0.04).” The levels of coagulation indicators, including activated partial thromboplastin time and D-dimer were also improved in the HDIVC compared to the control group on Day 7.Conclusion: HDIVC may be beneficial in limiting disease aggravation in the early stage of COVID-19 pneumonia, which may be related to its improvements on the inflammatory response, immune function and coagulation function. Further randomized controlled trials are required to augment these findings.

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