scholarly journals Predictors for Adherence to Treatment Strategies in Elderly HNSCC Patients

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 423
Author(s):  
Raphaela Graessle ◽  
Carmen Stromberger ◽  
Max Heiland ◽  
Christian Doll ◽  
Veit M. Hofmann ◽  
...  
Keyword(s):  
Karnofsky Performance Status ◽  
Performance Status ◽  
Treatment Strategies ◽  
Lymph Node Involvement ◽  
Biological Age ◽  
Treatment Recommendation ◽  
Clinical Predictors ◽  
Patient Health ◽  
Node Involvement ◽  
T Classification

Finding a cure may be less important than ensuring the quality of life in elderly patients with head and neck squamous cell carcinoma (HNSCC). The aim of this study was to determine predictors for adherence. Clinical and pathological data from patients ≥70 years with HNSCC (initial diagnoses 2004-2018) were investigated retrospectively. Evaluated clinical predictors included biological age (Charlson Comorbidity Index; CCI), patient health (Karnofsky Performance Status; KPS) and therapy data. A total of 1125 patients were included. The median age was 75 years, 33.1% reached CCI ≥6, and 53.7% reached KPS ≤ 70%. In total, 968 patients were adherent, whereas 157 were nonadherent. Nonadherent patients were significantly more often smokers (p = 0.003), frequent drinkers (p = 0.001), had a worse health status (p ≤ 0.001) and a lower biological age (p = 0.003), an advanced T classification and lymph node involvement or UICC stage (each p ≤ 0.001). Approximately 88.0% of the included patients received a curative treatment recommendation. A total of 6.9% discontinued the therapy, and 7.0% refused the therapy. With the increasing complexity of a recommended therapy, adherence decreased. The 5-year overall survival was significantly higher in adherent patients (45.1% versus 19.2%). In contrast to the chronological patient age, biological age is a significant predictor for adherence. The evaluated predictors for nonadherence need to be verified prospectively.

scholarly journals Sinonasal malignant melanoma: an analysis of 115 cases assessing outcomes of surgery, postoperative radiotherapy and endoscopic resection

2012 ◽  
Vol 50 (2) ◽  
pp. 203-210
Author(s):  
V.J. Lund ◽  
E.J. Chisholm ◽  
D.J. Howard ◽  
W.I. Wei
Keyword(s):  
Overall Survival ◽  
Endoscopic Resection ◽  
Local Control ◽  
Postoperative Radiotherapy ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Lymph Node Involvement ◽  
Sinonasal Malignancies ◽  
Node Involvement ◽  
Predicting Outcome

Background: Melanomas account for 4% of sinonasal malignancies. We present the largest single institution series reported thus far and analyze the outcome with reference to lymph node involvement, radiotherapy and endoscopic resection. Methodology: Survival and recurrence data were analyzed on sinonasal melanoma cases collected from 1963-2010 to compare treatment strategies and to ascertain factors predicting outcome. Results: 115 cases (mean age 65.9) were treated at our institution during this period. All underwent surgical resection of the tumour, 31 (27%) endoscopically, and 51 (44%) also received radiotherapy. Five year overall survival was 28% and disease-free survival was 23.7%. Local control was achieved for a median of 21 months, 5-year disease control rate of 27.7%. Endoscopically resected cases showed a significant overall survival advantage up to 5 years. Radiotherapy did not improve local control or survival. Cervical metastases conferred a dramatically worse outcome. Conclusions: Endoscopic resection of sinonasal melanoma does not prejudice outcome. The role of radiotherapy is unproven.

Pattern and clinical predictors of lymph node involvement in neuroendocrine neoplasms of the pancreas

Pancreatology ◽  
2012 ◽  
Vol 12 (6) ◽  
pp. 583-584
Author(s):  
S. Partelli ◽  
R. Cherif ◽  
L. Boninsegna ◽  
S. Gaujoux ◽  
S. Crippa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Involvement ◽  
Neuroendocrine Neoplasms ◽  
Clinical Predictors ◽  
Node Involvement

scholarly journals Pattern and Clinical Predictors of Lymph Node Involvement in Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PanNETs)

JAMA Surgery ◽  
2013 ◽  
Vol 148 (10) ◽  
pp. 932 ◽  
Author(s):  
Stefano Partelli ◽  
Sebastien Gaujoux ◽  
Letizia Boninsegna ◽  
Rim Cherif ◽  
Stefano Crippa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Lymph Node Involvement ◽  
Pancreatic Neuroendocrine Tumors ◽  
Clinical Predictors ◽  
Node Involvement

scholarly journals Merkel Cell Carcinoma - A Rare Form of Skin Cancer with New Therapeutic Options

2019 ◽  
Vol 70 (9) ◽  
pp. 3245-3249
Author(s):  
Dana Lucia Stanculeanu ◽  
Oana Toma ◽  
Cristian Vasile ◽  
Cornelia Nitipir ◽  
Alina Bodilcu ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Regional Lymph Node ◽  
Performance Status ◽  
Lymph Node Involvement ◽  
The Body ◽  
Therapeutic Options ◽  
Merkel Cell ◽  
Node Involvement ◽  
And Performance

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine carcinoma of the skin, with very aggressive behavior. Etiological factors contributing to MCC development, include exposure to UV radiation, infection with Merkel cell polyomavirus (MCPyV) and chronic immunosuppression. It is commonly found in regions of the body that are exposed to sun -55% of cases are located in the head and neck. The 5 years survival rate for metastatic disease is approximately 25%. The estimated mortality rate for MCC is between 33% and 46%. Therapeutic options for MCC depends on disease characteristics (stage of disease at presentation, location of the tumor, regional lymph node involvement, comorbidities and performance status of the patient) and it includes multimodal treatments like surgery, chemotherapy and emerging immunotherapeutic treatments with early promising results. Our clinic experience is very limited with this type of malignancy, only three cases were diagnosed and treated in our department, but with encouraging results regarding the newest immunotherapeutic options, with good quality of life and results similar with the data from the literature.

scholarly journals Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement

2016 ◽  
Vol 34 (22) ◽  
pp. 2627-2635 ◽  
Author(s):  
Matthew D. Galsky ◽  
Kristian Stensland ◽  
John P. Sfakianos ◽  
Reza Mehrazin ◽  
Michael Diefenbach ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Preoperative Chemotherapy ◽  
Comparative Effectiveness ◽  
Combined Modality Therapy ◽  
Treatment Strategies ◽  
Distant Metastases ◽  
Lymph Node Involvement ◽  
Node Involvement

Purpose Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. Methods We included cTanyN1-3M0 bladder cancer patients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. Results Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. Conclusion A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.

Comparative effectiveness of treatment strategies for urothelial cancer of the bladder (UCB) with clinical lymph node involvement (cN+).

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 4530-4530
Author(s):  
Matt D. Galsky ◽  
Kristian Stensland ◽  
John Sfakianos ◽  
Reza Mehrazin ◽  
Michael Diefenbach ◽  
...  
Keyword(s):  
Lymph Node ◽  
Comparative Effectiveness ◽  
Urothelial Cancer ◽  
Treatment Strategies ◽  
Lymph Node Involvement ◽  
Cancer Of The Bladder ◽  
Node Involvement

scholarly journals Management Evaluation of Metastasis in the Brain (MEMBRAIN) – A UK & Ireland prospective, multicentre observational study

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv4-iv4
Author(s):  
Josephine Jung ◽  
Jignesh Tailor ◽  
Emma Dalton ◽  
Laurence J Glancz ◽  
Joy Roach ◽  
...  
Keyword(s):  
Decision Making ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Disease Status ◽  
Median Number ◽  
Treatment Modalities ◽  
Treatment Recommendation ◽  
Primary Disease ◽  
Number Of Patients ◽  
The Uk

Abstract Background Over the recent years an increasing number of patients with brain metastasis are being referred to the neuro-oncology multi-disciplinary team (NMDT). Our aim was to determine if referrals of this group of patients to the NMDT in the UK & Ireland comply with NICE guidelines and to assess referral volume, quality of information provided and its impact on NMDT decision-making. Methods Prospective multicentre oberservational study including all adult patients referred with ≥1 cerebral metastasis. Data was collected in neurosurgical units from 11/2017 to 02/2018. Demographics, primary disease, Karnofsky performance status (KPS), imaging and treatment recommendation were entered into an online database. Results 1049 patients were analysed from 24 neurosurgical units. Median age was 63[range 21–93] years with a median number of 3[range 1–17] referrals per NMDT. The most common primary malignancies were lung (36.5%, n=383), breast (18.5%, n=194) and melanoma (12.0%, n=126). 51.6% (n=541) of the referrals to the NMDT were within the NICE 2006 guidelines, and resulted in specialist intervention being offered in 68.8%. 41.2% (n=197) of patients being referred outside of the NICE 2006 guidelines were offered specialist treatment. NMDT decision-making was influenced by number of metastases, age, KPS, primary disease status and extent of extracranial disease (univariate logistic regression, p<0.0001) as well as metastasis location/histology (p<0.05). Conclusions This study confirmed a national change in culture of referral patterns. We identified a delay in NMDT decision-making in ~20%, contributing to increased NMDT workload. New stratification tools may be needed to reflect advancements in diagnostics and treatment modalities.

Sign in / Sign up

Export Citation Format

Share Document