The Management of Radiation-Induced Sarcomas: A Cohort Analysis from a Sarcoma Tertiary Center

(1) Background: Radiation-induced sarcomas (RIS) are rare diseases with poor prognoses. The aim of the study was to analyze outcomes and identify factors affecting survival in a cohort of patients with RIS. (2) Methods: We included consecutive patients with RIS that we found in the available electronic medical records of a sarcoma tertiary center. We analyzed patients’ RIS characteristics, management of RIS, the occurrence of local recurrence and distant metastases, the date of disease progression, the date of death, and the date of the last follow-up. (3) Results: Fifty-eight patients met the inclusion criteria. The most frequent sites of RIS development were the thorax and pelvis. The majority of RIS were poorly differentiated, high-grade tumors. Forty patients underwent surgery or radiotherapy with curative intent. The others were referred to palliative chemotherapy. Median progression-free survival and overall survival were 15 and 21 months, respectively. Treatment with curative intent and tumor localization on breasts and upper extremities were associated with a lower risk of death in univariate analysis. (4) Conclusions: The study confirms the poor prognosis of RIS. Treatments with locally curative intent at the tumor site are of prognostic value. Secondary radiotherapy is rarely used in RIS.

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Factors affecting radiotherapy prescribing patterns in the post-mastectomy setting

Current Oncology ◽

10.3747/co.25.3773 ◽

2018 ◽

Vol 25 (2) ◽

pp. 146 ◽

Cited By ~ 2

Author(s):

T.A. Koulis ◽

A. Dang ◽

C. Speers ◽

R.A. Olson

Keyword(s):

Breast Cancer ◽

Background Radiation ◽

Prescribing Patterns ◽

Autologous Reconstruction ◽

Breast Cancer Patients ◽

Prescribing Practices ◽

Curative Intent ◽

Factors Affecting ◽

Treatment Information ◽

Treatment Centre

Background Radiation therapy (rt) after mastectomy for breast cancer can improve survival outcomes, but has been associated with inferior cosmesis after breast reconstruction. In the literature, rt dose and fractionation schedules are inconsistently reported. We sought to determine the pattern of rt prescribing practices in a provincial rt program for patients treated with mastectomy and reconstruction.Methods Women diagnosed with stages 0–iii breast cancer between January 2012 and December 2013 and treated with curative-intent rt were identified from a clinicopathology database. Patient demographic, tumour, and treatment information were extracted. Of the identified patients, those undergoing mastectomy were the focus of the present analysis.Results Of 4016 patients identified, 1143 (28%) underwent mastectomy. The patients treated with mastectomy had a median age of 57 years, and 37% of them underwent reconstruction. Treatment with more than 16 fractions of rt was associated with autologous reconstruction [odds ratio (or): 37.2; 95% confidence interval (ci): 11.2 to 123.7; p < 0.001], implant reconstruction (or: 93.3; 95% ci: 45.3 to 192.2; p < 0.001), and treating centre. Hypofractionated treatment was associated with older age (or: 0.94; 95% ci: 0.92 to 0.96; p < 0.001), and living more than 400 km from a treatment centre (or: 0.37; 95% ci: 0.16 to 0.86; p = 0.02).Conclusions Prescribing practices in breast cancer patients undergoing mastectomy are influenced by reconstruction intent, age, nodal status, and distance from the treatment centre. Those factors should be considered when making treatment decisions.

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Rituximab and High-Dose Dexamethasone (R-dex) Is Effective In The Treatment Of Relapsed/Refractory Chronic Lymphocytic Leukemia

Blood ◽

10.1182/blood.v122.21.4184.4184 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4184-4184

Author(s):

Martin Simkovic ◽

David Belada ◽

Monika Motyckova ◽

Lukas Smolej ◽

Pavel Zak

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Conflicts Of Interest ◽

Antimicrobial Prophylaxis ◽

Univariate Analysis ◽

Progression Free Survival ◽

Lymphocytic Leukemia ◽

Published Data ◽

High Dose ◽

High Dose Dexamethasone ◽

Tertiary Center

Abstract Introduction High-dose methylprednisolone (HDMP) in combination with rituximab is active in the treatment of relapsed/refractory chronic lymphocytic leukemia (CLL) but serious infections are frequent. Recently published data suggest that high-dose dexamethasone might be equally effective to HDMP despite lower cumulative dose. Aims To assess efficacy and safety of high-dose dexamethasone combined with rituximab (R-dex) in relapsed/refractory CLL. Patients and Methods A total of 60 pts (pts) with relapsed/refractory CLL treated at a single tertiary center between September 2008 and October 2012 were included in this retrospective analysis. Basic characteristics are summarized in Table 1. The schedule of R-dex consisted of rituximab 500 mg/m2 i.v. day 1 (375 mg/m2 in cycle 1) and dexamethasone 40 mg orally on days 1-4 and 10-13. Treatment was repeated every 3 weeks for a maximum of 8 cycles. All pts received antimicrobial prophylaxis with sulfamethoxazole/trimethoprim and aciclovir. Results Median number of administered R-dex cycles was 6 (range, 1-8). The overall response (ORR)/complete remissions (CR) were achieved in 75/3%. At the median follow-up of 9 months, median progression-free survival was 8 months and median overall survival 24 months. Significant predictors of short PFS in univariate analysis were bulky lymphadenopathy (p=0.023) and refractoriness to fludarabine (p=0.02). Interestingly, activity of R-dex in bulky fludarabine-refractory CLL was similar to ofatumumab (ORR 62 %, median PFS, 4 months, median OS, 12 months) (Wierda et al., 2010). R-dex was successfully used as a debulking regimen before allogeneic stem cell transplantation in 8 patients. Serious (CTCAE grade III/IV) infections occurred in 29% of patients; 19% pts developed steroid diabetes requiring temporary short-acting insulin. Conclusions Our data show that R-Dex is an active and feasible treatment for patients with relapsed/refractory CLL; however, major infections remain relatively frequent despite combined antimicrobial prophylaxis. In addition, durable responses are infrequent. Therefore, further optimization of this therapeutic approach is warranted. Updated results will be presented. Disclosures: No relevant conflicts of interest to declare.

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Evaluation of liver toxicity using Child-Pugh, MELD, and MELD-Na following stereotactic body radiation therapy (SBRT) of hepatocellular carcinomas.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.365 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 365-365

Author(s):

Louis Lu ◽

Eman ElAlfy ◽

Daniel Wahl ◽

Matthew H. Stenmark ◽

Theodore Steven Lawrence ◽

...

Keyword(s):

Time Course ◽

Liver Toxicity ◽

Background Radiation ◽

Univariate Analysis ◽

Vein Thrombosis ◽

Point Increase ◽

Chi Squared ◽

Radiation Induced ◽

The University ◽

Hep B

365 Background: Radiation-induced liver disease (RILD) has been tracked when assessing the safety of fractionated liver radiotherapy. However, due to the rarity and severity of events, a more sensitive measure of liver damage is necessary. This study characterizes the time course of changes in generalizable measures of liver function as potential toxicity metrics. Methods: In this IRB-approved retrospective study, the records of 63 patients with 87 HCC tumors treated with SBRT at the University of Michigan between 2006 and 2012 were reviewed. Changes in Child-Pugh (CP), MELD, and MELD-Na were analyzed using the Student t test and chi-squared test. Results: 83% of the patients had cirrhosis, 62% hepatitis (hep) C, 7% hep B, 25% alcoholic, and 13% other. 83% had prior liver-directed therapy. 24% had >1 tumor concurrently treated with SBRT. Median tumor size was 2.3 cm (0.7-10), gross tumor volume was 9.2 cc (0.6-469), and mean liver dose-GTV was 4.4 Gy (0-17.6 Gy). Prior to SBRT, 73% were CP A, 25% CP B, and 2% CP C. Median baseline CP, MELD, and MELD-Na were 5, 9, and 10. Mean CP increases after 3, 6, 9, and 12 months were 0.84, 1.79, 1.72, and 1.33; increases in MELD 1.47, 2.88, 5.38, and 3.91; increases in MELD-Na 1.45, 2.03, 4.24, and 2.48. All changes were significantly increased from baseline. On univariate analysis, >1 tumor and cirrhosis predicted for a 1+ point increase in CP and >1 tumor and higher mean liver dose-GTV for a 2+ point increase in CP. Older age, >1 tumor, smaller GTV, and smaller max tumor dimension predicted for a 10+ point increase in MELD and >1 tumor, hep C cirrhosis, and higher baseline MELD-Na for MELD-Na. Patients treated concurrently to >1 tumor had greater increases in CP (3.60 vs. 0.81), MELD (9.33 vs. 1.97), and MELD-Na (8.47 vs. 2.19), p < 0.0001 for all, compared to those with 1 tumor. No differences were seen with gender, portal vein thrombosis, number of prior treatments and baseline Child-Pugh classifications. Conclusions: We describe a time course and predictive factors for change in CP, MELD, and MELD-Na scores after SBRT for HCCs. These should be investigated further for potential use in toxicity modeling after incorporating dosimetric parameters.

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Pre-treatment neutrophil to lymphocyte ratio (NLR) association with curative intent metastasectomy (MSX) in metastatic renal cell carcinoma (RCC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16051 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16051-e16051

Author(s):

Aline Fusco Fares ◽

Daniel Vilarim Araujo ◽

Eliza Dalsasso Ricardo ◽

Marcelo Corassa ◽

Maria Nirvana Cruz Formiga ◽

...

Keyword(s):

Proportional Hazards ◽

Univariate Analysis ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Regression Tree ◽

Positive Association ◽

Cox Proportional Hazards ◽

Curative Intent ◽

Risk Of Death ◽

Metastatic Rcc

e16051 Background: NLR is a marker of inflammation and when elevated is associated with poor outcome in many tumors, including RCC. Hereby we evaluate the association of NLR with the likelihood of curative intent MSX. Methods: We retrospectively studied 846 patients diagnosed with metastatic RCC between 2007 and 2016. 116 patients fulfilled inclusion criteria: previous nephrectomy, no sarcomatoid features and available tumor specimens from metastatic site. Regression tree for censored data method was used to find the best NLR cut-off value. NLR was examined baseline – prior to MSX or targeted therapy. Chi-square test was used to evaluate associations between variables. We estimated overall survival (OS) using Kaplan-Meier curves. Cox proportional hazards regression models were fitted to evaluate the prognostic significance of NLR in univariable and multivariable analysis. Results: The median OS for the whole cohort was 45 months (95% CI, 27.6 to 62.4 months), and the median follow-up was 78.2 months. The best cut-off NLR value was 4.07. Higher NLR was associated with shorter OS when compared to the lower NLR cohort (11.5 months vs 68.3 months HR = 0.26, 95% CI: 0.15 – 0.97, p ≤ 0.0001, respectively). Univariate analysis revealed that bone metastasis and poor IMDC criteria were associated with worse OS and that MSX and lower NLR were associated with better OS. On multivariate analysis MSX, lower NLR and favourable/intermediate group on IMDC criteria were associated with a decreased risk of death (HR = 0.41, 95% CI 0.19-0.85, p = 0.018 and HR = 0.45, 95% CI 0.22-0.90, p = 0.025, HR = 0.35, 95% CI 0.16-0.79, p = 0.012, respectively). We found a positive association of lower NLR and curative intent MSX (p = 0.002). Conclusions: NLR is a prognostic marker in metastatic RCC and a ratio ≤ 4,07 is associated with a higher likelihood of curative intent MSX.

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LDH Levels Predict Progression-Free Survival in Treatment-NaÏVe Patients with Trisomy 12 Chronic Lymphocytic Leukemia

Blood ◽

10.1182/blood.v128.22.3211.3211 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3211-3211 ◽

Cited By ~ 2

Author(s):

Francesco Autore ◽

Paolo Strati ◽

Idanna Innocenti ◽

Francesco Corrente ◽

Livio Trentin ◽

...

Keyword(s):

Research Funding ◽

Cohort Analysis ◽

Univariate Analysis ◽

External Validation ◽

Progression Free Survival ◽

Control Group ◽

Free Survival ◽

Biological Features ◽

Treatment Naïve ◽

Trisomy 12

Abstract Introduction. Patients with CLL and FISH positive for trisomy 12 (+12) have unique clinical and biological features. We, therefore, performed an analysis of the association between demographic, clinical, laboratoristic and biological features and outcomes in treatment-naive patients with +12 CLL. Methods. This study included 312 treatment-naive patients with +12 CLL from 9 centers. These patients, diagnosed between January 2000 and July 2016, were compared to a control group of 580 treatment-naive patients with FISH negative CLL, matched by age and gender and followed in the same centers. An additional cohort of 250 patients with +12 CLL followed at a single US institution was used as external validation. Results. Patients' baseline characteristics are shown in Table 1. As compared to patients with negative FISH, patients with +12 had a significant higher prevalence of elevated LDH (p<0.001), elevated β-2-microglobulin (p<0.001), ZAP70 positivity (p<0.001), CD38 positivity (p<0.001), CD49d positivity (p<0.001) and unmutated IGHV (p<0.001). Among patients with +12, 206 (66%) progressed and 193 (62%) required treatment, 76 (24%) patients died and 28 (9%) deaths were attributed to CLL. Among patients with negative FISH, 260 (45%) progressed and 213 (37%) were treated, 97 (17%) patients died and 46 (8%) deaths were attributed to CLL progression. Patients with +12 CLL showed shorter survival in terms of progression free survival (PFS: 69 months vs 110 months, p<0.001), treatment free survival (TFS: 77 months vs 125 months, p<0.001) and overall survival (OS: 147 months vs 165 months, p=0.005). Clinico-biological factors associated with shorter PFS were found performing univariate analysis among +12 CLL patients. These data were confirmed also when using the external validation group of +12 patients for ZAP70 positivity (p=0.03), CD38 positivity (p=0.004), β-2-microglobulin levels (p<0.001) and Rai stage (p<0.001). Furthermore we divided our cohort of patients with +12 CLL according to LDH levels available at diagnosis: 73 patients showed levels above the normal limit many times and 149 patients had normal levels. High LDH levels resulted associated with a shorter PFS (37 months vs 73 months, p<0.001; Figure 1), shorter TFS (41 months vs 84 months, p<0.001), shorter OS (115 months vs 155 months, p=0.002) and shorter CLL-specific survival (134 months vs 179 months, p<0.001). This association was maintained on multivariable analyses both for PFS (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.3 to 3.0; p=0.002) and TFS (HR 1.81, 95% CI 1.1-3.0; p=0.025). LDH levels were also significantly correlated to OS (p<0.05) evaluating the events attributed to CLL. Conclusions. In this large cohort analysis of 321 patients with +12 CLL, we were able to confirm that LDH levels above normal are common in this group and we observed that LDH levels independently predict a shorter PFS, TFS and CLL-specific survival in this population. LDH levels at diagnosis could allow to suspect trisomy 12 in CLL patients and predict different prognosis. Disclosures Coscia: Karyopharm: Research Funding; ROCHE: Honoraria, Other: Advisory board; Gilead: Honoraria; Mundipharma: Honoraria; Janssen: Honoraria. D'Arena:Janssen-Cilag: Honoraria. Reda:Gilead: Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees.

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Clinical factors affecting the late resistance to gefitinib in patients with non-small cell lung cancer (NSCLC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7191 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7191-7191

Author(s):

Y. Segawa ◽

K. Hotta ◽

S. Umemura ◽

Y. Fujiwara ◽

T. Shinkai ◽

...

Keyword(s):

Brain Metastasis ◽

Univariate Analysis ◽

Survival Rates ◽

Progression Free Survival ◽

Proportional Hazard ◽

Clinical Factors ◽

Free Survival ◽

Factors Affecting ◽

Cox Proportional Hazard

7191 Background: The mechanism of late resistance of NSCLC to gefitinib is unclear. In this study, we assessed clinical factors affecting the late resistance in patients with NSCLC. Methods: Between 2000 and 2004, 197 consecutive patients with NSCLC underwent treatment with gefitinib in our institutions. Of those, 56 patients who had received a prior chemotherapy and continued treatment with gefitinib during at least 6 months were included in this study. The characteristics of these patients were as follows: median age, 62.5 years (range, 28 to 77 years); male/female, 22/34 patients; PS 0/1/2/3/4, 15/31/8/0/2 patients; and adeno/nonadenocarcinoma, 52/4 patients. Thirty-two patients never smoked and 24 were former or current smokers. Nineteen patients underwent surgical resection of NSCLC. Numbers of chemotherapy regimens were one in 31 patients, two in 18, three in 6, four in 1, respectively. Results: Of 56 patients, three achieved a CR and 39 attained a PR, with an overall response rate of 75% (95% CI, 69.2 to 80.8%). The remaining 14 patients had a long SD. At a median follow-up time of 21.6 months (range, 7.7 to 59.7 months), median time to progression was 19.5 months, with progression-free survival rates of 68.5% at 1-year, 33.6% at 2-year, and 21.2% at 3-year, respectively. In a univariate analysis regarding progression-free survival, presences of metastasis to brain (p = 0.008), bone (p = 0.025), liver (p = 0.046), and adrenal (p = 0.008), decreased levels of hemoglobin (p = 0.021) and albumin (p = 0.017), and use of multiple chemotherapy regimens prior to treatment with gefitinib (p = 0.026) were significant factors. In a multivariate analysis using Cox proportional hazard model, presence of brain metastasis was a significant factor clinically affecting the late resistance to gefitinib (hazard ratio, 2.14; 95% CI, 1.10 to 4.17, p = 0.025). In addition, decreased hemoglobin level (p = 0.074) and prior multiple chemotherapy regimens (p = 0.069) were tended to be significant. Conclusions: In patients undergoing treatment with gefitinib, presence of brain metastasis was an important factor indicative of the emergence of late resistance in this study. It is needed to confirm this finding in a large cohort of patients with NSCLC. No significant financial relationships to disclose.

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Protein BIII-tubulin expression as a prognostic and/or predictive factor of response to docetaxel in patients with hormone-refractory prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.84 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 84-84

Author(s):

Quionia Perez ◽

Carlos Alvarez ◽

Lucrecia Ruiz ◽

Eduardo Gutierrez ◽

David Rodriguez ◽

...

Keyword(s):

Prostate Cancer ◽

Cohort Analysis ◽

Univariate Analysis ◽

Progression Free Survival ◽

Hormone Treatment ◽

Biochemical Response ◽

Hormone Refractory Prostate Cancer ◽

Over Expression ◽

Prostate Biopsies ◽

Hormone Refractory

84 Background: Docetaxel is a standard treatment for hormone-refractory prostate cancer. Preclinical-clinical studies suggest that the determination of the BIII-tubulin is associated with response to taxanes. This study analyzes the role of that subunit of microtubules in prostate biopsies of patients with HRPC treated with docetaxel. Methods: Thirty two patients with prostate biopsy who received docetaxel in first-line chemotherapy between 2006 and 2011 were included in this retrospective cohort analysis. The clinic-pathological characteristics, PSA response, progression-free survival (PFS) and overall survival (OS) were collected. The findings were correlated with the overexpression of BIII-tubulin protein measured by immunohistochemistry techniques (IHC) with a purified and monoclonal Ac mouse. Results: The median age and Karnofstky index (KI) were 68 years (range 49-77) and 80% (60-90) respectively. Five patients (15.6%) had received only one anti-hormone treatment, fifteen (46.8), two and twelve (37.5) more than two lines. Twenty patients (62.5) had only one metastatic localization. The median of PSA value before the docetaxel treatment was 302 (4-3745). With a median of eight cycles (3-10) of docetaxel (75mg/m2/ /3s) 41% of patients achieved biochemical response with a median PFS and OS of 4.9 and 19.6 months respectively. Moderate-intense overexpression of BIII-tubulin was identified in five patients (15.6) and minimal or absent in 27 (84.4). In univariate analysis, over-expression was correlated with KI, but not with Gleason score. PSA responses to docetaxel was observed in four patients (80%) with over-expression compared with 20% of those with minimal or absent BIII-tubulin staining. The median PFS and OS for patients with over-expression was 8.6 and 20 months respectively compared to 4.3 and 17 months for those with minimal or absent BIII-tubulin. Conclusions: Over-expression of BIII-tubulin in tumor prostate tissue, applying the present technique is unusual. Its presence appears to be related with higher biochemical response to docetaxel and improvement in PFS and OS. These findings are discordant with those previously published.

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Defining radiation induced liver toxicity in the treatment of hepatocellular carcinoma: Which metric is most predictive for survival?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.361 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 361-361

Author(s):

Tobias Robert Chapman ◽

Stephen R. Bowen ◽

Matthew J. Nyflot ◽

Smith Apisarnthanarax

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Tumor Size ◽

Cox Regression ◽

Liver Toxicity ◽

Background Radiation ◽

Univariate Analysis ◽

Hepatic Reserve ◽

Radiation Induced ◽

Pre Treatment

361 Background: Radiation induced liver disease (RILD) is of critical concern in the treatment of hepatocellular carcinoma (HCC) with radiation therapy (RT). Variability exists in metrics used to define RILD with no consensus on which best predict for overall survival (OS) and RILD-specific survival (RILDSS). We examined the correlation between toxicity metrics and clinical outcomes in a heavily pre-treated population that received RT. Methods: The charts of 37 HCC patients treated from 2013 - 2015 were reviewed retrospectively. At baseline, 62% were Child-Pugh (CP)-A, 32% CP-B and 5% CP-C. The majority (59%) had prior liver-directed therapy (LDT), 43% received stereotactic body RT and 49% proton RT. Pre-treatment, toxicity ( ≤ 6 months from treatment) and outcomes data were collected. Deaths from RILD were scored. Pre-treatment factors and toxicity outcomes were assessed by univariate Cox models for association with OS and RILDSS. Statistically significant predictors formed the basis for stepwise multivariate Cox regression to retain independent predictors of survival. Results: At a median follow-up of 8 months, 14 patients had an increase in CP score ( ≥ 2, n = 7) and 3 had ≥ G3 RTOG transaminitis. There were 11 deaths, 5 from RILD. On univariate analysis (UA), tumor size, pre-treatment liver function, prior LDT and 5 toxicity metrics (CP score increases and transaminitis) were significantly associated with OS. An increase of ≥ 1 CP score (HR 22.7, p = 0.005), pre-treatment ALBI grade (HR 6.0, p = 0.02) and tumor size (HR 1.2, p = 0.01) were independent predictors of OS on multivariate analysis (MVA). Similar factors were associated with RILDSS on UA, including ≥ 2 CP score increase and ≥ G3 ALT elevation; however, only pre-treatment CP score (HR 4.0, p = 0.01) and tumor size (HR 1.5, p = 0.03) were independently predictive on MVA. Conclusions: Pre-treatment liver functional status and tumor size were highly predictive of OS and RILDSS, suggesting that baseline functional hepatic reserve is the primary determinant in developing fatal RILD rather than post-RT changes in liver function. Further work is needed to define dosimetric parameters and pre-treatment factors that predict RILD toxicity.

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Oncologic Outcomes of Surgery in T3 Prostate Cancer: Experience of a Single Tertiary Center

Advances in Urology ◽

10.1155/2012/164263 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

D. Milonas ◽

G. Smailyte ◽

M. Jievaltas

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Cox Regression ◽

Progression Free Survival ◽

Oncologic Outcomes ◽

Cancer Specific Survival ◽

Free Survival ◽

Risk Of Death ◽

Tertiary Center

Aim. The aim of this study is to present the oncologic outcomes and to determine the prognostic factors of overall survival (OS), cancer-specific survival (CSS), disease-progression-free survival (DPFS), and biochemical-progression-free survival (BPFS) after surgery for pT3 prostate cancer (PCa).Methods. Between 2002 and 2007, a pT3 stage after radical prostatectomy was detected in 182 patients at our institution. The Kaplan-Meier analysis was used to calculate OS, CSS, DPFS, and BPFS. Cox regression was used to identify predictive factors of survival.Results. pT3a was detected in 126 (69%) and pT3b in 56 (31%) of cases. Five-year OS, CSS, DPFS, and BPFS rates were 90.7%, 94%, 91.8%, and 48.4%, respectively. Survival was significantly different when comparing pT3a to pT3b groups. The 5-year OS, CSS, DPFS, and BPFS were 96% versus 72%, 98% versus 77%, 97.3% versus 79.3%, and 60% versus 24.2%, respectively. Specimen Gleason score was the most significant predictor of OS, CSS, DPFS, and BPFS. The risk of death increased up to 3-fold when a Gleason score 8–10 was present at the final pathology.Conclusions. Radical prostatectomy may offer very good CSS, OS, DPFS, and BPFS rates in pT3a PCa. However, outcomes in patients with pT3b or specimen Gleason ≥8 were significantly worse, suggesting the need for multimodality treatment in those cases.

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PET metabolic tumor volume as a new prognostic factor in childhood rhabdomyosarcoma

PLoS ONE ◽

10.1371/journal.pone.0261565 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261565

Author(s):

Helio Fayolle ◽

Nina Jehanno ◽

Valerie Lauwers-Cances ◽

Marie-Pierre Castex ◽

Daniel Orbach ◽

...

Keyword(s):

Tumor Volume ◽

Primary Tumour ◽

Univariate Analysis ◽

Progression Free Survival ◽

Distant Metastases ◽

Metabolic Tumor Volume ◽

University Hospitals ◽

Prognostic Accuracy ◽

Tumour Spread ◽

Bone Lysis

Purpose Childhood RMS is a rare malignant disease in which evaluation of tumour spread at diagnosis is essential for therapeutic management. F-18 FDG-PET imaging is currently used for initial RMS disease staging. Materials and methods This multicentre retrospective study in six French university hospitals was designed to analyse the prognostic accuracy of MTV at diagnosis for patients with RMS between 1 January 2007 and 31 October 2017, for overall (OS) and progression-free survival (PFS). MTV was defined as the sum of the primitive tumour and the largest metastasis, where relevant, with a 40% threshold of the primary tumour SUVmax. Additional aims were to define the prognostic value of SUVmax, SUVpeak, and bone lysis at diagnosis. Results Participants were 101 patients with a median age of 7.4 years (IQR [4.0-12.5], 62 boys), with localized disease (35 cases), regional nodal spread (43 cases), or distant metastases (23). 44 patients had alveolar subtypes. In a univariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 3.47 [1.79;6.74], p<0.001) and PFS (HR = 3.03 [1.51;6.07], p = 0.002). SUVmax, SUVpeak, and bone lysis also influenced OS (respectively p = 0.005, p = 0.004 and p = 0.007) and PFS (p = 0.029, p = 0.019 and p = 0.015). In a multivariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 2.642 [1.272;5.486], p = 0.009) and PFS (HR = 2.707 [1.322;5.547], p = 0.006) after adjustment for confounding factors, including SUVmax, SUVpeak, and bone lysis. Conclusion A metabolic tumor volume greater than 200 cm3, SUVmax, SUVpeak, and bone lysis in the pre-treatment assessment were unfavourable for outcome.

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