scholarly journals Cancer of unknown primary origin: utility and futility in clinical practice

2012 ◽  
Author(s):  
Gianluca Airoldi
Keyword(s):  
Quality Of Life ◽  
Primary Tumor ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Cancer Of Unknown Primary ◽  
Current Evidence ◽  
Unknown Primary ◽  
Dismal Prognosis ◽  
Poorly Differentiated

Introduction Metastatic cancer of unknown primary (CUP) origin is one of the 10 most frequent cancers in humans; it accounts for approximately 3% to 5% of all solid malignancies. Patients with CUP present with metastatic disease whose site of origin cannot be identified at the time of diagnosis despite a thorough history, physical examination and appropriate laboratory testing, histopathology investigations and modern imaging technology (including computed tomography, magnetic resonance imaging, and positron emission tomography).Materials and methods A “state of the art” review was written reflecting all articles retrieved through a PubMed Medline search with the keywords “cancer of unknown primary”, “occult primary tumor”, and “metastases of unknown origin”, with no limits regarding date of publication, type of article, or field.Results CUP represents a heterogeneous group of malignancies that can be classified into distinct clinicopathological entities. Certain entities are included in favorable sub-sets that are responsive to systemic chemotherapy and/or locoregional treatment: these include poorly differentiated carcinomas involving the mediastinal–retroperitoneal nodes, peritoneal papillary serous adenocarcinomatosis in females, poorly differentiated neuroendocrine carcinomas, isolated axillary node adenocarcinomas in females, cervical and inguinal node involvement by squamous cell carcinoma, and any other single metastatic site of limited extension. In these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Therefore, invasive endoscopic and laparoscopic procedures are rarely warranted in the absence of symptoms. Patients who belong to the non-favorable sub-sets (mainly metastatic CUP involving the liver, lung/pleura, brain, bones, or multiple sites) or have a poor performance status have a dismal prognosis (average median survival of 4-8 months).Discussion The current evidence does not support the hypothesis that palliative chemotherapy improves survival and/or quality of life in CUP patients who do not fit into any of the favorable sub-sets. Therefore, only low-toxicity empirical chemotherapy regimens should be offered to patients with a good performance status, and quality of life issues should be given priority for any choice of treatment.

Psychiatric manifestations, personality traits and health-related quality of life in cancer of unknown primary site

2013 ◽  
Vol 22 (9) ◽  
pp. 2009-2015 ◽  
Author(s):  
Thomas Hyphantis ◽  
Ilias Papadimitriou ◽  
Dimitrios Petrakis ◽  
George Fountzilas ◽  
Dimitra Repana ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Health Related Quality ◽  
Unknown Primary Site ◽  
Related Quality ◽  
Health Related ◽  
Psychiatric Manifestations

P12.07 The potential of cannabinoids to improve quality of life in glioma patients: A meta-analysis in patients with neurological and oncological disease

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii32-ii32
Author(s):  
V Belgers ◽  
J G Röttgering ◽  
L Douw ◽  
M Klein ◽  
P M van de Ven ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Meta Analysis ◽  
Well Being ◽  
Risk Of Bias ◽  
Added Value ◽  
Current Evidence ◽  
Cns Disease ◽  
Dismal Prognosis ◽  
Mental Well Being

Abstract BACKGROUND Gliomas are primary brain tumors with a dismal prognosis. Reducing symptoms and maintaining quality of life (QoL) are main treatment aims in glioma patients. Mental well-being is an important subdomain of QoL. Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety or depression. Glioma patients frequently report unprescribed cannabinoid use for these reasons. We performed a meta-analysis of the current evidence on cannabinoid efficacy on QoL and mental well-being to identify its added value in treatment of glioma patients. MATERIAL AND METHODS We performed a systematic PubMed, Embase and Web of Science search according to the PRISMA guidelines on September 22nd and 23rd, 2020. The effects of any dose of tetrahydrocannabinol (THC) or cannabidiol (CBD) on both general QoL and mental well-being were evaluated. The intervention had to be given for at least a week to establish a steady-state concentration. Effect size was calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane’s Risk of Bias tool 2.0. RESULTS We retrieved no publications on cannabinoids use and QoL in glioma and, therefore, we expanded the search to cannabinoid use in other cancer types and chronic central nervous system (CNS) diseases. Sixteen studies were identified: four in cancer and twelve in CNS disease. Meta-analysis showed no effect of cannabinoids on general QoL (twelve studies in 1,740 patients; g = -0.02, 95% CI -0.11 to 0.07, p = 0.65) and mental well-being (twelve studies in 1,587 patients; g = -0.00, 95% CI -0.15 to 0.14, p = 0.96). Risk of bias was low in five studies, raised some concern in one study and was high in ten studies, mainly due to possible unblinding of patients after psychoactive adverse effects. CONCLUSION No studies on the effects of cannabinoids on QoL in glioma patients have been reported. A pooled analysis of studies in oncological patients and patients with CNS disease showed no effect of cannabinoids on QoL or mental well-being. However, studies were clinically heterogeneous and only one small study investigated monotherapy CBD with undecided results. As many glioma patients currently use cannabinoids, and monotherapy CBD has not been sufficiently investigated, future studies are necessary to evaluate its value in this specific population. SUPPORT/DISCLOSURE This meta-analysis has been funded by The Anita Veldman Foundation (CCA-2019-2-21).

scholarly journals QOLP-07. A PILOT STUDY TO ASSESS THE INTEGRATION OF A UNIQUE PROQOL TOOL AND EARLY PALLIATIVE CARE INTERVENTION IN THE CARE OF HIGH GRADE GLIOMA PATIENTS AND THEIR CAREGIVERS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi198-vi199
Author(s):  
Akanksha Sharma ◽  
Eric Wolfe ◽  
Celina Barrera ◽  
Samantha Williamson ◽  
Hannah Farfour ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Metastatic Cancer ◽  
Performance Status ◽  
High Grade Glioma ◽  
Smart Device ◽  
Control Group ◽  
High Grade ◽  
Patient Reported

Abstract BACKGROUND Early involvement of palliative care (PC) in patients with metastatic cancer has been associated with improved quality of life (QOL). Patients with high grade glioma (pwHGG) and their caregivers have unique needs such that similar results are anticipated in this population but cannot be extrapolated. Recognizing that pwHGG often require a caregiver early in the course of disease, this patient population also experiences significant personal and caregiver distress that has been given limited attention and resources. AIM: To assess the feasibility of implementation of a novel patient reported outcomes (PRO) quality of life (QOL) tool administered by smart device in routine office visit (OV) and early integration of palliative care (PC) for pwHGG and their caregivers to improve QOL for both. DESIGN: Prospective, single-center cluster-randomized pilot conducted for 6 months during completion of adjuvant therapy for newly diagnosed high grade glioma. After informed consent was obtained, 15 pwHGG and their caregivers were randomized to: routine OV with basic QOL survey; OV with PROQOL; or PC consultation, in addition to OV with PROQOL. RESULTS Two elderly patients with declining performance status transitioned to hospice after initial visit, and one moved out of state prior to adjuvant visits. Thus far 5/15 patients/caregivers have successfully completed the pilot with the 6 remaining participants due to complete in November 2019. DISCUSSION The PROQOL appears to be easily integrated into OV without significant patient, caregiver, or provider burden. Providers confirmed utility in prioritizing symptoms and concerns. Thus far, it appears that patients (and caregivers) appeared to benefit from the PROQOL and PC support as evidenced by longitudinal improvement in QOL scores over the control group. CONCLUSIONS A unique PROQOL tool and early PC can be easily integrated into practice, and may improve the QOL of pwHGG and their caregivers.

Quality of Life of Patients with Spinal Metastasis from Cancer of Unknown Primary Origin

2017 ◽  
Vol 99A (19) ◽  
pp. 1629-1639 ◽  
Author(s):  
Yifei Ma ◽  
Shaohui He ◽  
Tielong Liu ◽  
Xinghai Yang ◽  
Jian Zhao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Metastasis ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Primary Origin ◽  
Unknown Primary Origin

scholarly journals Prediction of Primary Tumors in Cancers of Unknown Primary

2017 ◽  
Vol 14 (2) ◽  
Author(s):  
Dan Søndergaard ◽  
Svend Nielsen ◽  
Christian N.S. Pedersen ◽  
Søren Besenbacher
Keyword(s):  
Primary Tumor ◽  
Metastatic Cancer ◽  
Large Fraction ◽  
Molecular Data ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Expression Data ◽  
Tumor Biopsy ◽  
Primary Tumors ◽  
The Right

AbstractA cancer of unknown primary (CUP) is a metastatic cancer for which standard diagnostic tests fail to identify the location of the primary tumor. CUPs account for 3–5% of cancer cases. Using molecular data to determine the location of the primary tumor in such cases can help doctors make the right treatment choice and thus improve the clinical outcome. In this paper, we present a new method for predicting the location of the primary tumor using gene expression data: locating cancers of unknown primary (LoCUP). The method models the data as a mixture of normal and tumor cells and thus allows correct classification even in impure samples, where the tumor biopsy is contaminated by a large fraction of normal cells. We find that our method provides a significant increase in classification accuracy (95.8% over 90.8%) on simulated low-purity metastatic samples and shows potential on a small dataset of real metastasis samples with known origin.

Identifying biomarkers to guide immunotherapy treatment of cancer of unknown primary.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15252-e15252
Author(s):  
Linda R. Mileshkin ◽  
Atara Posner ◽  
Andrew Pattison ◽  
Shiva Balachander ◽  
Dariush Etemadmoghadam ◽  
...  
Keyword(s):  
Gene Expression ◽  
Immune Response ◽  
Metastatic Cancer ◽  
Expression Patterns ◽  
Genomic Data ◽  
Cancer Of Unknown Primary ◽  
Immune Response Gene ◽  
Current Evidence ◽  
Unknown Primary ◽  
Immune Gene

e15252 Background: Cancer of unknown primary (CUP) is a metastatic cancer where the primary tissue of origin (ToO) evades detection despite extensive clinical investigation. Recent approaches to the management of CUP have involved gene-expression profiling to resolve the likely ToO and mutational profiling to identify targeted treatments. Current evidence is that both of these methods can have some clinical benefit but only in a minority of cases. Immunotherapy may also be effective in CUP, but clinical trials looking at this are yet to report and the best way to select patients who may benefit is uncertain. Methods: Through a national cohort study called Solving Unknown Primary Cancer (SUPER), 245 CUP patients had molecular profiling performed and clinical follow-up. Variant detection from DNA sequencing using a targeted panel of 386 genes (SureSelect Agilent) was used to calculate tumour mutation burden (TMB). Additionally, a custom gene expression assay including 225 genes associated with ToO and 35 immune genes (SUPERDx, nCounter NanoString) was used to classify the likely ToO and immune profile the tumours. We used the genomic data from 217 of these patients to explore interdependencies between immune gene-expression patterns and TMB. We also retrospectively reviewed the outcomes of patients treated with anti-PD1/PD-L1 immune checkpoint inhibition (ICI) therapy in whom genomic data was available. Results: TMB was weakly correlated with a gene-expression score for immune response (IR) based on averaged z-score values of six genes (CD8A, IFNG, PRF1, PD-L1, GZMA, GZMB) (Spearman rho = 0.21) with many outliers exhibiting low TMB but high IR scores. Among twenty patients treated with ICIs, with both molecular data and response data available, 6 had a partial response (PR), 5 had stable disease (SD) and 9 had progressive disease (PD). We found that an elevated IR score was more predictive of ICI response than TMB. Most patients with either PR or SD to ICI treatment had a high IR score (9/10), and most patients with PD had low IR scores. However, only 3/10 patients with TMB available and a PR or SD had a high TMB ( > 10). Conclusions: Our results demonstrate that ICI therapy may benefit some CUP patients and that an immune response gene-expression scoremay predict ICI treatment response.

scholarly journals Feminizing adrenocortical carcinoma with distant metastases: can surgery be considered?

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Alessandro Fancellu ◽  
Antonio Pinna ◽  
Alberto Porcu
Keyword(s):  
Quality Of Life ◽  
Rare Diseases ◽  
Adrenocortical Carcinoma ◽  
Primary Tumor ◽  
Stage Iv ◽  
Distant Metastases ◽  
Dismal Prognosis ◽  
Acceptable Quality ◽  
Adrenocortical Carcinomas

Functioning adrenocortical carcinomas are rare diseases with dismal prognosis. A 41-year-old man presenting with gynecomastia had a giant feminizing adrenocortical carcinoma at stage IV. Although surgical resection was controversial, we removed the primary tumor to reduce the mass effects. He lived for 12 months with an acceptable quality of life. Gynecomastia may be the first sign of feminizing adrenal malignancies. Surgery may ameliorate the quality of life in selected patients with metastatic disease.

scholarly journals The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 773
Author(s):  
Wei-Ting Wu ◽  
Tsung-Min Lee ◽  
Der-Sheng Han ◽  
Ke-Vin Chang
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Current Evidence ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

scholarly journals Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival

2020 ◽  
Author(s):  
Lars Axelsson ◽  
Erik Holmberg ◽  
Jan Nyman ◽  
Anders Högmo ◽  
Helena Sjödin ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Prognostic Factors ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Multicenter Study ◽  
Performance Status ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
N Stage

Abstract Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.

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