1
|
Von Werne K, Mair K, Fader ME, DeAngulo G, Eiseler N, Kalman NS, Press RH, Daghistani D, Jimenez R, Paraliticci G, Pretell J, Chang JHC, Vern-Gross TZ, Mihalcik SA, Kwok Y, Tsai HK, Zeng J, Rotondo R, Wolden SL, Hall MD. Multi-Institutional Experience of Proton Therapy for Rhabdomyosarcoma and Ewing Sarcoma in the Proton Collaborative Group (PCG) Prospective Registry. Int J Radiat Oncol Biol Phys 2023; 117:e551-e552. [PMID: 37785696 DOI: 10.1016/j.ijrobp.2023.06.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report on outcomes, acute toxicities, and the use of dose-escalation with proton therapy (PT) in patients with rhabdomyosarcoma and Ewing sarcoma in a prospective multi-institutional registry (PCG). MATERIALS/METHODS Data on patients with primary rhabdomyosarcoma and Ewing sarcoma treated with definitive PT (defined as ≥45 Gy) were queried from the PCG registry. A similar query was performed of our institutional database with IRB approval. Overall survival rates were calculated by Kaplan-Meier. Toxicities were scored using CTCAE v4.0. RESULTS A total of 354 patients across 10 institutions (203 rhabdomyosarcoma, 151 Ewing sarcoma) met the eligibility criteria. Median age was 9 years (Interquartile Range: 5-15). Median dose was 50.4 GyRBE for rhabdomyosarcoma patients (Range: 45-66 GyRBE) and 55.8 GyRBE for Ewing sarcoma patients (Range: 45-66 GyRBE). Median follow-up was 2.4 years (Range 0.3-12.3 years). Two-year overall survival rates were 81.1% (95% CI: 73.7%-88.5%) for rhabdomyosarcoma and 79.1% (95% CI: 71.7%-86.2%) for Ewing sarcoma. The Table lists the prescription doses delivered by tumor histology; 28.1% of rhabdomyosarcoma and 21.9% of Ewing sarcoma patients, respectively, received dose-escalated radiotherapy (defined as >50.4 Gy for rhabdomyosarcoma and >55.8 Gy for Ewing sarcoma). Excluding alopecia and skin desquamation, 153 patients (43.2%) developed any acute grade 2+ non-hematologic toxicity, while 49 patients (13.8%) developed one or more grade 3 toxicities. The most common grade 3 toxicities were anorexia/weight loss (7.3%), pain (7.3%) mucositis/esophagitis (4.8%), and nausea/vomiting (3.1%). One grade 4 toxicity (esophagitis) and no deaths were reported during treatment. CONCLUSION In this multi-institutional prospective registry, 28.1% of rhabdomyosarcoma and 21.9% of Ewing sarcoma patients received dose-escalated PT, with 13.8% of patients developing grade 3 toxicities. Long-term outcomes for disease control and late toxicity and anticipated cooperative group trial results are needed to fully assess the benefits and risks of dose-escalated radiotherapy for these tumors.
Collapse
Affiliation(s)
- K Von Werne
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - K Mair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M E Fader
- Nicklaus Children's Hospital, Miami, FL
| | | | - N Eiseler
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N S Kalman
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R H Press
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - D Daghistani
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R Jimenez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - G Paraliticci
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J Pretell
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J H C Chang
- Oklahoma Proton Center/OU Health Science Center, Oklahoma City, OK
| | - T Z Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S A Mihalcik
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - H K Tsai
- ProCure Proton Therapy Center, Somerset, NJ
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Rotondo
- University of Kansas, Kansas City, KS
| | - S L Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M D Hall
- Miami Cancer Institute, Miami, FL
| |
Collapse
|
2
|
Mair K, Von Werne K, Kalman NS, Eiseler N, Jimenez R, Paraliticci G, Pretell J, Press RH, Chang JHC, Vern-Gross TZ, Mihalcik SA, Zeng J, Kwok Y, Tsai HK, Simone CB, Chuong MD, Hall MD. Multi-Institutional Experience of Proton Therapy for Osteosarcoma in the Proton Collaborative Group (PCG) Prospective Registry. Int J Radiat Oncol Biol Phys 2023; 117:e322. [PMID: 37785149 DOI: 10.1016/j.ijrobp.2023.06.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report on the utilization of dose-escalated radiotherapy, acute toxicities, and survival following definitive proton therapy (PT) for osteosarcoma patients in a prospective multi-institutional study. MATERIALS/METHODS Data on patients with osteosarcoma treated with definitive intent PT were queried from the Proton Collaborative Group (PCG) prospective registry. A similar query was performed on an institutional database with IRB approval. Overall survival rates were calculated by Kaplan-Meier. Toxicities were scored using CTCAE v4.0. RESULTS Forty osteosarcoma patients across 9 institutions received definitive intent PT between 2011-2021 and met the eligibility criteria. Median age was 32 years (Range: 6-86 years). Median PT dose was 66.6 GyRBE (Range: 50.4-80.0 GyRBE); 38 patients received proton therapy alone, whereas 2 received combined proton/photon therapy. Seventeen (42.5%) patients received doses ≥70 GyRBE. Median follow-up was 3.1 years (Range: 0.9-10.5 years). One-year and three-year overall survival rates were 83.5% and 59.1%, respectively, with 14 deaths due to disease. Excluding skin desquamation and alopecia, 22 patients (55.0%) developed any acute grade 2+ toxicity, and 5 patients (12.5%) developed any grade 3 toxicities. No acute grade 4-5 toxicities were reported. The most frequent grade 2+ non-skin toxicities were fatigue (37.5%), anorexia/weight loss (17.5%), mucositis/esophagitis (22.5%), pain (20.0%), and nausea/vomiting (10.0%). The most frequent grade 3 toxicities were anorexia/weight loss (5.0%), mucositis/esophagitis (5.0%), and neurologic symptoms (5.0%). CONCLUSION In this multi-institutional study, 42.5% of osteosarcoma patients treated with PT received doses between 70-80 Gy, with 12.5% experiencing any grade 3 toxicity. Long-term outcomes for disease control, late toxicity, and quality-of-life are needed to more fully assess the benefits and risks of dose-escalated radiotherapy in this radioresistant tumor. The authors plan to assess the outcomes of osteosarcoma patients treated with dose-escalated radiotherapy for unresectable or gross residual disease in future studies.
Collapse
Affiliation(s)
- K Mair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - K Von Werne
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N S Kalman
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N Eiseler
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R Jimenez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - G Paraliticci
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J Pretell
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R H Press
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J H C Chang
- Oklahoma Proton Center/OU Health Science Center, Oklahoma City, OK
| | | | - S A Mihalcik
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - H K Tsai
- ProCure Proton Therapy Center, Somerset, NJ
| | | | - M D Chuong
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M D Hall
- Miami Cancer Institute, Miami, FL
| |
Collapse
|
3
|
Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
Shrivastava G, Jarboe J, Ahmed A, Conway S, Pretell J, Wolfson A, Freedman L, Rosenberg A, Trent J, Yechieli R. Pathologic Response Rates after Neoadjuvant Therapy For Sarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Nash TE, Pretell J, Garcia HH. Calcified cysticerci provoke perilesional edema and seizures. Clin Infect Dis 2001; 33:1649-53. [PMID: 11595994 DOI: 10.1086/323670] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2001] [Revised: 05/25/2001] [Indexed: 11/03/2022] Open
Abstract
In cases of cysticercosis, seizures and other symptoms occur in persons with only calcified brain lesions. The presence of perilesional edema has been documented in association with calcified lesions in symptomatic patients, but the frequency of this complication and characteristics of the patients who develop it are not known. Patients in Peru and the United States with neurocysticercosis, documented by positive results of serological testing and with only calcified lesions as shown using computerized tomography, were studied using magnetic resonance imaging. Perilesional edema was observed in slightly more than one-third of the patients, and some patients had frequent, severely disabling episodes. Those with an increased proportion of enhancing calcified lesions were more likely to show perilesional edema. Edema around calcified lesions is common in this population and is associated with seizures and neurological morbidity.
Collapse
Affiliation(s)
- T E Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | |
Collapse
|
6
|
Abstract
Sixteen individuals presenting with seizures in a rural village of Peru were screened for antibodies to Taenia solium, and those willing to attend were offered a complete neurological work-up including EEG and cerebral CT scan in a reference center. Seroprevalence using immunoblot was 35% (5/16). Eight individuals came for examination. CT scans were abnormal in all four seropositive cases (an enhancing lesion in one case, multiple live cysts and calcifications in one case, and multiple calcifications in two cases), and normal in the four seronegative individuals. Electroencephalographic tracings were normal in six cases, and abnormal in one seronegative and in one seropositive individual. Neurocysticercosis (NCC) is frequently found in epileptic individuals in most developing countries, and is probably the major cause of seizures in this zone.
Collapse
Affiliation(s)
- H H Garcia
- Department of Microbiology and Pathology, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | | | | | | |
Collapse
|
7
|
Flyer DC, Pretell J, Campbell AE, Liao WS, Tevethia MJ, Taylor JM, Tevethia SS. Biology of simian virus 40 (SV40) transplantation antigen (TrAg). X. Tumorigenic potential of mouse cells transformed by SV40 in high responder C57BL/6 mice and correlation with the persistence of SV40 TrAg, early proteins and sequences. Virology 1983; 131:207-20. [PMID: 6316651 DOI: 10.1016/0042-6822(83)90546-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Primary mouse embryo fibroblasts of C57Bl/6 origin and cells derived from a tumor induced by polyoma virus in a C57Bl/6 mouse were transformed with SV40. The tumorigenic potential of these cells in normal adult and SV40-immunized mice was correlated with the synthesis of SV40 tumor antigens including the transplantation rejection antigen (TrAg) and with the presence of SV40 early region DNA sequences. Primary cells transformed by SV40 (B6/WT-3) induced tumors in immunocompetent adult syngeneic mice after adaptation in the immunosuppressed host. Passage of these tumor cells (B6/WT-3-T) through SV40-immunized mice resulted in the retention of both T and t antigens and TrAg. However, passage of SV40-transformed polyoma tumor cells through SV40-immunized immunocompetent adult mice but not in nonimmunized mice resulted in the loss of expression of SV40 tumor antigens including TrAg. This loss correlated with the loss of SV40 early region sequences from these double transformed cells. These results demonstrate that the establishment of in vitro SV40-transformed primary mouse cells into a tumor capable of progressive growth in high responder mice does not lead to the selection of variants which have lost the expression of early region DNA sequences.
Collapse
|
8
|
Kemp J, Louie D, Mattingly J, Bennett J, Higuchi C, Pretell J, Horowitz M, Gershon R. Suppressor cells in vitro: differential effects of indomethacin and related compounds. J Immunopharmacol 1980; 2:471-89. [PMID: 6451653 DOI: 10.3109/08923978009026407] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In vitro immune response systems known to involve suppressor cell regulation were examined for effects produced by the drug indomethacin and other compounds known to inhibit the cyclooxygenase pathway of arachidonic acid metabolism. In all cases tested where suppressor T cell activity is known to be the dominant inhibitory mechanism, suppression was not blocked by drug addition and was sometimes more pronounced. In the cases tested where suppression could be attributed to a non-T cell, most likely a macrophage-like cell (M0), suppression could be abolished by drug treatment. Indomethacin and related compounds may be useful analytical tools for separation of T cell vs. non-T cell mediated suppression.
Collapse
|
9
|
Pretell J, Greenfield RS, Tevethia SS. Biology of simian virus 40 (SV40) transplantation antigen (TrAg). V In vitro demonstration of SV40 TrAg in SV40 infected nonpermissive mouse cells by the lymphocyte mediated cytotoxicity assay. Virology 1979; 97:32-41. [PMID: 224580 DOI: 10.1016/0042-6822(79)90370-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
10
|
Pretell EA, Moncloa F, Salinas R, Kawano A, Guerra-Garcia R, Gutierrez L, Beteta L, Pretell J, Wan M. Prophylaxis and treatment of endemic goiter in Peru with iodized oil. J Clin Endocrinol Metab 1969; 29:1586-95. [PMID: 4310499 DOI: 10.1210/jcem-29-12-1586] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|