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Sinukumar S, Rajan F, Mehta S, Damodaran D, Zaveri S, Kammar P, Bhatt A. A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer - A study by INDEPSO. Eur J Surg Oncol 2021; 47:75-81. [PMID: 30857879 DOI: 10.1016/j.ejso.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare clinical outcomes following total and selective peritonectomy performed during interval cytoreductive surgery (CRS) for stage IIIC/IVA serous epithelial ovarian cancer. METHODS In this retrospective study, extent of peritonectomy was classified as total parietal peritonectomy (TPP) which comprised of removal of the entire parietal peritoneum and the greater and lesser omenta or selective parietal peritonectomy (SPP) that included 1/>1 of parietal peritonectomies performed to resect sites of residual disease. A comparison of patient and disease characteristics, morbidity, mortality and survival outcomes between the two groups was made. RESULTS From January 2013 to December 2017, 79 patients underwent CRS (TPP-30, SPP-49) with or without intraperitoneal chemotherapy (IPC). The median PCI was 14 for TPP and 8 for SPP. The 90-day grade 3-4 morbidity (23.3% for TPP, 14.2% for SPP, p = 0.58) the 90-day mortality was similar (p = 0.58). The median disease free survival (DFS) was 37 months for SPP and 33 months for TPP (p = 0.47) and median overall survival (OS) not reached for both. The 3-year OS was 95% for TPP and 70.8% for SPP (p = 0.06). The only independent predictor of OS was grade 3-4 morbidity (p = 0.01) and not TPP (p = 0.09). Microscopic residual disease was seen in 23.3% with normal looking peritoneum in TPP group. CONCLUSIONS TPP was not associated with increased morbidity compared to SPP. There was a trend towards a longer OS in the TPP group and the finding of residual disease in 'normal looking' peritoneum' warrants prospective evaluation of the benefit of TPP in this setting.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/surgery
- Cytoreduction Surgical Procedures
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/surgery
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/surgery
- Postoperative Complications
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center, Coimbatore, India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Centre and Research Institute, Calicut, India
| | | | - Praveen Kammar
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India.
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Fang C, Zhang Y, Zhao L, Chen X, Xia L, Zhang P. The relationship between retroperitoneal lymphadenectomy and survival in advanced ovarian cancer patients. BMC Cancer 2020; 20:654. [PMID: 32660444 PMCID: PMC7359502 DOI: 10.1186/s12885-020-07144-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients. Nevertheless, the corresponding therapeutic may not provide a survival benefit. The aim of this study was to assess the effect of systematic retroperitoneal lymphadenectomy in such patients. METHODS Patients with advanced ovarian cancer (stage III-IV, according to the classification presented by the International Federation of Gynecology and Obstetrics) who were admitted and treated in Zhejiang Cancer Hospital from January 2004 to December 2013 were enrolled and reviewed retrospectively. All patients were optimally or suboptimally debulked (absent or residual tumor < 1 cm) and divided into two groups. Group A (no-lymphadenectomy group, n = 170): patients did not undergo lymph node resection; lymph nodes resection or biopsy were selective. Group B (n = 240): patients underwent systematic retroperitoneal lymphadenectomy. RESULTS A total of 410 eligible patients were enrolled in the study. The patients' median age was 51 years old (range, 28-72 years old). The 5-year overall survival (OS) and 2-year progression-free survival (PFS) rates were 78 and 24% in the no-lymphadenectomy group and 76 and 26% in the lymphadenectomy group (P = 0.385 and 0.214, respectively). Subsequently, there was no significant difference in 5-year OS and 2-year PFS between the two groups stratified to histological types (serous type or non-serous type), the clinical evaluation of negative lymph nodes or with macroscopic peritoneal metastasis beyond pelvic (IIIB-IV). Multivariate Cox regression analysis indicated that systematic retroperitoneal lymphadenectomy was not a significant factor influencing the patients' survival. Patients in the lymphadenectomy group had a higher incidence of postoperative complications (incidence of infection treated with antibiotics was 21.7% vs. 12.9% [P = 0.027]; incidence of lymph cysts was 20.8% vs. 2.4% [P < 0.001]). CONCLUSIONS Our study showed that systematic retroperitoneal lymphadenectomy did not significantly improve survival of advanced ovarian cancer patients with residual tumor < 1 cm or absent after cytoreductive surgery, and were associated with a higher incidence of postoperative complications.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/secondary
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/secondary
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/secondary
- Cystadenocarcinoma, Serous/surgery
- Cytoreduction Surgical Procedures/mortality
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/secondary
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision/mortality
- Lymphatic Metastasis
- Middle Aged
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/secondary
- Peritoneal Neoplasms/surgery
- Prognosis
- Retroperitoneal Space/pathology
- Retroperitoneal Space/surgery
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Chenyan Fang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Yingli Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Lingqin Zhao
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Xi Chen
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Liang Xia
- Department of Neurosurgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Ping Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
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González IA, Kang LI, Williams GA, Liu J, DeNardo DG, Hawkins WG, Chatterjee D. Tumor-insular Complex in Neoadjuvant Treated Pancreatic Ductal Adenocarcinoma Is Associated With Higher Residual Tumor. Am J Surg Pathol 2020; 44:817-825. [PMID: 32091434 PMCID: PMC7225071 DOI: 10.1097/pas.0000000000001454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The tumor microenvironment in pancreatic ductal adenocarcinoma (PDAC) plays a vital role in treatment response, and therefore, patient survival. We and others have observed an intimate association of neoplastic ductal cells with non-neoplastic islet cells, recapitulating the ductoinsular complex. We define this phenomenon as tumor-insular complex (TIC). Herein, we describe the clinicopathologic characteristics of TIC in neoadjuvant treated PDAC cases for the first time. We retrospectively reviewed the pathology of 105 cases of neoadjuvant treated PDAC resected at our institution. TIC was noted in 35 cases (33.3%), the mean tumor bed size was 2.7±1.0 cm, mean percentage of residual tumor 40±28% and mean Residual Tumor Index (RTI) (an index previously established as a prognostic parameter by our group) was 1.1±1.0. TIC was significantly associated with perineural invasion (P=0.001), higher tumor bed size (P=0.007), percentage of residual tumor (P=0.009), RTI (P=0.001), ypT stage (P=0.045), and poor treatment response, grouped by a previously established criteria (P=0.010). Using our prior binary reported prognostic cutoff for RTI of ≤0.35 and >0.35, TIC was associated with a RTI >0.35 (P=0.002). Moreover, patients who did not receive neoadjuvant radiation were associated with a higher frequency of TIC (P=0.003). In this cohort, RTI but not TIC was also shown to be a significant independent prognosticator for recurrence-free survival and overall survival on multivariate analysis. In conclusion, TIC is significantly associated with a more aggressive neoplasm which shows a poor treatment response. Further studies will be needed to better understand the tumor biology of TICs.
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Affiliation(s)
- Iván A. González
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
| | - Liang-I Kang
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
| | - Gregory A. Williams
- Division of HPB and GI surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Jingxia Liu
- Division of Public Health, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - David G. DeNardo
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - William G. Hawkins
- Division of HPB and GI surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
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Ikuta S, Aihara T, Yamanaka N. Preoperative C-reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma. Asia Pac J Clin Oncol 2019; 15:e109-e114. [PMID: 30632282 DOI: 10.1111/ajco.13123] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
Abstract
AIM Systemic inflammation and nutritional status are associated with clinical outcomes of cancer patients. We investigated the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in patients with pancreatic ductal adenocarcinoma (PDA) after pancreatic resection. METHODS One-hundred and thirty-six PDA patients who underwent pancreatic resection between January 2005 and June 2017 were retrospectively enrolled. Preoperative inflammation-based scores including CAR, modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were evaluated as potential predictor of overall survival (OS) using Cox regression models. An optimal cutoff value for the continuous variable was estimated by receiver-operating characteristic (ROC) analysis. RESULTS Patients were categorized by CAR using a cutoff value of 0.09. High CAR was associated with advanced stage, increased mGPS and decreased LMR and PNI, but not with other factors such as tumor location, preoperative biliary drainage or preoperative chemotherapy. In univariate analysis, patients with high CAR had poor OS compared with those with low CAR (P = 0.01). Multivariate analysis indicated that high CAR was an independent predictor of poor OS (P = 0.03) in addition to advanced stage and residual tumors. The predictive ability of CAR evaluated by area under the ROC curve was consistently higher than that of other inflammation-based factors. CONCLUSION Preoperative CAR was an independent and superior predictor of survival after pancreatic resection in patients with PDA. [Correction added on 17 January 2019, after first online publication: In Conclusion, "in" has been corrected to "independent" for clarity.].
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Abstract
Blinatumomab, a bispecific T-cell engager (BiTE) associated with improved survival in relapsed or refractory acute lymphoblastic leukemia (ALL), was recently approved for treatment of minimal residual disease (MRD). MRD is an important predictor of survival in ALL, and recent studies suggest that achievement of MRD-negativity with blinatumomab improves outcomes in patients with ALL. However, further research is needed to determine how to optimally incorporate blinatumomab, and other novel therapies, into current therapies for ALL.
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Affiliation(s)
- Emily Curran
- Section of Hematology/Oncology, Department of Medicine, and University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, and University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL
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6
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Kuang WY, Zheng MC, Li WL, Yang HX, Zhang BS, Wu P. [Effects of minimal residual disease level on day 33 of remission induction and IKZF1 genotype on the survival of children with B-lineage acute lymphoblastic leukemia]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:538-542. [PMID: 30022754 PMCID: PMC7389200 DOI: 10.7499/j.issn.1008-8830.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the effects of minimal residual disease (MRD) level on day 33 of remission induction and IKZF1 genotype on the survival of children with B-lineage acute lymphoblastic leukemia (B-ALL). METHODS A total of 152 children with newly-diagnosed B-ALL who had complete remission after the first cycle of the chemotherapy and had complete follow-up information were enrolled in this study. According to the MRD detection by flow cytometry on day 33 of remission induction, they were divided into three groups: standard-risk (SR) group (MRD <10-4; n=60), intermediate-risk (IR) group (10-4≤ MRD <10-2; n=55), and high-risk (HR) group (MRD ≥10-2; n=37). Nested RT-PCR was used to determine the IKZF1 genotype of all children before chemotherapy. The effects of MRD level on day 33 of remission induction and IKZF1 genotype on the recurrence-free survival (RFS) of children with B-ALL were analyzed. RESULTS There were 7 common IKZF1 subtypes in all the 152 children with B-ALL: IK1, IK2/3, IK4, IK6, IK8, IK9, and IK10. Of the 152 children, 130 had functional subtypes of IKZF1 and 22 had non-functional subtypes of IKZF1. During the follow-up period, relapse occurred in 26 (17%) children, and the recurrence rate was highest in the HR group (P<0.05). However, there was no significant difference in the recurrence rate between the SR group and the IR group (P>0.05). The cumulative recurrence rate of the children with non-functional subtypes of IKZF1 was significantly higher than that of those with functional types of IKZF1 (P<0.01). The predicted 5-year RFS rates in the SR, IR, and HR groups were (94.2±2.9)%, (86.7±3.8)%, and (56.2±4.5)% respectively (P<0.05). The 5-year RFS rate of the children with functional subtypes of IKZF1 was significantly higher than that of those with non-functional subtypes of IKZF1 (P<0.01). There was no significant difference in the predicted 5-year RFS rate between the children with functional subtypes of IKZF1 and those with non-functional subtypes of IKZF1 in the SR group (P>0.05). However, the predicted 5-year RFS rate of the children with functional subtypes of IKZF1 was significantly higher than that of those with non-functional subtypes of IKZF1 in the IR group and the HR group (P<0.05). CONCLUSIONS B-ALL children with non-functional subtypes of IKZF1 have a high recurrence rate, and the recurrence rate will be even higher in B-ALL children with non-functional subtypes of IKZF1 and MRD ≥10-4 on day 33 of chemotherapy.
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Affiliation(s)
- Wen-Yong Kuang
- Department of Hematology, Hunan Children's Hospital, Changsha 410007, China.
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7
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Noordman BJ, Spaander MCW, Valkema R, Wijnhoven BPL, van Berge Henegouwen MI, Shapiro J, Biermann K, van der Gaast A, van Hillegersberg R, Hulshof MCCM, Krishnadath KK, Lagarde SM, Nieuwenhuijzen GAP, Oostenbrug LE, Siersema PD, Schoon EJ, Sosef MN, Steyerberg EW, van Lanschot JJB. Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study. Lancet Oncol 2018; 19:965-974. [PMID: 29861116 DOI: 10.1016/s1470-2045(18)30201-8] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND After neoadjuvant chemoradiotherapy for oesophageal cancer, roughly half of the patients with squamous cell carcinoma and a quarter of those with adenocarcinoma have a pathological complete response of the primary tumour before surgery. Thus, the necessity of standard oesophagectomy after neoadjuvant chemoradiotherapy should be reconsidered for patients who respond sufficiently to neoadjuvant treatment. In this study, we aimed to establish the accuracy of detection of residual disease after neoadjuvant chemoradiotherapy with different diagnostic approaches, and the optimal combination of diagnostic techniques for clinical response evaluations. METHODS The preSANO trial was a prospective, multicentre, diagnostic cohort study at six centres in the Netherlands. Eligible patients were aged 18 years or older, had histologically proven, resectable, squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction, and were eligible for potential curative therapy with neoadjuvant chemoradiotherapy (five weekly cycles of carboplatin [area under the curve 2 mg/mL per min] plus paclitaxel [50 mg/m2 of body-surface area] combined with 41·4 Gy radiotherapy in 23 fractions) followed by oesophagectomy. 4-6 weeks after completion of neoadjuvant chemoradiotherapy, patients had oesophagogastroduodenoscopy with biopsies and endoscopic ultrasonography with measurement of maximum tumour thickness. Patients with histologically proven locoregional residual disease or no-pass during endoscopy and without distant metastases underwent immediate surgical resection. In the remaining patients a second clinical response evaluation was done (PET-CT, oesophagogastroduodenoscopy with biopsies, endoscopic ultrasonography with measurement of maximum tumour thickness, and fine-needle aspiration of suspicious lymph nodes), followed by surgery 12-14 weeks after completion of neoadjuvant chemoradiotherapy. The primary endpoint was the correlation between clinical response during clinical response evaluations and the final pathological response in resection specimens, as shown by the proportion of tumour regression grade (TRG) 3 or 4 (>10% residual carcinoma in the resection specimen) residual tumours that was missed during clinical response evaluations. This study was registered with the Netherlands Trial Register (NTR4834), and has been completed. FINDINGS Between July 22, 2013, and Dec 28, 2016, 219 patients were included, 207 of whom were included in the analyses. Eight of 26 TRG3 or TRG4 tumours (31% [95% CI 17-50]) were missed by endoscopy with regular biopsies and fine-needle aspiration. Four of 41 TRG3 or TRG4 tumours (10% [95% CI 4-23]) were missed with bite-on-bite biopsies and fine-needle aspiration. Endoscopic ultrasonography with maximum tumour thickness measurement missed TRG3 or TRG4 residual tumours in 11 of 39 patients (28% [95% CI 17-44]). PET-CT missed six of 41 TRG3 or TRG4 tumours (15% [95% CI 7-28]). PET-CT detected interval distant histologically proven metastases in 18 (9%) of 190 patients (one squamous cell carcinoma, 17 adenocarcinomas). INTERPRETATION After neoadjuvant chemoradiotherapy for oesophageal cancer, clinical response evaluation with endoscopic ultrasonography, bite-on-bite biopsies, and fine-needle aspiration of suspicious lymph nodes was adequate for detection of locoregional residual disease, with PET-CT for detection of interval metastases. Active surveillance with this combination of diagnostic modalities is now being assessed in a phase 3 randomised controlled trial (SANO trial; Netherlands Trial Register NTR6803). FUNDING Dutch Cancer Society.
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Affiliation(s)
- Bo Jan Noordman
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Manon C W Spaander
- Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | - Joël Shapiro
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | | | | | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | | | - Peter D Siersema
- Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands; Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Erik J Schoon
- Department of Gastroenterology, Catharina Hospital, Eindhoven, Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, Netherlands
| | - J Jan B van Lanschot
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Abstract
Follicular lymphoma (FL) is generally considered an indolent disorder. With modern day treatments, long remissions are often achieved both in the front-line and relapsed setting. However, a subset of patients has a more aggressive course and a worse outcome. Their identification is the main purpose of modern day prognostic tools. In this review, we attempt to summarize the evidence concerning prognostic and predictive factors in FL, including (1) pre-treatment factors, from baseline clinical characteristics and imaging tests to histological grade, the microenvironment and genomic abnormalities; (2) post-treatment factors, i.e., depth of response, measured both by imaging tests and minimal residual disease; (3) factors at relapse and duration of response; and (4) prognostic factors in histological transformation. We conclude that, despite the existence of numerous tools, the availability of some of them is still limited; they generally suffer from notable downsides, and most have unproven predictive value, thus having scarce bearing on the choice of regimen at present. However, with the technological and scientific developments of the last few years, the potential for these prognostic factors is promising, particularly in combination, which will probably, in time, help guide therapeutic decisions.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols
- Bone Marrow/drug effects
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Chromosomes, Human, Pair 14/chemistry
- Chromosomes, Human, Pair 18/chemistry
- Clinical Trials as Topic
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/mortality
- Mutation
- Neoplasm Grading
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Neoplasm, Residual/mortality
- Positron-Emission Tomography
- Prognosis
- Recurrence
- Risk Factors
- Translocation, Genetic
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain.
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain
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9
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Dinaux AM, Amri R, Bordeianou LG, Hong TS, Wo JY, Blaszkowsky LS, Allen JN, Murphy JE, Kunitake H, Berger DL. The Impact of Pathologic Complete Response in Patients with Neoadjuvantly Treated Locally Advanced Rectal Cancer-a Large Single-Center Experience. J Gastrointest Surg 2017; 21:1153-1158. [PMID: 28386670 DOI: 10.1007/s11605-017-3408-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/16/2017] [Indexed: 01/31/2023]
Abstract
Small cohort studies demonstrated better oncologic outcomes for patients with pathologic complete response (PathCR) after neoadjuvant treatment for locally advanced rectal cancer. This study reviews long-term outcomes of a large cohort of clinically stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery. This is a retrospective analysis of a single-center cohort, including all clinical stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery between 2004 and 2014 (n = 271). Cox regressions were done to assess the influence of PathCR on recurrence-free survival (RFS) and overall survival (OS), adjusting for postoperative chemotherapy, clinical AJCC staging, comorbidity, and age where appropriate. PathCR patients had significantly lower distant recurrence rates (4 vs. 15.8%; P = 0.028) and lower disease-specific mortality rates (0 vs. 8.1%; P = 0.052), compared to patients with residual disease. PathCR was associated with longer RFS (HR, 5.6 [95% CI 1.3-23.1] P = 0.018) and longer OS (HR, 3.4 [1.31-10.0] P = 0.014) compared to having pathological residual disease. This large single-center study shows that patients with PathCR have significant longer RFS and OS than patients with residual disease on pathology after neoadjuvant chemoradiation.
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Affiliation(s)
- A M Dinaux
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Amri
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L G Bordeianou
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - T S Hong
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Y Wo
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L S Blaszkowsky
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J N Allen
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J E Murphy
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - H Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of General Surgery & Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA.
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Preffer FI, Yuan CM, Lin P, Stetler-Stevenson M, Marti GE. Introduction to multiple myeloma special issue: The flow cytometric detection of minimal residual disease. Cytometry B Clin Cytom 2016; 90:9-10. [PMID: 26780351 DOI: 10.1002/cyto.b.21342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Milano F, Gooley T, Wood B, Woolfrey A, Flowers ME, Doney K, Witherspoon R, Mielcarek M, Deeg JH, Sorror M, Dahlberg A, Sandmaier BM, Salit R, Petersdorf E, Appelbaum FR, Delaney C. Cord-Blood Transplantation in Patients with Minimal Residual Disease. N Engl J Med 2016; 375:944-53. [PMID: 27602666 PMCID: PMC5513721 DOI: 10.1056/nejmoa1602074] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The majority of patients in need of a hematopoietic-cell transplant do not have a matched related donor. Data are needed to inform the choice among various alternative donor-cell sources. METHODS In this retrospective analysis, we compared outcomes in 582 consecutive patients with acute leukemia or the myelodysplastic syndrome who received a first myeloablative hematopoietic-cell transplant from an unrelated cord-blood donor (140 patients), an HLA-matched unrelated donor (344), or an HLA-mismatched unrelated donor (98). RESULTS The relative risks of death and relapse between the cord-blood group and the two other unrelated-donor groups appeared to vary according to the presence of minimal residual disease status before transplantation. Among patients with minimal residual disease, the risk of death was higher in the HLA-mismatched group than in the cord-blood group (hazard ratio, 2.92; 95% confidence interval [CI], 1.52 to 5.63; P=0.001); the risk was also higher in the HLA-matched group than in the cord-blood group but not significantly so (hazard ratio, 1.69; 95% CI, 0.94 to 3.02; P=0.08). Among patients without minimal residual disease, the hazard ratios were lower (hazard ratio in the HLA-mismatched group, 1.36; 95% CI, 0.76 to 2.46; P=0.30; hazard ratio in the HLA-matched group, 0.78; 95% CI, 0.48 to 1.28; P=0.33). The risk of relapse among patients with minimal residual disease was significantly higher in the two unrelated-donor groups than in the cord-blood group (hazard ratio in the HLA-mismatched group, 3.01; 95% CI, 1.22 to 7.38; P=0.02; hazard ratio in the HLA-matched group, 2.92; 95% CI, 1.34 to 6.35; P=0.007). Among patients without minimal residual disease, the magnitude of these associations was lower (hazard ratio in the HLA-mismatched group, 1.28; 95% CI, 0.51 to 3.25; P=0.60; hazard ratio in the HLA-matched group, 1.30; 95% CI, 0.65 to 2.58; P=0.46). CONCLUSIONS Our data suggest that among patients with pretransplantation minimal residual disease, the probability of overall survival after receipt of a transplant from a cord-blood donor was at least as favorable as that after receipt of a transplant from an HLA-matched unrelated donor and was significantly higher than the probability after receipt of a transplant from an HLA-mismatched unrelated donor. Furthermore, the probability of relapse was lower in the cord-blood group than in either of the other groups.
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Affiliation(s)
- Filippo Milano
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Ted Gooley
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Brent Wood
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Ann Woolfrey
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Mary E Flowers
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Kristine Doney
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Robert Witherspoon
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Marco Mielcarek
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Joachim H Deeg
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Mohamed Sorror
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Ann Dahlberg
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Brenda M Sandmaier
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Rachel Salit
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Effie Petersdorf
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Frederick R Appelbaum
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
| | - Colleen Delaney
- From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle
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Abstract
Patients with locally advanced thyroid carcinoma were studied to document survival, posttreatment vocal cord function, and dysphagia. A retrospective medical record review collected patient data recorded, including age, gender, and tumor-specific data. The outcome data collected included vocal cord function, presence of a tracheotomy or feeding tube, and the presence or absence of dysphagia. I studied 95 patients with surgically managed thyroid cancer. Forty-three patients had locally invasive disease and/or recurrent disease. During a median follow-up of 5 years, 18% of the patients with invasive cancer died of disease. The patients with completely resected invasive cancers had a significantly better survival rate than did the patients with microscopic residual disease. I conclude that complete resection of invasive disease provides a survival advantage and should be accomplished if speech and swallowing can be preserved. Most patients can obtain local control with minimal morbidity, and they rarely die of local disease.
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Affiliation(s)
- Jan L Kasperbauer
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Health Quality Ontario. Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: A Clinical Evidence Review. Ont Health Technol Assess Ser 2016; 16:1-52. [PMID: 27099643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Leukemia accounts for nearly a third of childhood cancers in Canada, with acute lymphoblastic leukemia (ALL) comprising nearly 80% of cases. Identification of prognostic factors that allow risk stratification and tailored treatment have improved overall survival. However, nearly a quarter of patients considered standard risk on the basis of conventional prognostic factors still relapse, and relapse is associated with increased morbidity and mortality. Relapse is thought to result from extremely low levels of leukemic cells left over once complete remission is reached, termed minimal residual disease (MRD). Poor event-free survival (EFS) as well as overall survival for those who are classified as MRD-positive have been substantiated in seminal studies demonstrating the prognostic value of MRD for EFS in the past few decades. This review sought to further elucidate the relationship between MRD and EFS by looking at relapse, the primary determinant of EFS and the biological mechanism through which MRD is thought to act. This evidence review aimed to ascertain whether MRD is an independent prognostic factor for relapse and to assess the effect of MRD-directed treatment on patient-important outcomes in childhood ALL. METHODS Large prospective cohort studies with a priori multivariable analysis that includes potential confounders are required to draw confirmatory conclusions about the independence of a prognostic factor. Data on the prognostic value of MRD for relapse measured by molecular methods (polymerase chain reaction [PCR] of immunoglobulin or T-cell receptor rearrangements) or flow cytometry for leukemia-associated immunophenotypes or difference-from-normal approach were abstracted from included studies. Relevant data on relapse, EFS, and overall survival were abstracted from randomized controlled trials (RCTs) evaluating the effect of MRD-directed treatment. RESULTS A total of 2,832 citations were reviewed, of which 12 studies were included in this review. All cohort studies evaluating MRD as a prognostic factor for relapse found significant independent value when added to various existing prognostic factors. Seven studies showed prognostic value of MRD measured at the end of induction therapy and two at the end of consolidation therapy in de novo ALL, one study in relapsed ALL after re-induction therapy, and three studies before hematopoietic stem cell transplant. One large RCT in standard-risk patients found no compromise to outcomes when reducing treatment in MRD-negative patients, and also showed a 45% reduction in relapse risk and nearly 40% benefit in EFS when escalating treatment in MRD-positive patients. CONCLUSIONS Minimal residual disease is an independent prognostic factor for relapse in childhood ALL. Relapse is a key determinant of EFS and patients' quality of life. Treatment selected on the basis of MRD status appears to improve outcomes.
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14
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Hayashi K, Isohashi F, Ogawa K, Oikawa H, Onishi H, Ito Y, Takemoto M, Karasawa K, Imai M, Kosaka Y, Yamazaki H, Yoshioka Y, Nemoto K, Nishimura Y. Postoperative External Irradiation of Patients with Primary Biliary Tract Cancer: A Multicenter Retrospective Study. Anticancer Res 2015; 35:6231-6237. [PMID: 26504056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM The aim of the present study was to assess clinical outcomes of postoperative radiotherapy for biliary tract cancer patients. PATIENTS AND METHODS Clinical results of 187 patients treated with external irradiation in 31 Japanese Institutions between 2000 and 2011 were retrospectively analyzed. The median radiation dose was 50.4 Gy in fractions of 1.8-2 Gy. RESULTS Two-year actuarial overall survival and locoregional control (LCs) rates were 56% and 68%, respectively. In multivariate analysis, macroscopic residual tumor (R2) and irradiated doses <54 Gy were significant indicators of poor LC prognosis. For patients with complete resection (R0) or microscopic residual tumor (R1), 2-year LCs were 71% for <54 Gy and 83% for ≥54 Gy; doses ≥54 Gy were associated with high long-term LCs. There was no significant difference in acute adverse event rates between <54 Gy and ≥54 Gy. CONCLUSION Postoperative irradiation doses of approximately 54 Gy are safe and effective for R0 or R1 resection patients.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Biliary Tract Neoplasms/mortality
- Biliary Tract Neoplasms/pathology
- Biliary Tract Neoplasms/radiotherapy
- Biliary Tract Neoplasms/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/radiotherapy
- Neoplasm, Residual/surgery
- Postoperative Period
- Prognosis
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Kazuhiko Hayashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirobumi Oikawa
- Department of Radiology, Iwate Medical University, Iwate, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Katsuyuki Karasawa
- Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Michiko Imai
- Department of Radiation Oncology, Iwata City Hospital, Shizuoka, Japan
| | - Yasuhiro Kosaka
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University, Yamagata, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka, Japan
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Schwartz L, Schrot-Sanyan S, Brigand C, Baldauf JJ, Wattiez A, Akladios C. Impact of Pelvic and Para-aortic Lymphadenectomy in Advanced Ovarian Cancer After Neoadjuvant Chemotherapy. Anticancer Res 2015; 35:5503-5509. [PMID: 26408716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of our study was to evaluate the impact of systemic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer after neoadjuvant chemotherapy. PATIENTS AND METHODS This multi-centric descriptive study included patients with initially inoperable advanced ovarian cancer, undergoing neoadjuvant chemotherapy followed by cytoreductive surgery with no residual tumor between 1998 and 2012. They were distributed into two groups depending on if they underwent lymphadenectomy or not during the interval surgery. RESULTS Among the 101 included patients, 54 underwent lymphadenectomy and 47 did not. The multivariate analysis for overall survival showed no significant difference between the two groups [hazard ratio (HR)=1.88, confidence interval (CI)=0.89-3.94; p=0.08]. The multivariate analysis for progression-free survival showed no significant difference (HR=1.43, 95% CI=0.86-2.39; p=0.17). CONCLUSION In patients with advanced ovarian cancer, treated by neoadjuvant chemotherapy and interval surgery with no residual tumor, lymphadenectomy does not seem to improve the survival rate.
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Affiliation(s)
- Lucie Schwartz
- Department of Gynecology and Obstetrics, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Stephanie Schrot-Sanyan
- Department of Gynecology and Obstetrics, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Jacques Baldauf
- Department of Gynecology and Obstetrics, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Arnaud Wattiez
- Department of Gynecology and Obstetrics, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecology and Obstetrics, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
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Gzell C, Wheeler H, Huang D, Gaur P, Chen J, Kastelan M, Back M. Proliferation Index Predicts Survival after Second Craniotomy within 6 Months of Adjuvant Radiotherapy for High-grade Glioma. Clin Oncol (R Coll Radiol) 2015; 28:215-22. [PMID: 26382848 DOI: 10.1016/j.clon.2015.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/31/2015] [Accepted: 08/25/2015] [Indexed: 01/21/2023]
Abstract
AIMS To determine pathological features that predict survival in patients having repeat craniotomy within 6 months of radiotherapy for high-grade glioma (HGG). MATERIALS AND METHODS HGG patients (World Health Organization grade 3/4) managed with repeat craniotomy within 6 months of completing radiotherapy between 2008 and 2012 were included. Based on the presence of residual tumour cells, the pathology was reported as pathological progression or pathological pseudoprogression. The proliferation index (Ki67) was reported and compared with initial pathology as a percentage change. Tumour necrosis was estimated as a percentage of the specimen. Overall survival was calculated in months. RESULTS Of 327 patients managed with HGG, 27 patients underwent repeat craniotomy within 6 months of radiotherapy. The median survival after reoperation was 11 months (95% confidence interval 1-22). Ki67 at reoperation of 0%, 1-9% and >10% was associated with survival with a median survival of 13, 13 and 3 months, respectively (P = 0.007). Change in Ki67 was also associated with median survival, with <50% reduction median survival 3 months, 50-80% median survival 7 months and >80% reduction median survival 13 months, P = 0.02. Widespread treatment-related necrosis improved outcome, with >80% necrosis having a median survival of 13 months versus 3 months in those with <80% necrosis (P = 0.003). CONCLUSION The presence of residual tumour at repeat craniotomy within 6 months of radiotherapy is not an independent indicator of prognosis. Patients with residual tumour that had a low Ki67 had a similar median survival as those with only treatment necrosis. Reduced proliferation of residual tumour cells and widespread necrosis may be more important indicators for future outcome.
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Affiliation(s)
- C Gzell
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - H Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - D Huang
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - P Gaur
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - J Chen
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - M Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - M Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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17
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Park HJ, Kim K, Chie EK, Jang JY, Kim SW, Han SW, Oh DY, Im SA, Kim TY, Bang YJ, Ha SW. Chemoradiotherapy for extrahepatic bile duct cancer with gross residual disease after surgery. Anticancer Res 2014; 34:6685-6690. [PMID: 25368275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The purpose of the present study was to analyze the outcome of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients with gross residual disease after surgical resection. PATIENTS AND METHODS We retrospectively analyzed 30 patients with EHBD adenocarcinoma who underwent chemoradiotherapy after palliative resection (R2 resection). Postoperative radiotherapy was delivered to the tumor bed including residual tumor and regional lymph nodes (range=40-55.8 Gy). Most patients underwent chemoradiotherapy concurrently with 5-fluorouracil (5-FU) or gemcitabine. RESULTS The 2-year locoregional progression-free, distant metastasis-free and overall survival rates were 33.3%, 42.4% and 44.5%, respectively. High radiation dose≥50 Gy had a marginally significant impact on superior locoregional progression-free survival compared to 40 Gy (p=0.081). One patient developed grade 3 late gastrointestinal toxicity. CONCLUSION Adjuvant chemoradiotherapy for EHBD cancer patients with gross residual disease after surgery was well-tolerated. There could be a chance for durable locoregional control and even long-term survival in selected patients.
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Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung W Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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18
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Attarbaschi A, Panzer-Grümayer R, Mann G, Möricke A, König M, Mecklenbräuker A, Teigler-Schlegel A, Bradtke J, Harbott J, Göhring G, Stanulla M, Schrappe M, Zimmermann M, Haas OA. Minimal residual disease-based treatment is adequate for relapse-prone childhood acute lymphoblastic leukemia with an intrachromosomal amplification of chromosome 21: the experience of the ALL-BFM 2000 trial. Klin Padiatr 2014; 226:338-43. [PMID: 25431866 DOI: 10.1055/s-0034-1387795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently, the UK CCLG and COG reported that an intrachromosomal amplification of chromosome 21 (iAMP21) in acute lymphoblastic leukemia (ALL) loses its adverse prognostic impact with intensified therapy. PATIENT AND METHODS We evaluated the prognosis of iAMP21 among patients from the ALL-BFM (Berlin-Frankfurt-Münster) 2000 trial with 46 of 2 637 (2%) patients iAMP21+. RESULTS 8-year event-free-survival (EFS, 64 ± 8% vs. 81 ± 1%, p=0.0026) and cumulative incidence of relapse (CIR, 29 ± 8% vs. 14 ± 1%, p=0.008) of the iAMP21 cases were significantly worse compared with non-iAMP21 patients. Within the MRD low-risk group, iAMP21 cases (n=14) had an inferior 8-year EFS (76 ± 12% vs. 92 ± 1%, p=0.0081), but no increased CIR (10 ± 10% vs. 6 ± 1%, p=0.624). Within the MRD intermediate-risk group, iAMP21 cases (n=27) had a worse 8-year EFS (56 ± 11% vs. 78 ± 2%, p=0.0077) and CIR (44 ± 11% vs. 20 ± 2%, p=0.003) with 6/10 relapses occurring after 2 years. CONCLUSIONS Conclusively, we believe that there is no necessity for enrolling all iAMP21 patients into the high-risk arm of ongoing ALL-BFM trials because MRD low-risk patients have a moderate relapse risk under current therapy. Whether the increased relapse risk in MRD intermediate-risk patients can be avoided by late treatment intensification remains to be answered by the AIEOP-BFM ALL 2009 trial randomly using protracted pegylated L-asparaginase during delayed intensification and early maintenance.
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Affiliation(s)
- A Attarbaschi
- Department of pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | | | - G Mann
- Department of pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - A Möricke
- Department of Pediatric Hematology and Oncology, Children's University Hospital, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M König
- Children's Cancer Research Institute (CCRI), Vienna, Austria
| | | | - A Teigler-Schlegel
- Department of Pediatric Hematology and Oncology, Oncogenetic Laboratory, Justus-Liebig-University, Giessen, Germany
| | - J Bradtke
- Institute of Pathology, Justus-Liebig-University, Giessen, Germany
| | - J Harbott
- Department of Pediatric Hematology and Oncology, Oncogenetic Laboratory, Justus-Liebig-University, Giessen, Germany
| | - G Göhring
- Institute of Cell and Molecular Pathology, Medical School of Hannover, Hannover, Germany
| | - M Stanulla
- Department of Pediatric Hematology and Oncology, Medical School of Hannover, Hannover, Germany
| | - M Schrappe
- Department of Pediatric Hematology and Oncology, Children's University Hospital, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M Zimmermann
- Department of Pediatric Hematology and Oncology, Medical School of Hannover, Hannover, Germany
| | - O A Haas
- Department of pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
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19
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Wenz F, Sperk E, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Fussl C, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer IV: radiotherapy following mastectomy for invasive breast cancer. Strahlenther Onkol 2014; 190:705-14. [PMID: 24888511 DOI: 10.1007/s00066-014-0687-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. METHODS The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio >20 %, resection margins <3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size >2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. RESULTS The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, >3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. CONCLUSION PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present.
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Affiliation(s)
- Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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20
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Pang TCY, Wilson O, Argueta MA, Hugh TJ, Chou A, Samra JS, Gill AJ. Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility. Pathology 2014; 46:188-92. [PMID: 24614707 DOI: 10.1097/pat.0000000000000072] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of frozen section to assess resection margins intraoperatively during pancreaticoduodenectomy facilitates further resection. However, it is unclear whether this actually improves patient survival.We reviewed the overall survival and resection margin status in consecutive pancreaticoduodenectomies performed for carcinoma. An R1 resection was defined as an incomplete excision (≤1 mm margin); R0(p) resection as complete excision without re-resection and R0(s) resection as an initially positive neck margin which was converted to R0 resection after re-resection. Between 2007 and 2012, 116 pancreatoduodenectomies were performed for adenocarcinoma; 101 (87%) underwent frozen section of the neck margin which was positive in 19 (19%). Sixteen of these patients had negative neck margins after re-excision but only seven patients had no other involved margins [true R0(s) resections]. Median survival for the R0(p), R0(s) and R1 groups were 29, 16, 23 months, respectively (p = 0.049; R0(p) versus R0(s) p = 0.040). Intra-operative frozen section increased the overall R0 rate by 7% but this did not improve survival. Our findings question the clinical benefit of intraoperative margin assessment, particularly if re-excision cannot be performed easily and safely.
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Affiliation(s)
- Tony C Y Pang
- 1Sydney Medical School, University of Sydney 2Department of Upper GIT Surgery, Royal North Shore Hospital, St Leonards 3Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards 4Anatomical Pathology, Sydpath, St Vincent's Hospital, Darlinghurst 5Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
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21
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Dieci MV, Criscitiello C, Goubar A, Viale G, Conte P, Guarneri V, Ficarra G, Mathieu MC, Delaloge S, Curigliano G, Andre F. Prognostic value of tumor-infiltrating lymphocytes on residual disease after primary chemotherapy for triple-negative breast cancer: a retrospective multicenter study. Ann Oncol 2014; 25:611-618. [PMID: 24401929 PMCID: PMC3933248 DOI: 10.1093/annonc/mdt556] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/09/2013] [Accepted: 11/18/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a need to develop surrogates for treatment efficacy in the neoadjuvant setting to speed-up drug development and stratify patients according to outcome. Preclinical studies showed that chemotherapy induces an antitumor immune response. In order to develop new surrogates for drug efficacy, we assessed the prognostic value of tumor-infiltrating lymphocytes (TIL) on residual disease after neoadjuvant chemotherapy (NACT) in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS Three hundred four TNBC patients with residual disease after NACT were retrospectively identified in three different hospitals. Hematoxylin and eosin-stained slides from surgical postchemotherapy specimens were evaluated for intratumoral (It-TIL) and stromal (Str-TIL) TIL. Cases were classified as High-TIL if It-TIL and/or Str-TIL >60%. RESULTS TIL were assessable for 278 cases. Continuous It-TIL and Str-TIL variables were strong prognostic factors in the multivariate model, both for metastasis-free [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.77-0.96, P = 0.01 and HR 0.85, 95% CI 0.75-0.98, P = 0.02 for Str-TIL and It-TIL, respectively] and overall survival (HR 0.86, 95% CI 0.77-0.97, P = 0.01 and HR 0.86, 95% CI 0.75-0.99, P = 0.03 for Str-TIL and It-TIL, respectively). The 5-year overall survival rate was 91% (95% CI 68% to 97%) for High-TIL patients (n = 27) and 55% (95% CI 48% to 61%) for Low-TIL patients (HR 0.19, 95% CI 0.06-0.61, log-rank P = 0.0017). The major prognostic impact of TIL was seen for patients with large tumor burden following NACT (residual tumor >2 cm and/or node metastasis). In all but one High-TIL case, It-TIL and Str-TIL values were lower on the prechemotherapy sample. CONCLUSIONS The presence of TIL in residual disease after NACT is associated with better prognosis in TNBC patients. This parameter may represent a new surrogate of drug efficacy to test investigational agents in the neoadjuvant setting and a new prognostic marker to select patients at high risk of relapse.
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Affiliation(s)
- M V Dieci
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Criscitiello
- Early Drug Development for Innovative Therapies Division, Department of Medicine, Istituto Europeo di Oncologia, Milano
| | - A Goubar
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, Milano; Faculty of Medicine, University of Milan, Milano
| | - P Conte
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - V Guarneri
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - G Ficarra
- Division of Pathology, Modena University Hospital, Modena, Italy
| | - M C Mathieu
- Departments of Medical Biology and Pathology
| | - S Delaloge
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Medical Oncology, Institut Gustave Roussy, Villejuif
| | - G Curigliano
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - F Andre
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Medical Oncology, Institut Gustave Roussy, Villejuif; Faculty of Medicine, Paris Sud University, Kremlin-Bicêtre, France.
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22
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Lambaudie E, Chereau E, Pouget N, Thomassin J, Minsat M, Charafe-Jauffret E, Jacquemier J, Houvenaeghel G. Cytokeratin 7 as a predictive factor for response to concommitant radiochemotherapy for locally advanced cervical cancer: a preliminary study. Anticancer Res 2014; 34:177-181. [PMID: 24403459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The role of completion surgery after concurrent radiochemotherapy (CCRC) for advanced cervical cancer remains controversial. Individual predictive factors of CCRC response and survival are mandatory for treatment adaptation and to determine a population who would take interest in completion surgery after CCRC. The aim of this study was to evaluate the ability of biomarkers to predict the response to CCRC. PATIENTS AND METHODS Between 1996 and 2008, in 58 patients with advanced cervical cancer for whom pre-therapeutic cone biopsy was available, we tested several biomarkers (ALDH1, CD44, CD24, IDO, Ki67, P63, CK7, p-Stat3, Foxp3 and IDO). RESULTS Residual disease was found in 49.1% of cases (n=26). We found a significant association between progression-free survival and residual disease on completion hysterectomy (p=0.044). Univariate analysis of the different factors showed that negativity for cytokeratin 7 expression was a strong predictor for the presence of residual tumor (p=0.001). CONCLUSION These results are encouraging and CK7 could be used as a predictive factor of response to CCRC.
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Affiliation(s)
- Eric Lambaudie
- Service de Chirurgie Oncologique, Institut Paoli Calmettes, 232, bd Sainte Marguerite, 13009 Marseille, France.
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23
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Abstract
OPINION STATEMENT Local residual disease occurs in 7-13 % after primary treatment for nasopharyngeal carcinoma (NPC). To prevent tumor progression and/or distant metastasis, treatment is indicated. Biopsy is the "gold standard" for diagnosing residual disease. Because late histological regression frequently is seen after primary treatment for NPC, biopsy should be performed when imaging or endoscopy is suspicious at 10 weeks. Different modalities can be used in the treatment of local residual disease. Interestingly, the treatment of residual disease has better outcomes than treatment of recurrent disease. For early-stage disease (rT1-2), treatment results and survival rates are very good and comparable to patients who had a complete response after the first treatment. Surgery (endoscopic or open), brachytherapy (interstitial or intracavitary), external or stereotactic beam radiotherapy, or photodynamic therapy all have very good and comparable response rates. Choice should depend on the extension of disease, feasibility of the treatment, and doctor's and patient's preferences and experience, as well as the risks of the adverse events. For the more extended tumors, choice of treatment is more difficult, because complete response rates are poorer and severe side effects are not uncommon. The results of external beam reirradiation and stereotactic radiotherapy are better than brachytherapy for T3-4 tumors. Photodynamic therapy resulted in good palliative responses in a few patients with extensive disease. Also, chemotherapeutics or the Epstein-Barr virus targeted therapies can be used when curative intent treatment is not feasible anymore. However, their advantage in isolated local failure has not been well described yet. Because residual disease often is a problem in countries with a high incidence of NPC and limited radiotherapeutic and surgical facilities, it should be understood that most of the above mentioned therapeutic modalities (radiotherapy and surgery) will not be readily available. More research with controlled, randomized trials are needed to find realistic treatment options for residual disease.
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Affiliation(s)
- S. D. Stoker
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - J. N. A. van Diessen
- Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - J. P. de Boer
- Department of Hemato-oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - B. Karakullukcu
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - C. R. Leemans
- Department of otolaryngology/head and neck surgery, VU University Medical Center Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - I. B. Tan
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
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24
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Abstract
CONTEXT Thyroid cancers represent a conglomerate of diverse histological types with equally variable prognosis. There is no reliable prognostic model to predict the risks of relapse and death for different types of thyroid cancers. OBJECTIVE The purpose of this study was to build prognostic nomograms to predict individualized risks of relapse and death of thyroid cancer within 10 years of diagnosis based on patients' prognostic factors. DESIGN Competing risk subhazard models were used to develop prognostic nomograms based on the information on individual patients in a population-based thyroid cancer cohort followed up for a median period of 126 months. Analyses were conducted using R version 2.13.2. The R packages cmprsk10, Design, and QHScrnomo were used for modeling, developing, and validating the nomograms for prediction of patients' individualized risks of relapse and death of thyroid cancer. SETTING This study was performed at CancerCare Manitoba, the sole comprehensive cancer center for a population of 1.2 million. PATIENTS Participants were a population-based cohort of 2306 consecutive thyroid cancers observed in 2296 patients in the province of Manitoba, Canada, during 1970 to 2010. MAIN OUTCOME MEASURES Outcomes were discrimination (concordance index) and calibration curves of nomograms. RESULTS Our cohort of 570 men and 1726 women included 2155 (93.4%) differentiated thyroid cancers. On multivariable analysis, patient's age, sex, tumor histology, T, N, and M stages, and clinically or radiologically detectable posttreatment gross residual disease were independent determinants of risk of relapse and/or death. The individualized 10-year risks of relapse and death of thyroid cancer in the nomogram were predicted by the total of the weighted scores of these determinants. The concordance indices for prediction of thyroid cancer-related deaths and relapses were 0.92 and 0.76, respectively. The calibration curves were very close to the diagonals. CONCLUSIONS We have successfully developed prognostic nomograms for thyroid cancer with excellent discrimination (concordance indices) and calibration.
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MESH Headings
- Adult
- Cancer Care Facilities
- Carcinoma/diagnosis
- Carcinoma/mortality
- Carcinoma/prevention & control
- Carcinoma/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/prevention & control
- Carcinoma, Papillary/therapy
- Cohort Studies
- Female
- Follow-Up Studies
- Humans
- Incidence
- Lymphatic Metastasis
- Male
- Manitoba/epidemiology
- Models, Biological
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/therapy
- Prognosis
- Risk
- Survival Analysis
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/prevention & control
- Thyroid Neoplasms/therapy
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Affiliation(s)
- K Alok Pathak
- MS, DNB, FRCS(Glasg.), FRCSEd, MNAMS, FRCSC,University of Manitoba, Head and Neck Surgical Oncologist, Cancer Care Manitoba, GF 440 A, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
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25
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Lad NL, Squires MH, Maithel SK, Fisher SB, Mehta VV, Cardona K, Russell MC, Staley CA, Adsay NV, Kooby DA. Is it time to stop checking frozen section neck margins during pancreaticoduodenectomy? Ann Surg Oncol 2013; 20:3626-33. [PMID: 23838908 DOI: 10.1245/s10434-013-3080-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 03/21/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Residual disease after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) adversely impacts survival. The value of taking additional neck margin after a positive frozen section (FS) to achieve a negative margin remains uncertain. METHODS All patients who underwent PD for PDAC from January 2000 August 2012 were identified and classified as negative (R0) or positive (R1) based on final neck margin. We examined factors for association with a positive FS neck margin and overall survival (OS). We assessed the value of converting an R1 neck margin to R0 via additional parenchymal resection. RESULTS A total of 382 patients had FS neck margin analysis, of which 53 (14 %) were positive. Positive FS neck margin was associated with decreased OS (11.1 vs. 17.3 months, p = 0.01) on univariate analysis. On multivariate analysis poor histologic grade (p = 0.007), increased tumor size (p = 0.003), and a positive retroperitoneal margin (p = 0.009) were independently associated with decreased OS, but positive FS neck margin was not. Of the 53 patients with positive FS, 41 underwent additional neck resection and 23 were converted to R0. On permanent section, R0 neck margin was achieved in 322 patients (84 %), R1 in 37 patients (10 %), and R1 converted to R0 in 23 patients (6 %). Both the converted and the R1 groups had significantly poorer OS than the R0 group (11.3 vs. 11.1 vs. 17.3 months respectively; p = 0.04). CONCLUSIONS Positive FS margin at the pancreatic neck during PD for PDAC is associated with poor survival. Extending the neck resection after a positive FS to achieve R0 margin status does not appear to improve OS.
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Affiliation(s)
- Neha L Lad
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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26
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Chereau E, DE LA Hosseraye C, Ballester M, Monnier L, Rouzier R, Touboul E, Daraï E. The role of completion surgery after concurrent radiochemotherapy in locally advanced stages IB2-IIB cervical cancer. Anticancer Res 2013; 33:1661-1666. [PMID: 23564812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The gold standard for treating patients with locally advanced stages of cervical cancer is concurrent radiochemotherapy (CRT), but recent studies have failed to demonstrate the effect of completion surgery on survival. The aim of this study was to evaluate the role of completion surgery in stage IB2-IIB cervical cancer. PATIENTS AND METHODS From 2002 to 2012, 80 women (stage IB2-IIB disease) underwent a pre-therapeutic pelvic and para-aortic lymphadenectomy associated with CRT. RESULTS Forty-six patients (57.5%) underwent completion surgery. Multivariate analysis identified pelvic lymph node status as a predictive factor for completion surgery (p<0.001) and histological type for tumor residue (p=0.04). In multivariate analysis, positivity of para-aortic nodes (p=0.01 for DFS and p=0.01 for OS) and emboli on completion hysterectomy (p=0.03 for DFS and p=0.006 for OS) were significant. CONCLUSION Only patients without para-aortic metastases or limited pelvic involvement and with residual disease and emboli seem to be good candidates for completion surgery.
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27
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Yoon JH, Kim HJ, Shin SH, Yahng SA, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS, Park CW, Lim JH. Serial measurement of WT1 expression and decrement ratio until hematopoietic cell transplantation as a marker of residual disease in patients with cytogenetically normal acute myelogenous leukemia. Biol Blood Marrow Transplant 2013; 19:958-66. [PMID: 23542687 DOI: 10.1016/j.bbmt.2013.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
Abstract
Using real-time quantitative PCR, we monitored Wilms tumor gene 1 (WT1) expression from diagnosis to hematopoietic stem cell transplantation (HSCT) in adult patients with cytogenetically normal acute myelogenous leukemia (CN-AML) and FLT3-ITD and NPM1 mutations. The values at diagnosis were evaluated in 104 patients. Data collected after induction chemotherapy were available for all patients, but only 68 patients were treated with HSCT. Significant WT1 expression cut-offs were determined by receiver operation characteristic curve analysis, and rates of overall survival (OS) and disease-free survival (DFS) were estimated. WT1 decrement ratios (DR) at postinduction chemotherapy and at pre- and post-HSCT compared with the diagnostic level were calculated. Higher WT1 expression at diagnosis, postinduction chemotherapy, and pre-HSCT showed inferior OS (P = .015, <.001, and .002) and DFS (P = .006, <.001, and .003). The cut-offs were determined at the median for diagnostic WT1 expression and at the 25% level from the top for other time points excluding post-HSCT. The WT1 DR ≥ 1-log after induction chemotherapy showed superior OS and DFS (P = .009 and .002) and WT1 DR ≥ 1-log preceding HSCT also showed superior OS and DFS (P = .009 and .003). Results of WT1 DR were consistently applicable in each subgroup with higher (≥ 1.0) and lower (<1.0) WT1 expression at diagnosis and also in NPM1-wild-type/FLT3-ITD-negative CN-AML. The WT1 DR therefore predicted survival outcomes after HSCT more accurately than did the diagnostic WT1 expression. WT1 expression may serve as a reliable marker for residual disease and WT1 DR as a prognostic indicator, particularly in NPM1-wild-type/FLT3-ITD-negative CN-AML. These measures may be applied throughout the course of treatment and even after HSCT.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Cytogenetic Analysis
- Female
- Gene Expression
- Graft vs Host Disease/diagnosis
- Graft vs Host Disease/immunology
- Graft vs Host Disease/mortality
- Graft vs Host Disease/therapy
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Myeloablative Agonists/therapeutic use
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/immunology
- Neoplasm, Residual/mortality
- Neoplasm, Residual/therapy
- Nuclear Proteins/genetics
- Nuclear Proteins/immunology
- Nucleophosmin
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/immunology
- Recurrence
- Retrospective Studies
- Survival Analysis
- Transplantation Conditioning
- Transplantation, Homologous
- Treatment Outcome
- WT1 Proteins/genetics
- WT1 Proteins/immunology
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Affiliation(s)
- Jae-Ho Yoon
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Nagafuji K, Miyamoto T, Eto T, Kamimura T, Taniguchi S, Okamura T, Ohtsuka E, Yoshida T, Higuchi M, Yoshimoto G, Fujisaki T, Abe Y, Takamatsu Y, Yokota S, Akashi K, Harada M. Monitoring of minimal residual disease (MRD) is useful to predict prognosis of adult patients with Ph-negative ALL: results of a prospective study (ALL MRD2002 Study). J Hematol Oncol 2013; 6:14. [PMID: 23388549 PMCID: PMC3574830 DOI: 10.1186/1756-8722-6-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/03/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) for patients with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) is much more intensive than multi-agent combined chemotherapy, although allogeneic HSCT is associated with increased morbidity and mortality when compared with such chemotherapy. Minimal residual disease (MRD) status has been proven to be a strong prognostic factor for adult patients with Ph-negative ALL. METHODS We investigated whether MRD status in adult patients with ALL is useful to decide clinical indications for allogeneic HSCT. We prospectively monitored MRD after induction and consolidation therapy in adult patients with Ph-negative ALL. RESULTS Of 110 adult ALL patients enrolled between July 2002 and August 2008, 101 were eligible, including 59 Ph-negative patients. MRD status was assessed in 43 patients by the detection of major rearrangements in TCR and Ig and the presence of chimeric mRNA. Thirty-nine patients achieved CR1, and their probabilities of 3-year overall survival and disease-free survival (DFS) were 74% and 56%, respectively. Patients who were MRD-negative after induction therapy (n = 26) had a significantly better 3-year DFS compared with those who were MRD-positive (n = 13; 69% vs. 31%, p = 0.004). All of 3 patients who were MRD-positive following consolidation chemotherapy and did not undergo allogeneic HSCT, relapsed and died within 3 years after CR. CONCLUSIONS These results indicate that MRD monitoring is useful for determining the clinical indications for allogeneic HSCT in the treatment of ALL in CR1.
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Affiliation(s)
- Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Tomohiko Kamimura
- Department of Hematology, HaraSanshin General Hospital, Fukuoka, Japan
| | | | - Takashi Okamura
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Eiichi Ohtsuka
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Takashi Yoshida
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masakazu Higuchi
- Department of Hematology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan
| | | | - Tomoaki Fujisaki
- Department of Hematology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Yasunobu Abe
- Department of Medicine and Bioregulatory Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasushi Takamatsu
- Department of Oncology Hematology, Fukuoka University Hospital, Fukuoka, Japan
| | - Shouhei Yokota
- Department of Hematology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mine Harada
- Medical Center for Karatsu Higashimatuura Medical Association, Karatsu, Japan
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29
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Zhong XS, Lan F, Cui X, Jiang NG, Zhu HL, Jia YQ. [Early detection of MRD in peripheral blood after induction chemotherapy of newly diagnosed patients with AML and its correlation with curative effects]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2013; 21:57-61. [PMID: 23484692 DOI: 10.7534/j.issn.1009-2137.2013.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to detect the minimal residual disease (MRD) in peripheral blood of newly diagnosed patients with acute myeloid leukemia (AML) on day 8 of induction chemotherapy and analyze the correlation between day 8 MRD (D8RD) and therapeutic effectiveness. 29 adult patients (13 males and 16 females, aged 16 - 75 years, median 41 years) with AML diagnosed and treated in West China Hospital from September 2009 to June 2010 were analyzed and followed up in the study. The leukemia-associated aberrant immunophenotype (LAIP) of all the patients were detected by multiparameter flow cytometry (FCM) before therapy. The level of MRD in the peripheral blood at day 8 of induction chemotherapy was detected by FCM based on the LAIP. The overall survival curve was drawn by calculation using Kaplan-Meier method using, and the comparison between different groups was carried out by Log-rank test. The results indicated that after first course therapy, the levels of peripheral D8RD in 7 out of 29 AML cases were lower than 0.01% (negative group), and that in another 22 cases were higher than 0.01% (0.08% - 55%, positive group). The sex, age, WBC, LDH, percentage of bone marrow blasts at diagnosis in these groups were not statistically different. 6 cases achieved CR (86%) in D8RD negative group, and also 6 cases achieved CR (27%) in D8RD positive group, CR rate in D8RD negative group was higher than in D8RD positive group (86% vs 27%, P < 0.05). The median follow-up of 29 cases lasted for 15 months; the 1-year overall survival rate of D8RD negative and D8RD positive groups was 100% and 39.4%, respectively (P < 0.01). It is concluded that MRD level in peripheral blood at day 8 of induction chemotherapy is an early index to predict clinical efficacy of induction therapy in AML.
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Affiliation(s)
- Xu-Shu Zhong
- Department of Hematology, Sichuan University, Chengdu, Sichuan Province, China
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30
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Boras Z, Kondza G, Sisljagić V, Busić Z, Gmajnić R, Istvanić T. Prognostic factors of local recurrence and survival after curative rectal cancer surgery: a single institution experience. Coll Antropol 2012; 36:1355-1361. [PMID: 23390833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of our study is to evaluate the importance of prognostic factors, both tumor-related and therapy related, and their impact on local recurrence rate of rectal carcinoma. It is also important to evaluate impact of chemoradiotherapy (CRT) on local recurrence rate and survival. We used the data of 514 patients with rectal carcinoma treated at Clinic of surgery at University Hospital Centre in Osijek, during the period from 2000 to 2007. Routine follow-up was carried out until March of 2012 or death. Median life expectancy for all patients who underwent surgery was 98 months. 47% of patients with resection without residual tumor (R0) did not develop local recurrence after median of observation of 90 months. 5-year survival rate for patients with R0 resection was 76.4%. The patients who had preoperative serum levels of carcinoembryonic antigen (CEA) within the normal range (< 5 microg/mL) had a significantly better prognosis with 5-year survival of 75.8%, than patients with elevated levels who had 5-year survival of 46.5%. Tumor stage had great influence on survival and was defined by UICC TNM (International Union against Cancer, Tumor Node Metastases) classification, 7th edition. 5-year survival rate was (93.5% for stage I, 87.4% for stage II, 58.2% for stage III, 8.1% for stage IV). Patients with low grade differentiation tumors had 5-year survival rate of 73.5%, and those with high-grade had 38.2%. We have found that preoperative CRT significantly reduces the rate of local recurrence (5.3% vs. 14.1%), but patients who were treated with preoperative CRT did not appear to benefit significantly in terms of their long-term prognosis, because there was no difference in overall survival between the patients who received preoperative radiochemotherapy and those who did not receive it (66.2% vs. 67.8%). It was found that the R-classification, anatomical extent of tumor described by the TNM classification of the UICC, tumor grade, and preoperative CEA serum level were prognostic factors that influenced survival.
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Affiliation(s)
- Zdenko Boras
- "J. J. Strossmayer" University, School of Medicine, Department of Surgery, Osijek, Croatia.
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31
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Tshering Vogel DW, Zbaeren P, Geretschlaeger A, Vermathen P, De Keyzer F, Thoeny HC. Diffusion-weighted MR imaging including bi-exponential fitting for the detection of recurrent or residual tumour after (chemo)radiotherapy for laryngeal and hypopharyngeal cancers. Eur Radiol 2012; 23:562-9. [PMID: 22865270 DOI: 10.1007/s00330-012-2596-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess whether diffusion-weighted magnetic resonance imaging (DW-MRI) including bi-exponential fitting helps to detect residual/recurrent tumours after (chemo)radiotherapy of laryngeal and hypopharyngeal carcinoma. METHODS Forty-six patients with newly-developed/worsening symptoms after (chemo)radiotherapy for laryngeal/hypopharyngeal cancers were prospectively imaged using conventional MRI and axial DW-MRI. Qualitative (visual assessment) and quantitative analysis (mono-exponentially: total apparent diffusion coefficient [ADC(T)], and bi-exponentially: perfusion fraction [F(P)] and true diffusion coefficient [ADC(D)]) were performed. Diffusion parameters of tumour versus post-therapeutic changes were compared, with final diagnosis based on histopathology and follow-up. Mann-Whitney U test was used for statistical analysis. RESULTS Qualitative DW-MRI combined with morphological images allowed the detection of tumour with a sensitivity of 94% and specificity 100%. ADC(T) and ADC(D) values were lower in tumour with values 120 ± 49 × 10(-5) mm(2)/s and 113 ± 50 × 10(-5) mm(2)/s, respectively, compared with post-therapeutic changes with values 182 ± 41 × 10(-5) mm(2)/s (P < 0.0002) and 160 ± 47 × 10(-5) mm(2)/s (P < 0.003), respectively. F(P) values were significantly lower in tumours than in non-tumours (13 ± 9% versus 31 ± 16%, P < 0.0002), with F(P) being the best quantitative parameter for differentiation between post-therapeutic changes and recurrence. CONCLUSIONS DW-MRI in combination with conventional MRI substantially improves detection and exclusion of tumour in patients with laryngeal and hypopharyngeal cancers after treatment with (chemo)radiotherapy on both qualitative and quantitative analysis, with F(P) being the best quantitative parameter in this context.
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MESH Headings
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Chemoradiotherapy/methods
- Cohort Studies
- Diffusion Magnetic Resonance Imaging/methods
- Female
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/therapy
- Humans
- Hypopharyngeal Neoplasms/diagnosis
- Hypopharyngeal Neoplasms/mortality
- Hypopharyngeal Neoplasms/therapy
- Immunohistochemistry
- Laryngeal Neoplasms/diagnosis
- Laryngeal Neoplasms/mortality
- Laryngeal Neoplasms/therapy
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Prognosis
- Prospective Studies
- ROC Curve
- Risk Assessment
- Squamous Cell Carcinoma of Head and Neck
- Statistics, Nonparametric
- Survival Rate
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Affiliation(s)
- Dechen W Tshering Vogel
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
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32
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Chatterjee D, Katz MH, Rashid A, Varadhachary GR, Wolff RA, Wang H, Lee JE, Pisters PWT, Vauthey JN, Crane C, Gomez HF, Abbruzzese JL, Fleming JB, Wang H. Histologic grading of the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adenocarcinoma: a predictor for patient outcome. Cancer 2012; 118:3182-90. [PMID: 22028089 PMCID: PMC3269538 DOI: 10.1002/cncr.26651] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 08/08/2011] [Accepted: 09/13/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several grading schemes for the extent of residual tumor in posttreatment pancreaticoduodenectomy (PD) specimens have been proposed. However, the prognostic significance of these grading schemes is unknown. METHODS Histopathologic slides of 223 cases who received neoadjuvant chemoradiation and PD were reviewed. The extent of residual tumor was graded using both the College of American Pathologists (CAP) and the Evans grading systems. The grading results were correlated with clinicopathological parameters and survival. RESULTS Among the 223 patients, 6 patients (2.7%) showed pathologic complete response (pCR; CAP grade 0 or Evans grade IV), 36 cases (16.1%) had minimal residual tumor (CAP grade 1 or Evans grade III), 124 cases (55.6%) had moderate response (CAP grade 2 or Evans grade IIb), and 57 cases (25.6%) had poor response (CAP grade 3, where 18 had Evans grade I and 39 had Evans grade IIa response). Patients with pCR or minimal residual tumor (response group 1) had better survival rates than those with moderate and poor response (response group 2). Response group 1 patients had lower posttherapy tumor and American Joint Committee on Cancer stages and lower rates of lymph node metastasis, positive resection margin, and recurrence and/or metastasis. Grading the extent of residual tumor is an independent prognostic factor for overall survival in multivariate analysis. CONCLUSIONS pCR or minimal residual tumor in posttreatment PD specimens correlate with better survival in patients with pancreatic ductal adenocarcinoma who received neoadjuvant therapy and PD. Histologic grading of the extent of residual tumor in PD specimen is an important prognostic factor in patients with pancreatic ductal adenocarcinoma who received neoadjuvant therapies.
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Affiliation(s)
- Deyali Chatterjee
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Matthew H. Katz
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Asif Rashid
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Gauri R. Varadhachary
- Departments of Gastrointestinal Medical Oncology, Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Robert A. Wolff
- Departments of Gastrointestinal Medical Oncology, Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Hua Wang
- Departments of Gastrointestinal Medical Oncology, Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Peter W T Pisters
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Christopher Crane
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Henry F. Gomez
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - James L. Abbruzzese
- Departments of Gastrointestinal Medical Oncology, Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Jason B Fleming
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Huamin Wang
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
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Fuks D, Regimbeau JM, Le Treut YP, Bachellier P, Raventos A, Pruvot FR, Chiche L, Farges O. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg 2011; 35:1887-97. [PMID: 21547420 DOI: 10.1007/s00268-011-1134-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry. METHODS Data on patients with GBC treated between 1998 and 2008 were retrospectively collated in a French, multicenter database. RESULTS The registry contained 218 patients with incidental GBC (67 men and 151 women; median age = 64 years; age range = 31-88). One hundred forty-eight (68%) patients underwent re-resection after a median time interval of 48 days (range = 2-245). The most common complete procedure (66% of cases) was 4b + 5 segmentectomy with lymphadenectomy but not bile duct resection. Port-site excision was performed in 54 patients. The mortality and morbidity rates were 3 and 37%, respectively. Resection of the common bile duct (43%) increased postoperative complications (60 vs. 23%, p = 0.0001). Local residual tumor was found in 83 (56%) patients; it was significantly correlated with the T stage and influenced long-term survival. R0 was obtained in 143 (97%) patients and port-site invasion was histologically confirmed in one patient (1.8%). After a median follow-up period of 34 months, the 1-, 3-, and 5-year survival rates for the 148 patients with re-resection were 76, 54, and 41%, respectively. Re-resection significantly increased survival in patients with T2 (p = 0.0001) and T3 (p = 0.04) disease. Resection of the common bile duct increased neither R0 resection nor overall survival (p = 0.06). CONCLUSION This study validates the concept of re-resection in T2 and T3 GBC. Bile duct resection increases postoperative morbidity but does not improve survival. There is currently a modification in the surgical management of incidental GBC, with minor liver resection and no common bile duct resection.
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Affiliation(s)
- David Fuks
- Department of Digestive Surgery, Hôpital Nord, Amiens, France
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34
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Advani AS. Blinatumomab: a novel agent to treat minimal residual disease in patients with acute lymphoblastic leukemia. Clin Adv Hematol Oncol 2011; 9:776-777. [PMID: 22252580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Anjali S Advani
- Cleveland Clinic Lerner College of Medicine, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, Ohio, USA
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35
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Jaworska-Posadzy A, Styczynski J, Kubicka M, Debski R, Rafinska-Kurylo B, Kolodziej B, Pogorzala M, Wysocki M. Prognostic value of persistent peripheral blood and bone marrow lymphoblasts on day 15 of therapy in childhood acute lymphoblastic leukemia as detected by flow cytometry. Anticancer Res 2011; 31:1453-1457. [PMID: 21508402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The predictive value of residual disease measured by flow cytometry at day 15 of induction therapy was analyzed in 182 children treated for acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS Peripheral blood (PB) and bone marrow were assessed for leukemia cells by morphology and flow cytometry at days 0, 8, and 15. RESULTS Absolute blast count (ABC) >200/μl in PB by day 15 assessed by flow cytometry predicted a lower probability of disease free survival (pDFS) (p=0.056). Patients with bone marrow lymphoblast (BML)>0.5% had a lower pDFS (p=0.002). Cumulative relapse incidence for patients with BML<0.5% was 8.9% vs. 47.1% (OR=4.6, p=0.036). In common/pre-B-ALL patients aged >10 years with BML>0.5%, pDFS value was significantly lower. In the multivariate analysis, the only significant factor with adverse prognostic value for pDFS was BML>0.5% (HR=5.3 p=0.030). CONCLUSION BML>0.5% analyzed by flow cytometry at day 15 is possibly the strongest prognostic factor in pediatric ALL.
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Affiliation(s)
- Anna Jaworska-Posadzy
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University, Bydgoszcz, Poland
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36
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Risum S, Loft A, Høgdall C, Berthelsen AK, Høgdall E, Lundvall L, Nedergaard L, Engelholm SA. Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovarian cancer. Acta Oncol 2011; 50:415-9. [PMID: 20698810 DOI: 10.3109/0284186x.2010.500296] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In patients with advanced ovarian cancer undergoing preoperative PET/CT, we investigated the prognostic value of SUV in the primary tumor and we evaluated the value of SUV for predicting incomplete primary cytoreduction (macroscopic residual tumor). MATERIAL AND METHODS From September 2004 to August 2007, 201 consecutive patients with a pelvic tumor and a Risk of Malignancy Index (RMI) > 150 based on serum CA-125, ultrasound examinations and menopausal state, underwent PET/CT within two weeks prior to standard surgery/debulking of a pelvic tumor. At two-year follow-up (August 15, 2009) the association between SUV and overall survival/cytoreductive result were analyzed in 60 ovarian cancer patients (58 stage III and two stage IV). RESULTS At inclusion median age was 62 years (range 35-85 years); 97% (58/60) had a performance status ≤2; 42% (25/60) underwent complete debulking (no macroscopic residual tumor); median SUV(max) was 13.5 (range 2.5-39.0). Median follow-up was 30.2 months. At follow-up 57% (34/60) were alive and 43% (26/60) had died from ovarian cancer. SUV(max) in patients alive was not statistically different from SUV(max) in dead patients (p=0.69), and SUV(max) was not correlated with the amount of residual tumor after surgery (p=0.19). Using univariate Cox regression analysis, residual tumor was a significant prognostic variable (p=0.001); SUV(max) was not a statistically significant prognostic variable (p=0.86). DISCUSSION FDG uptake (SUV(max)) in the primary tumor of patients with advanced ovarian cancer was not a prognostic variable and the FDG uptake did not predict complete cytoreduction after primary surgery. Future prospective clinical trials will need to clarify if other PET tracers can serve as prognostic variables in ovarian cancer.
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Affiliation(s)
- Signe Risum
- Department of Oncology, the Finsen Center, Rigshospitalet, Copenhagen University Hospital, Denmark.
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Zhang L, Zhu YX, Wang Y, Huang CP, Wu Y, Ji QH. Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma: a 10-year experience. Ann Surg Oncol 2011; 18:233-8. [PMID: 20737217 PMCID: PMC3018243 DOI: 10.1245/s10434-010-1292-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND To assess the outcome of and determine prognostic factors for neck residue or recurrence of nasopharyngeal carcinoma (NPC) in patients treated with a salvage neck dissection. MATERIALS AND METHODS Over a 10-year period (from January 1998 through December 2007) in a tertiary hospital, we systematically reviewed the clinical charts of 355 patients with NPC who were diagnosed with neck residue or recurrence of nasopharyngeal carcinoma, after radical definitive radiotherapy with or without chemotherapy. RESULTS The group with recurrent nodal disease consisted of 285 patients (80.3%), while the group with residual nodal disease included 70 patients (19.7%). There were no patients died of the surgery complications. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were 54.11, 35.01, and 55.59%, respectively, at 3-year, and 26.03, 22.65, and 27.84%, respectively, at 5-year. The local control rate in the neck was 70.92% at 3 years and 60.98% at 5 years. For all the 3 survival outcomes (OS, DFS, and DSS) and the local control rate of disease in the neck, there were significant differences between the "residue group" and "recurrence group." CONCLUSIONS Radical neck dissection is proven to be safe and effective in the treatment of the neck failure. Our study has demonstrated that it may be possible to choose the selective lymph node dissection for patients of the residue group.
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Affiliation(s)
- Ling Zhang
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
| | - Yong-xue Zhu
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
| | - Cai-ping Huang
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
| | - Yi Wu
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
| | - Qing-hai Ji
- Department of Head and Neck Surgery, Fudan University Cancer Hospital, Shanghai, People’s Republic of China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China
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Abstract
The purpose of this study was to describe the characteristics of well differentiated thyroid carcinoma (WTC) in Hispanic children and analyze treatment response. Retrospective evaluation of records seen at our institution from 1970-2007 was undertaken. Twenty-seven cases were evaluated, 24 were treated with radioiodine, followed for a mean period of 15 years. There were 18 females, 9 males, median age 11 years. Eleven tumors were papillary, 15 papillary-follicular variant and one follicular. All had total thyroidectomy and iodine scan. Initially 75% of the tumors were T2, 79% were N1, and 29% had distant metastases. Radioiodine was given to 89%. The cumulative radiation dose ranged from 110-925 mCi. Residual disease was present in 25% at last follow up, maximal follow up 37 years without tumor recurrence. Patients were all alive, 75% were disease-free. WTC in pediatrics is extensive at diagnosis; treatment outcome and long-term survival are excellent.
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Affiliation(s)
- Frieda Silva
- Nuclear Medicine Section, Radiological Sciences Department, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
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Mitterbauer M, Mitterbauer-Hohendanner G, Sperr WR, Kalhs P, Greinix HT, Fonatsch C, Haas OA, Jäger U, Mannhalter C, Lechner K. Molecular Disease Eradication is a Prerequisite for Long-term Remission in Patients with t(8;21) Positive Acute Myeloid Leukemia: a Single Center Study. Leuk Lymphoma 2009; 45:971-7. [PMID: 15291357 DOI: 10.1080/10428190310001638913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Association of long-term clinical remission and molecular disease-eradication is well established in acute myeloid leukemia (AML) patients with t(15;17) and inv(16). In patients with t(8;21) positive AML no consensus exists over the disappearance of the AML1/ETO fusion transcript during the course of disease and most studies reported reverse transcriptase polymerase chain reaction (RT-PCR) positivity as a common finding after consolidation chemotherapy, autologous and allogeneic stem cell transplantation (alloSCT). In our single center study, we performed RT-PCR monitoring in 14 patients with t(8;21) in CR1 (n = 13) and/or CR2 (n = 4). The median number of bone marrow (BM) and/or peripheral blood (PB) samples per patient was 18 (range, 2-43). In 5 out of 6 cases relapse occurred after persistence of minimal residual disease (MRD) in CR for 4-14 months. The sixth patient relapsed despite molecular remission (MR) in BM and PB for 3 months, molecular relapse preceded hematological relapse for 7 months. Eleven patients with a median follow-up of 7.8 (range, 1.5-15.4) years are in persistent CR and MR after consolidation chemotherapy (n = 7). mainly with repetitive cycles of high-dose Ara-C, autologous (n = 1) or myeloablative allogeneic (n = 3) stem cell transplantation. Molecular remission was attained immediately after alloSCT, but after 6-26 months in CR in patients with consolidation chemotherapy. In 7 patients, MRD was only studied in long-term remission. In conclusion, long-term CR was associated with persistent molecular disease-eradication. In our patients, molecular remission was a prerequisite but not a guarantee for long-term disease-free survival. Hematological relapse never occurred without prior molecular relapse. Due to the slow kinetics of AML1/ETO after consolidation chemotherapy the value of qualitative RT-PCR to predict early relapse is limited. In this situation quantitative RT-PCR might help to define individual relapse risk and to improve as well as facilitate clinical decision-making.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 8
- Disease-Free Survival
- Female
- Humans
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Male
- Middle Aged
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/mortality
- Predictive Value of Tests
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Margit Mitterbauer
- Department of Medicine I, Bone Marrow Transplantation Unit, University Hospital of Vienna, Vienna, Austria.
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40
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Langsenlehner T, Mayer R, Quehenberger F, Prettenhofer U, Langsenlehner U, Pummer K, Kapp KS. The role of radiation therapy after incomplete resection of penile cancer. Strahlenther Onkol 2008; 184:359-63. [PMID: 19016034 DOI: 10.1007/s00066-008-1818-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 03/26/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To retrospectively assess the outcome in patients treated with adjuvant radiotherapy for penile cancer. PATIENTS AND METHODS Between 1987 and 2006, 24 patients (median age, 62.7 years; range, 35.5-90.4 years) with squamous cell carcinoma of the penis (T1, n = 10; T2, n = 11; T3, n = 3) received megavoltage external radiotherapy (n = 22) or (192)Ir high-dose-rate brachytherapy (n = 2) following total penectomy (n = 7), partial penectomy (n = 10), or local excision (n = 7); lymphadenectomy was performed in eight patients. In 14 patients, radiotherapy was delivered after incomplete tumor resection, and in 20 patients the planning target volume included the regional lymph nodes. Median total dose of external radiotherapy was 56 Gy/1.8-2 Gy (range, 50-60 Gy). Brachytherapy was given with a total dose of 45 Gy/3 Gy. RESULTS During a median follow-up of 58.4 months, penile or perineal recurrence was found in four patients giving a 5-year local control rate of 74.8%. Regional failure occurred in two patients. 5-year metastases-free survival and progression-free survival rates were 86.7% and 64.5%, respectively. Four patients died due to tumor progression. The actuarial 5-year cause-specific and overall survival rates were 84.3 and 56.6%, respectively. CONCLUSION Radiation therapy is a successful method of treatment for penile cancer in terms of local control and organ preservation after microscopically incomplete surgery. Radiotherapy of the regional lymph nodes might also be effective in preventing regional recurrence and can be considered in case of high-risk features and following excision of extensive lymph node involvement.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Brachytherapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy
- Disease Progression
- Disease-Free Survival
- Humans
- Lymphatic Irradiation
- Lymphatic Metastasis/pathology
- Lymphatic Metastasis/radiotherapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/radiotherapy
- Penile Neoplasms/mortality
- Penile Neoplasms/pathology
- Penile Neoplasms/radiotherapy
- Penile Neoplasms/surgery
- Radiotherapy, Adjuvant
- Radiotherapy, High-Energy
- Retrospective Studies
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Affiliation(s)
- Tanja Langsenlehner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria.
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Ware RE, Matthews JP, Hicks RJ, Porceddu S, Hogg A, Rischin D, Corry J, Peters LJ. Usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with a residual structural abnormality after definitive treatment for squamous cell carcinoma of the head and neck. Head Neck 2008; 26:1008-17. [PMID: 15459925 DOI: 10.1002/hed.20097] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residual structural abnormalities after definitive treatment of head and neck squamous cell carcinoma (HNSCC) are common and pose difficult management problems. The usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) to supplement conventional evaluation with clinical and standard radiologic examination (CE) in such patients was assessed. METHODS Fifty-three eligible patients were identified with residual structural abnormalities on CE. True disease extent could be validated in 46 patients. Patients had a median potential follow-up of 55 months (range, 41-75 months) from the date of PET scan to the analysis closeout date. RESULTS PET had better diagnostic accuracy than CE (p = .0002) and induced management change in 21 patients (40%; 95% confidence interval [CI], 26%-54%), including avoidance of unnecessary planned surgery in 14 patients with negative PET. Appropriate management change was confirmed in 19 (95%) of 20 evaluable cases. Disease presence and extent assessment by PET were significant predictors of survival (p < .0001), whereas the extent of disease determined by CE was not. CONCLUSION PET added significantly to the value of CE in restaging disease in patients with structural abnormalities after definitive treatment of HNSCC. Management decisions based on PET were appropriate in most patients.
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Affiliation(s)
- Robert E Ware
- The Department of Diagnostic Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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42
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Suprasert P, Tiyanon J, Kietpeerakool C. Outcome of interval debulking in advanced ovarian cancer patients. Asian Pac J Cancer Prev 2008; 9:519-524. [PMID: 18990031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Interval debulking and neoadjuvant chemotherapy have been used in management of advanced epithelial ovarian cancer for many years in order to achieve optimal residual disease and reduce surgical morbidity. The present study was conducted to evaluate the outcomes of advanced ovarian cancer patients treated with these two approaches prior to cytoreductive surgery in Chiang Mai University Hospital between January 2001 and December 2006. The medical records of 29 patients who met the criteria were retrospectively reviewed. Most had stage IIIC serous cystadenocarcinomas. We found that the 5-year progression free survival and overall survival were 10% and 22% while the median values were 13 months and 34 months, respectively. Multivariate analysis showed that a suboptimal residual tumor volume was a statistically significant adverse prognostic factor for overall survival. In conclusion, interval debulking surgery and neoadjuvant chemotherapy before cytoreductive surgery lead to a more favorable outcome with advanced epithelial ovarian cancers.
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Affiliation(s)
- Prapaporn Suprasert
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
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43
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Abstract
Macroscopic and microscopic complete resection, i.e. R0 resection, is a basic principle of oncologic hepatopancreatobiliary (HPB) surgery. The reported R1 rates for different HPB tumor entities vary considerably, most likely because of ambiguities in the exact definition of R1 resection and the lack of standardized histopathologic examination and reporting. R1 resections can be interpreted as technical/surgical failure (e.g. for small, peripherally located liver tumors). In most cases, however, R1 resections are determined by the anatomic location of the tumor and the growth pattern (e.g. pancreatic cancer with perineural invasion). R0 resections have been identified as positive predictive markers for several HPB tumors (in comparison to R1 resection). Therefore HPB surgeons should always aim at macroscopic and microscopic complete resections. Nonetheless, R1 resections often provide an advantage over no resection with respect to survival and quality of life in patients with these tumors.
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Affiliation(s)
- A Kolb
- Chirurgische Klinik, Universität Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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44
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Black D, Iasonos A, Ahmed H, Chi DS, Barakat RR, Abu-Rustum NR. Effect of perioperative venous thromboembolism on survival in ovarian, primary peritoneal, and fallopian tube cancer. Gynecol Oncol 2007; 107:66-70. [PMID: 17614125 DOI: 10.1016/j.ygyno.2007.05.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 05/21/2007] [Accepted: 05/22/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Venous thromboembolism (VTE) affects 15% of cancer patients and is the second leading cause of death in hospitalized cancer patients. The purpose of this study was to describe the overall survival of patients with ovarian, primary peritoneal, and fallopian tube cancers treated for VTE within 30 days of initial surgery. METHODS We reviewed the medical records of all patients who developed VTE within 30 days of primary surgery for stage I-IV epithelial ovarian, tubal, or primary peritoneal cancer at our institution from 1/99 to 4/05. Standard statistical tests were used. RESULTS Fifty-seven (10%) of 559 patients developed VTE within 30 days of initial surgery. There were no deaths from VTE within 30 days of surgery. With a median follow-up of 2.8 years (range, 0.11-7.3 years), the median overall survival for the entire cohort was 5.9 years (95% CI, 4.6-NR). The proportion of advanced-stage (III-IV) patients within the VTE group compared to the group with no VTE was higher (90% versus 72%; P=0.0078), as was the proportion of patients with ascites compared to those with none (74% versus 54%; P=0.0045), and the proportion of patients with residual disease >1 cm compared to those with <or=1 cm (37% versus 19%; P=0.0021). On multivariate analysis, advanced stage (P<0.0001), the presence of ascites (P=0.0210), and residual disease>1 cm (P<0.0001) were significant predictors of poorer overall survival. VTE within 30 days of surgery was not found to be independently associated with overall survival (hazard ratio, 1.1; 95% CI, 0.71-1.7); P=0.65). CONCLUSIONS Previous studies have shown that a significant number of patients undergoing primary surgery for ovarian cancer will develop postoperative VTE, especially those undergoing extensive cytoreductive procedures. In this large cohort of patients with ovarian, tubal, or primary peritoneal cancer, we found no detrimental effects of perioperative VTE on overall survival.
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Affiliation(s)
- Destin Black
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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45
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Hasegawa S, Ikai I, Fujii H, Hatano E, Shimahara Y. Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg 2007; 31:1256-63. [PMID: 17453285 DOI: 10.1007/s00268-007-9001-y] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgery is the only potentially curative treatment for hilar bile duct cancer. This study sought to evaluate the efficacy and feasibility of surgical management of hilar bile duct carcinoma, including radical hepatectomy, at a single institution. METHODS We performed a retrospective review of 49 consecutive patients who underwent surgery at our hospital between 1990 and 2003. RESULTS Altogether, 44 of 49 patients underwent radical hepatectomy combined with caudate lobectomy and lymphadenectomy. One and four patients underwent partial hepatectomy or bile duct resection, respectively. No patients underwent preoperative portal vein embolization. The 5-year survival rate was 39.7%, with a median survival time of 3.75 years. The postoperative morbidity and mortality rates were 46.8% and 2.0%, respectively. Cox's proportional hazard model revealed that lymph node status and the residual tumor factor were independent prognostic factors. Multivariate analysis revealed that preoperative hyperbilirubinemia, postoperative complications, and extended surgical procedures were independently associated with postoperative hyperbilirubinemia. After potentially curative resection, 39.4% of patients suffered from disease recurrence. In 60% of the total cases, the sites of recurrence were distant metastases. CONCLUSION Surgery, including radical hepatectomy combined with caudate lobectomy and lymph node dissection, is a feasible, effective treatment for hilar bile duct cancer.
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Affiliation(s)
- Suguru Hasegawa
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
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46
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Delpech Y, Haie-Meder C, Rey A, Zafrani Y, Uzan C, Gouy S, Pautier P, Lhommé C, Duvillard P, Castaigne D, Morice P. Para-Aortic Involvement and Interest of Para-Aortic Lymphadenectomy after Chemoradiation Therapy in Patients with Stage IB2 and II Cervical Carcinoma Radiologically Confined to the Pelvic Cavity. Ann Surg Oncol 2007; 14:3223-31. [PMID: 17713822 DOI: 10.1245/s10434-007-9526-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/22/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pelvic radiation therapy with concomitant chemotherapy (PCRT) is the standard treatment of stage IB2/II cervical carcinoma. The impact of concomitant chemotherapy on positive para-aortic nodes (PA+), however, remains unknown. The aim of this study was twofold: to evaluate the rate of histological PA+ after PCRT and to determine the survival of patients with PA+. METHODS Patients fulfilling the following inclusion criteria were studied: (1) stage IB2/II cervical carcinoma, (2) histological subtype: squamous cell, adenocarcinoma or an adenosquamous tumor, (3) exclusion of patients with radiological PA+ (CT scan/MRI), (4) pelvic external radiation therapy of 45 Gy with concomitant chemotherapy (cisplatin 40 mg/m2/week) + utero-vaginal brachytherapy, and (5) completion surgery after the end of PCRT including at least a para-aortic lymphadenectomy. RESULTS Seventy-three patients (16 stage IB2, 57 stage II) treated between 1998 and 2004 fulfilled all the inclusion criteria. PA+ after PCRT were observed in 13 patients (18%) with a median of five (range, 2-22) positive nodes. Overall and disease-free survival at 24 months in patients with PA+ was 40% and 17%. Only two patients with PA+ are currently alive and in remission. CONCLUSIONS The rate of PA+ remains high after PCRT in patients treated for stage IB2/II cervical carcinoma. Furthermore, the survival rate of patients with PA+ is very low. These important results suggest that detection of PA + at the time of completion surgery (after PCRT) is not beneficial for improving survival.
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Affiliation(s)
- Yann Delpech
- Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France
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47
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Wright JD, Grigsby PW, Rader JS, Mutch DG, Powell MA, Gao F, Gibb RK. Effect of a T0 radical hysterectomy specimen on survival for early stage cervical cancer. Gynecol Oncol 2007; 107:280-4. [PMID: 17698175 DOI: 10.1016/j.ygyno.2007.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 05/30/2007] [Accepted: 06/21/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE : Radical hysterectomy with regional lymphadenectomy is the surgical procedure of choice for stage IA-IIA cervical carcinoma. The goal of this study was to evaluate the outcome of patients with no residual tumor (T0) in their hysterectomy specimens. METHODS : An analysis of all women who underwent type II or III hysterectomy for invasive cervical cancer from 1989 to 2005 was performed. The pathologic data and clinical outcome of each patient was documented. T0 subjects were compared to the remainder of the cohort. Survival was evaluated with the Kaplan-Meier method. RESULTS : A total of 594 patients were identified. No residual tumor was noted in the hysterectomy specimens of 171 (29%). T0 patients had earlier stage tumors than the controls (IA 32%, IB 68%) (p<0.0001). Lymphadenectomy was performed in 89% of the T0 subjects. No T0 patients had lymphatic or parametrial disease. The median node yield was similar between the T0 group and those with residual tumors (24 vs. 25) (p=0.34). Adjuvant therapy was not administered to any of the T0 subjects. There were no recurrences and no cancer-related deaths in the T0 patients. Kaplan-Meier analysis revealed an improved disease free (p<0.0001) and overall survival (p<0.0001) for the T0 subjects compared to women with residual tumors. The results were similar when the analysis was restricted to stage IB1 patients (p=0.0004 and 0.002). CONCLUSIONS : A T0 radical hysterectomy specimen indicates a curative therapy. This subgroup of patients has a favorable prognosis with minimal risk of recurrence. Patients with T0 tumors may be candidates for less intensive, abbreviated follow-up.
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Affiliation(s)
- Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032, USA
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Baratti D, Kusamura S, Nonaka D, Oliva GD, Laterza B, Deraco M. Multicystic and well-differentiated papillary peritoneal mesothelioma treated by surgical cytoreduction and hyperthermic intra-peritoneal chemotherapy (HIPEC). Ann Surg Oncol 2007; 14:2790-7. [PMID: 17661150 DOI: 10.1245/s10434-007-9475-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/11/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multicystic peritoneal mesothelioma (MPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM) are exceedingly uncommon lesions with uncertain malignant potential and no uniform treatment strategy. The aim of the current study was to review our experience with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in these clinical settings. METHODS Four women with MPM and eight with WDPPM underwent 13 procedures of cytoreduction and close-abdomen HIPEC with cis-platin and doxorubicin. Seven patients had recurrent disease after previous debulking (one operation in five patients, two in one, four in one). Potential clinicopathological prognostic factors were assessed. RESULTS Optimal cytoreduction (residual tumor nodules <or=2.5 mm) was performed in 12 of 13 procedures. Median follow-up was 27 months (range 6-94). One grade 4 postoperative complication (NCI/CTCAE v.3.0) and no operative mortalities occurred. One patient underwent the procedure twice due to locoregional MPM recurrence. Transition of typical WDPPM to malignant biphasic mesothelioma was documented in one patient who died of disease progression following incomplete cytoreduction and HIPEC. Following multimodality treatment, 5-year overall and progression-free survival were 90.0% (standard error = 9.0) and 79.7% (11.9), respectively. Progression-free survival following previous debulking surgery (median 24 months; range 2-87) was statistically worse (P = .0156). Incomplete cytoreduction and poor performance status correlated to both reduced overall and progression-free survival after cytoreduction and HIPEC. CONCLUSIONS MPM and WDPPM are borderline tumors capable of transformation into potentially lethal processes. Definitive tumor eradication by means of cytoreduction and HIPEC seems more effective than debulking surgery in preventing disease recurrence or transition to aggressive malignancies.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Chemotherapy, Cancer, Regional Perfusion
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Hyperthermia, Induced
- Infusions, Parenteral
- Mesothelioma, Cystic/drug therapy
- Mesothelioma, Cystic/mortality
- Mesothelioma, Cystic/pathology
- Mesothelioma, Cystic/surgery
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/surgery
- Reoperation
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Affiliation(s)
- D Baratti
- Department of Surgery, National Cancer Institute, Milan, Italy
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49
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Schiller DE, Cummings BJ, Rai S, Le LW, Last L, Davey P, Easson A, Smith AJ, Swallow CJ. Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 2007; 14:2780-9. [PMID: 17638059 DOI: 10.1245/s10434-007-9491-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/20/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND For patients with anal canal cancer who fail combined modality treatment (CMT), salvage surgery (SS) offers the potential for long term survival. The literature regarding SS is limited by small patient numbers and/or heterogeneous treatment protocols. We report on a large series of patients initially treated with chemoradiation at a major referral center. METHODS We identified 60 patients with persistent or recurrent anal cancer who had undergone SS; 20 were excluded. Overall and disease-free survival (OS, DFS) curves were constructed using the Kaplan Meier method. Univariate analysis was done using the Log-Rank test, and multivariable analysis using Cox proportional hazards. RESULTS The 40 patients (29 women, 11 men, median age 57) underwent curative intent resection. The initial procedure was multivisceral resection (n = 24), abdominoperineal resection alone (n = 14) or local excision (n = 2). Postoperative mortality was 5%. Postoperative complications were seen in 72%. Median follow-up was 18 months overall and 36 months in survivors. Median OS was 41 months; OS and disease free survival at 5 years were 39% and 30%, respectively. Recurrence was present in 21 patients at time of analysis. Failure was locoregional in 86% (18 of 21) and distant in 48% (10 of 21). Independent predictors of poor OS were male gender, Charlson Comorbidity Score and tumor size. Independent predictors of poor disease free survival were positive margins and lymphovascular invasion. CONCLUSION SS for anal canal cancer was associated with significant morbidity. Long-term survival was achieved in 39% of patients. Comorbidities should guide patient selection, and R0 resection should be the goal.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anal Canal/pathology
- Anal Canal/surgery
- Anus Neoplasms/mortality
- Anus Neoplasms/pathology
- Anus Neoplasms/surgery
- Cancer Care Facilities
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Ontario
- Registries
- Reoperation
- Retrospective Studies
- Salvage Therapy
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Affiliation(s)
- Dan E Schiller
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Suite 1224, 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada
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50
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Wu CY, Wu MS, Chen YJ, Chen CJ, Chen HP, Shun CT, Chen GH, Huang SP, Lin JT. Clinicopathological significance of MMP-2 and TIMP-2 genotypes in gastric cancer. Eur J Cancer 2007; 43:799-808. [PMID: 17236757 DOI: 10.1016/j.ejca.2006.10.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 09/30/2006] [Accepted: 10/06/2006] [Indexed: 01/13/2023]
Abstract
AIMS Single nucleotide polymorphisms in matrix metalloproteinase-2 (MMP-2) -1306 C/T and tissue inhibitor of metalloproteinase-2 (TIMP-2) -418 G/C abolish the Sp-1 binding site and down-regulate expression of these genes. We aim to elucidate the role of MMP-2 and TIMP-2 in clinicopathological manifestations of gastric cancer. METHODS We enrolled 240 gastric cancer patients and 283 controls. DNA was extracted from peripheral blood leucocytes. MMP-2 and TIMP-2 genotypes were analysed by PCR-direct sequencing and PCR-RFLP method, respectively. RESULTS MMP-2 and TIMP-2 genotypes were not associated with gastric cancer development. However, patients with MMP-2 -1306 C/C genotype showed higher risk of lymphatic invasion (odds ratio (OR)=2.77, p=0.01) and venous invasion (OR=2.93, p=0.012). TIMP-2 G/G genotype was associated with serosal invasion (OR=1.89, p=0.009), lymph node metastasis (OR=2.19, p=0.021), lymphatic invasion (OR=2.87, p=0.016) and venous invasion (OR=2.65, p=0.033). CONCLUSION Our results suggest MMP-2 and TIMP-2 genotypes play a crucial role in gastric cancer invasion, but not with development of gastric cancer.
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Affiliation(s)
- Chun-Ying Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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