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Koro S, Balagamwala EH, Sahgal A, Chapman D, Schaff EM, Siddiqui F, Lo SS, Wei W, Tseng CL, Tsai J, Schaub SK, Angelov L, Billena C, Bommireddy A, Mayo ZS, Suh JH, Chao ST. Multi-Institutional Validation of the Recursive Partitioning Analysis for Overall Survival in Patients Undergoing Spine Radiosurgery for Spine Metastasis. Int J Radiat Oncol Biol Phys 2023; 117:S59-S60. [PMID: 37784533 DOI: 10.1016/j.ijrobp.2023.06.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The recently published spine radiosurgery (sSRS) recursive partitioning analysis (RPA) for overall survival (OS) separated patients into 3 distinct prognostic groups. We sought to externally validate this RPA using 3 separate multi-institutional datasets. MATERIALS/METHODS A total of 444 patients were utilized to develop the recently published sSRS RPA predictive of OS in patients with spine metastases. The RPA identified three distinct prognostic classes. RPA Class 1 was defined as KPS >70 and controlled systemic disease (n = 142); RPA Class 2 was defined as KPS>70 with uncontrolled systemic disease or KPS ≤70, age ≥54 and absence of visceral metastases (n = 207); RPA Class 3 was defined as KPS ≤70 and age <54 years or KPS≤70, age ≥54 years and presence of visceral metastases (n = 95). We utilized data from 3 large tertiary care centers to independently validate this RPA. Data from each institution was utilized independently to validate the RPA to minimize confounding based on institutional differences in patient selection. A total of 1,184 patients (221 patients from institution A, 749 institution B, and 214 from institution C) were in the validation cohort and were divided based on their RPA Class. Kaplan-Meier method was used to estimate OS and log-rank test was used to compare OS between RPA classes. RESULTS In each of the validation cohorts, the median OS was 19.9 months (institution A), 11.0 months (institution B), and 24.4 months (institution C). The patient distribution into RPA classification based on Institution A/B/C was, Class 1 (19.4%, 15.1%, 50.5%), Class 2 (74.7%, 57.7%%, 37.9%), and Class 3 (5.9%, 27.2%%, 11.2%), respectively. The median OS for patients in the validation cohort at Institution A/B/C based on RPA class was Class 1 (54 months, 27.1 months, 50.0 months), Class 2 (15.9 months, 13.0 months, 15.1 months) and Class 3 (6.9 months, 3.5 months, 6.1 months), respectively. Patients in RPA Class 1 had a significantly better OS compared to those in Class 2 of the each of the three external institution validation cohorts (p<0.01). Similarly, patients in RPA Class 2 had a significantly better OS compared to those in Class 3 (p<0.01). CONCLUSION The external datasets from three large institutions independently validated the spine SRS RPA successfully for OS in patients undergoing sSRS for spinal metastases. This is the first RPA for OS to have been externally validated using multiple large datasets. Based on this validation, upfront spine SRS is strongly supported for patients in RPA Class 1 and Class 2 and is also cost effective with median OS >11 months for these patients. Patients in RPA Class 3 would benefit most from upfront conventional radiotherapy given their poor expected survival. Given successful external validation, this RPA helps guide physicians to identify those patients with spinal metastases who most benefit from sSRS.
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Affiliation(s)
- S Koro
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E H Balagamwala
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - E M Schaff
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - F Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - S S Lo
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - W Wei
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Tsai
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - S K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - L Angelov
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - C Billena
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - A Bommireddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z S Mayo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J H Suh
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - S T Chao
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Nguyen MH, Swensen SN, Colbert CM, Amin AG, Sponseller PA, Melancon D, Schaub SK, Tseng YD, Blau MH, Halasz LM, Yang JT, Rengan R, Bloch C, Mossa-Basha M, Hofstetter CP, Lo SS. Dosimetric Impact of Radiolucent Carbon Fiber Hardware for Post-Operative Spine Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e140-e141. [PMID: 37784713 DOI: 10.1016/j.ijrobp.2023.06.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The spine is the most common site of osseous metastases. In the non-operative setting, there is growing support for stereotactic body radiation therapy (SBRT) over conventional radiation therapy for improved pain relief and local control. Hybrid therapy consisting of separation surgery and post-operative SBRT is considered in patients with biomechanical instability and epidural cord compression. Surgery traditionally requires titanium (Ti) implants, which introduce artifacts on post-operative imaging in addition to increased uncertainty and beam attenuation. Use of radiolucent carbon fiber reinforced polyetheretherketone (CFR-PEEK) hardware has been shown to provide safe and comparable surgical outcomes as compared to Ti. Our primary objective is to assess the dosimetric impact of Ti versus carbon fiber implants in spine SBRT. MATERIALS/METHODS Single institution retrospective series of post-operative spine SBRT from 2019-2020. Re-irradiation cases were excluded. The electronic medical record and treatment planning systems (TPS) were queried. Dosimetric analyses compared original Ti plans with reoptimized plans, replacing Ti hardware electronic density with carbon fiber. Maintaining clinical goals, dose calculations were performed in a treatment planning system using a collapsed cone algorithm. All treatments used step and shoot intensity modulated radiation therapy to avoid beam angles with significant metal along the beam path. Metallic artifacts were contoured and assigned the appropriate tissue density. A D'Agostino-Pearson test was used to assess data for normality. We used paired Student's t-tests to compare three dosimetric outcomes in the setting of Ti and carbon fiber implants. Planning target volume (PTV) coverage was represented by the volume receiving at least the prescribed dose (%), the maximum point dose (dmax, cGy) to the spinal cord planning risk volume (PRV, 2 mm margin), and the overall hot spot intensity (plan dmax). RESULTS A series of 14 consecutive SBRT cases were evaluated (dose 27-30 Gy in 3-5 fractions). All dosimetric outcomes were normally distributed (p>0.05). We found a statistically significant difference in PTV coverage between the original SBRT treatment plans with Ti hardware (mean 85.1 ± 7.9%) and reoptimized carbon fiber hardware (87.3 ± 6.6%; p = 0.002). There was no significant difference in mean spinal cord PRV dmax between Ti and carbon fiber plans (1846 ± 483 cGy vs. 1842 ± 495 cGy; p>0.05). We observed a nonsignificant increase in mean overall dmax from 3932 ± 416 cGy in the Ti cohort to 4111 ± 906 cGy in the carbon fiber cohort (p>0.05). CONCLUSION Carbon fiber implants provide a significant increase in SBRT target coverage, without impacting the overall plan and spinal cord PRV dmax in this retrospective series. In addition to improved post-operative imaging and reduced uncertainty, carbon fiber hardware may offer dosimetric advantages as compared to traditional Ti spinal implants, and warrants further investigation in a larger cohort.
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Affiliation(s)
- M H Nguyen
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - S N Swensen
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - C M Colbert
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A G Amin
- Department of Neurological Surgery, University of Washington, Seattle, WA
| | - P A Sponseller
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - D Melancon
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - S K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Y D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - M H Blau
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - L M Halasz
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - J T Yang
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - R Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - C Bloch
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - M Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA
| | - C P Hofstetter
- Department of Neurological Surgery, University of Washington, Seattle, WA
| | - S S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Ebadi M, Morse M, Gooley T, Ermoian RP, Halasz LM, Lo SS, Yang JT, Percival ME, Cassaday R, Graber J, Taylor L, Venur V, Tseng YD. Craniospinal Irradiation for CNS Leukemia: Rates of Response and Durability of CNS Control. Int J Radiat Oncol Biol Phys 2023; 117:e464-e465. [PMID: 37785483 DOI: 10.1016/j.ijrobp.2023.06.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Craniospinal irradiation (CSI) is used in the management of leukemia patients with central-nervous-system (CNS) involvement, though the data on response and local control are limited. Given the radioresponsiveness of leukemia, we hypothesized that response to CSI would be high, but CNS control would be influenced by control of systemic disease. MATERIALS/METHODS This retrospective, single-institution analysis included consecutive pediatric and adult patients between 2009-2021 with leukemia that underwent CSI for CNS involvement, defined as presence of blasts (i.e., >0%) on CSF flow cytometry. Endpoints included CNS response rate (RR), CNS local recurrence (LR), progression-free survival (PFS), and overall survival (OS), which were estimated from start of CSI. The probability of CNS LR was summarized using a cumulative incidence estimate, where death without LR was considered a competing risk. The probabilities of OS and PFS were obtained using Kaplan-Meier estimates. RESULTS Among the 39 eligible patients (43% AML, 49% ALL, 8% blast-phase CML), most were male (59%). All had CSF confirmation of disease. Median age at CSI was 31 years (range 7-67). CSI (protons 54%, photons 46%) was utilized early within the CNS disease course (median 0 CNS relapses prior to CSI). Twenty-five patients (64%) received CSI immediately prior to a stem-cell transplant (SCT), of which 21 (84%) had TBI conditioning to a median dose of 12 Gy (range 2-13.2). Patients treated with CSI alone received a higher CSI dose (median 18 Gy; range 10.8-24) than those treated with SCT consolidation (median 12 Gy; range 10.8-24). Fifteen patients had CSF-positive disease immediately prior to CSI; all 14 of those assessed for response (RR 100%) had confirmed clearance of blasts at a median of 23 days (range 7-197) from CSI start. With a median follow-up of 48 months (range 0.4-123) for survivors, 2-year PFS and OS estimates were 32% and 43%, respectively. Only 5 CNS relapses were noted (2-year CNS LR of 14%). All CNS relapses either occurred after (n = 4) or concurrently (n = 1) with a systemic relapse. In Cox regression univariate models, age, sex, time to CNS disease, positive CSF immediately prior to CSI, and SCT did not show demonstrable evidence of association with CNS LR. However, systemic relapse after CSI (HR 5.9, 95% CI 2.5-13.8, P<0.0001) and systemic disease at the time of CSI (HR 3.9, 95% CI 1.6-9.5, P = 0.003) were associated with higher risk of CNS LR. No grade-3+ acute toxicity was seen during CSI. CONCLUSION CSI is a well-tolerated and effective treatment option for patients with CNS leukemia. Though CNS local recurrence was modest, there was a high risk of systemic relapse and/or death. Control of systemic disease, both before and after CSI, may be important for CNS local control, and raises consideration that CNS recurrence may reflect reseeding from the systemic space.
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Affiliation(s)
- M Ebadi
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - M Morse
- University of Washington, Seattle, WA
| | - T Gooley
- Fred Hutchinson Cancer Center, Seattle, WA
| | - R P Ermoian
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - L M Halasz
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - S S Lo
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - J T Yang
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - M E Percival
- Department of Medical Oncology, Fred Hutchinson Cancer Center, Seattle, WA
| | - R Cassaday
- Department of Medical Oncology, Fred Hutchinson Cancer Center, Seattle, WA
| | - J Graber
- Department of Neuro-Oncology, University of Washington, Seattle, WA
| | - L Taylor
- Department of Neuro-Oncology, University of Washington, Seattle, WA
| | - V Venur
- Department of Medical Oncology, Fred Hutchinson Cancer Center, Seattle, WA
| | - Y D Tseng
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
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Tan VS, Correa RJM, Warner A, Ali M, Muacevic A, Ponsky L, Ellis RJ, Lo SS, Onishi H, Swaminath A, Kwon YS, Morgan SC, Cury F, Teh BS, Mahadevan A, Kaplan ID, Chu W, Hannan R, Staehler M, Grubb W, Louie AV, Siva S. 5-Year Renal Function Outcomes after SABR for Primary Renal Cell Carcinoma: A Report from the International Radiosurgery Oncology Consortium of the Kidney (IROCK). Int J Radiat Oncol Biol Phys 2023; 117:S84. [PMID: 37784588 DOI: 10.1016/j.ijrobp.2023.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Renal cell carcinoma (RCC) presents uncommonly in patients with a congenital solitary kidney or prior contralateral nephrectomy. The objective of this study was to compare renal function outcomes of stereotactic ablative body radiotherapy (SABR) in patients with solitary vs. bilateral kidneys. MATERIALS/METHODS Patients with primary RCC with ≥2 years of follow-up at 12 participating International Radiosurgery Consortium for Kidney (IROCK) institutions were included. Patients with upper tract urothelial carcinoma or metastatic disease were excluded. Renal function was measured by estimated glomerular filtration rate (eGFR). For patients where eGFR was not recorded, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate eGFR based on known creatinine. Baseline characteristics and renal function outcomes were compared between solitary vs. bilateral kidneys. Multivariable logistic regression was used to identify factors predictive of eGFR decline ≥ 15 mL/min and any eGFR increase evaluated at 1-year post-SABR. RESULTS One hundred and ninety patients with solitary (n = 56) or bilateral kidneys (n = 134) underwent SABR and were followed for a median of 5.0 years (IQR: 3.4-6.8). Pre-SABR eGFR (mean ± SD) was similar in patients with solitary (61.1 ± 23.2 mL/min) vs. bilateral kidneys (58.0 ± 22.3 mL/min, p = 0.324). Mean tumor size was 3.70 ± 1.40 cm in solitary and 4.35 ± 2.50 cm in bilateral kidneys (p = 0.026). After SABR, an initial compensatory increase in eGFR was observed in both cohorts (22.7% solitary and 17.7% bilateral at 1 year). This compensatory increase persisted in patients with bilateral but not a solitary kidney (10.3% vs. 0% at 3-years and 21.1% vs. 0% at 5-years, respectively). At 5-years post-SABR, eGFR decreased by -14.5 ± 7.6 in solitary and -13.3 ± 15.9 mL/min in bilateral kidneys (p = 0.665). At all timepoints assessed, there were no significant differences in eGFR decline between solitary vs. bilateral cohorts (all p > 0.05). There were also no significant differences in post-SABR end-stage renal disease (7.1% vs. 6.7%) or dialysis (3.6% vs. 3.7%) in solitary vs. bilateral, respectively. Multivariable analysis demonstrated that increasing tumor size (OR per 1 cm: 1.57; 95% CI: 1.14-2.16, p = 0.006) and baseline eGFR (OR per 10 mL/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) was more likely to be associated with eGFR decline ≥ 15 mL/min. There was no significant association between solitary vs. bilateral kidney and eGFR decline (OR: 1.22; 95% CI: 0.45-3.34, p = 0.693). CONCLUSION There was no observed difference between renal function outcomes in patients with a solitary vs. bilateral kidneys. While larger tumor size may increase the risk of eGFR decline post-SABR, treatment of a solitary kidney does not appear to increase the risk of renal dysfunction long-term.
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Affiliation(s)
- V S Tan
- London Regional Cancer Program, London, ON, Canada
| | - R J M Correa
- London Regional Cancer Program, London, ON, Canada
| | - A Warner
- London Regional Cancer Program, London, ON, Canada
| | - M Ali
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - A Muacevic
- University of Munich Hospitals, Munich, Germany
| | - L Ponsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - S S Lo
- University of Washington School of Medicine, Seattle, WA
| | - H Onishi
- University of Yamanashi, Chuo, Japan
| | - A Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Y S Kwon
- University of Texas Southwestern Medical Center, Dallas, TX
| | - S C Morgan
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - F Cury
- McGill University Health Centre, Montreal, QC, Canada
| | - B S Teh
- Houston Methodist Hospital, Houston, TX
| | - A Mahadevan
- NYU Langone Health Laura and Isaac Perlmutter Cancer Center, New York, NY
| | - I D Kaplan
- Beth Israel Deaconess Medical Center, Boston, MA
| | - W Chu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R Hannan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - M Staehler
- University of Munich Hospitals, Munich, Germany
| | - W Grubb
- Augusta University, Augusta, GA
| | - A V Louie
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Leung E, Gladwish A, Sahgal A, Lo SS, Kunos CA, Lanciano RM, Mantz CA, Guckenberger M, Zagar TM, Mayr NA, Chang AR, Jorcano S, Biswas T, Pontoriero A, Albuquerque KV. Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy. Radiat Oncol 2020; 15:24. [PMID: 32000833 PMCID: PMC6993370 DOI: 10.1186/s13014-020-1469-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background Stereotactic Ablative Radiotherapy (SABR) is an effective treatment that improves local control for many tumours. However, the role of SABR in gynecological cancers (GYN) has not been well-established. We hypothesize that there exists considerable variation in GYN-SABR practice and technique. The goal of this study is to describe clinical and technical factors in utilization of GYN-SABR among 11 experienced radiation oncologists. Materials and methods A 63 question survey on GYN-SABR was sent to 11 radiation oncologists (5 countries) who have published original research, conducted trials or have an established program at their institutions. Responses were combined and analyzed at a central institution. Results Most respondents indicated that salvage therapy (non-irradiated or re-irradiated field) for nodal (81%) and primary recurrent disease (91%) could be considered standard options for SABR in the setting of inability to administer brachytherapy. All other indications should be considered on clinical trials. Most would not offer SABR as a boost in primary treatment off-trial without absolute contraindications to brachytherapy. Multi-modality imaging is often (91%) used for planning including PET, CT contrast and MRI. There is a wide variation for OAR tolerances however small bowel is considered the dose-limiting structure for most experts (91%). Fractionation schedules range from 3 to 6 fractions for nodal/primary definitive and boost SABR. Conclusions Although SABR has become increasingly standard in other oncology disease sites, there remains a wide variation in both clinical and technical factors when treating GYN cancers. Nodal and recurrent disease is considered a potential indication for SABR whereas other indications should be offered on clinical trials. This study summarizes SABR practices among GYN radiation oncologists while further studies are needed to establish consensus guidelines for GYN-SABR treatment.
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Affiliation(s)
- E Leung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - A Gladwish
- Royal Victoria Hospital, Barrie, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - C A Kunos
- National Cancer Institute, Rockville, MD, USA
| | - R M Lanciano
- Delaware County Memorial Hospital/Philadelphia Cyberknife, Drexel Hill, PA, USA
| | - C A Mantz
- 21st Century Oncology, Fort Myers, FL, USA
| | | | - T M Zagar
- Northeastern Radiation Oncology, Glen Falls, NY, USA
| | - N A Mayr
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - A R Chang
- Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - S Jorcano
- Instituto Oncologico Teknon, Barcelona, Spain
| | - T Biswas
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - K V Albuquerque
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wendell KB, Nadeem S, Martin B, Camacho PM, Albain KS, Robinson P, Lo SS. Abstract P4-16-10: Bone health in young women with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
There are limited data and consensus regarding bone mineral density (BMD) monitoring, and management of bone loss in younger women with breast cancer (BC). Adjuvant endocrine therapy for estrogen receptor positive (ER+) BC may include ovarian function suppression (OFS) plus use of aromatase inhibitors (AIs) for 5-10 years, both of which contribute to bone loss. The WHO risk prediction tool FRAX does not include BC or AI use as independent risk factors in its calculation thus underestimating risk of fracture. This study aims to evaluate current screening and management of bone health in young women with BC.
Methods:
A retrospective, IRB-approved chart review was performed in consecutive women ≤40 with BC diagnosed at Loyola University Chicago Medical Center between 01/01/2015 and 12/13/17. Demographic data, BC treatment, and factors contributing to secondary causes of bone loss were collected through 4/1/18. A descriptive analysis included summary values for all categorical and continuous risk factors.
Results:
BC ≤40yrs was identified in 136 women; 18 were excluded due to missing data. The analysis was performed on 118 patients (pts). Mean pt age was 34.6 yrs (SD 4.7). Stage at diagnosis included: stage 0 = 9 (7.6%), stage 1 = 26 (22%), stage 2 = 44 (37.3%), stage 3 = 23 (19.5%), stage 4 = 7 (5.9%), unknown = 9 (7.6%). Seventy-nine (67%) had ER+ BC; 32 (27.1%) had HER2-positive disease. The majority of pts (101, 85.6%) received chemotherapy in their treatment plan. Menopause was documented in 69 (59.0%) pts. Goserelin was used in 31 pts (44.9%), oophorectomy in 17 (24.6%), both in 5 (7.2%). Tamoxifen was used in 44 (55.7%) ER+ pts; 34 (43.0%) received an AI, and 18 (22.8%) received sequential tamoxifen and AI. 25 Hydroxy-Vitamin D (25 OHD) levels were checked in 61 (51.7%); 43 (70.5%) had levels <30 ng/ml; 24 (55.8%) received vitamin (vit) D supplementation. There was no difference in the 25 OHD in pre- and post-menopausal women (p=0.64). Pts with vit D deficiency had a median BMI of 26.8 vs 23.8 in those with sufficient vit D levels (exact p=.049). Secondary diagnoses contributing to low BMD were identified in 14 (11.8%). Dual energy xray absorptiometry (DXA) scans were checked in 23 pts (19.7%), 18 of whom were post-menopausal. At the femur, 0 pts had a z-score (age-matched standard deviation) of ≤-2.0, 9 pts (39.1%) had a score between 0 to -2.0. At the lumbar spine, 1 pt (4.3%) had a z-score ≤-2.0, 9 pts (39.1%) had a z-score between 0 to -2.0. No T-scores were in the osteoporosis range; 11 pts had T-scores at both femur and lumbar spine in the osteopenia range. The median 10 yr probability of a major osteoporotic fracture (FRAX score) was 1.9% (1.6-2.7%); the median 10 yr probability for hip fracture was 0.1% (0.10-0.20%). There were no differences in FRAX scores between pre- and post-menopausal women. No fractures were reported in the time period studied. Anti-resorptive therapy was used only in patients with metastatic bone disease.
Conclusions:
25 OHD and DXA scans are not routinely checked in younger women diagnosed with BC. Vit D deficiency and evidence of bone loss is prevalent in those pts who do undergo testing. Further research and guidelines are necessary to address management of bone health in young women with BC to minimize future fracture risk and morbidity.
Citation Format: Wendell KB, Nadeem S, Martin B, Camacho PM, Albain KS, Robinson P, Lo SS. Bone health in young women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-10.
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Affiliation(s)
- KB Wendell
- Loyola University Medical Center, Maywood, IL
| | - S Nadeem
- Loyola University Medical Center, Maywood, IL
| | - B Martin
- Loyola University Medical Center, Maywood, IL
| | - PM Camacho
- Loyola University Medical Center, Maywood, IL
| | - KS Albain
- Loyola University Medical Center, Maywood, IL
| | - P Robinson
- Loyola University Medical Center, Maywood, IL
| | - SS Lo
- Loyola University Medical Center, Maywood, IL
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Lam MC, Lo SS. Use of Uterine Artery Embolisation for Pregnancy-related Complications: a Single-Institution Experience. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1615358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tse KH, Lo SS. Mild Encephalitis / Encephalopathy with Reversible Splenial and Cerebellar Lesions (MERS Type II) in a Patient with Diabetic Ketoacidosis and Hypernatraemia. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1515304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Devadas MS, Devkota T, Johns P, Li Z, Lo SS, Yu K, Huang L, Hartland GV. Imaging nano-objects by linear and nonlinear optical absorption microscopies. Nanotechnology 2015; 26:354001. [PMID: 26266335 DOI: 10.1088/0957-4484/26/35/354001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Absorption based microscopy measurements are emerging as important tools for studying nanomaterials. This review discusses the three most common techniques for performing these experiments: transient absorption microscopy, photothermal heterodyne imaging, and spatial modulation spectroscopy. The focus is on the application of these techniques to imaging and detection, using examples taken from the authors' laboratory. The advantages and disadvantages of the three methods are discussed, with an emphasis on the unique information that can be obtained from these experiments, in comparison to conventional emission or scattering based microscopy experiments.
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Affiliation(s)
- Mary Sajini Devadas
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556-5670, USA
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Spence GT, Lo SS, Ke C, Destecroix H, Davis AP, Hartland GV, Smith BD. Near-Infrared Croconaine Rotaxanes and Doped Nanoparticles for Enhanced Aqueous Photothermal Heating. Chemistry 2014; 20:12628-35. [DOI: 10.1002/chem.201403315] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/23/2014] [Indexed: 12/11/2022]
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Major TA, Lo SS, Yu K, Hartland GV. Time-Resolved Studies of the Acoustic Vibrational Modes of Metal and Semiconductor Nano-objects. J Phys Chem Lett 2014; 5:866-874. [PMID: 26274080 DOI: 10.1021/jz4027248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the past decade, there have been a number of transient absorption studies of the acoustic vibrational modes of metal and semiconductor nanoparticles. This Perspective provides an overview of this work. The way that the frequencies of the observed modes depend on the size and shape of the particles is described, along with their damping. Future research directions are also discussed, especially how these measurements provide information about the way nano-objects interact with their environment.
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Affiliation(s)
- Todd A Major
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670, United States
| | - Shun Shang Lo
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670, United States
| | - Kuai Yu
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670, United States
| | - Gregory V Hartland
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670, United States
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Devadas MS, Li Z, Major TA, Lo SS, Havard N, Yu K, Johns P, Hartland GV. Detection of single gold nanoparticles using spatial modulation spectroscopy implemented with a galvo-scanning mirror system. Appl Opt 2013; 52:7806-7811. [PMID: 24216741 DOI: 10.1364/ao.52.007806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/17/2013] [Indexed: 06/02/2023]
Abstract
The optical extinction of single nanoparticles can be sensitively detected by spatial modulation spectroscopy (SMS), where the particle is moved in and out of a tightly focused laser beam with a piezo-device. Here we show that high sensitivity can be obtained by modulating the beam with a galvo-mirror system, rather than by moving the sample. This work demonstrates an inexpensive method for making a SMS microscope, and shows how an existing laser scanning microscope can be adapted for SMS measurements. The galvo-mirror technique also allows SMS measurements to be performed in a liquid, which is difficult to do with piezo-modulation.
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Woo YH, Lo SS. Intralabyrinthine Schwannoma: an Uncommon but Underdiagnosed Entity. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1312124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Ultrafast x-ray diffraction studies reveal the lattice vibrations of single gold nanoparticles.
[Also see Report by
Clark
et al.
]
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Affiliation(s)
- Gregory V Hartland
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46557-5670, USA.
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Lo SS, Shi HY, Huang L, Hartland GV. Imaging the extent of plasmon excitation in Au nanowires using pump-probe microscopy. Opt Lett 2013; 38:1265-1267. [PMID: 23595453 DOI: 10.1364/ol.38.001265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Knowledge of how energy and charge carriers move in nanoscale systems is essential for engineering efficient devices. In this Letter, we demonstrate a technique to directly image dynamics in nanostructures based on laser scanning transient absorption microscopy, which provides near diffraction-limited spatial resolution and ultrafast time resolution. The capabilities of the technique are demonstrated by experiments on propagating surface plasmon polariton modes of Au nanowires, although these measurements can be used to study a variety of fluorescent and nonfluorescent systems.
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Affiliation(s)
- Shun Shang Lo
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 45665, USA.
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Major TA, Crut A, Gao B, Lo SS, Fatti ND, Vallée F, Hartland GV. Damping of the acoustic vibrations of a suspended gold nanowire in air and water environments. Phys Chem Chem Phys 2013. [DOI: 10.1039/c2cp43330c] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lo SS, Guo R, Czaplicki KL, Robinson PA, Gaynor E, Barhamand FB, Schulz WC, Kash JJ, Horvath LE, Bayer RA, Petrowsky C, De la Torre R, Park JH, Albain KS. Abstract P1-12-04: Carboplatin, nab-paclitaxel and bevacizumab as first-line treatment for metastatic breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-12-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bevacizumab added to weekly paclitaxel resulted in improved progression free survival (PFS) and objective response rates (ORR) compared to weekly paclitaxel alone. Nab-paclitaxel and the platins are active in MBC. We conducted an efficacy and safety study of carboplatin, nab-paclitaxel and bevacizumab.
Methods: A phase II open label prospective multi-site study enrolled patients (pts) who had measurable MBC according to RECIST 1.1 criteria and no prior chemotherapy for advanced disease. The primary endpoint was PFS with secondary endpoints of overall survival (OS), ORR, and safety. Pts initially received carboplatin AUC 6 day 1, 22,43, plus weekly nab-paclitaxel 100mg/m2 and bevacizumab 15mg/m2 day 1,22,43 of a 56 day cycle. This was later changed to carboplatin AUC 6 day 1, nab-paclitaxel 100mg/m2 day 1,8,15, and bevacizumab 10mg/m2 day 1,15 of a 28 day cycle. Thirty-two pts were required to detect an increase in median PFS from 6.7 to 10.5 mo with 80% power based on a one-sided p = 0.05. Kaplan–Meier analyses estimated PFS and OS. The log rank test was used for the comparison of survival curves between pts with triple negative MBC (TNBC) and pts with non-TNBC.
Results: Thirty-two pts were enrolled between 2/2008 and 11/2011 by 1 academic and 5 community oncology practices. Two pts were ineligible due to non-measurable disease and not included in the response analyses. The median age was 58 years (range 35–81), 22 pts (69%) had an ECOG PS 0, 9 (28%) had a PS 1, 1 (3%) PS 2. Twenty-four (75%) pts had ER+ disease, 7 (22%) had TNBC, 1 (3%) had ER-HER2+ disease not eligible for trastuzumab-based therapy. Metastatic sites were bone (26%), liver (18%), loco-regional (16%), and lung (12%). One pt (3%) had bone and loco-regional disease only, 19 (59%) had visceral dominant disease. The median number of weeks on treatment was 28.9 (range 5–131). The median PFS in all pts was 13.6 months (mo) (95% CI 11.2–21.9), with a median OS of 26.8 mo (95% CI 13.3–41.2). The ORR (2 CR and 18 PR) was 66.7% (CI 47.2–82.7). There also were 6 (20%) unconfirmed PR and 3 (10%) stable disease, resulting in a clinical benefit rate of 96.7% (CI 82.78–99.92). There was no significant difference in PFS (median 13.6 vs 16.1mo, p = 0.37) or OS (median 13.6 vs 26.8mo, p = 0.32) in pts with TNBC versus non-TNBC disease. The most common toxicities of any grade (gr) include neutropenia and thrombocytopenia in 24 pts (75%) each, leukopenia and fatigue in 17 pts (53%) each, anemia in 15 (47%), and neuropathy in 10 (31%). Gr 4 neutropenia was seen in 7 pts (22%) without febrile neutropenia, and gr 4 thrombocytopenia occurred in 6 (19%). There were no pts with gr 4 sensory neuropathy. All pts required chemotherapy dose delays, 15 (47%) had chemotherapy dose reductions.
Conclusions: The carboplatin, nab-paclitaxel and bevacizumab combination is highly effective with good tolerance in first line MBC. As the role of anti-angiogenic therapy in first line metastatic breast cancer is being clarified, this would be an attractive regimen to test in the (neo)adjuvant setting and together with novel molecular targeted agents.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-12-04.
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Affiliation(s)
- SS Lo
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - R Guo
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - KL Czaplicki
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - PA Robinson
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - E Gaynor
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - FB Barhamand
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - WC Schulz
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - JJ Kash
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - LE Horvath
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - RA Bayer
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - C Petrowsky
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - R De la Torre
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - JH Park
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
| | - KS Albain
- Loyola University Medical Center, Maywood, IL; Hematology Oncology Consultants Ltd., Naperville, IL; Swedish Americal Regional Cancer Center, Rockford, IL; Edward Cancer Center, Naperville, IL; Central Dupage Cancer Center, Winfield, IL; CDPG Oncology at Delnor, Delnor, IL
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Lakhani A, Guo R, Duan X, Ersahin C, Gaynor ER, Godellas C, Kay C, Lo SS, Mai H, Perez C, Albain K, Robinson P. Abstract PD10-02: Metabolic syndrome and recurrence within the 21-gene recurrence score assay risk categories in lymph node negative breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd10-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The incidence of the metabolic syndrome (MS) has been increasing in the United States and elsewhere. The interaction of MS with breast cancer (BC) incidence, tumor biology and outcomes are under study. We hypothesized that the presence of MS would predict BC recurrence to a variable degree across the diverse BC biology as defined by the risk categories of the 21-gene recurrence score (RS) assay.
Patients and Methods: We studied consecutive patients (pts) with newly diagnosed, estrogen receptor (ER) positive, lymph node (LN) negative BC treated in our institution between 2006–2011 who had a 21-gene RS assay done on their tumors. All pts were treated with standard systemic and local therapy. The electronic medical record was queried for key diagnoses including MS and its constituent parts. The WHO definition was used to categorize pts as having MS defined as diabetes mellitus (DM) or glucose intolerance, plus at least 2 of the following: hypertension (HTN), dyslipidemia (HL), central obesity and microalbuminemia. Tumor characteristics including Ki67 index, grade, tumor size, HER2/neu status; and pt characteristics including age, race, menopausal status, body mass index were recorded. The association of MS and the tumor and patient characteristics with the RS tertiles of low, intermediate and high risk was analyzed.
Results: We identified 332 pts, median age 62 years, of whom 88 (27%) had MS. There was no significant association between the MS and any of the patient or tumor variables including the 21-gene RS assay, except for race (p = 0.004). Eleven of 21 (52%) African-American women had MS, 68 of 284 (24%) Caucasian women had MS, and 9 of 21 (43%) others including Hispanic and Asian women had MS. However, there was a significant association between recurrence and MS (p = 0.0002) independent of other factors. Of the 21 pts who recurred, 13 (61.9%) had MS. There was an association of recurrence and MS within RS tertiles. For pts with low risk scores, 7/44 (15.9%) with MS vs. 1/126 (0.79%) without MS had recurrence (p = 0.0003). For pts with intermediate risk scores, 5/30 (16.67%) with MS vs. 4/83 (4.82%) without MS had recurrence (p = 0.05). For patients with high risk scores, 1/9 (11.11%) with MS vs. 2/15 (13.33%) without MS had recurrence (p = 1).
Conclusion: MS is an independent risk factor for BC recurrence among women with LN negative, ER positive BC treated with standard adjuvant therapy. There is a striking impact of MS on recurrence in pts with tumor biologies defined by low (and to a lesser degree) intermediate risk 21-gene RS assay scores. However, there is no difference in recurrence risk by MS among those pts with high RS. This implies that interventions directed at modifying MS in newly diagnosed pts with early BC may potentially favorably impact survival in those with specific tumor biologies as defined by multigene assays. Thus, long-term prospective studies should be conducted to further evaluate both the short and long term effects of MS on BC outcomes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD10-02.
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Affiliation(s)
- A Lakhani
- Loyola University Medical Center, Maywood, IL
| | - R Guo
- Loyola University Medical Center, Maywood, IL
| | - X Duan
- Loyola University Medical Center, Maywood, IL
| | - C Ersahin
- Loyola University Medical Center, Maywood, IL
| | - ER Gaynor
- Loyola University Medical Center, Maywood, IL
| | - C Godellas
- Loyola University Medical Center, Maywood, IL
| | - C Kay
- Loyola University Medical Center, Maywood, IL
| | - SS Lo
- Loyola University Medical Center, Maywood, IL
| | - H Mai
- Loyola University Medical Center, Maywood, IL
| | - C Perez
- Loyola University Medical Center, Maywood, IL
| | - K Albain
- Loyola University Medical Center, Maywood, IL
| | - P Robinson
- Loyola University Medical Center, Maywood, IL
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Affiliation(s)
- Daniel E. Gómez
- School of Physics, The University of Melbourne, Parkville, Victoria 3010,
Australia
- Materials Science
and Engineering, CSIRO, Clayton, Victoria
3169, Australia
| | - Shun Shang Lo
- Department
of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670,
United States
| | - Timothy J. Davis
- Materials Science
and Engineering, CSIRO, Clayton, Victoria
3169, Australia
- Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria
3168, Australia
| | - Gregory V. Hartland
- Department
of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670,
United States
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Lo AXN, Hon TYW, Luk WH, Loke TKL, Lo SS, Chan JCS. Ultrasound-guided thrombin injection for pseudoaneurysms: a case series at a local hospital. Hong Kong Med J 2012; 18:333-337. [PMID: 22865179] [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: 06/01/2023] Open
Abstract
Post-catheterization pseudoaneurysms are increasingly prevalent due to widespread use of endovascular procedures. Ultrasound-guided thrombin injection has emerged as a treatment of choice for these pseudoaneurysms. We review our experience performing this procedure for a series of cases from 2007 to 2010 with different clinical manifestations at a single hospital in Hong Kong. We achieved a high technical success rate with no complications.
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Affiliation(s)
- Adrian X N Lo
- Department of Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
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Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Vichare A, Hahn C, Chang EL. International Practice Survey on the Management of Brain Metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control. Clin Oncol (R Coll Radiol) 2012; 24:e81-92. [PMID: 22794327 DOI: 10.1016/j.clon.2012.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 01/27/2012] [Accepted: 03/22/2012] [Indexed: 11/30/2022]
Affiliation(s)
- M N Tsao
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, Ontario, Canada.
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Lo SS, Major TA, Petchsang N, Huang L, Kuno MK, Hartland GV. Charge carrier trapping and acoustic phonon modes in single CdTe nanowires. ACS Nano 2012; 6:5274-5282. [PMID: 22559050 DOI: 10.1021/nn3010526] [Citation(s) in RCA: 11] [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: 05/29/2023]
Abstract
Semiconductor nanostructures produced by wet chemical synthesis are extremely heterogeneous, which makes single particle techniques a useful way to interrogate their properties. In this paper the ultrafast dynamics of single CdTe nanowires are studied by transient absorption microscopy. The wires have lengths of several micrometers and lateral dimensions on the order of 30 nm. The transient absorption traces show very fast decays, which are assigned to charge carrier trapping into surface defects. The time constants vary for different wires due to differences in the energetics and/or density of surface trap sites. Measurements performed at the band edge compared to the near-IR give slightly different time constants, implying that the dynamics for electron and hole trapping are different. The rate of charge carrier trapping was observed to slow down at high carrier densities, which was attributed to trap-state filling. Modulations due to the fundamental and first overtone of the acoustic breathing mode were also observed in the transient absorption traces. The quality factors for these modes were similar to those measured for metal nanostructures, and indicate a complex interaction with the environment.
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Affiliation(s)
- Shun Shang Lo
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556-5670, USA
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Huang Z, Mayr NA, Lo SS, McLawhorn R, Gao M, Liu T, Yuh WTC. SU-E-T-04: Repair Kinetics of Sublethal Damage in Rat Cervical Spinal Cord - Application of the GLQ Model Incorporating Reciprocal Time Pattern. Med Phys 2012; 39:3703. [DOI: 10.1118/1.4735058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Proof-of-concept transient absorption microscopy (TAM) with simultaneously high spatial and temporal resolution was demonstrated to image charge generation and recombination in model systems of poly(3-hexylthiophene) (P3HT) and [6,6]-phenyl-C61-butyric acid methyl ester (PCBM) blends upon extended thermal annealing. Significant spatial heterogeneity in charge generation and recombination dynamics was revealed on the length scale of hundreds of nanometers near the micrometer-sized PCBM crystallites, suggesting that information obtained in ensemble measurements by integrating over microscopically inhomogeneous areas could be misleading. In contrast to previous studies, high sensitivity of our instrumentation allows us to employ low excitation intensities to minimize higher-order recombination processes. TAM provides a unique noncontact tool to probe local functionality in microscopically heterogeneous energy harvesting systems.
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Affiliation(s)
- Chris Tsz On Wong
- †Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Shun Shang Lo
- ‡Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Libai Huang
- †Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, United States
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Albain KS, Czerlanis C, Rajan P, Zlobin A, Godellas C, Bova D, Lo SS, Robinson P, Sarker S, Gaynor ER, Cooper R, Aranha G, Czaplicki K, Busby B, Rizzo P, Chisamore M, Demuth T, Blackman S, Watters J, Stiff P, Fuqua SAW, Miele L. Abstract PD05-12: Combination of Notch Inhibitor MK-0752 and Endocrine Therapy for Early Stage ERα + Breast Cancer in a Presurgical Window Pilot Study. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd05-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast tumor initiating cells (TIC) use Notch receptors/ligands with other pathways for self renewal, resulting in tumor proliferation and progression. We showed that Notch inhibition with gamma secretase inhibitors (GSI) potentiates the effects of tamoxifen (tam) in xenografts (Rizzo et al. Cancer Res 2008). It is unknown whether GSIs plus endocrine therapy result in modulation of Notch and other proliferation markers in human breast cancer. Our objective was to add short exposure of the GSI MK-0752 to ongoing tam or letrozole (letr) during the presurgical window to determine 1) feasibility, 2) safety/tolerance, and 3) impact on biomarkers. We report the initial cohort of this pilot study (ClinTrials. gov NCT00756717).
Methods: Patients (pts) with early stage ERα + breast cancer were treated with 25 days of tam or letr. On day 15 MK-0752 was added to endocrine therapy (350 mg orally 3 days on, 4 days off, 3 days on), with definitive surgery day 25. Formalin fixed, paraffin embedded biopsies were obtained at baseline, day 14 and final surgery, with histologic confirmation of tumor content >50% and RNA extraction by standard methods. Q-PCR was done for Notch1, Notch3, Notch4, Deltex, Jagged1, c-myc, HEY1, HEY2, HES1, PS2, C-Myc, Cyclin A2, NOXA (pro-apoptotic protein), Ki67, Dicer-1, RPL13 (internal control). Ct averages for 3 replicates were used and mRNA levels were calculated by the 2ΔΔCt method. Baseline gene expression levels were used as comparators for days 14 and 25 levels in each pt. The first cohort of 10 pts was analyzed to determine if enough signals were present to justify expanding the cohort at this dose to 20 pts and possibly test a second cohort on an alternate MK-0752 dose/schedule. Results: The initial cohort of 10 pts completed all therapy (4 tam, 6 letr), all biopsies and definitive surgery on schedule. One other pt withdrew prior to starting MK-0752 due to hypertension. Toxicity was minimal: grade 1 periorbital edema/cough, nausea, and axillary paresthesias in 1 pt each; grade 1 facial rash, 2 pts; and grade 2 fatigue, 1 pt. There was no diarrhea or surgical complications. Significant changes occurred in molecular marker levels after MK-0752 plus tam/letr (day 25) vs. end of tam/letr alone (day 14) as follows: Ki67 mRNA decreased in 9/10 pts; Notch4 decreased, 10/10; NOXA increased, 6/10; and Notch1 decreased, 6/10. Other markers showed inter-individual variations and will be presented, along with results of the global gene expression profiling (in progress). Conclusions: The addition of a short exposure of the GSI MK-0752 to ongoing endocrine therapy was feasible, safe, and well tolerated in pts with ERα + early breast cancer prior to definitive surgery. It results in anti-proliferative and pro-apoptotic effects at the molecular level. Notch4, which plays a key role in breast TIC, was the most consistent molecular marker of response in this setting. This suggests a potential anti-TIC effect of this combination and a role in overcoming endocrine resistance. Accrual to the expanded cohort is underway. If findings are confirmed, the second study with alternate MK-0752 dose/schedule may commence. Funding: Swim Across America, Inc. (clinical trial costs); Merck (drug supply, profiling)
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD05-12.
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Affiliation(s)
- KS Albain
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - C Czerlanis
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - P Rajan
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - A Zlobin
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - C Godellas
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - D Bova
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - SS Lo
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - P Robinson
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - S Sarker
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - ER Gaynor
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - R Cooper
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - G Aranha
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - K Czaplicki
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - B Busby
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - P Rizzo
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - M Chisamore
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - T Demuth
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - S Blackman
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - J Watters
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - P Stiff
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - SAW Fuqua
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
| | - L. Miele
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL; Merck Oncology, North Wales, PA; Baylor Breast Center, Houston, TX; University of Mississippi Cancer Institute, Jackson, MS
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Huang Z, Mayr NA, Yuh WTC, Lo SS, Wang JZ. MO-E-BRB-04: Combining Model Parameters - Radiosensitivity and Dead-Cell Resolving Time to Predict Outcome of Radiation Therapy for Cervical Cancer. Med Phys 2010. [DOI: 10.1118/1.3469114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hartsell WF, Konski AA, Lo SS, Hayman JA. Single fraction radiotherapy for bone metastases: clinically effective, time efficient, cost conscious and still underutilized in the United States? Clin Oncol (R Coll Radiol) 2009; 21:652-4. [PMID: 19744843 DOI: 10.1016/j.clon.2009.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 12/25/2022]
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Lo SS, Sahgal A, Hartsell WF, Lutz ST, Kardamakis D, van der Linden Y, Hoskin PJ. The treatment of bone metastasis with highly conformal radiation therapy: a brave new world or a costly mistake? Clin Oncol (R Coll Radiol) 2009; 21:662-4. [PMID: 19744842 DOI: 10.1016/j.clon.2009.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/06/2009] [Indexed: 11/16/2022]
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Chan CC, Lau PY, Sun LK, Lo SS. Arachnoiditis ossificans. Hong Kong Med J 2009; 15:146-148. [PMID: 19342743] [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
Arachnoiditis ossificans is a rare type of chronic arachnoiditis characterised by the presence of calcification or ossification of the spinal arachnoid. There are a few reports of this condition in Japanese and western populations but no case has been reported in a Chinese population before. We describe a 35-year-old woman with typical findings of arachnoiditis ossificans. A brief review of the literature is also presented.
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Affiliation(s)
- C C Chan
- Radiology Department, United Christian Hospital, Kwun Tong, Hong Kong.
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Lo SS, Ong YE, Sheppard MN, Bennett JG, Weinbren MJ, Poole-Wilson PA. Streptococcal mural endocarditis and myocardial abscess occurring in a left ventricular aneurysm--case report and review. Clin Cardiol 2009; 21:435-8. [PMID: 9631275 PMCID: PMC6655303 DOI: 10.1002/clc.4960210614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 11/06/2022] Open
Abstract
Infection of the mural endocardium within a left ventricular aneurysm without valvular involvement is exceedingly rare. The presenting clinical features can be non-specific, and a high index of suspicion is required for its diagnosis. Delay in diagnosis invariably leads to a fatal outcome. Although no controlled studies are available to guide therapy and management of these patients, appropriate antibiotic therapy and early surgical resection of the infected ventricular aneurysm remain the cornerstone of therapy.
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Affiliation(s)
- S S Lo
- Royal Brompton Hospital, London, U.K
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Elson DW, Whiten S, Hillman SJ, Johnson RJ, Lo SS, Robb JE. The conjoint junction of the triceps surae: Implications for gastrocnemius tendon lengthening. Clin Anat 2007; 20:924-8. [PMID: 17879312 DOI: 10.1002/ca.20544] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/06/2022]
Abstract
Forty embalmed cadaver lower limbs were dissected to identify the morphology of the conjoint junction of the tendons of gastrocnemius and soleus and the location of the gastrocnemius tendon relative to bony landmarks. Five patterns of conjoint junction morphology were found: transverse (25%), oblique passing distally and medially (45%), oblique passing distally and laterally (5%) and arcuate as an inverted U (17.5%) and a U-shape (7.5%). Left-right asymmetry of the junction was observed in 31.6% of 19 paired cadaver legs. On the medial side of the calf the gastrocnemius tendon could be located between 38 and 46% of the proportion of the distance between the upper border of the calcaneus and the fibular head. Corresponding values for the midline and lateral side of the calf were 45-58% and 48-51%. The location of the gastrocnemius tendon relative to bony landmarks may help to guide incision planning for open or endoscopic division of the tendon.
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Affiliation(s)
- D W Elson
- Bute Medical School, University of St. Andrews, St. Andrews, Scotland, United Kingdom
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Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Lui WY, Whang-Peng J. Stage migration influences on stage-specific survival comparison between D1 and D3 gastric cancer surgeries. Eur J Surg Oncol 2005; 31:153-7. [PMID: 15698731 DOI: 10.1016/j.ejso.2004.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2004] [Indexed: 11/19/2022] Open
Abstract
AIMS We evaluate the influency stage migration in a randomised trial comparing D1 (N 1 lymphadenectomy) and D3 (N 1, 2 and 3 lymphadenectomy) dissections. METHODS Two hundred and thirteen curatively resected patients were analysed, with this TNM data. RESULTS After applying D3 patients' data according to simulated D1 staging, D3 resections were associated with up-staging to N2-3 levels in 8% of patients according to the N stage. The likelihood of N-status migration increased with increasing depth of invasion into the gastric wall. The increases in the calculated survival rate after stage migration on known 5-year survival rates were: 2% in stage IB, 1% in stage II, 4% in stage IIIA, and 1% in stage IIIB. CONCLUSIONS Stage migration secondary to meticulous lymph node dissection affects stage-specific survival rates. True therapeutic survival benefit of D3 resection can only be assessed in this context.
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Affiliation(s)
- C W Wu
- Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University, ShiPai Road, Taipei 112, Taiwan, ROC.
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Abstract
BACKGROUND A randomized comparison of D1 (level 1 lymphadenectomy) and D3 (levels 1, 2 and 3 lymphadenectomy) dissection was performed to evaluate morbidity and effects on survival from gastric cancer. METHODS A total of 221 patients were studied after resection for gastric cancer, 110 after D1 surgery and 111 after D3 surgery. RESULTS The morbidity rate was higher after D3 than after D1 resection (17.1 (95 per cent confidence interval (c.i.) 10.1 to 24.1) versus 7.3 (95 per cent c.i. 2.4 to 12.2) per cent respectively; P = 0.012). The difference was largely related to abdominal abscess (8.1 per cent after D3 versus none after D1 resection; P = 0.003). The D3 group had an anastomotic leak rate of 4.5 per cent whereas there was no leakage in the D1 group (P = 0.060). All anastomotic leaks were minor and were managed non-operatively with nutritional support. Patients who had D3 resection had longer operating times, greater blood loss and postoperative drain outputs, and more patients needed blood transfusion. There was no death in either group. The hospital stay was longer after D3 than D1 surgery (mean(s.d.) 19.6(13.9) (range 10-98) versus 15.0(4.0) (range 10-30) days; P = 0.001). CONCLUSION Extended lymphadenectomy for gastric cancer is associated with more complications than limited lymphadectomy but this does not lead to significant mortality.
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Affiliation(s)
- C W Wu
- Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, Republic of China.
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Lo SS, Cho KH, Hall WA, Hernandez WL, Kossow RJ, Lee CK, Clark HB. Does the extent of surgery have an impact on the survival of patients who receive postoperative radiation therapy for supratentorial low-grade gliomas? Int J Cancer 2002; 96 Suppl:71-8. [PMID: 11992388 DOI: 10.1002/ijc.10359] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 11/12/2022]
Abstract
We evaluate the impact of extent of surgery (EOS) on survival of patients with supratentorial nonpilocytic low-grade gliomas (LGG) treated with postoperative radiation therapy (PORT). Sixty-five patients with pathologically confirmed supratentorial nonpilocytic LGG (36 astrocytomas and 29 oligodendrogliomas) were treated with PORT after different extents of surgery: 12 gross total resections (GTR), 27 minimal or subtotal resections (MR/SR), and 26 biopsies (B). EOS was confirmed with postoperative imaging. The median radiation dose delivered was 5,940 cGy (range, 4,950-6,620 cGy). One of 12 patients (8%) in the GTR group and 12 of 53 patients (23%) in the less than GTR group demonstrated contrast enhancement. The median follow-up was 61 months (range 5-194 month). The 10-year overall survival (OS) was 82.5% and 32% for the GTR and the less than GTR groups, respectively (P = 0.0008). The corresponding 10-year disease-specific survival (DSS) was 90% and 41.4%%, respectively (P = 0.001). Multivariate analysis showed that only contrast enhancement and EOS were predictors for OS and DSS. Our data suggest that EOS correlates with OS and DSS in patients who have PORT. GTR should be the goal if technically achievable without causing significant morbidity, and its combination with PORT is compatible with long-term survival.
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Affiliation(s)
- S S Lo
- Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota, USA.
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Affiliation(s)
- J Y H Hui
- Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, Hong Kong
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Abstract
BACKGROUND Microsatellite instability (MSI) has been described in many human carcinomas, including gastric carcinomas (GCs). There are inconsistent findings regarding the association of MSI with various subsets of GC with specific clinicopathologic features. The objective of this study was to define MSI in advanced GC at a genome-wide level and to evaluate the clinical relevance of MSI in these patients. METHODS Forty-one gastric adenocarcinomas with serosa invasion (T3) were analyzed at 59 loci that detected at least one site per arm of each autosome in human genome. The expression patterns of mismatch repair proteins hMLH1 and hMSH2 were examined by immunohistochemistry. Comparisons were made by categorizing tumors into three groups: tumors with MSI at multiple loci (at more than three loci), tumors with MSI at low level (at one to three loci), and microsatellite-stable (MSS) tumors. Clinical significance of MSI in advanced GC was evaluated. The relative rates of hypermutability of the 59 markers also were determined. RESULTS A significant association was found between tumors with MSI at multiple loci and the expanding type of tumor growth by Ming's histologic classification (P = 0.001), whereas tumors with MSI at low level and MSS tumors are clinicopathologically indistinguishable. The 59 dinucleotide repeat markers displayed varying degrees of susceptibility toward genetic instability. The relative rates of hypermutability of these markers were consistent with a normal distribution pattern in which the frequency of unstable tumors detected at different chromosomal loci varied from 0% to 20%. CONCLUSIONS The authors' results showed that advanced GC with MSI at multiple loci progress preferentially in an expanding mode, supporting the notion that high MSI tumors and low MSI/MSS tumors evolve through different genetic pathways. Thus, microsatellite testing may have clinical utility as a favorable prognostic marker.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Taipei, Taiwan
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Abstract
BACKGROUND Microsatellite instability (MSI) has been described in many human carcinomas, including gastric carcinomas (GCs). There are inconsistent findings regarding the association of MSI with various subsets of GC with specific clinicopathologic features. The objective of this study was to define MSI in advanced GC at a genome-wide level and to evaluate the clinical relevance of MSI in these patients. METHODS Forty-one gastric adenocarcinomas with serosa invasion (T3) were analyzed at 59 loci that detected at least one site per arm of each autosome in human genome. The expression patterns of mismatch repair proteins hMLH1 and hMSH2 were examined by immunohistochemistry. Comparisons were made by categorizing tumors into three groups: tumors with MSI at multiple loci (at more than three loci), tumors with MSI at low level (at one to three loci), and microsatellite-stable (MSS) tumors. Clinical significance of MSI in advanced GC was evaluated. The relative rates of hypermutability of the 59 markers also were determined. RESULTS A significant association was found between tumors with MSI at multiple loci and the expanding type of tumor growth by Ming's histologic classification (P = 0.001), whereas tumors with MSI at low level and MSS tumors are clinicopathologically indistinguishable. The 59 dinucleotide repeat markers displayed varying degrees of susceptibility toward genetic instability. The relative rates of hypermutability of these markers were consistent with a normal distribution pattern in which the frequency of unstable tumors detected at different chromosomal loci varied from 0% to 20%. CONCLUSIONS The authors' results showed that advanced GC with MSI at multiple loci progress preferentially in an expanding mode, supporting the notion that high MSI tumors and low MSI/MSS tumors evolve through different genetic pathways. Thus, microsatellite testing may have clinical utility as a favorable prognostic marker.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Taipei, Taiwan
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Affiliation(s)
- W C Chen
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
BACKGROUND Microsatellite instability (MSI) has been described in many human carcinomas, including gastric carcinomas (GCs). There are inconsistent findings regarding the association of MSI with various subsets of GC with specific clinicopathologic features. The objective of this study was to define MSI in advanced GC at a genome-wide level and to evaluate the clinical relevance of MSI in these patients. METHODS Forty-one gastric adenocarcinomas with serosa invasion (T3) were analyzed at 59 loci that detected at least one site per arm of each autosome in human genome. The expression patterns of mismatch repair proteins hMLH1 and hMSH2 were examined by immunohistochemistry. Comparisons were made by categorizing tumors into three groups: tumors with MSI at multiple loci (at more than three loci), tumors with MSI at low level (at one to three loci), and microsatellite-stable (MSS) tumors. Clinical significance of MSI in advanced GC was evaluated. The relative rates of hypermutability of the 59 markers also were determined. RESULTS A significant association was found between tumors with MSI at multiple loci and the expanding type of tumor growth by Ming's histologic classification (P = 0.001), whereas tumors with MSI at low level and MSS tumors are clinicopathologically indistinguishable. The 59 dinucleotide repeat markers displayed varying degrees of susceptibility toward genetic instability. The relative rates of hypermutability of these markers were consistent with a normal distribution pattern in which the frequency of unstable tumors detected at different chromosomal loci varied from 0% to 20%. CONCLUSIONS The authors' results showed that advanced GC with MSI at multiple loci progress preferentially in an expanding mode, supporting the notion that high MSI tumors and low MSI/MSS tumors evolve through different genetic pathways. Thus, microsatellite testing may have clinical utility as a favorable prognostic marker.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Taipei, Taiwan
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Tseng LM, Hsu CY, Wang HC, Liu JM, Chang HM, Lo SS, Wu CW, Lui WY, Chi CW. Tie-1 tyrosine kinase is an independent prognostic indicator for invasive breast cancer. Anticancer Res 2001; 21:2163-70. [PMID: 11501841] [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: 02/21/2023]
Abstract
Receptor tyrosine kinases are known to be involved in the growth, progression and metastasis of solid tumors. We investigated the relationship between tie-1 expression and progression of invasive ductal breast carcinoma with immunohistochemical analysis. Tie-1 protein was detected in the microvessel endothelial cells and cytoplasm of tumor cells. The tumor size and stage were significantly associated with the expression of tie-1, which portends a worse 5-year disease-free status (39.3% v 59.2%, p = 0.07) and overall survival rate (67.3% v 93%, p = 0.02) than those without tie-1 expression. Multivariate analysis demonstrated that larger tumor size, presence of lymph node metastasis and tie-1 expression were independent prognostic parameters, both in 5-year disease-free survival and overall survival. Patients with lymph node metastases and tie-1 expression had the worst 5-year disease-free survival (0%) and overall survival (42.4%) compared to those without tie-1 expression (50.2%, 85%). In lymph node negative patients, those without tie-1 expression had better 5-year disease-free survival and overall survival (72.9%, 100%) compared to those with tie-1 expression (65.5%, 87.7%). We conclude that tie-1 expression is an independent prognostic factor for invasive ductal breast carcinoma, adversely affecting survival of breast cancer patients with positive nodes to a significant extent.
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Affiliation(s)
- L M Tseng
- Department of Surgery, Taipei-Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taiwan
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Wu CW, Hsieh MC, Lo SS, Shen KH, Lui WY, P'eng FK. Comparison of the UICC/AJCC 1992 and 1997 pN categories for gastric cancer patients after surgery. Hepatogastroenterology 2001; 48:279-84. [PMID: 11268985] [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: 02/19/2023]
Abstract
BACKGROUND/AIMS UICC/AJCC 1997 classification changes pN category. We evaluated its prognostic impact. METHODOLOGY A total of 710 patients who underwent a > or = D2 gastrectomy were recruited. Among them, the data of 319 patients who had involved regional lymph nodes and no evidence of distant metastases were used for comparing the 1992 and 1997 pN categories. RESULTS For 1997 category, 201 patients (64%) were pN1, 75 (23.5%) pN2, and 43 (13.5%) pN3. For 1992 category, 143 patients (44.8%) were pN1, and 147(46.1%) pN2. 29 patients (9.1%) with lymph node metastasis to the hepatoduodenal ligament were distant metastasis. The 1997 pN category was a more powerful prognostic discriminant (relative risk: 2.086) than the 1992 category. Compared to the 1992 stage classification, the 1997 one had a skewed distribution of patients with marked shift of patients of stage IIIA (105-126 patients), IIIB (116-58 patients), and IV (100-122 patients). The survival difference between stage IIIA and IIIB for the 1997 stage classification is narrower than for 1992. CONCLUSIONS The 1997 pN category allows for estimation of prognosis superior to the 1992 category.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Shih-Pai Road, Taipei, Taiwan, 11217, Republic of China.
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Abstract
BACKGROUND A major cause of morbidity in type I diabetes is congestive heart failure due predominantly to left ventricular diastolic dysfunction. The mechanism of diastolic dysfunction remains unknown and does not relate to blood pressure, microvascular complications and glycated haemoglobin. Hyperglycaemia is the hallmark of diabetes and is a potential determinant of left ventricular diastolic dysfunction. OBJECTIVE To determine whether acute hyperglycaemia can induce changes in left ventricular diastolic function in normal subjects similar to those observed in insulin-dependent diabetes mellitus (IDDM). DESIGN Cross-sectional study. SETTING London teaching hospital. SUBJECTS Sixteen twins from eight identical twin pairs discordant for IDDM (age 18-38 years, five male) were studied; none had a history or evidence of myocardial ischaemia, valvular or primary heart muscle disease, systemic hypertension or nephropathy. INTERVENTIONS Non-diabetic twins underwent a hyperglycaemic clamp at 10 mmol/l. MAIN OUTCOME MEASURES Doppler echocardiography was performed in basal condition in identical twin pairs discordant for IDDM and repeated in the non-diabetic twins during hyperglycaemia. Blood glucose, insulin and catecholamines were measured at baseline and during hyperglycaemia. RESULTS Transmitral Doppler E/A velocity ratio was significantly lower in diabetic than non-diabetic twins at baseline (1.44 (0.38) vs. 1.51 (0.19), P<0.05). Glucose infusion in the non-diabetic twins resulted in an increase in their E/A ratio (1.51 (0.19) vs. 1.82 (0. 47), P<0.05) due to an increase in E velocity (68 (12) to 64.7 (10. 7), P<0.05) and a decrease in the peak A velocity (42.7 (3.85) to 38. 0 (4.1), P<0.05). No significant changes were observed in peak E velocity or isovolumic relaxation time in the non-diabetic twins between baseline and hyperglycaemia. CONCLUSIONS The alterations in left ventricular diastolic function induced by acute hyperglycaemia and consequent increase in plasma catecholamines do not mimic those demonstrated in IDDM patients.
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Affiliation(s)
- S S Lo
- Royal Brompton National Heart Hospital, London, UK
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Lo SS, Wu CW, Chi KH, Tseng HS, Shen KH, Hsieh MC, Lui WY. Concomitant chemoradiation treatment in the management of patients with extrahepatic biliary tract recurrence of gastric carcinoma. Cancer 2000; 89:29-34. [PMID: 10896997] [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: 02/17/2023]
Abstract
BACKGROUND The aim of this study was to determine the role of concomitant chemoradiation in the alleviation of obstructive jaundice in patients with extrahepatic biliary tract metastases from gastric carcinoma. METHODS Thirteen patients with good performance status who had obstructive jaundice resulting from extrahepatic biliary metastases after gastrectomy for gastric carcinoma were treated with palliative intent. Treatment consisted of insertion of a percutaneous transhepatic choledochal drainage (PTCD) catheter followed by external radiation up to a total dose of 40-60 grays in combination with chemotherapy (cisplatin 20 mg/m(2)/day, 5-fluorouracil 600 mg/m(2)/day, and leucovorin 90 mg/m(2)/day for 96 hours during the first and fifth weeks) on an outpatient basis. RESULTS The concomitant chemoradiation produced a good palliative effect in all 13 patients. Hyperbilirubinemia continued to improve after treatment, patients' clay-colored stool resolved within an average of 4 weeks (range, 2-6 weeks), and bilirubin levels returned to normal. The PTCD catheter could be removed after treatment was completed (the seventh week); the mean duration of PTCD placement was 2 months. The entire treatment course was performed on an outpatient basis; hospital admission was necessary only for PTCD insertion and chemotherapy. Ten patients died of their disease, with an average survival of 14.4 months (range, 4-31 months) from the time of PTCD insertion. Three patients are still alive at 16, 21, and 8 months. Biliary tract patency was maintained until death. No serious treatment-related complications occurred, and no endoprothesis or intraluminal brachytherapy was needed in this study. CONCLUSIONS Satisfactory palliation can be achieved by concomitant chemoradiation for patients with obstructive jaundice resulting from extrahepatic biliary metastases from gastric carcinoma, providing an alternative treatment choice for these patients.
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Affiliation(s)
- S S Lo
- Division of General Surgery, Department of Surgery, Veterans General Hospital-Taipei and National Yang Ming University, Taipei, Taiwan
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Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 2000; 24:465-72. [PMID: 10706921 DOI: 10.1007/s002689910074] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [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: 12/13/2022]
Abstract
Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged >/= 65 years (1987-1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those > 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41. 3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged >74 years had a higher mortality rate than those aged 65 to 74 years (10. 1% vs. 3.5%; p = 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long-term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Shih-Pai, Taipei, Taiwan 11217, Republic of China
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Shen KH, Chi CW, Lo SS, Kao HL, Lui WY, Wu CW. Serum matrix metalloproteinase-9 level associated with stromal reaction in patients with gastric cancer. Anticancer Res 2000; 20:1307-10. [PMID: 10810440] [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: 02/16/2023]
Abstract
BACKGROUND Matrix metalloproteinase 9 (MMP-9) plays an important role in cancer invasion and metastasis. The relationship between serum MMP-9 levels and clinicopathological factors in gastric cancer patients is not clear. MATERIALS AND METHODS Preoperative serum was obtained from 170 patients who had undergone gastrectomy for gastric cancer at the Veterans General Hospital-Taipei. The serum MMP-9 level was measured using a sandwich enzyme-linked immunoassay by monoclonal antibodies. RESULTS The median serum MMP-9 level was 368.6 ng/mL (range: 43.9-1871.3 ng/mL). Univariate analysis showed that stromal reaction and Lauren's histological classification were two factors related to serum MMP-9 levels (p = 0.014 and p = 0.030 respectively). Multivariate analysis revealed that stromal reaction was the only factor independently (odds ratio: 1.695) associated with MMP-9 levels. Patients with a serum MMP-9 level < 368.5 ng/mL had a tendency towards better survival rate (5-year survival rate: 64.4%) than those with > 368.5 ng/mL (58.5%), but this tendency did not reach statistical significance (p = 0.512). CONCLUSION These data suggests that serum MMP-9 levels are associated with stromal reaction in gastric cancer.
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Affiliation(s)
- K H Shen
- Department of Surgery, Veterans General Hospital-Taipei, Republic of China
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Lo SS, Khoo US, Cheng DK, Ng TY, Wong LC, Ngan HY. Role of serial tumor markers in the surveillance for recurrence in endometrial cancer. Cancer Detect Prev 1999; 23:397-400. [PMID: 10468891 DOI: 10.1046/j.1525-1500.1999.99043.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study is to evaluate the usefulness of tumor markers in the follow-up of patients with endometrial cancer. The sera of 23 patients with elevated pretreatment CA125, CA15.3, and CA19.9 were collected at each follow-up visit and analyzed. Eleven patients had normal posttreatment levels and none of them developed recurrence. Twelve patients had one or more increased tumor markers, 7 (58.3%) of them developed recurrence. Among these seven patients, six had CA125 elevated by at least 10-fold and one had elevated CA19.9. The median lead time between elevation of tumor markers and clinical evidence of recurrence was 6 months. Hence posttreatment elevation of CA125 is a useful predictor for recurrence in patients with elevated pretreatment levels.
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Affiliation(s)
- S S Lo
- Department of Obstetrics and Gynecology, University of Hong Kong
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Abstract
Through a mechanism similar to renal artery stenosis, patients with reninoma and page kidney also suffered from renin mediated hypertension. Captopril renograms performed on our patients with the latter two conditions, however, did not yield diagnostic findings. Therefore, equivocal or negative captopril renography cannot serve to rule out conditions with elevated renin other than renal artery stenosis.
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Affiliation(s)
- B C Yung
- Department of Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Lo SS, Kuo HS, Wu CW, Hsieh MC, Shyr YM, Wang HC, Lui WY. Poorer prognosis in young patients with gastric cancer? Hepatogastroenterology 1999; 46:2690-3. [PMID: 10522066] [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: 02/14/2023]
Abstract
BACKGROUND/AIMS Although the relationship between prognosis and age of patients with gastric cancer is controversial, a poorer prognosis in young patients has been suggested by most investigators. To further examine the hypothesis, a retrospective study was undertaken to analyze a large series of patients with gastric cancer in Taiwan. METHODOLOGY A total of 1,642 consecutive patients diagnosed with gastric cancer and receiving further management at one medical center from 1988 to 1993 were reviewed. The gender, TNM tumor stage, rate of curative resection and survival of the patients were compared in the young age group (< or = 39 years) and the old age group (> 39 years). Survival was estimated with the product-limit method and difference in survival was tested by the log-rank test. Multivariate analysis was done by the Cox proportional hazard model. RESULTS Among the 1,642 patients, 61 patients were in the young age group and 1,581 patients were in the old age group. There was no significant difference for the 2 groups of patients in the distribution of TNM stage (stage I: 20%; II: 8%; III: 13%; IV: 59% vs. 19%, 11%, 25% and 45% respectively, in the old age group, p = 0.098) and rate of curative resection (38% vs 51% in the old age group, p = 0.059). The overall 5-year survival showed no significant difference between the 2 groups (25% vs. 29% in the old). Subgroup analyses showed that survival after curative resection and survival without curative treatment (including palliative resection and no resection) also had no difference in the 2 groups. Multivariate analysis also showed that age was not an independent factor. CONCLUSIONS Although most reports suggested a dismal prognosis in young patients with gastric cancer, based on our findings, young patients (< or = 39 years) do not have a worse prognosis than older patients.
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Affiliation(s)
- S S Lo
- Department of Surgery, Veterans General Hospital, Taipei, Taiwan, ROC.
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