scholarly journals Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Tomoko Takagishi ◽  
Yuta Niimi ◽  
Goshi Matsuki ◽  
Shinta Nagano ◽  
Junsuke Hinami ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Multidisciplinary Approach ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Duodenal Wall ◽  
Abdominal Ct ◽  
Pet Ct ◽  
Life Threatening ◽  
Consolidation Radiotherapy ◽  
Disease Free

Treatment of duodenal malignant lymphoma is difficult due to life-threatening complications such as intestinal obstruction, perforation, and pancreatitis. Thus, multidisciplinary procedures are required alongside surgical intervention. Contrast abdominal CT images of a 75-year-old female suffering from vomiting revealed thickening of the duodenal wall (from the second to third segment). Gastrojejunostomy and biopsy identified the tumor as diffuse large B-cell lymphoma. A diagnosis of stage II duodenal lymphoma was made. The lymphoma continued to grow, resulting in jaundice and intestinal perforation, which was first treated with two cycles of rituximab and antibiotics. Thereafter, less intensive chemotherapy (two cycles each of R-mini-CHP, CHP, and R-CHOP) was administered, which led to significant improvement upon assessment by PET-CT. Residual lymphoma was treated with consolidation radiotherapy (50 Gy in 25 fractions) over 5 weeks after chemotherapy. The patient attained a complete response and has been disease-free for more than 4 years. Thus, duodenal perforated lymphoma can be treated successfully using a multidisciplinary approach that combines surgery, immunochemotherapy, and radiation therapy.

scholarly journals Early Interim Chemotherapy Response Evaluation by F-18 FDG PET/CT in Diffuse Large B Cell Lymphoma

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1002
Author(s):  
Hye Park ◽  
Eun Han ◽  
Joo O ◽  
Byung-Ock Choi ◽  
Gyeongsin Park ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Chemotherapy Response ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
The Absolute ◽  
One Year ◽  
Disease Free ◽  
Large B Cell

Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after one cycle of standard chemotherapy in patients with diffuse large B cell lymphoma (DLBCL) was assessed. Prospectively enrolled 51 patients had four PET/CT studies using the same protocol and system: at baseline and after one, three, and six cycles of chemotherapy (PET0, PET1, PET3, PET6). The PET1 and PET6 Deauville five-point score (D5PS) agreed in 60.8%, while PET3 and PET6 D5PS agreed in 90.2%. The absolute and percent changes of peak standard uptake value corrected for lean body mass (SULpeak) compared to baseline were significantly different between PET1 and PET3 (p = 0.001, p < 0.001) and PET1 and PET6 (p = 0.002, p = 0.001), but not between PET3 and PET6 (p = 0.276, p = 0.181). The absolute SULpeak from PET1 predicted treatment failure with accuracy of 78.4% (area under the curve 0.73, p = 0.023). D5PS, SULpeak, and metabolic tumor volume (MTV) were not statistically different between responders versus non-responders, or the one year disease-free versus relapse groups. D5PS and PERCIST responses showed 100% agreement at end-of-therapy. In conclusion, the responses after three and six cycles of therapy showed high degree of agreement. D5PS or MTV after one cycle of chemotherapy could not predict response or one-year disease-free status, but the SULpeak from PET1 was associated with response to first line therapy in DLBCL. Deauville and PERCIST criteria show high concordance.

Successful Treatment of Primary Central Nervous System Post-Transplant Lymphoproliferative Disorder (PCNS-PTLD) with Zidovudine (AZT), Ganciclovir (GCV), Rituximab and Dexamethasone: A Single-Institution Case Series

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3067-3067 ◽  
Author(s):  
Ludmila Katherine Martin ◽  
Mark E Lustberg ◽  
Fengting Yan ◽  
John T. Patton ◽  
Pierluigi Porcu ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Median Duration ◽  
Cell Lymphoma ◽  
Solid Organ Transplantation ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Solid Organ ◽  
Inter Quartile Range ◽  
Quartile Range ◽  
Disease Free

Abstract Abstract 3067 BACKGROUND: Primary central nervous system post-transplant lymphoproliferative disorder (PCNS PTLD) is a rare complication of solid organ transplantation, with no standard therapy. Most PCNS PTLDs are associated with Epstein-Barr virus (EBV) infection, thus EBV could serve as a potentially attractive therapeutic target. For EBV-targeted antiviral therapy to be effective, antiviral agents must be phosphorylated by lytic-phase EBV kinases BXLF1/vTK and BGLF4. We hypothesized that PCNS-PTLDs would express viral kinases and that antiviral therapy would prove an attractive therapeutic alternative to high dose methotrexate-based chemotherapy for patients who often have impaired organ function and poor performance status. METHODS: We investigated the safety and efficacy of EBV-targeted therapy with zidovudine (AZT), ganciclovir (GCV), rituximab, and dexamethasone in patients with PCNS PTLD, as well as the relationship of viral protein kinase expression with response to therapy. Patients with biopsy-proven PCNS PTLD following solid organ transplantation were eligible for treatment. Induction therapy consisted of AZT 1500 mg IV, and GCV 5 mg/kg IV, dexamethasone 10 mg IV, twice daily on days 1–14 and 4 weekly doses of rituximab 375 mg/m2 on days 1, 8, 15, and 22. Maintenance therapy was initiated on day 15 with valganciclovir 500 mg twice daily, and AZT 300 mg twice daily until disease progression or intolerable toxicity. Treatment was adjusted for hematologic toxicity and impaired liver and kidney function. Responses were evaluated by serial brain MRIs beginning 4 weeks after initiation of treatment. Brain biopsy specimens were evaluated for expression of viral kinases BGLF4 and BXLF1/vTK by in situ hybridization. RESULTS: Eight patients (5 M, 3 F) with a median age of 49 were treated at our institution from 1999–2011. Transplant history included kidney (N=7), and kidney + pancreas (N=1). Pathology data was available for all patients and included diffuse-large B-cell lymphoma (N=4), grade III lymphomatoid granulomatosis (N=2), and B-cell lymphoma, not further classifiable (N=2). EBV positivity (EBER) and CD20 expression was documented in all cases. Evaluation of BXLF1/vTK and BGLF4 was completed in 4 patients and found to be positive. Areas of tumor expressing viral kinases did not express LMP1. Immune suppression was reduced in all patients prior to treatment. All patients completed induction therapy. Median duration of maintenance therapy was 16.6 months. At the time of analysis, 6 patients were still alive and disease free (median duration of follow-up = 19.6 months, inter-quartile range = 10.6 – 28.3). All 8 patients achieved a complete response by MRI criteria with a median duration to response of 2 months (inter-quartile range = 1.5 – 4 months). Two patients died with survival times of 3 and 143 months after diagnosis. No patients had documented disease progression. Thus far, median duration of progression free survival has been 17.1 months (inter-quartile range = 7 – 31 months). Patient 1 was disease-free for 141 months but developed and died from complications of colon cancer. Patient 8 died of multi-organ failure related to pneumonia and septic shock, which was considered non-treatment-related, 3 months after initiation of therapy. At that time, a brain MRI showed evidence of complete response. Grade 3–4 toxicity was primarily hematologic, including anemia (N=4), thrombocytopenia (N=3), leukopenia (N=5) and neutropenia (N=4). Toxicity in the maintenance phase was generally reversible within 7 days of holding therapy. One patient required discontinuation of AZT during maintenance treatment for persistent, transfusion-dependent anemia. CONCLUSIONS: EBV-targeted therapy with AZT, GCV, rituximab and dexamethasone appears to be safe for the treatment of EBV+ PCNS PTLD, with promising evidence of activity. Responses were generally rapid and durable. Expression of BXLF1/vTK and BGLF4 kinases provides mechanistic rationale for an antiviral approach for this disease. Given the lack of effective standard therapy for these patients, this regimen deserves further investigation. Unanswered questions include the optimum length of maintenance therapy that is still effective while minimizing toxicity, and whether rituximab is necessary to achieve the responses observed. A multi-center phase II trial is in development to further investigate this regimen. Disclosures: Off Label Use: We will discuss the use of zidovudine and ganciclovir to treat primary CNS lymphoma in transplant patients.

The Response Evaluation Criteria in Solid Tumors Can be Substituted for the International Workshop Criteria?: Comparison Using Japan Clinical Oncology Group Study JCOG0203 for Untreated Indolent B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4779-4779
Author(s):  
Kenichi Miyamoto ◽  
Takashi Watanabe ◽  
Hideaki Kitahara ◽  
Masashi Wakabayashi ◽  
Kenichi Nakamura ◽  
...  
Keyword(s):  
B Cell ◽  
Malignant Lymphoma ◽  
Solid Tumors ◽  
Research Funding ◽  
Cell Lymphoma ◽  
International Workshop ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Kappa Coefficient ◽  
Response Evaluation

Abstract Introduction: The International Workshop Criteria (IWC) has been used for response evaluation in malignant lymphoma since 1999. In contrast, the Response Evaluation Criteria in Solid Tumors (RECIST) has been used for most solid tumors since 2000. The IWC is more complicated than RECIST, partly because it requires calculating the sum of the product of bidimensional diameters of the target lesions, whereas RECIST is based on unidimensional assessment of target lesions. If RECIST can be demonstrated to be more valid and precise than the IWC for malignant lymphoma, RECIST would be the substitute for IWC even for malignant lymphoma. The objective of this study was to evaluate whether RECIST could be substituted for the IWC using data from the JCOG0203 trial, a phase II/III study of R-CHOP-21 versus R-CHOP-14 in untreated, advanced-stage indolent B-cell lymphoma where the superiority of R-CHOP-14 in progression-free survival (PFS) was not shown (hazard ratio [HR], 0.92; 95% CI, 0.68-1.25; one-sided log-rank p = 0.30) (J Clin Oncol 2011;29:3990-8). Methods: Three hundred patients aged 20-69 with stage III or IV indolent B-cell NHL were enrolled in the JCOG0203 trial between 2002 and 2007. Patients ineligible after the central pathological review (CPR) or patients with no target lesions for RECIST were excluded from this analysis. We calculated the kappa coefficient to evaluate the degree of agreement between IWC and RECIST. RECIST would be considered better in cases of a kappa coefficient of ≥0.7 because this indicates that both are in good agreement and RECIST is less complicated. If the kappa coefficient is <0.7, RECIST would be considered discordant with IWC. We evaluated which criteria were more predictive for PFS. In particular, criteria that can show a good separation of PFS, namely, the lower point estimate of the hazard ratio (HR) of a complete response (CR, including complete response and unconfirmed CR [CRu]) vs. a non-CR, is defined as more useful criteria. The landmark-time analysis was applied to PFS counted from day 168, when response status (CR vs. non-CR) for all patients was fixed. Results: Overall, 269 patients were included in this analysis, 14 patients were ineligible by the CPR and 17 patients without target lesions for RECIST were excluded.The median age was 54 years, and 46.8% of the patients were men. Two-hundred fifty-six (95.2%) were diagnosed as having follicular lymphoma and 8 (3.0%) with extranodal marginal zone B-cell lymphoma. According to the Follicular Lymphoma International Prognostic Index, 85 (31.6%), 112 (41.6%), and 72 (26.8%) patients were classified as being at low, intermediate, and high risk, respectively.Based on the IWC, 207 patients (77.0%) had a CR/CRu, 54 (20.1%) a partial response (PR), 3 (1.1%) had stable disease (SD), 4 (1.5%) had progressive disease (PD), and 1 (0.4%) was not evaluable (NE). Based on RECIST, 120 (44.6%) had a CR, 137 (50.9%) had a PR, 6 (2.2%) SD, 4 (1.5%) had PD, and 2 (0.7%) were NE. The kappa coefficient between IWC and RECIST was 0.342 (95% CI, 0.261-0.424), indicating poor agreement. Subsequently, we calculated the HR (CR vs. non-CR) of PFS for each criterion with 264 patients in the landmark analysis. The HR of the IWC (0.473: 95% CI, 0.330-0.677, log-rank test p < 0.001) was lower than that of RECIST (0.635: 95% CI, 0.454-0.888, p = 0.0075). In terms of overall survival, the HR (CR vs. non-CR) was 0.500 (95% CI, 0.223-1.119, p = 0.0856) and 0.471 (95% CI, 0.197-1.130, p = 0.0843) according to IWC and RECIST, respectively. Conclusion: RECIST cannot be substituted for the IWC in untreated, advanced-stage indolent B-cell NHL. Although fluorodeoxyglucose-positron emission tomography should be included in the standard response criteria currently used, introduction of unidimensional assessment is not recommended. Disclosures Maruyama: Takeda: Honoraria; Janssen: Honoraria. Tobinai:Chugai Pharma: Research Funding; Ono Pharmaceutical: Research Funding; Abbvie: Research Funding; Takeda: Honoraria, Research Funding; Kyowa Hakko Kirin: Research Funding; Eisai: Honoraria, Research Funding; Janssen Pharmaceuticals: Honoraria, Research Funding; Celgene: Research Funding; HUYA Bioscience: Honoraria; Mundipharma KK: Honoraria, Research Funding; SERVIER: Research Funding; Zenyaku Kogyo: Honoraria; GlaxoSmithKline: Research Funding; Daiichi Sankyo Co., Ltd.: Consultancy. Tsukasaki:Daiichi Sankyo Co., Ltd.: Consultancy; Takeda: Research Funding.

Primary nasopharyngeal non Hodgkin lymphoma: A retrospective investigation of 26 patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19552-e19552
Author(s):  
I. N. Nabil ◽  
W. Allam ◽  
K. Alaoui ◽  
H. Errihani
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Disease Stage ◽  
Cervical Lymph Nodes ◽  
Female Ratio ◽  
Non Hodgkin Lymphoma ◽  
T Lymphoma ◽  
Disease Free

e19552 Background: Primary nasopharyngeal non-Hodgkin lymphoma (NNHL) was uncommon. In this retrospective study we report our experience dealing with this disease at the National Institute of Oncology. Methods: We retrospectively analyzed various characteristics of Primary NNHL: patient demographics, clinical and histological diagnosis, disease stage, treatment effects and outcome, in 26 patients treated at our institution between January 2001 and December 2007. Results: The average age of our patients was 52.7 years (range: 31 - 87 years). The male/female ratio was equal to 1.5/1. The major symptoms at first diagnosis were: nasal obstruction (88.6%), hypoacousia (88.4%), epistaxis (33.3%) and rhinorrhea (15.3%). Clinical examination founded bilateral cervical lymph nodes in 17 cases (65%). Histological analysis showed follicular lymphoma in 7 cases (26.9%), large B-cell lymphoma in 11 cases (42,3%) and T lymphoma in 4 cases ( 15,3%). Four (15.4%) of the patients were at stage I, 15 (57.6%) were at stage II, and 7 (27%) were at stage III/IV. At early stage, the patients were managed with chemo-radiotherapy and were managed with CHOP based chemotherapy at advanced stage. At the end of total treatment, 18 patients (69.2%) achieved complete response and remained disease free while 4 (15.4%) achieved partial response (>70%) and 4 (15.4%) were progressive (these patients received second line chemotherapy). After 110 months median flow-up, median disease free and overall survival were not reached. Overall, the treatment was well tolerated. Conclusions: From our study and from the literature, we conclude that histological characteristics, principle of treatment and outcome of primary NNHL patients are similar to that of patients with nodal lymphoma. No significant financial relationships to disclose.

“Incidental Carcinomas” Detected by PET/CT Scans In the Patients with Malignant Lymphoma: A Single-Center Experience with 363 Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4132-4132
Author(s):  
Kazuya Sato ◽  
Katsutoshi Ozaki ◽  
Tomohiro Matsuyama ◽  
Ken Ohmine ◽  
Takahiro Suzuki ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Incidental Findings ◽  
Hodgkin’S Lymphoma ◽  
B Cell Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Ct Scans ◽  
Benign Tumors ◽  
Second Primary ◽  
Pet Ct ◽  
Pet Scans

Abstract Abstract 4132 Background: 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) scans or combination of computed tomography (CT) have been clinically standardized as an essential assessment modality in the field of oncology. A major advantage of PET/CT scans over conventional radiologic imaging techniques is its functional ability to distinguish between benign tumors or necrotic lesions (or fibrosis) and malignant diseases. Due to the recent application of PET scans, the concept of the complete remission/unconfirmed established by international working group (IWG), was eliminated in 2007 by themselves. According to the IWG revised response criteria for malignant lymphoma, PET scans have been recommended for pretreatment staging and response assessment in potentially curative patients with diffuse large B-cell lymphoma and Hodgkin's lymphoma. However, these modalities are also associated with false-positive findings (attributed to infection or inflammation), and are known to be affected by glucose metabolism. Moreover, depending on the type of lymphoma, the body-wide distribution of non-Hodgkin's lymphoma can be quite variable and often unexpected. In addition, incidental findings of carcinomas have been reported during routine interpretation of PET/CT. Therefore, the purpose of this study was to evaluate second primary carcinomas incidentally detected by PET/CT for more accurate assessment of patients with malignant lymphoma. Material and Method: Retrospective analysis was performed on 363 patients (203 male and 160 female) with a mean age of 59.9 years (range of 16–93 y) with malignant lymphoma who underwent a total of 519 consecutive PET/CT scans in our institution from April 2008 through March 2010. All PET/CT scans for initial staging, restaging, response monitoring (mid-treatment) and post-therapy surveillance were included in this study. Brief clinical information including patient characteristics, disease status and treatments were provided to radiologists in advance. Results: Of the 363 patients, 14 (3.9%) were recommended by radiologists for further investigation in order to evaluate suspicious new abnormalities on the basis of PET/CT findings. Three of the 14 cases did not receive further investigation due to a hematologist's recommendation. Three cases had pathologically proven benign tumors (granuloma, lyomyoma and adenomatous change in thyroid). The remaining eight patients (2.2%) had pathologically confirmed second primary carcinomas, consisting of four colon cancers, three lung cancers, and one pancreatic cancer. The accuracy for detection of the second carcinomas by PET/CT in the present study was excellent (72.7%). No patients had any symptoms due to second carcinomas. Two cases were diagnosed at the first staging, and the others were detected following the chemotherapy for lymphoma. PET scans revealed high accumulations in six of eight patients (75%) despite of no anatomical changes by conventional CT scans. Of note, all of focal intensities in the colon were identified as colon carcinomas (adenocarcinoma), and all patients underwent potentially curative surgery or endoscopic resection. Conclusion: The present study suggests that early intervention can potentially achieve detection and cure of second malignancies that are incidental findings by PET in malignant lymphoma. This is the first report that evaluated the unexpected lesions detected by PET/CT scans, which were diagnosed as second primary carcinomas, in the patients with malignant lymphoma. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Primary nasopharyngeal interdigitating dendritic cell tumor presentation and response to radiation therapy

Rare Tumors ◽  
2010 ◽  
Vol 2 (1) ◽  
pp. 27-30 ◽  
Author(s):  
Neal E Dunlap ◽  
Randell L Woodford ◽  
Asal N Shoushtari ◽  
James F Reibel ◽  
Michael G Douvas ◽  
...  
Keyword(s):  
Dendritic Cell ◽  
Primary Tumor ◽  
Cervical Lymphadenopathy ◽  
Complete Response ◽  
Large Mass ◽  
Primary Site ◽  
Cell Tumor ◽  
Dendritic Cell Differentiation ◽  
Pet Ct ◽  
Disease Free

We report the case of a primary nasopharyngeal interdigitating dendritic cell tumor (IDDCT). A 25-year old male presented with bilateral decreased hearing, double vision, and ataxia. Flexible nasopharyngoscopy reviewed a large mass obstructing and filling the entire nasopharynx. MRI and PET-CT confirmed the presence of the primary tumor and demonstrated bilateral cervical lymphadenopathy. Biopsy of the nasopharynx revealed a hematolymphoid neoplasm with dendritic cell differentiation, most consistent with an IDDCT. The lesion was unresectable. The patient was treated with definitive radiotherapy to 66 Gy to the primary tumor and 50 Gy to the bilateral cervical lymphatics using an IMRT technique. A complete response was achieved and the patient remains disease free at the primary site 23 months after completion of radiotherapy.

Interim 18-FDG-PET/CT failed to predict the outcome in diffuse large B-cell lymphoma patients treated at the diagnosis with rituximab-CHOP

Blood ◽  
2012 ◽  
Vol 119 (9) ◽  
pp. 2066-2073 ◽  
Author(s):  
Patrizia Pregno ◽  
Annalisa Chiappella ◽  
Marilena Bellò ◽  
Barbara Botto ◽  
Simone Ferrero ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cox Models ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Role of interim-PET (I-PET) in diffuse large B-cell Lymphoma (DLBCL) is controversial. To determine predictive value of I-PET on progression-free survival (PFS), we enrolled 88 first-line DLBCL patients treated with 6-8 R-CHOP courses regardless of I-PET. PET/CT were performed at diagnosis, after 2 to 4 courses and at the end of therapy with central reviewing according to visual dichotomous criteria. Results are as follows: I-PET, 72% negative, 28% positive; final-PET (F-PET), 88% negative, 12% positive; clinical complete response 90%. Concordance between clinical response and F-PET negativity was 97% because of 2 false positive. With a median follow-up of 26.2 months, 2-year overall survival and PFS were 91% and 77%, respectively. Two-year PFS for I-PET and F-PET negative versus positive were as follows: I-PET 85% versus 72% (P = .0475); F-PET 83% versus 64% (P < .001). Because of a small number of events, 2 independent bivariate Cox models were tested for PFS. In model 1, F-PET contradicted I-PET (hazard ratio [HR] = 5.03, P = .015 vs 1.27, P = 691); in model 2, F-PET (HR = 4.54) and International propnostic Index score (HR = 5.36, P = .001) remained independent prognostic factors. In conclusion, positive I-PET is not predictive of a worse outcome in DLBCL; larger prospective studies and harmonization of I-PET reading criteria are needed.

Rituximab, gemcitabine, cisplatin, and methylprednisolone (R-GEM-P) in treatment of relapsed diffuse large B-cell lymphoma (DLBCL).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19543-e19543
Author(s):  
Sarah Rachel Barton ◽  
Eliza Anne Hawkes ◽  
David Cunningham ◽  
Clare Peckitt ◽  
Sue Chua ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Salvage Regimen ◽  
Line Therapy ◽  
Pet Ct ◽  
Outcome Improvement ◽  
Grade 3 ◽  
Fdg Pet Ct

e19543 Background: Patients with DLBCL who relapse after 1st line therapy have poor prognosis. Although there is limited evidence for benefit of rechallenging patients with rituximab, this is considered justified by minimal toxicity and potential outcome improvement. GEM-P+/-R is an accepted salvage regimen, with merits of outpatient delivery and mainly non-overlapping toxicity with 1stline therapy, but there are relatively few reports of its efficacy and tolerability. Methods: We performed a retrospective single centre analysis of all patients meeting the following criteria: age≥18, histologically proven DLBCL, ≥1 FDG-PET, treated between 2001-2011 with GEM-P+/-R (gemcitabine 1000mg/m2 D1, D8, D15, methylprednisolone 1000mg D1-5, cisplatin 100mg/m2 D15 every 28 days +/- rituximab 375mg/m2 D1 & D15) or GEM-CARBO+/-R (cisplatin substituted for carboplatin AUC5). Data were collected on patient and treatment characteristics, response evaluated by modified IWG 2007 criteria (FDG-PET +/- CT), survival, and toxicity (CTCAE v4.0). Results: We identified 74 patients with median age 56 (range 25-79) who received a median of 3 cycles (range 1-6) of either GEM-P (89%) or GEM-CARBO(11%), combined with rituximab in 69%. 41% had transformed indolent lymphoma. Overall response rate (ORR) was 49% (complete response (CR) 16%, partial response (PR) 32%). Among 40/74 patients evaluated with FDG-PET, metabolic ORR was 63% (mCR 23%, mPR 40%). Of 51/74 patients treated in 2ndline, ORR was 45%. Significantly higher ORR was observed in patients treated with R-chemotherapy (61% vs 22%, p=0.002), despite 88% having received prior rituximab. 17 patients proceeded to autologous transplant. With median follow up of 50.5 months, 3 yr overall survival in all patients from start of GEM-P was 39% and 3 yr progression free survival 19%. Predominant Grade≥3 toxicity was haematological; thrombocytopenia 69%, neutropenia 58%, anaemia 15% and febrile neutropenia 8%. Conclusions: R-GEM-P is an effective salvage regimen in DLBCL, with the convenience of outpatient delivery. Despite previous rituximab exposure, patients in our cohort benefited from the addition of rituximab, supporting current practice.

The utility of PET-CT after preoperative chemoradiation in predicting treatment outcomes in locally advanced esophageal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 182-182
Author(s):  
Gary Lewis ◽  
Bin S. Teh ◽  
Shraddha Dalwadi ◽  
Stephen Chiang ◽  
Edward Brian Butler ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
Preoperative Chemoradiation ◽  
Survival Outcomes ◽  
Free Survival ◽  
Pet Ct ◽  
Pre Treatment ◽  
Disease Free

182 Background: In the treatment of gastroesophageal junction (GEJ) cancer, trimodality treatment with preoperative chemoradiation followed by surgery is the standard of care. However, predicting patient survival outcomes remains difficult. One possible means of predicting outcomes is comparing pre-treatment PET-CT with post-treatment PET-CT to see if a favorable response on imaging correlates with survival outcomes. Methods: We conducted a retrospective chart review of locally advanced GEJ cancer patients who underwent preoperative chemoradiotherapy followed by esophagectomy with negative margins. All patients underwent two PET-CT scans (before and after preoperative chemoradiation). We compared PET-CT imaging results and pathology results with survival outcomes. Values such as pre-treatment max SUV, post-treatment max SUV, change in max SUV, percent residual max SUV, complete response on PET-CT, and pathologic complete response were analyzed for potential impacts on recurrence rates and survival outcomes. Results: Forty patients had sufficient data to be included in our study. The median follow-up was 22.5 months. The majority of patients were male (82.5%), Caucasian (84.2%) and had adenocarcinoma histology (97.5%). Altogether, 75% of patients had stage III disease and 67.5% had locoregional nodal involvement. The majority (90%) of patients received some form of taxane and platinum based chemotherapy. Pre-treatment max SUV, post-treatment max SUV, change in max SUV, percent residual max SUV, and complete response on PET-CT were not associated with local recurrence, regional recurrence, disease-free survival, or overall survival. Pathologic complete response was associated with a decrease in the rate of distant metastasis ( P= 0.021) but not disease-free survival ( P= 0.411) or overall survival ( P= 0.878). Conclusions: Response on PET-CT after preoperative chemoradiation is not a predictive factor for recurrence, disease-free survival, or overall survival. Pathologic complete response predicted for a decrease in the rate of distant metastasis but not disease-free survival or overall survival.

scholarly journals Can multidisciplinary approach win the battle against metastatic rectal cancer?

2021 ◽  
pp. 25-25
Author(s):  
Suzana Stojanovic-Rundic ◽  
Vesna Plesinac-Karapandzic ◽  
Jelena Dedovic-Stojakovic ◽  
Nenad Mijalkovic ◽  
Violeta Skrelja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Systemic Chemotherapy ◽  
Multidisciplinary Approach ◽  
Rectal Cancer Patient ◽  
Rectal Adenocarcinoma ◽  
Disease Free Survival ◽  
Complete Response ◽  
Free Survival ◽  
Disease Free

Introduction. Colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths in men and women worldwide. The contemporary multidisciplinary approach has decreased rates of local recurrence and improved outcomes in metastatic colorectal cancer. We present a case of a primarily metastatic rectal cancer patient who underwent multidisciplinary planned treatment and showed complete response with now three years disease-free survival. Case outline. A 61-year-old female was diagnosed with a T4N2M1a rectal adenocarcinoma at the age of 58. She underwent six cycles of systemic chemotherapy capecitabine-oxaliplatin plus bevacizumab with partial response confirmed by diagnostic imaging procedures. According to multidisciplinary board decision, preoperative radiotherapy treatment was administered with concomitant Capecitabine-based chemotherapy. A 50.4 Gy total dose was delivered with 1.8 Gy fraction dose. After concomitant chemoradiotherapy treatment, two more cycles of systemic chemotherapy Capecitabine-Oxaliplatin plus Bevacizumab were administered. One month after completion of systemic chemotherapy, primary rectal cancer was operated with a complete response on histopathologic specimens. Six weeks following previous surgery, metastasectomy of lung deposits was performed; histopathology confirmed metastatic adenocarcinoma of colorectal origin. Three more cycles of postoperative chemotherapy capecitabine-oxaliplatin plus bevacizumab were administered. Conclusion. On regular follow-up, no evidence of disease was shown, with disease-free survival of three years. The treatment improved the patient?s quality of life.

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