scholarly journals Investigation of the Definition of De Novo Oligometastatic Nasopharyngeal Carcinoma: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hongmei Wang ◽  
Fang He ◽  
Xuejun Wang ◽  
Haoyun Tao ◽  
Zhihao Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Nasopharyngeal Carcinoma ◽  
Survival Data ◽  
De Novo ◽  
Progression Free Survival ◽  
Multiple Organ ◽  
Entire Group ◽  
Term Survival ◽  
Metastatic Lesions ◽  
Definition Of

Background. The prognosis of metastatic nasopharyngeal carcinoma (mNPC) is highly heterogeneous. As a special stage of distant metastasis of mNPC, quite a few oligometastatic NPC (omNPC) patients can still achieve a long-term survival after treatment. However, there is no uniform standard for the definition of omNPC until now. Methods. We retrospectively analyzed the survival data of 191 patients with de novo mNPC at the Affiliated Cancer Hospital and Institute of Guangzhou Medical University between 2010 and 2017 and specifically analyzed the clinical outcomes associated with the number of metastatic organs/lesions and tried to find a cohort with relatively better prognosis to define as omNPC. Results. The median overall survival (OS) of the entire group of patients was 21.5 months (95% CI 15.0–28.0), and the 1-year, 2-year, and 3-year OS rates were 72.2%, 46.1%, and 34.3%, respectively. Multiple-organ metastases ( P < 0.001 ) and >5 metastatic lesions ( P < 0.001 ) were adverse influencing factors of prognosis, and the number of metastatic lesions ( P < 0.001 ) was the independent factor influencing the prognosis of de novo mNPC. The overall survival (OS) and progression-free survival (PFS) of patients with ≤5 metastatic lesions were significantly better than those of patients with >5 metastatic lesions. Conclusion. Patients with ≤5 metastatic lesions presented a better survival, and this criterion may be a definition standard for the de novo omNPC.

Phase II Study of the Frontline Hyper-CVAD in Combination with Ofatumumab for Adult Patients (pts) with CD-20 Positive Acute Lymphoblastic Leukemia (ALL)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1295-1295 ◽  
Author(s):  
Koji Sasaki ◽  
Paul B. Koller ◽  
Hagop M. Kantarjian ◽  
Deborah A Thomas ◽  
Maria R. Khouri ◽  
...  
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Multiple Organ Failure ◽  
Research Funding ◽  
De Novo ◽  
Residual Disease ◽  
Progression Free Survival ◽  
Multiple Organ ◽  
Free Survival ◽  
Minimal Residual

Abstract Background: The hyper-CVAD regimen is an effective frontline regimen for de novo adult ALL. Expression of CD20 was identified as an adverse prognostic factor, associated with a higher incidence of relapse, lower 3-year complete remission duration (CRD) and lower 3-year overall survival (OS) rate. The addition of rituximab to the hyper-CVAD regimen in pts with CD20-positive ALL (≥20% expression by multicolor flow cytometry - FCI) improved outcome with 3-year CRD and OS rates by 68% and 65%, respectively. Ofatumumab (HuMax-CD20) targets a membrane proximal small-loop epitope on the CD20 molecule and was found to be more potent than rituximab in promoting complement-dependent cytotoxicity in vitro. Ofatumumab's safety and efficacy has been proven in chronic lymphocytic leukemia. Therefore a combination of the hyper-CVAD regimen and ofatumumab may be associated with better response rates, higher 3-year CRD and overall survival rates. Methods: Pts with newly diagnosed ALL and pts who received one prior course of chemotherapy received 4 courses of hyper-CVAD (fractionated cyclophosphamide, vincristine [VCR], doxorubicin, dexamethasone; the odd courses 1, 3, 5, 7); ofatumumab was given on courses 1 and 3, and 4 courses of MTX-Ara-C (methotrexate-cytarabine; the even courses 2, 4, 6, 8); ofatumumab was given on courses 2 and 4. This treatment would be followed by POMP (6-mercaptopurine, MTX, VCR, prednisone) maintenance therapy for approximately 30 months, interrupted by intensifications months 6, 7 and 18, 19 with MTX/Pegylated asparaginase and hyper-CVAD-ofatumumab. Central nervous system prophylaxis with MTX and ara-C was administered. When indicated local radiotherapy was administered in patients with bulky mediastinal disease Results: To date 37 pts with de novo ALL and 4 pts in complete remission (CR) previously treated (2 with prior cycle of hyper-CVAD, 1 post fludarabine-cytarabine based regimen, 1 with cyclophosphamide and dexamethasone) have received a median of 6 cycles (1-8) of therapy. Median age is 46 years (32-71). Median WBC at diagnosis was 5.4 x 109/L (1 -202 x 109/L). CD20 expression above 20% was found in 27 pts (66%), between 10 and 20% in 3 (7%) and below 10% in 11 (27%). 2 pts (5%) had concomitant CNS disease at diagnosis. Among the 34 pts with evaluable baseline cytogenetic analysis, 20 (49%) were abnormal. All but one pt (97%) achieved a CR after cycle 1 (4 pts were in CR at the start); 1 pt died of septic shock and multiple organ failure at day 21 of cycle 1. Thirty-eight (95%) pts achieved minimal residual disease (MRD) negativity as assessed by FCI; of whom 23 (64%) achieved MRD negativity after induction. Ten (27%) pts did not receive the full 8 planned courses of induction-consolidation; 16 (43%) pts are receiving maintenance in CR; 4 (11%) pts finished all treatment; 5 (%) pts were referred to allogeneic stem cell transplantation due to multiple cytogenetic abnormalities and delay in achieving negative MRD. Median time to neutrophil and platelet recovery for cycle 1 was 18 and 22 days after induction chemotherapy, respectively. Grade ≥ 3 toxicity included increase of LFT's in 13 pts (32%), increase of bilirubin in 7 (17%), nausea/vomiting in 4 (10%), mucositis in 3 (7%), neuropathy in 3 (7%), and thrombotic events in 1 (2%). Febrile neutropenia episodes during induction and consolidation cycles were reported at rates of 67% and 89%, respectively. With a median follow up of 15 months (1-45), 35 pts are alive; 6 pts relapsed and one had molecular relapse only. Six pts died: 1 at C1D22 of sepsis and intracranial bleed; 1 at C3D17 of sepsis and multiple organ failure; 1 at maintenance C16D35 of sepsis; 1 of relapse post ASCT; 1 post salvage therapy for minimal residual disease relapse; 1 of progressive disease after relapse. The 2-year PFS and OS rates were 68% and 87% respectively. Conclusion: The combination of hyper-CVAD with ofatumumab is safe and highly effective in pts with CD20-positive ALL. Table 1. Patient characteristics and outcome N (%)/Median [range] N=41 Age (yrs) 44 [22-71] Sex Male 25 (61) Female 16 (39) PS 0-1 38 (93) 2-3 3 (7) WBC (x 109/L) 5.4 [0.7-201.7] CNS disease positivity 2 (5) CD20 + (%) 1-10 9 (22) 10-20 3 (7) >20 27 (66) Pos 2 (5) CG Diploid 14 (34) Abnormal 20 (49) IM/ND 7 (17) Response CR 37/38 (97) CR after induction 37/38 (97) MRD at CR 23/36 (64) MRD overall 38/40 (95) Early death 1 (3) Figure 1. Progression-free survival and overall survival Figure 1. Progression-free survival and overall survival Disclosures Cortes: Teva: Research Funding; BerGenBio AS: Research Funding; Pfizer: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Ariad: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Astellas: Consultancy, Research Funding; Ambit: Consultancy, Research Funding; Arog: Research Funding; Celator: Research Funding; Jenssen: Consultancy. Chahoud:American Society of Hematology (ASH): Other: 2015 HONORS Award recipient. Verstovsek:Incyte Corporation: Research Funding. Konopleva:Novartis: Research Funding; AbbVie: Research Funding; Stemline: Research Funding; Calithera: Research Funding; Threshold: Research Funding. O'Brien:Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding.

scholarly journals Optimizing the Treatment Mode for de Novo Metastatic Nasopharyngeal Carcinoma with Bone-Only Metastasis

2021 ◽  
Author(s):  
Cheng Lin ◽  
Sheng Lin ◽  
li Li Zhu ◽  
jun Shao Lin ◽  
ji Jian Pan ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Nasopharyngeal Carcinoma ◽  
Cox Regression ◽  
De Novo ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Rank Test ◽  
Bone Lesions ◽  
Metastatic Lesions ◽  
Metastatic Nasopharyngeal Carcinoma

Abstract Purpose: No standard radiotherapy regimens was established in the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LLRT) with or without local radiotherapy (RT) to bone metastatic lesions in mNPC, and identify the optimal candidates.Methods: We retrospectively analyzed 141 de novo mNPC patients with bone-only metastasis who received at least two cycles of PCT with or without LLRT and RT to bone metastasis. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analysis was made by Cox regression. Results: Patients who received PCT plus LLRT had significantly longer overall survival (OS) (45.0 months vs 13.5 months, HR = 0.30 , p = 0.001) and progression-free survival (PFS) (29.0 months vs 11.0 months, HR = 0.34, p = 0.014), especially in patients who had less than 3 metastatic bone lesions. Multivariate analysis confirmed that LRRT, more chemotherapy cycles (≥ 4) and limited number of bone metastasis (≤ 3) were favorable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bones had a tendency to prolong the survival time in the unselected population who received PCT plus LLRT (p > 0.05), while further data suggested that RT to metastatic bones dramatically improve OS (72.0 months vs 26.0 months, p = 0.002) and PFS (60.0 months vs 20.0 months, p = 0.006) for mNPC with less than 3 metastatic bone lesions.Conclusions: LLRT and RT to bone metastatic lesions followed by PCT in de novo mNPC with bone-only metastasis significantly prolonged survival in patients with less than 3 metastatic bone lesions.

scholarly journals Optimizing the Treatment Mode for De Novo Metastatic Nasopharyngeal Carcinoma With Bone-only Metastasis

2021 ◽  
Author(s):  
Cheng Lin ◽  
Sheng Lin ◽  
lili Zhu ◽  
JianJi Pan ◽  
Yun Xu ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Nasopharyngeal Carcinoma ◽  
Cox Regression ◽  
De Novo ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Rank Test ◽  
Bone Lesions ◽  
Metastatic Lesions ◽  
Metastatic Nasopharyngeal Carcinoma

Abstract Purpose: No standard radiotherapy regimens was established in the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LLRT) with or without local radiotherapy (RT) to bone metastatic lesions in mNPC, and identify the optimal candidates.Methods: We retrospectively analyzed 141 de novo mNPC patients with bone-only metastasis who received at least two cycles of PCT with or without LLRT and RT to bone metastasis. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analysis was made by Cox regression. Results: Patients who received PCT plus LLRT had significantly longer overall survival (OS) (45.0 months vs 13.5 months, HR = 0.30 , p = 0.001) and progression-free survival (PFS) (29.0 months vs 11.0 months, HR = 0.34, p = 0.014), especially in patients who had less than 3 metastatic bone lesions. Multivariate analysis confirmed that LRRT, more chemotherapy cycles (≥ 4) and limited number of bone metastasis (≤ 3) were favorable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bones had a tendency to prolong the survival time in the unselected population who received PCT plus LLRT (p > 0.05), while further data suggested that RT to metastatic bones dramatically improve OS (72.0 months vs 26.0 months, p = 0.002) and PFS (60.0 months vs 20.0 months, p = 0.006) for mNPC with less than 3 metastatic bone lesions.Conclusions: LLRT and RT to bone metastatic lesions followed by PCT in de novo mNPC with bone-only metastasis significantly prolonged survival in patients with less than 3 metastatic bone lesions.

Comparison of Treatment, Cost, and Survival in Patients With Metastatic Colorectal Cancer in Western Washington, United States, and British Columbia, Canada

2020 ◽  
Vol 16 (5) ◽  
pp. e425-e432 ◽  
Author(s):  
Todd A. Yezefski ◽  
Dan Le ◽  
Leo Chen ◽  
Caroline H. Speers ◽  
Shasank Chennupati ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
British Columbia ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Systemic Therapy ◽  
Survival Data ◽  
De Novo ◽  
Tumor Resection ◽  
Care Utilization ◽  
Western Washington

PURPOSE: Few studies have directly compared health care utilization, costs, and outcomes between patients treated in the US multipayer health system and Canada’s single-payer system. Using cancer registry and claims data, we assessed treatment types, costs, and survival for patients with metastatic colorectal cancer (mCRC) in Western Washington State (WW) and British Columbia (BC). MATERIALS AND METHODS: Patients age ≥ 18 years diagnosed with mCRC in 2010 and later were identified from the BC Cancer database and a regional database linking WW SEER to claims from Medicare and two large commercial insurers. Demographics, treatment characteristics, costs of systemic therapy, and survival data were obtained from these databases and compared between the two regions. RESULTS: A total of 1,592 patients from BC and 901 from WW were included in the study. Median age was similar (BC, 66 years; WW, 63 years), but patients in BC were more likely to be male (57.1% v 51.2%; P ≤ .01) and to have de novo metastatic disease (61.0% v 38.3%; P ≤ .01). The use of radiation therapy was similar between regions (BC, 31.2%; WW, 33.9%; P = .18), but primary tumor resection was more common in BC (74.1% v 66.3%; P ≤ .01) as was hepatic metastasectomy (12.4% v 2.3%; P ≤ .01). Similar percentages of patients received systemic therapy (BC, 68.8%; WW, 67.1%; P = .40), but costs were significantly higher for first-line systemic therapy in WW ($6,226 v $15,792 per patient per month; P ≤ .01). Median overall survival was similar (BC, 16.9 months; WW, 18 months). CONCLUSION: Cost of systemic therapy for mCRC was significantly higher for patients in WW than in BC, but this did not translate to a difference in overall survival.

Refining TNM-8 M1 categories with anatomic subgroups for previously untreated de novo metastatic nasopharyngeal carcinoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6046-6046
Author(s):  
Sik-Kwan Chan ◽  
Cheng Lin ◽  
Shao Hui Huang ◽  
Tin Ching Chau ◽  
Qiaojuan Guo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Bone Metastases ◽  
Validation Cohort ◽  
De Novo ◽  
Multivariable Analysis ◽  
Term Survival ◽  
Training Cohort ◽  
Study Results ◽  
Multivariable Analyses

6046 Background: The eighth edition TNM (TNM-8) classified de novo metastatic (metastatic disease at presentation) nasopharyngeal carcinoma (NPC) as M1 without further subdivision. However, survival heterogeneity exists and long-term survival has been observed in a subset of this population. We hypothesize that certain metastatic characteristics could further segregate survival for de novo M1 NPC. Methods: Patients with previously untreated de novo M1 NPC prospectively treated in two academic institutions (The University of Hong Kong [n = 69] and Provincial Clinical College of Fujian Medical University [n = 114] between 2007 and 2016 were recruited and re-staged based on TNM-8 in this study. They were randomized in 2:1 ratio to generate a training cohort (n = 120) and validation cohort (n = 63) respectively. Univariable and multivariable analyses (MVA) were performed for the training cohort to identify the anatomic prognostic factors of overall survival (OS). We then performed recursive partitioning analysis (RPA) which incorporated the anatomic prognostic factors identified in multivariable analyses and derived a new set of RPA stage groups (Anatomic-RPA groups) which predicted OS in the training cohort. The significance of Anatomic-RPA groups in the training cohort was then validated in the validation cohort. UVA and MVA were performed again on the validation cohorts to identify significant OS prognosticators. Results: The training and the validation cohorts had a median follow-up of 27.2 months and 30.2 months, respectively, with the 3-year OS of 51.6% and 51.1%, respectively. Univariable analysis (UVA) and multivariable analysis (MVA) revealed that co-existing liver and bone metastases was the only factor prognostic of OS. Anatomic-RPA groups based on the anatomic prognostic factors identified in UVA and MVA yielded good segregation (M1a: no co-existing liver and bone metastases and M1b: co-existing both liver and bone metastases; median OS 39.5 and 23.7 months respectively; P =.004). RPA for the validation set also confirmed good segregation with co-existing liver and bone metastases (M1a: no co-existing liver and bone metastases and M1b: co-existing liver and bone metastases), with median OS 47.7 and 16.0 months, respectively; P =.008). It was also the only prognostic factor in UVA and MVA in the validation cohort. Conclusions: Our Anatomic-RPA M1 stage groups with anatomical factors provided better subgroup segregation for de novo M1 NPC. The study results provide a robust justification to refine M1 categories in future editions of TNM staging classification.

CURE OF THREE PATIENTS WHO HAD SKELETAL METASTASES IN DISSEMINATED NEUROBLASTOMA

PEDIATRICS ◽  
1968 ◽  
Vol 41 (1) ◽  
pp. 47-51
Author(s):  
Douglas Reilly ◽  
Mark E. Nesbit ◽  
William Krivit
Keyword(s):  
Overall Survival ◽  
Survival Data ◽  
Specific Treatment ◽  
Skeletal Metastases ◽  
University Of Minnesota ◽  
Term Survival ◽  
Long Term Survival ◽  
Skeletal Involvement ◽  
The University

The long-term survival of three children with disseminated skeletal metastases due to neuroblastoma is reported. These three patients are added to eight other patients reported in the literature who have survived longer than 2 years after the development of their metastatic osseous lesions. A review of the cases did not reveal a specific treatment regime which provided the success in these cases. The presence of skeletal involvement, therefore, should not indicate a hopeless prognosis. A review of 33 patients with neuroblastoma at the University of Minnesota from 1956-1966 is also given to provide overall survival data.

scholarly journals BRAF V600E Mutation in Triple-Negative Breast Cancer: A Case Report and Literature Review

2021 ◽  
pp. 1-7
Author(s):  
Liye Wang ◽  
Qianyi Lu ◽  
Kuikui Jiang ◽  
Ruoxi Hong ◽  
Shusen Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Progression Free Survival ◽  
Multiple Organ ◽  
Braf V600e ◽  
Case Presentation ◽  
Free Survival ◽  
Metastatic Lesions ◽  
Potential Prognostic Factor ◽  
New Mutations

<b><i>Background:</i></b> The B-Raf proto-oncogene (BRAF<sup>V600E</sup>) gene mutation has been identified in a variety of malignancies, but no evidence of the efficacy of vemurafenib treatment in BRAF<sup>V600E</sup> mutant breast cancer (BC) has been reported. <b><i>Case Presentation:</i></b> We reported a 60-year-old woman with confirmed triple-negative BC with BRAF<sup>V600E</sup> mutation. Progression-free survival (PFS) for first-line chemotherapy was 7 months. The patient received vemurafenib and albumin-bound paclitaxel as second-line therapy, exhibiting regression of some pulmonary metastatic lesions with concomitant progression of other lesions, and achieved 4.4 months of PFS. Genetic testing of the progressed pulmonary lesion revealed the BRAF<sup>V600E</sup> mutation, and acquired new mutations and AR amplification. The patient ultimately died of multiple organ failure and achieved 12 months of overall survival. <b><i>Conclusions:</i></b> The BRAF<sup>V600E</sup> mutation may be a potential prognostic factor and therapeutic target for BC.

scholarly journals Early intra-treatment diffusion weighted magnetic resonance imaging in patients with recurrent nasopharyngeal carcinoma treated with nivolumab

2020 ◽  
Vol 6 (3) ◽  
pp. 568
Author(s):  
Tiffany Y. So ◽  
Qi-Yong Ai ◽  
Brigette B.Y. Ma ◽  
Ann D. King
Keyword(s):  
Magnetic Resonance Imaging ◽  
Overall Survival ◽  
Magnetic Resonance ◽  
Nasopharyngeal Carcinoma ◽  
Progression Free Survival ◽  
Tumour Volume ◽  
Resonance Imaging ◽  
Free Survival ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging

<p class="abstract">Immune check point inhibitors have demonstrated promising efficacy in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) in phase I and phase II trials. Early identification of treatment response is important in these patients. This report aimed to document the early intratreatment diffusion weighted magnetic resonance imaging (DW-MRI) findings in NPC patients following treatment with the programmed cell death-1 inhibitor, nivolumab. Two consecutive patients with histologically confirmed recurrent undifferentiated NPC treated with nivolumab were prospectively recruited. Nivolumab was administered at a dosage of 3 mg/kg intravenously every 2 weeks. Patients underwent magnetic resonance imaging examinations at baseline, and at 3 and 5 weeks after commencement of treatment. Intratreatment changes in tumour volume and apparent diffusion coefficient (ADC<sub>mean</sub>)were calculated. The endpoints were objective response by response evaluation criteria in solid tumors and survival. In patient 1, an intratreatment ADC increase at 5 weeks corresponded with anatomical tumour volume reduction and a better long-term survival outcome (progression free survival 1.3 years, overall survival 2.9 years). In patient 2, an intratreatment ADC decrease at 5 weeks corresponded to progressive disease and worse outcome (progression free survival 0.0 years, overall survival 0.9 years). Intratreatment ADC changes at 3 weeks were not associated with response outcome. These cases suggest that intratreatment changes in ADC at 5 weeks may potentially predict tumour response in patients treated with nivolumab. Dedicated studies are needed to clarify these findings and fully characterise patterns of treatment related ADC change.</p>

Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis

2020 ◽  
Vol 30 (6) ◽  
pp. 865-872 ◽  
Author(s):  
Cem Onal ◽  
Melis Gultekin ◽  
Ezgi Oymak ◽  
Ozan Cem Guler ◽  
Melek Tugce Yilmaz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
Term Survival ◽  
Free Survival ◽  
Oligometastatic Disease

IntroductionData supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer.MethodsThe clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival.ResultsA total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9–95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0–16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities.ConclusionsPatients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.

Stage IVA cervical cancer: outcomes of disease related complications and treatment

2020 ◽  
pp. ijgc-2019-000386
Author(s):  
Beman Roy Khulpateea ◽  
Annette Paulson ◽  
Matthew Carlson ◽  
David Scott Miller ◽  
Jayanthi Lea
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Progression Free Survival ◽  
Percutaneous Nephrostomy ◽  
Emergency Department Visits ◽  
Term Survival ◽  
Histologic Subtype ◽  
Free Survival ◽  
Gynecology And Obstetrics

IntroductionStage IVA cervical cancer is an uncommon diagnosis. The course of the disease and the complications of treatment are not well characterized. The goal of this study was to report treatment outcomes of patients with stage IVA cervical cancer.MethodsA single institution retrospective review was carried out of all patients treated for stage IVA cervical cancer from January 2008 to July 2017. Patients were clinically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging criteria for cervical cancer. Inclusion criteria were patients with stage IVA cervical cancer of any histologic subtype, including patients with evidence of para-aortic lymph node involvement, treated at the institution during this time period. Overall survival and progression free survival were calculated using the Kaplan–Meyer method. Comparisons between survival were done using the Cox proportional hazards regression model and the log rank test.ResultsWe identified 25 patients with stage IVA cervical cancer. Mean age at diagnosis was 54 years (range 27–77). Squamous cell carcinoma was the histologic diagnosis in 24 of 25 patients (96%), with 1 case of small cell carcinoma (4%). 21 patients completed a full course of radiation. The median overall survival for patients who completed their treatment was 60 months (range 3–136), with a 2 year overall survival of 63%. The median progression free survival was 27 months (range 0–125), with a 2 year progression free survival of 40%. 11 of 25 patients (44%) developed fistulas during the course of their disease, and 55% of these were complex fistulas. 19 of 25 (76%) patients had a percutaneous nephrostomy for either hydronephrosis or diversion of vesicovaginal fistula. 111 unplanned admissions occurred among the 25 patients, and infections of the urinary tract was implicated in 46 (41%) of these. The cohort had a total of 92 emergency department visits, with pain control (36%) and medication refills (15%) being the most common presentations.DiscussionPatients with stage IVA cervical cancer may have substantial long term survival, although the sequelae of disease and treatment is associated with significant morbidity. Symptoms of fistula, percutaneous nephrostomy complications, and chronic pain present unique issues that require extensive supportive care.

Sign in / Sign up

Export Citation Format

Share Document