scholarly journals Identification of Areas for Improvement in the Management of Bone Metastases in Patients with Neuroendocrine Neoplasms

2019 ◽  
Vol 110 (7-8) ◽  
pp. 688-696
Author(s):  
Kok Haw Jonathan Lim ◽  
Hussain Raja ◽  
Paolo D’Arienzo ◽  
Jorge Barriuso ◽  
Mairéad G. McNamara ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Distant Metastases ◽  
Unknown Primary ◽  
Neuroendocrine Neoplasms ◽  
Global Consensus ◽  
Skeletal Related Events ◽  
Grade 3 ◽  
Review Current

Background: There is no global consensus on the optimal management of bone metastases (BMs) in neuroendocrine neoplasms (NENs). Objectives: To review current management and outcomes of patients with BMs in NENs, in order to identify areas for improvement. Methods: A retrospective study of all patients with NENs, except Grade 3 lung NENs (April 2002 to March 2018) was conducted. Baseline characteristics, nature of BMs, treatment received and overall survival (OS) were evaluated. Statistical analyses were performed using SPSS version 23.0/STATA v12. Results: Of 1,212 patients, 85 (7%) had BMs; median age 58 years. The majority had a gastro-entero-pancreatic primary (49%, n = 42) followed by lung (25%, n = 21), unknown primary (20%, n = 17), and “others” (6%, n = 5). Two-thirds (n = 57) had G1–2 neuroendocrine tumours, and 41% (n = 35) had functional tumours. Overall, 28% (n = 24) presented with synchronous BMs at first NEN diagnosis, and 55% (n = 47) developed BMs at the same time as other distant metastases. For the subpopulation of patients in whom BMs developed metachronously to other distant metastases (45%, n = 38), median time to development of BMs was 14.0 months. BMs were “widespread” in 61% (n = 52). Although only 22% (n = 19) reported symptoms at initial diagnosis of BMs, most (78%) developed symptoms at some time during the follow-up period (pain/hypercalcaemia 64%, skeletal-related events 20%). BMs were mainly managed with analgesia (44%, n = 37). Radiotherapy and bisphosphonates were used in 34% (n = 29) and 22% (n = 19) respectively. Surgery was rarely performed (2%, n = 2). Median OS from identification of BMs was 31.0, and 18.9 months from development of BMs-related symptoms. Conclusions: In this cohort study, most patients with BMs developed symptoms. The utility of radiotherapy and/or bisphosphonates should be prospectively and systematically explored further for its potential impact on patients’ quality of life and survival outcomes.

Use of antiresorptive therapy (ART) and skeletal-related events (SREs) in patients with bone metastases of neuroendocrine neoplasms (NEN).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4096-4096
Author(s):  
Leonidas Apostolidis ◽  
Dirk Jaeger ◽  
Eva Caroline Winkler
Keyword(s):  
Bone Metastases ◽  
Rare Event ◽  
Neuroendocrine Neoplasms ◽  
Antiresorptive Therapy ◽  
Negative Prognostic Factor ◽  
Significant Toxicity ◽  
Osteolytic Metastases ◽  
Skeletal Related Events ◽  
Grade 3

4096 Background: Antiresorptive therapy (ART) with bisphosphonates or denosumab is effective in preventing skeletal-related events (SREs) in patients with bone metastases (BM). In neuroendocrine neoplasms (NEN), BM are a negative prognostic factor, however tend to be asymptomatic and SREs are considered a rare event. The role of ART in preventing SREs in NEN has not been investigated so far. Methods: Retrospective analysis of all patients with bone metastases in the NEN database of the National Center for Tumor Diseases who presented at our center between 12/2012 and 01/2017. Overall survival (OS) from diagnosis of BM as well as time to SRE (TTSRE) were calculated. In patients experiencing an SRE within 1 month after diagnosis (i.e. before efficacy of ART could be assessed), TTSRE was defined as the time to a subsequent SRE. Results: In a total of 513 patients in the database, 108 patients with BM could be identified. Median OS was not reached in a median follow-up of 15.2 months. ART was applied to 42.6 % of patients. OS with or without ART did not differ significantly (p = 0.2538). 28.7 % of patients experienced at least 1 SRE, 20.4 % after more than 1 month. Median TTSRE was 63.8 months with ART and 127.0 months without ART (p = 0.1751). TTSRE was shortened in grade 3 vs. grade 1+2 NEN (172 months vs. not reached, HR 4.058, p = 0.0032), as well as in lytic vs. non-lytic metastases (24.5 vs. not reached, HR 7.319, p < 0.0001), however not significantly different in oligometastatic vs. disseminated bone disease (not reached vs. 63,8 months, HR 1.415, p = 0.4287). Application of ART did not significantly change TTSRE in either of these subgroups. Significant toxicity attributable to ART was observed in 15.2 % of ART patients. Conclusions: SREs in NEN patients with BM were not uncommon, especially in patients with grade 3 NEN and osteolytic metastases. Application of ART did not significantly alter median OS or TTSRE, no subgroup with a benefit of ART could be identified. The use of ART in NEN should be questioned and evaluated prospectively.

scholarly journals Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
M. M. J. Van Rooijen ◽  
T. Tollens ◽  
L. N. Jørgensen ◽  
T. S. de Vries Reilingh ◽  
G. Piessen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hernia Recurrence ◽  
Recurrence Rates ◽  
Elective Repair ◽  
Significant Difference ◽  
Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

scholarly journals URINARY INCONTINENCE;

2017 ◽  
Vol 24 (06) ◽  
pp. 824-827
Author(s):  
Ambreen Amna ◽  
Farkhunda Nadeem ◽  
Pushpa Srichand
Keyword(s):  
Urinary Incontinence ◽  
Stress Incontinence ◽  
Urinary Fistula ◽  
University Hospital ◽  
Persistent Symptoms ◽  
Grade 3 ◽  
Time Of Admission ◽  
Study Setting

Background: Genitourinary fistula remains a major cause of morbidity worldwide.Approximately 2 million of women suffer from urinary leakage. Since the establishment ofGenito urinary Fistula center at Isra University Hospital –Hyderabad Sindh. We are able to shareour experience of fistulous women at the time of admission and at follow up visit. Objectives:To determine the different types of urinary incontinence in a woman after genitourinary fistularepair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done atFistula center Isra University Hospital Hyderabad GU – 11 from January 2011 to December2013. All the women who were admitted with true incontinence followed by Obstetrical andmajor gynecological surgeries were included. However women with stress incontinence andurge incontinence and women who are not willing to include in the study were excluded.Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were foundto have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continencestatus were explored at follow up visit. Out of 110 women, 108 (98.18%) & 96 (87.27 %) werehaving no signs of incontinence on examination at first visit and after six week and secondvisit after three month respectively. Only 7 % women fell into incontinence grade 2 at six weekfollow up and only one percent had persistent symptoms of stress incontinence at 3 monthrespectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month.Conclusion: Success rate of genitor- urinary fistula repair is 98 %. Majority of women (96 %)on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow upvisit at 3 months, these women reported improved quality of life and social reintegration afterfistula closure.

scholarly journals Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

Cartilage ◽  
2020 ◽  
pp. 194760352094636
Author(s):  
Yoshiharu Shimozono ◽  
John F. Dankert ◽  
John G. Kennedy
Keyword(s):  
Adipose Tissue ◽  
Advanced Stage ◽  
Arthroscopic Debridement ◽  
Posttraumatic Osteoarthritis ◽  
Significant Difference ◽  
The Mean ◽  
Grade 3

Objective To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. Design A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. Results A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048). Conclusions Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

Full Dose Vincristine (V) Negatively Impacts Progression Free Survival in Newly Diagnosed or Relapsed/Refractory Multiple Myeloma Patients Treated with Pegylated Doxorubicin, Vincristine, Reduced-Dose Dexamethasone, and Thalidomide (DVd-T).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2570-2570
Author(s):  
R. Suppiah ◽  
E. Walker ◽  
K. Almhanna ◽  
S. Andresen ◽  
J. Reed ◽  
...  
Keyword(s):  
Phase Ii ◽  
Overall Response Rate ◽  
Progression Free Survival ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Full Dose ◽  
Grade 3 ◽  
Positive Effect

Abstract Background: The activity of V in myeloma was first described in the 1970’s. Although Phase II data suggest that V demonstrates single agent activity, subsequent reports have questioned its role. Due to these conflicting results, we conducted a subanalysis investigating the effect of V dose in the phase II DVd-T regimen that we have previously reported (Agrawal et al ASH 2003). We evaluated the effects of V dose on progression free survival (PFS) and overall survival (OS) in newly diagnosed and relapsed/refractory patients treated with DVd-T. Patients and Methods: As previously reported, this Phase II study enrolled 102 patients with newly diagnosed or relapsed/refractory multiple myeloma with evidence of end organ damage. DVd-T was administered as previously reported. After best response, patients were maintained on prednisone 50mg every other day and the maximum tolerated dose of thalidomide until disease progression. For patients experiencing grade 1 neuropathy, V was reduced by 25%, and for grade 2, by 50%. Patients developing grade 3/4 neuropathy had V discontinued and thalidomide suspended until toxicity decreased by at least one grade. Univariate analyses were conducted to assess the effect of V dose reduction or elimination on PFS and OS. Multivariate analyses were performed to adjust for the impact of age, platelet count, stage, quality of response (CR or near CR versus SD or PR), and thalidomide dose. Results: Trial included 53 newly diagnosed and 49 relapsed/refractory patients. Median age was 62.9 years. 59% had stage 3 or 4 disease. 37% had abnormal cytogenetics. Median beta-2 microglobulin was 4.1. Overall response rate of 87% was seen in newly diagnosed patients (36% achieved CR; 13% near CR; 38% PR; 8% SD; 6% PD). In the relapsed/refractory patients, overall response rate of 87% was achieved (21% achieved CR; 26% near CR; 40% PR; 13% SD). Median follow up was 28.1 months. Median PFS for the newly diagnosed group was 28.2 months and 15.5 for the relapsed/refractory group. Median OS was 39.9 months for the relapsed/refractory group. After 50 months of follow-up for the newly diagnosed group, median OS has not been reached. In total, 464 cycles were administered, of which 225 were given with full dose V and 242 with reduced dose or eliminated V. Grade 3/4 neuropathy occurred in 22 patients. Univariate analysis revealed that reducing or eliminating V had a significant positive effect on PFS and OS (p = 0.0002 and 0.02 respectively). Multivariate analysis adjusting for age at start of study, platelet count, stage, quality of response [CR or near CR versus SD or PR], and thalidomide dose, similarly found that reducing or eliminating the dose of V had a significant positive effect (p = 0.0121) on PFS. However, multivariate analysis did not reveal the same effect on OS (p = 0.11). Conclusions: This subanalysis suggests that the use of full dose V in the DVd-T regimen may have a negative effect on PFS. The exact mechanism by which V affects PFS is not clear. Studies are now on-going investigating this regimen without V. Figure Figure

Colorectal cancer nutritional and quality-of-life parameters predict patients outcomes after radiotherapy: Long-term follow-up from a prospective randomized controlled trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14570-14570
Author(s):  
P. Ravasco ◽  
I. Monteiro Grillo ◽  
M. Camilo
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Controlled Trial ◽  
Distant Metastases ◽  
Disease Outcome ◽  
Nutritional Counseling ◽  
Diet Intake

14570 Background: Long term data of our published randomized trial of nutritional therapy in colorectal cancer showed that nutritional counseling optimizes pts prognosis. This study aimed to search whether outcomes were affected by individual nutritional & Quality of Life (QoL) parameters after nutrition intervention and radiotherapy (RT). Methods: Data were obtained from the trial pts’ records: G1 (n=37) on individualized nutritional counseling & education (regular foods), G2 (n=37) ad lib+polymeric protein supplements & G3 (n=37) ad lib intake. After RT, current intake (diet history), nutritional status (PG-SGA) & QoL scores (EORTC) were evaluated; their ability to predict survival, disease outcome [loco regional recurrence (LRR), distant metastases] & late RT toxicity (permanent flatulence, abdominal distension, diarrhea) were analyzed after a median follow-up of 3.7 (2.0–5.8) yrs. Results: Energy/protein intakes had decreased in G3 (p<0.01) & increased in G1>G2, p=0.007; wasting only occurred in G3>G2 (p<0.05); QoL scores worsened in G3>G2 (p<0.05) yet improved in G1, p<0.01. On multivariate analyzis of coded time-dependent variables: poorer diet intake, nutritional wasting & worse QoL scores were associated with decreased survival (p<0.002), LRR (p=0.01), distant metastases (p=0.005) & late RT toxicity, p<0.003. Landmark analysis showed that pts with nutritional intake/status & QoL deterioration, had significantly lower survival (hazard ratio [HR]: 8.25; 95% CI 2.74–26.47; p<0.001), worse disease outcome (HR: 8.15; 95% CI 2.22–25.40; p<0.002) & more severe late RT toxicity (HR: 7.15; 95% CI 2.25–16.11; p<0.004). Conclusions: In colorectal cancer after RT, poor diet intake, wasting & deteriorated QoL look as if significant predictors of survival, treatment response & late RT toxicity; such patients are prone to a more aggressive clinical course. No significant financial relationships to disclose.

Patient-reported quality of life in men with TURP undergoing proton therapy for prostate cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 220-220 ◽  
Author(s):  
Derek Lee ◽  
Bradford S. Hoppe ◽  
Tamara L. Smith ◽  
Christopher G. Morris ◽  
Romaine Charles Nichols ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Proton Therapy ◽  
Toxicity Assessment ◽  
Gu Toxicity ◽  
Significant Difference ◽  
Patient Reported ◽  
Grade 3

220 Background: We report on quality of life (QOL) and early toxicity following proton therapy (PT) among men with prostate cancer who underwent transurethral resection of the prostate (TURP) prior to treatment. Methods: Between 2006 and 2010, 1,540 patients were treated definitively with PT for prostate cancer at UFPTI and enrolled on a prospective IRB-approved outcomes protocol. One hundred of the men had received a TURP before PT. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Results: Men who had TURP prior to PT had lower EPIC scores at baseline and at all followup points for urinary function, urinary incontinence, and urinary summary (Table). The TURP group also had lower EPIC bowel bother, bowel function, and bowel summary at baseline, 6-month, and 1-year followup. EPIC urinary bother, urinary irritation/obstruction, and subscales did not show a statistically significant difference at baseline, but they did show lower scores for the TURP group at variable follow-up time points. The IPSS scores among the TURP group did not show a statistical difference from the non-TURP group, except at the 6-month follow-up time point. Toxicity assessment showed that the 2-year and 3-year cumulative incidence of grade 3 GU toxicity rate in the pretreatment TURP group were 14% and 18%, respectively. Conclusions: Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after PT treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up and further evaluation of risk factors for grade 3 GU toxicity among this cohort are needed. [Table: see text]

Stereotactic body radiotherapy (SBRT) versus high dose rate (HDR) brachytherapy (BT) boost for high-risk (HR) prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 12-12
Author(s):  
Alejandro Gonzalez-Motta ◽  
Mack Roach
Keyword(s):  
Radiation Therapy Oncology Group ◽  
High Dose Rate ◽  
Learning Curves ◽  
High Dose ◽  
Gu Toxicity ◽  
Patient Reported ◽  
The Common ◽  
Grade 3

12 Background: Declining use of BT has prompted questions regarding the use of SBRT in HR patients. A systematic literature review was conducted to assess toxicity, and biochemical outcomes following SBRT or HDR BT boost in HR patients. Methods: A search was carried out on the PubMed and Embase databases, for studies published between 2007 and 2017, including HR patients treated with SBRT or HDR boost. Results: We identified 11250 articles, with 6 SBRT and 41 HDR boost studies eligible. The median follow-up was 3.5-5.5 and 2.6-10.3 years in SBRT and HDR boost studies, respectively. The five-year bDFS was 41%–96% in HDR and 69%–98% in SBRT boost studies. Toxicity was reported using the Radiation Therapy Oncology Group (RTOG) scale or the Common Terminology Criteria for Adverse Events (CTCAE) scale and/or validated patient reported Quality of Life (QoL) outcomes. Single SBRT and HDR studies reported 1 year IPSS scores < 7, with 2 SBRT reports of excellent outcomes by the EPIC scale. Acute grade 2 (G2) genitourinary (GU) toxicity ranged from 24-46% and 0.4-33% in SBRT and HDR boost studies, respectively. Late G2 GU toxicity occurred in 2.3-25% and 0-22% following SBRT and the HDR boost, respectively. Late grade 3 (G3) GU toxicity was reported in 0-2.3% and 0-10% with SBRT and HDR boost, respectively. Late G3 GU was reported in 0.8% (2/226) and 4% (114/2763) following SBRT and HDR boost, respectively. Acute G2 gastrointestinal (GI) was noted in 8-19% and 0-19% of SBRT and HDR boost studies, respectively. Late G3 GI was reported in 0-10% and 0-4.6% of SBRT and HDR boost studies, respectively. Late G3 GI was reported in 2% (5/226) and 0.6% (18/2829) of SBRT and HDR boost studies, respectively. Conclusions: SBRT boost may be associated with higher acute G2 but lower late G3 GU toxicity but was not shown by QoL reports, and could be due to selection bias, learning curves or other factors. Randomized trials and validated QoL instruments are needed to accurately compare SBRT to HDR boost.

scholarly journals A Double Priming Induction Regimen for Acute Myeloid Leukemia with Inferior PS Among Resource Limited Areas

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5173-5173
Author(s):  
Stephen Liang ◽  
Siliang Chen ◽  
Xiaoli Huang ◽  
Zheyuan Qin ◽  
Sanbin Wang
Keyword(s):  
Quality Of Life ◽  
Acute Myeloid Leukemia ◽  
Pilot Study ◽  
Subcutaneous Injection ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Grade 3 ◽  
Acute Myeloid

Abstract The treatment options for patients with acute myeloid leukemia (AML) under inferior performance status (i.e. senior patients, MDS transformed AML, and patients with proven invasive fungal disease) are limited. The conventional "3+7" (idarubicin plus cytarabine) induction for those patients can be either too toxic, which leads to higher mortality rate, or requires prolonged recovery time thus raise medical cost. And the delay of consolidation may compromise outcome thus cause early relapse in such patients. Giving the rationale from the designing art of CPX-351, the prolonged IV time requirement for cytarabine, as well as mini-transplantation for AML treatment, at least in part, reflects the philosophy of a longer exposure to the chemo agent can be a more effective treatment approach for leukemia. On the other hand, the D-CAG protocol, which indicated an encouraging result for elderly patients with AML, indicated effectiveness of the strategy with reduced intensity. However, the cyto-toxic effect of decitabine with standard dose (20mg/m2) could still lead to severe treatment adverse events (AEs) thus raise the need of optimization of D-CAG regimen for patients with inferior PS. When considering the low dose hypo-methylation agent (HMA) can trigger the innate immunity response, the unique effect of homoharringtonine, as well as the effectiveness of CAG, we designed this DHCAG protocol following the principle of "longer exposure, lower intensity preceded by priming" and observed an unexpected excellent outcome with high CR rate, low induction failure and treatment mortality, as well as a higher cost effective value for patients with AML, when compared to "3+7" protocol, whom under inferior PS. From March 2016 - January 2018, we initiated this pilot study and investigated the safety and efficiency of this DHCAG protocol in patients with AML under poor PS. We enrolled 25 patients and administer the regimen as followings: i) G-CSF: 5μg/kg used when WBC <20×10^9/L at day 0-14 subcutaneous injection; ii) Decitabine: 6mg/m2 at day 0, 3, 6, 9, 12 iv drip; iii) Aclarubicin: 6mg/m2 at day 1-8 iv drip; iv) Homoharringtonine: 1mg/m2 at day 9-14 iv drip ( at day 9, if WBC >1*10^9/L then increase the dosage of homoharringtonine to 2mg/m2); iv) Cytarabine:10mg/m2 q12h at day 1-14 subcutaneous injection (if WBC >20*10^9/L then increase to 100mg/m2 by 24h CIV, or 50mg/m2 q12h by subcutaneous injection). The primary end point was complete hematologic remission, defined as a bone marrow blast cells ≤5%, Neutrophils in peripheral blood ≥1.0X109 /L, hemoglobin≥90g/L, and platelets ≥100X109/L and no any evidence of extramedullary leukemic infiltration; Secondary end points included numbers of adverse events, length of hospital stay, medical costs, and quality of life as measured with the use of the Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire. Among the 25 patients in the study, 23 completed the induction therapy. And 21/25 patients had a hematologic complete remission after a median time of 19 days. Once complete remission had occurred, all 21 patients received post-remission treatment for another 5 cycles of DHCAG. Median follow-up was 14 months (range, 8 to 19) by June 2018. Interestingly, regardless of grade 3-4 myelo-suppression occurred all of our patients during induction, eight patients did not experienced grade 3-4 myelo-suppression during the following cycles. The median hospital stay is 22 days. The median of total medical costs for induction was $9,815 (range, $5,053 to $16,336) vs $14,705 for "3+7" induction protocol (history control. Data unpublished). Patients resumed their usual lifestyle during post-remission therapy, and their quality of life was rated as nearly normal on the FACT-G questionnaire. At the time of the last follow-up, seven patients had had a hematologic relapse. The results of our pilot study, in which we tested a priming based, low dose and longer exposure in 25 patients with AML under poor PS, showed that the treatment was safe, effective, and economical. A prospective multicenter, randomized trial comparing DHCAG with IA is now under way in China. Disclosures No relevant conflicts of interest to declare.

scholarly journals Dealing with Bone Metastases from Breast Cancer - A Pathological and Clinical Overview

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 25
Author(s):  
O. Munteanu ◽  
A. Dumitru ◽  
O. Bodean ◽  
L. Arsene ◽  
D. Voicu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Malignant Tumors ◽  
Cord Compression ◽  
Pathological Fractures ◽  
Future Directions ◽  
Skeletal Related Events ◽  
Frequent Site ◽  
Clinical Overview

Abstract From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.

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