scholarly journals Relapsed Rhabdomyosarcoma

2021 ◽  
Vol 10 (4) ◽  
pp. 804
Author(s):  
Christine M. Heske ◽  
Leo Mascarenhas
Keyword(s):  
Chemotherapy Regimen ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Control Measures ◽  
Tumor Invasiveness ◽  
Patient Goals ◽  
Group I ◽  
Biopsy Confirmation ◽  
Poor Outcomes ◽  
Multiagent Chemotherapy

Relapsed rhabdomyosarcoma (RMS) represents a significant therapeutic challenge. Nearly one-third of patients diagnosed with localized RMS and over two-thirds of patients with metastatic RMS will experience disease recurrence following primary treatment, generally within three years. Clinical features at diagnosis, including primary site, tumor invasiveness, size, stage, and histology impact likelihood of relapse and prognosis post-relapse. Aspects of initial treatment, including extent of surgical resection, use of radiotherapy, and chemotherapy regimen, are also associated with post-relapse outcomes, as are features of the relapse itself, including time to relapse and extent of disease involvement. Although there is no standard treatment for patients with relapsed RMS, several general principles, including tissue biopsy confirmation of diagnosis, assessment of post-relapse prognosis, determination of the feasibility of additional local control measures, and discussion of patient goals, should all be part of the approach to care. Patients with features suggestive of a favorable prognosis, which include those with botryoid RMS or stage 1 or group I embryonal RMS (ERMS) who have had no prior treatment with cyclophosphamide, have the highest chance of achieving long-term cure when treated with a multiagent chemotherapy regimen at relapse. Unfortunately, patients who do not meet these criteria represent the majority and have poor outcomes when treated with such regimens. For this group, strong consideration should be given for enrollment on a clinical trial.

scholarly journals Frontline Maintenance Treatment for Ovarian Cancer

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Osnat Elyashiv ◽  
Yien Ning Sophia Wong ◽  
Jonathan A. Ledermann
Keyword(s):  
Ovarian Cancer ◽  
Drug Resistance ◽  
Dna Repair ◽  
Maintenance Treatment ◽  
Advanced Disease ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
New Paradigm ◽  
Maintenance Strategies ◽  
Advanced Epithelial Ovarian Cancer

Abstract Purpose of Review Advanced epithelial ovarian cancer remains the most lethal gynaecological cancer. Most patients with advanced disease will relapse within 3 years after primary treatment with surgery and chemotherapy. Recurrences become increasing difficult to treat due to the emergence of drug resistance and 5-year survival has changed little over the last decade. Maintenance treatment, here defined as treatment given beyond primary chemotherapy, can both consolidate the response and prolong the control of disease which is an approach to improve survival. Recent Findings Here we review maintenance strategies such as targeting angiogenesis, interference of DNA repair through inhibition of PARP, combinations of targeting agents, and immunotherapy and hormonal therapy. Summary Much has been learnt from the success and challenges of these treatments that have in the last few years which led to significant reduction in disease recurrence, changed the guidelines for treatment, and established a new paradigm for the treatment of ovarian cancer.

scholarly journals Chronic kidney disease predicts poor outcomes of COVID-19 patients

2021 ◽  
Author(s):  
Mahmut Gok ◽  
Hakki Cetinkaya ◽  
Tugba Kandemir ◽  
Erdem Karahan ◽  
İzzet Burak Tuncer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Hospital Data ◽  
Group I ◽  
Ckd Stage ◽  
Comorbid Diseases ◽  
Group Ii ◽  
Poor Outcomes

Abstract Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension (p < 0.001) and diabetes mellitus (p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality (p < 0.001), and mortality (p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).

scholarly journals Systemic treatment approaches in her2-negative advanced breast cancer—guidance on the guidelines

2015 ◽  
Vol 22 ◽  
pp. 29 ◽  
Author(s):  
A.A. Joy ◽  
M. Ghosh ◽  
R. Fernandes ◽  
M.J. Clemons
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
De Novo ◽  
Treatment Guidelines ◽  
Early Stage ◽  
Symptom Control ◽  
Growth Factor Receptor ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Advanced Breast

Despite advancements in the treatment of early-stage breast cancer, many patients still develop disease recurrence; others present with de novo metastatic disease. For most patients with advanced breast cancer, the primary treatment intent is noncurative—that is, palliative—in nature. The goals of treatment should therefore focus on maximizing symptom control and extending survival. Treatments should be evaluated on an individualized basis in terms of evidence, but also with full respect for the wishes of the patient in terms of acceptable toxicity. Given the availability of extensive reviews on the roles of endocrine therapy and her2 (human epidermal growth factor receptor 2)–targeted therapies for advanced disease, we focus here mainly on treatment guidelines for the non-endocrine management of her2-negative advanced breast cancer in a Canadian health care context.

scholarly journals HLA Genotyping using Next Generation Sequencing

2016 ◽  
Vol 54 (2) ◽  
pp. 98-104
Author(s):  
C. Lucan ◽  
Laura-Ancuta Pop ◽  
A. Florian ◽  
Valentina Pileczki ◽  
B. Petrushev ◽  
...  
Keyword(s):  
Stem Cell ◽  
Next Generation Sequencing ◽  
Brain Tumors ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Disease Recurrence ◽  
Hla Typing ◽  
Next Generation ◽  
Poor Outcomes ◽  
Generation Sequencing

Abstract From an oncological perspective, the second most common malignancies in children are brain tumors. Despite the recent therapeutic breakthroughs in this field, concerning surgery, radiotherapy and chemotherapy alike, some cases still have poor outcomes in curability. This is especially the case in patients with high-risk histological types of tumors, and those suffering from residual, remitting and disseminated diseases. Due to the unique neuroanatomical emplacement of brain tumors and their aggressive infiltrative behavior, their total removal remains a demanding task. This can be perceived in the high rates of failure treatment and disease recurrence. Furthermore, the adjacent healthy brain tissue is inevitably damaged in the surgical process of effectively removing these tumors. Thus, stem cell transplantation may be a viable solution for the clinical management of these malignancies, as proven by various recent breakthroughs. In the current concise review, we present the role of next generation sequencing in HLA typing for stem cell transplantation in primary CNS pediatric malignancies.

Intensive alternating 6-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma in children and adolescents: Impact on survival.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9566-9566 ◽  
Author(s):  
Gerges Attia Demian ◽  
Hany Hussein ◽  
Emad Nabil Ebeid ◽  
Samy Elbadawy
Keyword(s):  
High Risk ◽  
Chemotherapy Regimen ◽  
Clinical Stage ◽  
Local Therapy ◽  
Control Measures ◽  
Lymph Node Status ◽  
Risk Criteria ◽  
Significant Toxicity ◽  
Impact On Survival ◽  
Outpatient Settings

9566 Background: Both 5-year overall survival (OS) and event free survival (EFS) for pediatric rhabdomyosarcoma (RMS) has increased in the last 3 decades through multimodality, risk-adapted management. The reported EFS for high risk RMS in children treated at the NCI in Egypt during the 1990s was 50%. Using an intensive 6 drug alternating chemotherapy regimen in addition to local control measures was our aim to improve the outcome for this group of patients. Methods: Forty-six previously untreated patients, younger than 21 years of age, with localized high risk RMS received this regimen. High risk criteria included: (1) Localized tumors (T1) biopsied or incompletely resected, ortumors extending beyond the tissue or organ of origin (T2) completely or incompletely resected at any site (excluding orbit, uterus, vagina, and paratestis); (2)All node positive patients with primary tumor at any site; and (3) All RMS with alveolar histology at any site. Chemotherapy regimen comprised 27 weeks of alternating 6 drugs (carboplatin, doxorubicin hydrochloride, ifosfamide, actinomycin D, etoposide, vincristine). Local therapy (surgery, radiotherapy, or both) was offered at week 9. Results: Forty-six patients meeting high-risk criteria were recruited from September 2000 to November 2005. Median follow-up of survivors was 62 months. The 5-year OS and EFS for the whole group was 64% ± 10% and 47% ± 8% respectively. The EFS was significantly affected by: the size of the tumor (≤5 cm vs. > 5 cm, p= 0.03), SIOP UICC clinical stage (p = 0.004), IRS stage (p = 0.01), lymph node status (p = 0.02), surgery vs. incisional biopsy (p=0.01) and overall duration of time in which therapy was delivered (p = 0.04). There was significant toxicity, mainly hematologic, but only one treatment related fatality. Conclusions: The use of intensified alternating 6-drug CT did not improve the EFS compared with historical control although it was feasible to be delivered safely in a variety of outpatient settings. Surgical resection of the tumor is essential. Delivering therapy in a timely fashion appears to impact outcome and future investigations will focus on impediments to administering chemotherapy as scheduled.

Low-grade endometrial stromal sarcoma: a single center's experience with 22 cases

2008 ◽  
Vol 18 (5) ◽  
pp. 1084-1089 ◽  
Author(s):  
W. Y. Kim ◽  
J.-W. Lee ◽  
C. H. Choi ◽  
H. Kang ◽  
T.-J. Kim ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Stage I ◽  
Low Grade ◽  
Stromal Sarcoma ◽  
Case Surgery ◽  
Abnormal Vaginal Bleeding ◽  
Disease Free

The aim of this retrospective study was to evaluate the clinical behavior and management outcome of low-grade endometrial stromal sarcoma (LGESS). From September 1994, to March 2007, 22 patients with histologically proven stage I LGESS were included in this study. Clinicopathologic variables, recurrence, and management outcomes were reviewed retrospectively. The median age of the 22 patients was 43 years. The most common presenting symptom was abnormal vaginal bleeding. All patients underwent a hysterectomy and had stage I disease. Six patients had adjuvant therapy after the hysterectomy. The median follow-up period was 77 months (range 12–202 months). Ten patients had disease recurrence. The median disease-free survival period was 111 months (range 6–182 months). The pelvis (eight cases) was the most common site of recurrence followed by the lung (four cases) and the liver (one case). Recurrent disease was treated with surgery (one case), surgery plus chemotherapy (five cases), chemotherapy (two cases), and surgery plus radiotherapy (two cases). Two patients died after 25 and 54 months after disease recurrence. Treatment with a bilateral salpingo-oophorectomy or adjuvant chemoradiation did not affect the disease-free interval. LGESS is usually a slow-growing neoplasm with an indolent clinical course. Surgery is the primary treatment for recurrent endometrial stromal sarcoma when feasible. Adjuvant treatment (radiotherapy, chemotherapy, or both) had no effect on the prognosis of patients with stage I disease

Evaluation of PIK3CA Mutation As a Predictor of Benefit From Nonsteroidal Anti-Inflammatory Drug Therapy in Colorectal Cancer

2013 ◽  
Vol 31 (34) ◽  
pp. 4297-4305 ◽  
Author(s):  
Enric Domingo ◽  
David N. Church ◽  
Oliver Sieber ◽  
Rajarajan Ramamoorthy ◽  
Yoko Yanagisawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Pik3ca Mutation ◽  
Predictive Biomarker ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Optimal Regime ◽  
Pik3ca Mutations ◽  
Regular Aspirin ◽  
Anti Inflammatory ◽  
Reduced Rate

Purpose Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) protect against colorectal cancer (CRC) and are associated with reduced disease recurrence and improved outcome after primary treatment. However, toxicities of NSAIDs have limited their use as antineoplastic therapy. Recent data have suggested that the benefit of aspirin after CRC diagnosis is limited to patients with PIK3CA-mutant cancers. We sought to determine the predictive utility of PIK3CA mutation for benefit from both cyclooxygenase-2 inhibition and aspirin. Methods We performed molecular analysis of tumors from 896 participants in the Vioxx in Colorectal Cancer Therapy: Definition of Optimal Regime (VICTOR) trial, a large randomized trial comparing rofecoxib with placebo after primary CRC resection. We compared relapse-free survival and overall survival between rofecoxib therapy and placebo and between the use and nonuse of low-dose aspirin, according to tumor PIK3CA mutation status. Results We found no evidence of a greater benefit from rofecoxib treatment compared with placebo in patients whose tumors had PIK3CA mutations (multivariate adjusted hazard ratio [HR], 1.2; 95% CI, 0.53 to 2.72; P = .66; PINTERACTION = .47) compared with patients with PIK3CA wild-type cancers (HR, 0.87; 95% CI, 0.64 to 1.16; P = .34). In contrast, regular aspirin use after CRC diagnosis was associated with a reduced rate of CRC recurrence in patients with PIK3CA-mutant cancers (HR, 0.11; 95% CI, 0.001 to 0.832; P = .027; PINTERACTION = .024) but not in patients lacking tumor PIK3CA mutation (HR, 0.92; 95% CI, 0.60 to 1.42; P = .71). Conclusion Although tumor PIK3CA mutation does not predict benefit from rofecoxib treatment, it merits further evaluation as a predictive biomarker for aspirin therapy. Our findings are concordant with recent data and support the prospective investigation of adjuvant aspirin in PIK3CA-mutant CRC.

scholarly journals Effects of the COVID-19 pandemic on provision of electroconvulsive therapy

2021 ◽  
pp. 1-4
Author(s):  
Richard Braithwaite ◽  
Robert Chaplin ◽  
Vimal Sivasanker
Keyword(s):  
Electroconvulsive Therapy ◽  
Control Measures ◽  
Clinical Implications ◽  
Protective Equipment ◽  
Healthcare Provision ◽  
Infection Control Measures ◽  
Service Disruption ◽  
Poor Outcomes ◽  
The Uk ◽  
Virus Testing

Aims and method COVID-19 has had a heavy impact on healthcare provision worldwide, including delivery of electroconvulsive therapy (ECT). A survey was completed in the UK and Republic of Ireland in April and July 2020 by 95 and 89 ECT clinics respectively. Results In April 2020, 53% of the clinics provided only emergency treatment and 24% had closed. Reasons included unavailability of anaesthetists, infection control measures and staff sickness. Restrictions persisted in July, with disruption to an estimated 437 individuals’ treatment and poor outcomes, including clinical deterioration and readmission. Clinical implications Risk stratification, longer clinic sessions, improvements in ventilation, regular virus testing, pragmatic staff rostering and availability of personal protective equipment will protect against service disruption in subsequent waves of the pandemic.

scholarly journals Middle East Respiratory Syndrome in Al Ahsa, Saudi Arabia, 2015-18: A lingering epidemic

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Hanan Al Shaikh ◽  
Balaji Rama Naik ◽  
Ahmed Saleh Alsaad ◽  
Abdullah Ali Albinsaleh
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Middle East ◽  
Middle East Respiratory Syndrome ◽  
Control Measures ◽  
Limited Information ◽  
Comorbid Conditions ◽  
Presenting Symptoms ◽  
Security Personnel ◽  
Poor Outcomes

Middle East respiratory syndrome (MERS), an emerging disease with fatal outcomes, has limited information on regional variations and their impact on the control measures. The aim of this study was to describe data on distribution of and possible association of risk factors for the disease and poorer outcomes, and recommendations for better control of the disease. Data were collected for 2015-2018 in Al Ahsa, the largest region (population 1.2 million) in the eastern part of Saudi Arabia. In total, 103 cases were reported during the study period with fever and cough as predominant presenting symptoms. The majority were male, >50 years old, and Saudi nationals. One third of patients had comorbid conditions (diabetes and cardiac predominantly). Occupation profiles of the patients varied, with camel owners and security personnel constituting 40% of the study population. In conclusions, older age, nationality, extracorporeal membrane oxygenation (ECMO) treatment, and associated comorbid conditions were found to be probable risk factors for poor outcomes. The mortality rate (59%) was distinctly higher in patients aged >60 years. The study highlights probable risk factors for poor outcomes in MERS patients, and discusses scope for further intervention and better management.

Oligometastatic renal cell carcinoma in the palatine tonsil: successful resection using trans-oral robotic surgery

2020 ◽  
Vol 13 (12) ◽  
pp. e235768
Author(s):  
Talisa Ross ◽  
Akshat Malik ◽  
Zaid Awad
Keyword(s):  
Cell Carcinoma ◽  
Head And Neck ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Renal Clear Cell Carcinoma ◽  
Tonsillar Fossa ◽  
Robotic Assisted Surgery ◽  
Control And Prevention ◽  
Swallow Function ◽  
Myomucosal Flap

A man in his mid 70s was referred to head and neck outpatients with bulky tissue in the left tonsillar fossa. He had previously been treated for oligometastatic renal clear cell carcinoma (diagnosed over 15 years prior to disease recurrence) by tonsillectomy and adjuvant radiotherapy (years from primary treatment), followed by trans-oral laser surgery to his oropharyngeal recurrence 3 years later. Examination under anaesthetic and biopsy confirmed further recurrence of disease in the left tonsillar fossa, with parapharyngeal extension, which has not been previously reported in the literature. After discussion in the head and neck and urology multi-disciplinary teams meeting, the patient was offered trans-oral robotic-assisted surgery (TORS) for local control and prevention of progression of a fungating oropharyngeal mass. TORS partial pharyngectomy and left buccal artery myomucosal flap reconstruction were successfully carried out, with preservation of some swallow function.

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