Infusion of leukocytes from HLA haplo-identical familial donors as an adjuvant in the HLH-2004 protocol to treat the virus-associated adult hemophagocytic lymphohistiocytosis: a retrospective study of 26 patients

Abstract

Adult hemophagocytic lymphohistiocytosis (HLH) is a fatal disease with poor survival and a limited role of drug therapies. To help to recognize virus and enhance survival, we infused leukocytes derived from human leukocyte antigen (HLA) haplo-identical familial donors to patients. We retrospectively investigated 26 adult virus-associated hemophagocytic syndrome (VAHS) patients' medical records from 2006–2017. Eleven of the 26 patients accepted relatives' derived leukocytes infusions in addition to drug therapies recommended in the HLH-2004 protocol. The leukocyte doses ranged from 0.75 to 3.30×10⁸ per kilogram of body weight. The other 15 patients accepted immunosuppressive and supportive therapies referred to in the HLH-2004 protocol. We compared the treatment outcomes of the two groups of patients. Patients in the cell infusion group had a lower viral load (P = 0.023) and better laboratory results and prolonged overall survival (60.44 vs. 20.18 weeks, P = 0.047). A factor that might relate to overall survival is platelet count (P = 0.032), except for the leukocyte infusions (P = 0.012). For patients without acceptable donors, infusions of leukocytes from HLA haplo-identical familial donors could be a feasible treatment to prolong overall survival as an adjuvant to drug therapies.

http://ift.tt/2zEYlaz

Copyright

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1





http://ift.tt/2yuwlVM

Contributors

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1





http://ift.tt/2ABErx8

Contents

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1





http://ift.tt/2ysmgbR

Forthcoming Issues

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1





http://ift.tt/2AEhglV

Innovation in the Diagnosis and Management of Breast Cancer

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Timothy M. Pawlik




http://ift.tt/2ytJ62K

Changing Paradigms in Breast Cancer Diagnosis and Treatment

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Kelly K. Hunt




http://ift.tt/2AE5CHZ

Integrating New Knowledge and Surgical Innovation into the Diagnosis and Management of Breast Cancer

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Kelly K. Hunt




http://ift.tt/2ytJK0c

Considerations in Testing for Inherited Breast Cancer Predisposition in the Era of Personalized Medicine

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Benjamin Powers, Tuya Pal, Christine Laronga

Teaser

Technological advances realized through next-generation sequencing technologies coupled with the loss of the ability to patent genes have led to reduction in costs for genetic testing. As a result, more people are being identified with inherited breast cancer syndromes that may affect recommendations for surveillance and risk reduction. Surgeons, at the forefront for patients newly diagnosed with breast cancer, must keep current with the changing landscape of genetics to continue to provide appropriate counsel and care. This article provides an overview of individuals at risk for inherited cancer predisposition and recommendations for surveillance and management.


http://ift.tt/2ACA84H

When Does Atypical Ductal Hyperplasia Require Surgical Excision?

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Jennifer M. Racz, Amy C. Degnim

Teaser

Atypical ductal hyperplasia (ADH) is a proliferative, nonobligate precursor breast lesion and a marker of increased risk for breast carcinoma. Surgical excision remains the standard recommendation following a core needle biopsy result consistent with ADH. Recent research suggests that women with no mass lesion or discordance, removal of greater than or equal to 90% of calcifications at the time of core needle biopsy, involvement of less than or equal to 2 terminal duct lobular units, and absence of cytologic atypia or necrosis are likely to have a less than 5% chance of a missed cancer.


http://ift.tt/2ysmfVl

Tomosynthesis in Breast Cancer Imaging

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Mohammad Eghtedari, Catherine Tsai, Julie Robles, Sarah L. Blair, Haydee Ojeda-Fournier

Teaser

An important limitation of conventional two-dimensional mammography is the overlap of dense breast tissue obscuring masses. Digital breast tomosynthesis (DBT) has emerged as a mammographic technology that overcomes this limitation and is considered an overall better mammogram. DBT has been shown to detect significantly more breast cancer than conventional two-dimensional mammography, and to decrease the number of callbacks for diagnostic evaluation from screening mammography. Usually the callback evaluation is deemed to be overlap of tissue requiring no further management. DBT is used in the screening and diagnostic setting, and for guidance of wire localization or core biopsy, performing more accurately in the dense breast.


http://ift.tt/2ADrZNu

Anatomy and Breast Cancer Staging

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Jennifer K. Plichta, Brittany M. Campbell, Elizabeth A. Mittendorf, E. Shelley Hwang

Teaser

Breast cancer staging concisely summarizes disease status, creating a framework for assessing and relaying prognostic information. The fundamental concepts and components of breast cancer staging are reviewed. The AJCC Cancer Staging Manual, which includes traditional anatomic factors, now includes additional tumor characteristics: tumor grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, and (when available) multigene panel testing from the primary tumor. With these updates, staging provides the most reliable system for accurately predicting patient outcome. When the AJCC 8th edition guidelines are adopted, they will more closely reflect tumor biology.


http://ift.tt/2yuwaK6

Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ?

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Kelly J. Rosso, Anna Weiss, Alastair M. Thompson

Teaser

The management of ductal carcinoma in situ (DCIS) has traditionally followed the evidence base for invasive breast cancer using surgery, radiation therapy, and drug therapy to remove the DCIS from the breast and reduce the risk of recurrence for both DCIS and invasive breast cancer. Because of concerns regarding the overtreatment of DCIS, randomized controlled trials have been established to test the outcomes (invasive breast cancer outcomes and patient-reported outcome measures) of active surveillance compared with guideline-concordant care for low-risk (for progression) DCIS. These strategies are undergoing rigorous evaluation to evaluate alternatives to the current management of DCIS.


http://ift.tt/2AEhfOT

Lobular Breast Cancer

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Anita Mamtani, Tari A. King

Teaser

Invasive lobular carcinoma (ILC) is the second most common type of breast cancer, with a unique pathogenesis and distinct clinical biology. ILCs display a characteristic loss of E-cadherin, are largely estrogen receptor positive, HER2 negative, and low to intermediate grade. These features portend a favorable prognosis, but there is a tendency for late recurrences and atypical metastases. ILCs tend to be insidious and infiltrative, which can pose a challenge for diagnosis, and emerging data suggest they may have a propensity for a differing response to standard therapies.


http://ift.tt/2yuw990

Molecular Subtypes and Local-Regional Control of Breast Cancer

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Simona Maria Fragomeni, Andrew Sciallis, Jacqueline S. Jeruss

Teaser

In the era of personalized medicine, there has been significant progress regarding the molecular analysis of breast cancer subtypes. Research efforts have focused on how classification of subtypes could provide information on prognosis and influence treatment planning. Although much is known about the impact of different molecular subtypes on disease-specific survival, more recent studies have investigated the role of the different molecular subtypes on local-regional recurrence. This is an area of active study, and in recent years there has been significant progress. This article describes outcomes among disease subtypes to aid in optimal surgical decision-making to improve local-regional control.


http://ift.tt/2AzRgYR

Neoadjuvant Endocrine Therapy

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Julie Grossman, Cynthia Ma, Rebecca Aft

Teaser

Neoadjuvant endocrine therapy (NET) can be effective at downstaging patients with estrogen receptor–positive tumors and identifying those tumors that are endocrine sensitive and resistant. The optimal prognostic markers for stratification are under investigation. Use of NET will allow the identification of patients with estrogen receptor–positive tumors who might benefit from additional treatment and allow better understanding of endocrine resistance.


http://ift.tt/2yuw84W

Triple-Negative Breast Cancer

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Lubna N. Chaudhary, K. Hope Wilkinson, Amanda Kong

Teaser

Progress in the treatment of triple-negative breast cancer remains an important challenge. Given the aggressive biology and high risk of distant recurrence, systemic chemotherapy is warranted in most patients. Neaodjuvant chemotherapy benefits patients with locally advanced disease by downsizing the tumor and increasing the probability of breast-conserving surgery. Clinical and pathologic responses provide important prognostic information, which makes neoadjuvant therapy an attractive approach for all patients with triple-negative breast cancer. Clinical research in the neoadjuvant setting is focused on improvement in pathologic complete response rates and outcomes of patients with residual disease.


http://ift.tt/2AD0GD2

Intraoperative Margin Assessment in Breast Cancer Management

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Chantal Reyna, Sarah M. DeSnyder

Teaser

The goal of breast-conserving surgery is to excise the tumor with negative margins while achieving a successful cosmetic result. Although it is not feasible to have re-excision rates of zero, several techniques have been described to reduce the need for a return to the operating room. When rates of re-excision are high, consideration should be given to using 1 or more of these techniques. It is critical that re-excision rates are tracked when new techniques are implemented to ensure progress. In addition, attention must be paid to ensuring that cosmetic outcomes remain optimal.


http://ift.tt/2yuw4lI

Oncoplastic Breast Reconstruction

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Mehran Habibi, Kristen P. Broderick, Mohamad E. Sebai, Lisa K. Jacobs

Teaser

Oncoplastic surgery of the tissue defect from partial mastectomy should be considered for all patients. It can result in in significant asymmetries from scar contraction, skin tethering, and alterations in the nipple areolar complex location. Indications, risks, and benefits are discussed. Optimal procedures are described, considering resected specimen volume, primary tumor location, tumor to breast size ratio, and the impact on the nipple areolar complex. Indications for plastic surgery consultation and joint surgery are discussed. Surgical management includes incision planning, preservation of the nipple areolar complex pedicle and position, patient positioning, incision location, and recovery.


http://ift.tt/2ABEiK5

Alternatives to Standard Fractionation Radiation Therapy After Lumpectomy

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Nisha Ohri, Bruce G. Haffty

Teaser

Adjuvant whole-breast irradiation (WBI) after lumpectomy has been an established standard of care for decades. Standard-fractionation WBI delivered over 5 to 7 weeks can achieve durable tumor control with low toxicity but can be inconvenient for patients and cost ineffective. Hypofractionated WBI can be completed in 3 to 4 weeks and, based on long-term randomized data, is the preferred standard of care in select patients. Accelerated partial-breast irradiation can be delivered using even shorter treatment regimens. Although the available data on accelerated partial-breast irradiation is more limited, early results suggest it is an effective alternative to WBI in select patients.


http://ift.tt/2yuw2u6

Surgical Intervention for Lymphedema

Publication date: January 2018
Source:Surgical Oncology Clinics of North America, Volume 27, Issue 1
Author(s): Kristalyn Gallagher, Kathleen Marulanda, Stephanie Gray

Teaser

Lymphedema is a chronic, progressive disease with no curative treatment. Breast cancer therapy is the most common cause of secondary lymphedema in the developed world. Treatment includes nonsurgical and surgical strategies. Conservative measures are reserved for subclinical lymphedema. Surgical options are divided into physiologic (to restore function) and reductive (to remove diseased tissue). Early stage disease is managed with physiologic procedures. Reductive treatment is reserved for moderate to severe staged disease owing to high morbidity. Surgical options effectively decrease edema and improve quality of life. However, further research is necessary to best establish management of lymphedema.


http://ift.tt/2AAx1ua

Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite

Abstract

Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy. This study describes our initial experience with the MR overlay technique in the angiography suite during pediatric percutaneous extremity bone biopsies of lesions visible on MRI but not on CT or fluoroscopy and demonstrates its utility in relevant clinical cases.

from Cancer via ola Kala on Inoreader http://ift.tt/2zvfHci
via IFTTT

Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite

Abstract

Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy. This study describes our initial experience with the MR overlay technique in the angiography suite during pediatric percutaneous extremity bone biopsies of lesions visible on MRI but not on CT or fluoroscopy and demonstrates its utility in relevant clinical cases.

http://ift.tt/2zvfHci

Chest compression-related fatal internal mammary artery injuries manifesting after venoarterial extracorporeal membrane oxygenation: a case series

Cardiopulmonary resuscitation-related bleeding, especially internal mammary artery injuries, can become life-threatening complications after initiating venoarterial extracorporeal membrane oxygenation owing to...

http://ift.tt/2zCBtIS

Geometric and dosimetric accuracy of dynamic tumor tracking during volumetric-modulated arc therapy using a gimbal mounted linac

The aim was to examine the feasibility of a dynamic tumor-tracking volumetric modulated arc therapy (DTT-VMAT) technique using a gimbal-mounted linac and assess its positional, mechanical and dosimetric accuracy.

http://ift.tt/2mgseeq

Comparison of lung tumor motion measured using a model-based 4DCT technique and a commercial protocol

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): D. O'Connell, N. Shaverdian, A.U. Kishan, D.H. Thomas, T.H. Dou, J.H. Lewis, J.M. Lamb, M. Cao, S. Tenn, P. Lee, D.A. Low
PurposeTo compare lung tumor motion measured with a model-based technique to commercial 4DCT and describe a workflow for using model-based 4DCT as a clinical simulation protocol.Methods20 patients were imaged using a model-based technique and commercial 4DCT. Tumor motion was measured on each commercial 4DCT dataset, and was calculated on model-based datasets for three breathing amplitude percentile intervals: 5th–85th, 5th–95th and 0th–100th. Internal target volumes (ITV) were defined on the 4DCT and 5th to 85th interval datasets and compared using Dice similarity. Images were evaluated for noise and rated by two radiation oncologists for artifacts.ResultsMean differences in tumor motion magnitude between commercial and model-based images were 0.47±3.0mm, 1.63±3.17mm, and 5.16±4.90mm for the 5th–85th, 5th–95th, and 0th–100th amplitude intervals, respectively. Dice coefficients between ITVs defined on commercial and 5th–85th model-based images had a mean value of 0.77±.09. Single standard deviation image noise was 11.6±9.6 HU in the liver and 6.8±4.7 HU in the aorta for the model-based images compared to 57.7±30 and 33.7±15.4 for commercial 4DCT. Mean model error within the ITV regions was 1.71±0.81mm. Model-based images exhibited reduced presence of artifacts at the tumor compared to commercial.ConclusionTumor motion measured with the model-based technique using the 5th to 85th percentile breathing amplitude interval corresponded more closely to commercial 4DCT than the 5th–95th or 0th–100th intervals, which showed greater motion on average. The model-based technique tended to display increased tumor motion when breathing amplitude intervals wider than 5th–85th were used due to the influence of unusually deep inhalations. These results suggest that care must be taken in selecting the appropriate interval during image generation when using model-based 4DCT methods.



from Cancer via ola Kala on Inoreader http://ift.tt/2AyaRYv
via IFTTT

Three-Dimensional Printer-Aided Casting of Soft, Custom Silicone Boluses(Scsbs) for Head and Neck Radiotherapy

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): Tsuicheng Chiu, Jun Tan, Mathew Brenner, Xuejun Gu, Ming Yang, Kenneth Westover, Tobin Strom, David Sher, Steve Jiang, Bo Zhao
PurposeCustom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiotherapy.MethodsWe developed a method using 3D–printed parts for generating SCSBs for the treatment of head and neck cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose (PDD) and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on a HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of seven head and neck patients with lesions at nose, cheek, eye or ears. In vivo dose measurements with optically simulated luminescence dosimeters (OSLDs) were performed.ResultsTotal design and fabrication time from patient simulation to radiation treatment start required approximately one week, with fabrication constituting 1–2 working days depending on bolus surface area, volume and complexity. CT and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on seven treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3D printing technology. All treated patients tolerated SCSBs for the duration of therapy.ConclusionsGeneration and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers.



from Cancer via ola Kala on Inoreader http://ift.tt/2i7yxMV
via IFTTT

A Format for Reviewing a Research Paper

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): Robert J. Amdur




from Cancer via ola Kala on Inoreader http://ift.tt/2i7yvEN
via IFTTT

Comparison of lung tumor motion measured using a model-based 4DCT technique and a commercial protocol

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): D. O'Connell, N. Shaverdian, A.U. Kishan, D.H. Thomas, T.H. Dou, J.H. Lewis, J.M. Lamb, M. Cao, S. Tenn, P. Lee, D.A. Low
PurposeTo compare lung tumor motion measured with a model-based technique to commercial 4DCT and describe a workflow for using model-based 4DCT as a clinical simulation protocol.Methods20 patients were imaged using a model-based technique and commercial 4DCT. Tumor motion was measured on each commercial 4DCT dataset, and was calculated on model-based datasets for three breathing amplitude percentile intervals: 5th–85th, 5th–95th and 0th–100th. Internal target volumes (ITV) were defined on the 4DCT and 5th to 85th interval datasets and compared using Dice similarity. Images were evaluated for noise and rated by two radiation oncologists for artifacts.ResultsMean differences in tumor motion magnitude between commercial and model-based images were 0.47±3.0mm, 1.63±3.17mm, and 5.16±4.90mm for the 5th–85th, 5th–95th, and 0th–100th amplitude intervals, respectively. Dice coefficients between ITVs defined on commercial and 5th–85th model-based images had a mean value of 0.77±.09. Single standard deviation image noise was 11.6±9.6 HU in the liver and 6.8±4.7 HU in the aorta for the model-based images compared to 57.7±30 and 33.7±15.4 for commercial 4DCT. Mean model error within the ITV regions was 1.71±0.81mm. Model-based images exhibited reduced presence of artifacts at the tumor compared to commercial.ConclusionTumor motion measured with the model-based technique using the 5th to 85th percentile breathing amplitude interval corresponded more closely to commercial 4DCT than the 5th–95th or 0th–100th intervals, which showed greater motion on average. The model-based technique tended to display increased tumor motion when breathing amplitude intervals wider than 5th–85th were used due to the influence of unusually deep inhalations. These results suggest that care must be taken in selecting the appropriate interval during image generation when using model-based 4DCT methods.



http://ift.tt/2AyaRYv

Three-Dimensional Printer-Aided Casting of Soft, Custom Silicone Boluses(Scsbs) for Head and Neck Radiotherapy

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): Tsuicheng Chiu, Jun Tan, Mathew Brenner, Xuejun Gu, Ming Yang, Kenneth Westover, Tobin Strom, David Sher, Steve Jiang, Bo Zhao
PurposeCustom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiotherapy.MethodsWe developed a method using 3D–printed parts for generating SCSBs for the treatment of head and neck cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose (PDD) and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on a HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of seven head and neck patients with lesions at nose, cheek, eye or ears. In vivo dose measurements with optically simulated luminescence dosimeters (OSLDs) were performed.ResultsTotal design and fabrication time from patient simulation to radiation treatment start required approximately one week, with fabrication constituting 1–2 working days depending on bolus surface area, volume and complexity. CT and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on seven treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3D printing technology. All treated patients tolerated SCSBs for the duration of therapy.ConclusionsGeneration and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers.



http://ift.tt/2i7yxMV

A Format for Reviewing a Research Paper

Publication date: Available online 11 November 2017
Source:Practical Radiation Oncology
Author(s): Robert J. Amdur




http://ift.tt/2i7yvEN

Cancer chemoprevention revisited: Cytochrome P450 family 1B1 as a target in the tumor and the microenvironment

Publication date: Available online 11 November 2017
Source:Cancer Treatment Reviews
Author(s): Gabriele D'Uva, Denisa Baci, Adriana Albini, Douglas M. Noonan
Cancer chemoprevention is the use of synthetic, natural or biological agents to prevent or delay the development or progression of malignancies. Intriguingly, many phytochemicals with anti-inflammatory and anti-angiogenic effects, recently proposed as chemoprevention strategies, are inhibitors of Cytochrome P450 family 1B1 (CYP1B1) an enzyme overexpressed in a wide variety of tumors and associated with angiogenesis. In turn, pro-inflammatory cytokines were reported to boost CYP1B1 expression, suggesting a key role of CYP1B1 in a positive loop of inflammatory angiogenesis. Other well-known pro-tumorigenic activities of CYP1B1 rely on metabolic bioactivation of xenobiotics and steroid hormones into their carcinogenic derivatives. In contrast to initial in vitro observations, in vivo studies demonstrated a protecting role against cancer for the other CYP1 family members (CYP1A1 and CYP1A2) suggesting that that the specificity of CYP1 family inhibitors should be carefully taken into account for developing potential chemoprevention strategies. Recent studies also proposed a role of CYP1B1 in multiple cell types found within the tumor microenvironment, including fibroblasts, endothelial and immune cells. Overall, our review of the current literature suggests a positive loop between inflammatory cytokines and CYP1B1, which in turn may play a key role in cancer angiogenesis, acting on both cancer cells and the tumor microenvironment. Strategies aiming at specific CYP1B1 inhibition in multiple cell types may translate into clinical chemoprevention and angioprevention approaches.



http://ift.tt/2ACoAi0

Advances in sarcoma gene mutations and therapeutic targets

Publication date: Available online 11 November 2017
Source:Cancer Treatment Reviews
Author(s): Peng Gao, Nicole A. Seebacher, Francis Hornicek, Zheng Guo, Zhenfeng Duan
Sarcomas are rare and complex malignancies that have been associated with a poor prognostic outcome. Over the last few decades, traditional treatment with surgery and/or chemotherapy has not significantly improved outcomes for most types of sarcomas. In recent years, there have been significant advances in the understanding of specific gene mutations that are important in driving the pathogenesis and progression of sarcomas. Identification of these new gene mutations, using next-generation sequencing and advanced molecular techniques, has revealed a range of potential therapeutic targets. This, in turn, may lead to the development of novel agents targeted to different sarcoma subtypes. In this review, we highlight the advances made in identifying sarcoma gene mutations, including those of p53, RB, PI3K and IDH genes, as well as novel therapeutic strategies aimed at utilizing these mutant genes. In addition, we discuss a number of preclinical studies and ongoing early clinical trials in sarcoma targeting therapies, as well as gene editing technology, which may provide a better choice for sarcoma patient management.



http://ift.tt/2ytpufc

Irradiation préventive en une séance de 10Gy des sites d’intervention pleurale des patients atteints de mésothéliome pleural malin : étude de cohorte rétrospective monocentrique

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): H. Carette, J.-C. Faivre, J. Salleron, A.-S. Baumann, L. Uwer, C. Clément-Duchêne, J.-M. Vignaud, I. Petit, J. Siat, A. Tiotiu, V. Beckendorf
Objectif de l'étudeLe recours à la radiothérapie prophylactique afin de prévenir les métastases des sites d'intervention pleurale dans le mésothéliome pleural malin demeure controversé et les pratiques cliniques variées. L'objectif était d'évaluer l'efficacité d'une séance unique de radiothérapie externe de 10Gy en prévention de l'ensemencement des sites d'intervention pleurale chez des patients atteints de mésothéliome pleural malin.Matériel et méthodesIl s'agit d'une étude épidémiologique descriptive rétrospective de cohorte, incluant les patients atteints d'un mésothéliome pleural malin histologiquement prouvé irradiés en regard des sites d'intervention pleurale par des électrons de 6 à 18MeV, entre janvier 1990 et décembre 2013 à l'institut de cancérologie de Lorraine.RésultatsQuatre-vingt-onze patients ont été traités par irradiation prophylactique des sites d'intervention pleurale, soit 120 sites d'intervention pleurale, 91 thoracoscopies, 17 thoracotomies avec drainage pleural, 12 ponctions-biopsies guidées par scanographie ou échographie. Le suivi médian était de 7 mois (intervalle interquartile entre 3 et 15 mois). La probabilité de survie globale était de 43,5 % à 12 mois, celle de survie sans progression de 43,7 %. L'incidence de la progression locale était de 8 % à 12 mois. Le temps médian écoulé entre l'irradiation et la progression locale était de 4 mois (2 ; 32). Il n'y a pas eu d'effet secondaire précoce ou tardif de grade supérieur ou égal à deux.ConclusionL'irradiation des sites d'intervention pleurale en une séance unique de 10Gy est efficace, bien tolérée, simple, rapide et peu coûteuse.PurposeProphylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma.Material and methodsThis is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10Gy with 6 to 18MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France).ResultsNinety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed.ConclusionIrradiation of pleural intervention sites with a single fraction of 10Gy is effective, well tolerated, simple, fast and cost effective.



from Cancer via ola Kala on Inoreader http://ift.tt/2jjFv4S
via IFTTT

Robotic stereotactic treatment for malignant metastasis of solid tumour in the pancreas: A multiple case report and review of literature

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): M. Loi, A. Magallon-Baro, C. Papalazarou, M. Milder, J.J. Nuyttens
Metastatic involvement of the pancreas occurs in 5% of patients affected by advanced malignancies. Surgical resection has been reported by number of authors as a valuable option to improve disease control, in particular in patients with limited disease burden and favourable histotypes; however, the benefit of this procedure has been questioned due to patient selection, technical challenges and relevant risk of perioperative mortality and severe complications. In the present study, a cohort of surgically unfit patients affected by a solitary metastasis in the pancreas from various primary tumours received stereotactic radiotherapy with an ablative dose schedule, obtaining promising local and distant disease progression-free delay with minor toxicity. This is the first report to our knowledge on the use of ablative stereotactic radiotherapy of metastasis in the pancreatic gland.



from Cancer via ola Kala on Inoreader http://ift.tt/2hsFNWw
via IFTTT

High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): E. Parisi, A. Romeo, A. Sarnelli, G. Ghigi, S.R. Bellia, E. Neri, S. Micheletti, B. Dipalma, D. Arpa, G. Furini, M.A. Burgio, G. Genestreti, C. Gurioli, S. Sanna, P. Bovolato, F. Rea, G. Storme, E. Scarpi, C. Arienti, A. Tesei, R. Polico
PurposeThe role played by radiation therapy after pleurectomy/decortication or surgical biopsy in malignant pleural mesothelioma is uncertain. We treated patients with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy in an attempt to keep lung toxicity to a minimum. The present study reports the feasibility and toxicity of this approach.Material and MethodsBetween 2008 and 2012, 36 patients with malignant pleural mesothelioma underwent accelerated hypofractionated radiotherapy to the hemithorax after pleurectomy/decortication (19 patients) or biopsy (17 patients). The prescription dose was 25Gy in five fractions over 5 consecutive days.ResultsWe observed three patients with G3 pneumonitis, five cases of grade 2 dyspnea and six cases of grade 2 cough. The median follow-up was 37 months (range: 3–54 months). The median overall survival for patients who underwent pleurectomy/decortication followed by radiotherapy was 21.6 months [95% confidence interval (95% CI): 15.5–24.1] compared to 19.4 months for patients not submitted to surgery.ConclusionTreatment of intact lung with pleural intensity-modulated arc irradiation in malignant pleural mesothelioma patients with malignant pleural mesothelioma proved safe and feasible, with an acceptable rate of pneumonitis. Survival rates were encouraging for both biopsy-only and pleurectomy/decortication groups. We are currently conducting a phase II dose escalation trial in a similar patient setting to prospectively evaluate the impact of radiotherapy on toxicity, disease-free survival and overall survival.



from Cancer via ola Kala on Inoreader http://ift.tt/2jihN94
via IFTTT

Irradiation préventive en une séance de 10Gy des sites d’intervention pleurale des patients atteints de mésothéliome pleural malin : étude de cohorte rétrospective monocentrique

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): H. Carette, J.-C. Faivre, J. Salleron, A.-S. Baumann, L. Uwer, C. Clément-Duchêne, J.-M. Vignaud, I. Petit, J. Siat, A. Tiotiu, V. Beckendorf
Objectif de l'étudeLe recours à la radiothérapie prophylactique afin de prévenir les métastases des sites d'intervention pleurale dans le mésothéliome pleural malin demeure controversé et les pratiques cliniques variées. L'objectif était d'évaluer l'efficacité d'une séance unique de radiothérapie externe de 10Gy en prévention de l'ensemencement des sites d'intervention pleurale chez des patients atteints de mésothéliome pleural malin.Matériel et méthodesIl s'agit d'une étude épidémiologique descriptive rétrospective de cohorte, incluant les patients atteints d'un mésothéliome pleural malin histologiquement prouvé irradiés en regard des sites d'intervention pleurale par des électrons de 6 à 18MeV, entre janvier 1990 et décembre 2013 à l'institut de cancérologie de Lorraine.RésultatsQuatre-vingt-onze patients ont été traités par irradiation prophylactique des sites d'intervention pleurale, soit 120 sites d'intervention pleurale, 91 thoracoscopies, 17 thoracotomies avec drainage pleural, 12 ponctions-biopsies guidées par scanographie ou échographie. Le suivi médian était de 7 mois (intervalle interquartile entre 3 et 15 mois). La probabilité de survie globale était de 43,5 % à 12 mois, celle de survie sans progression de 43,7 %. L'incidence de la progression locale était de 8 % à 12 mois. Le temps médian écoulé entre l'irradiation et la progression locale était de 4 mois (2 ; 32). Il n'y a pas eu d'effet secondaire précoce ou tardif de grade supérieur ou égal à deux.ConclusionL'irradiation des sites d'intervention pleurale en une séance unique de 10Gy est efficace, bien tolérée, simple, rapide et peu coûteuse.PurposeProphylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma.Material and methodsThis is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10Gy with 6 to 18MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France).ResultsNinety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed.ConclusionIrradiation of pleural intervention sites with a single fraction of 10Gy is effective, well tolerated, simple, fast and cost effective.



http://ift.tt/2jjFv4S

Robotic stereotactic treatment for malignant metastasis of solid tumour in the pancreas: A multiple case report and review of literature

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): M. Loi, A. Magallon-Baro, C. Papalazarou, M. Milder, J.J. Nuyttens
Metastatic involvement of the pancreas occurs in 5% of patients affected by advanced malignancies. Surgical resection has been reported by number of authors as a valuable option to improve disease control, in particular in patients with limited disease burden and favourable histotypes; however, the benefit of this procedure has been questioned due to patient selection, technical challenges and relevant risk of perioperative mortality and severe complications. In the present study, a cohort of surgically unfit patients affected by a solitary metastasis in the pancreas from various primary tumours received stereotactic radiotherapy with an ablative dose schedule, obtaining promising local and distant disease progression-free delay with minor toxicity. This is the first report to our knowledge on the use of ablative stereotactic radiotherapy of metastasis in the pancreatic gland.



http://ift.tt/2hsFNWw

High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment

Publication date: Available online 11 November 2017
Source:Cancer/Radiothérapie
Author(s): E. Parisi, A. Romeo, A. Sarnelli, G. Ghigi, S.R. Bellia, E. Neri, S. Micheletti, B. Dipalma, D. Arpa, G. Furini, M.A. Burgio, G. Genestreti, C. Gurioli, S. Sanna, P. Bovolato, F. Rea, G. Storme, E. Scarpi, C. Arienti, A. Tesei, R. Polico
PurposeThe role played by radiation therapy after pleurectomy/decortication or surgical biopsy in malignant pleural mesothelioma is uncertain. We treated patients with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy in an attempt to keep lung toxicity to a minimum. The present study reports the feasibility and toxicity of this approach.Material and MethodsBetween 2008 and 2012, 36 patients with malignant pleural mesothelioma underwent accelerated hypofractionated radiotherapy to the hemithorax after pleurectomy/decortication (19 patients) or biopsy (17 patients). The prescription dose was 25Gy in five fractions over 5 consecutive days.ResultsWe observed three patients with G3 pneumonitis, five cases of grade 2 dyspnea and six cases of grade 2 cough. The median follow-up was 37 months (range: 3–54 months). The median overall survival for patients who underwent pleurectomy/decortication followed by radiotherapy was 21.6 months [95% confidence interval (95% CI): 15.5–24.1] compared to 19.4 months for patients not submitted to surgery.ConclusionTreatment of intact lung with pleural intensity-modulated arc irradiation in malignant pleural mesothelioma patients with malignant pleural mesothelioma proved safe and feasible, with an acceptable rate of pneumonitis. Survival rates were encouraging for both biopsy-only and pleurectomy/decortication groups. We are currently conducting a phase II dose escalation trial in a similar patient setting to prospectively evaluate the impact of radiotherapy on toxicity, disease-free survival and overall survival.



http://ift.tt/2jihN94

Comprehensive study of three novel cases of TFEB-amplified renal cell carcinoma and review of the literature: evidence for a specific entity with poor outcome

Abstract

The first case of TFEB-amplified renal cell carcinoma was published in 2014. Since then, 29 additional cases have been described. The prognostic and therapeutic implications of this rare entity remain to be determined. We describe here the clinical, histological and genetic features of three novel cases, as well as the first complete literature review. Four tumors were examined from three patients selected from the large collection of genetically characterized renal tumors in our institution. The pathological and immunohistochemical features were centrally reviewed by a uropathologist. Quantitative and structural genomic abnormalities were analyzed using comparative genomic hybridization, fluorescence in situ hybridization and next generation sequencing. The three cases showed high-level amplification but no translocation of TFEB. Histologically, two tumors showed a papillary or pseudopapillary architecture. They did not show similarities with renal cell carcinoma harboring translocation of TFEB. The tumors were locally advanced high-grade lesions. They exhibited a metastatic course, which was rapidly leading to death in one patient. A second patient developed metastatic disease that did not respond to four lines of targeted treatments. The third patient had a protracted history of pulmonary and cardiac metastases. Complete clinical and biological data were examined and compared to those of the reported cases. Within the classification of renal tumors, TFEB-amplified renal cell carcinoma may constitute a novel entity characterized histologically by high grade, papillary or pseudopapillary architecture and necrotic remodeling and clinically by a poor outcome. Its pathogenesis has to be further characterized in order to develop appropriate targeted therapy. This article is protected by copyright. All rights reserved.

http://ift.tt/2hrPpRo

Comprehensive study of three novel cases of TFEB-amplified renal cell carcinoma and review of the literature: evidence for a specific entity with poor outcome

Abstract

The first case of TFEB-amplified renal cell carcinoma was published in 2014. Since then, 29 additional cases have been described. The prognostic and therapeutic implications of this rare entity remain to be determined. We describe here the clinical, histological and genetic features of three novel cases, as well as the first complete literature review. Four tumors were examined from three patients selected from the large collection of genetically characterized renal tumors in our institution. The pathological and immunohistochemical features were centrally reviewed by a uropathologist. Quantitative and structural genomic abnormalities were analyzed using comparative genomic hybridization, fluorescence in situ hybridization and next generation sequencing. The three cases showed high-level amplification but no translocation of TFEB. Histologically, two tumors showed a papillary or pseudopapillary architecture. They did not show similarities with renal cell carcinoma harboring translocation of TFEB. The tumors were locally advanced high-grade lesions. They exhibited a metastatic course, which was rapidly leading to death in one patient. A second patient developed metastatic disease that did not respond to four lines of targeted treatments. The third patient had a protracted history of pulmonary and cardiac metastases. Complete clinical and biological data were examined and compared to those of the reported cases. Within the classification of renal tumors, TFEB-amplified renal cell carcinoma may constitute a novel entity characterized histologically by high grade, papillary or pseudopapillary architecture and necrotic remodeling and clinically by a poor outcome. Its pathogenesis has to be further characterized in order to develop appropriate targeted therapy. This article is protected by copyright. All rights reserved.

from Cancer via ola Kala on Inoreader http://ift.tt/2hrPpRo
via IFTTT

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer

Background and Objectives

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established.

Methods

Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals.

Results

Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction.

Conclusion

Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

http://ift.tt/2yv42Gz

Does neoadjuvant/perioperative vhemotherapy improve overall survival for T2N0 gastric adenocarcinoma?

Background

The purpose of this study was to determine whether neoadjuvant and/or perioperative chemotherapy (NAC) has an overall survival (OS) benefit for patients with T2N0 gastric adenocarcinoma.

Study Design

We performed retrospective analyses using the National Cancer Data Base, 2004-2013. Patients with T2N0 gastric adenocarcinoma were divided into two treatment groups: (1) NAC plus surgery (NA + S) and (2) surgery alone (S).

Results

Of 1,704 patients included, 277 (16.3%) received NAC, and 1,427 (83.7%) were treated with surgery alone. Patients in the NA + S group were more likely to be younger, have fewer comorbidities, and have larger tumors located in the proximal stomach. Although in an unadjusted analysis of OS, the NA + S group had improved survival compared to the S group (HR = 0.81, 95% CI 0.67-0.99, P < 0.0001), this was not maintained in a propensity adjusted analysis (HR = 0.89, 95% CI 0.68-1.18, P = 0.42). Similarly, propensity adjusted analyses accounting for potential bias from clinical misstaging or treatment effect from NAC did not show any OS benefit from NAC.

Conclusion

Based on the largest cohort of clinically staged T2N0 gastric adenocarcinoma, there was no OS benefit derived from NAC compared to surgery alone. For select patients with reliable preoperative staging, NAC may be omitted.

http://ift.tt/2ABt9Jw

Critical evaluation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with Hepatocellular Carcinoma (HCC): A Surveillance, Epidemiology, End Results (SEER) analysis

Background

Recently, the American Joint Committee on Cancer (AJCC) released its 8th edition changes to the staging system for hepatocellular cancer (HCC). We sought to validate the 8th edition staging system and compare the performance to the 7th edition using a population-based data set.

Methods

Using the Surveillance, Epidemiology and End Results (SEER) database (1998-2013), patients undergoing resection or transplant for non-metastatic HCC were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-indices) were calculated from Cox proportional hazards models to evaluate discriminatory power.

Results

The study included 8918 patients resected (63%) or transplanted (37%) for HCC. Nodal staging was performed in 19%, of whom 5% had positive nodes. The c-index for the AJCC 8th edition staging system was 0.60, similar to that for the 7th edition (0.59). Survival was better for solitary tumors >2 cm with vascular invasion than for multifocal tumors <5 cm (median not reached vs 57 months, P < 0.0001), although the staging system groups these tumors together as T2. For multifocal tumors ≤5 cm, those with vascular invasion had worse survival than those without (median 42 vs 50 months, P < 0.001), although the staging system draws no such distinction.

Conclusion

The AJCC 8th edition staging system for HCC performs similarly to the 7th edition. Future revisions should consider substratification of early HCC, specifically by distinguishing solitary tumors >2 cm from multifocal tumors ≤5 cm, and by considering the prognostic impact of vascular invasion in multifocal tumors ≤5 cm. Future studies should aim to validate these findings.

http://ift.tt/2ysrAMe

Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma

Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising.

http://ift.tt/2Azfqmm

The impact of preoperative magnetic resonance imaging and lumpectomy cavity shavings on re-excision rate in pure ductal carcinoma in situ—A single institution's experience

Background and Objectives

The impact of preoperative magnetic resonance imaging (pMRI) and cavity shave margins (CSM) on re-excision rate (RR) in DCIS is unclear. We investigated whether either modality was associated with RR in DCIS.

Methods

This is a single-institution retrospective study of 295 women undergoing breast conservation surgery for pure DCIS (2010-2013). CSM were the systematic resection of 4-6 margins during lumpectomy whereas selective shave margins (SSM) were the selective resection of 1-3 margins. Patient demographics and clinical characteristics were abstracted. RR was analyzed according to the use of pMRI, SSM, or CSM with respect to three high-volume breast surgeons at our institution.

Results

RR was not associated with the use of pMRI (P = 0.87). Any shave margins (P = 0.05), DCIS size (P < 0.001), and DCIS grade (P = 0.14) associated with a lower RR. Of our high-volume surgeons, RR was lower for Surgeon A (P = 0.02). Multivariate analyses showed larger DCIS (OR 1.35, P = 0.005) and practices specific to surgeons B (OR 3.23, P = 0.04) and C (OR 3.57, P = 0.04) increased re-excision odds.

Conclusions

SSM/CSM and pMRI use varied among surgeons. Our results suggested the routine use of CSM, not pMRI, could lower re-excision rate, which highlighted a quality improvement opportunity at our institution.

http://ift.tt/2yv401p

Management of the “Other” retroperitoneal sarcomas

The focus of this review is on the management of the less common sarcomas occurring in the retroperitoneal space, including solitary fibrous tumor (SFT), malignant peripheral nerve sheath tumor (MPNST), perivascular epithelioid cell tumor (PEComa), and undifferentiated pleomorphic sarcoma (UPS) of the psoas muscle. As for other retroperitoneal sarcomas, surgical resection is the mainstay of curative therapy, and multidisciplinary preoperative assessment, including percutaneous needle biopsy for histologic confirmation, is the basis for personalized management, as the surgical management, and the integration of systemic therapy and radiation therapy is unique to each histologic subtype.

http://ift.tt/2ABtw6L

The maximum standardized uptake value of preoperative positron emission tomography/computed tomography in lung adenocarcinoma with a ground-glass opacity component of less than 30 mm

Background and Objectives

This study evaluated the relationship between the maximum standardized uptake value (SUVmax) of preoperative positron emission tomography/computed tomography (PET/CT) and the characteristics of lung adenocarcinoma featuring ground-glass opacity nodules (GGN).

Methods

The association of the SUVmax of preoperative PET/CT with ground-glass opacity (GGO) proportion on CT, subtypes of adenocarcinoma (minimally invasive adenocarcinoma, invasive adenocarcinoma), predominant types of invasive adenocarcinoma, and size of the total and invasive components of pathology were evaluated in 190 patients who underwent resection for lung adenocarcinoma featuring GGN.

Results

The mean SUVmax of non-solid GGN and partly solid GGN were 0.53 and 1.32, respectively (P = 0.029). The mean SUVmax of the main masses in 38 patients with MIA and 152 with invasive adenocarcinoma were 0.86 and 1.36, respectively (P = 0.029). The mean SUVmax of acinar, lepidic, papillary, and solid tumors were 1.61, 0.87, 0.98, and 1.60, respectively. The mean SUVmax of invasive components measuring ≤10 mm, 11-20 mm, and >20 mm were 0.84, 1.66, and 2.09, respectively (P < 0.001).

Conclusions

The SUVmax of lung adenocarcinoma featuring GGN can vary depending on the GGO proportion. A higher SUVmax can be expected in invasive adenocarcinoma than in MIA, and solid and acinar-predominant invasive adenocarcinoma showed a higher SUVmax.

http://ift.tt/2yv3YXl

Retroperitoneal sarcomas: Big tumors that involve more than just “Getting it Out”

http://ift.tt/2AzfmmC

Inspiring hope—A physician's responsibility, translating the science into clinical practice

Giving hope to patients is our responsibility. It is the essence of a meaningful practice in medicine. Science now allows us to understand this complex and multidimensional human dynamic, and translate it into clinical practice. Quantitative research has shown hope is strong even in terminal illness. Through qualitative methodology hope fostering strategies and hope hindering behaviors have been identified. This exciting new knowledge facilitates the challenging task of disclosure of bad news while enabling hope.

http://ift.tt/2ys5Ksk

In reply: Management of thin melanoma

http://ift.tt/2ABd5XV

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer

Background and Objectives

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established.

Methods

Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals.

Results

Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction.

Conclusion

Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

http://ift.tt/2yv42Gz

Does neoadjuvant/perioperative vhemotherapy improve overall survival for T2N0 gastric adenocarcinoma?

Background

The purpose of this study was to determine whether neoadjuvant and/or perioperative chemotherapy (NAC) has an overall survival (OS) benefit for patients with T2N0 gastric adenocarcinoma.

Study Design

We performed retrospective analyses using the National Cancer Data Base, 2004-2013. Patients with T2N0 gastric adenocarcinoma were divided into two treatment groups: (1) NAC plus surgery (NA + S) and (2) surgery alone (S).

Results

Of 1,704 patients included, 277 (16.3%) received NAC, and 1,427 (83.7%) were treated with surgery alone. Patients in the NA + S group were more likely to be younger, have fewer comorbidities, and have larger tumors located in the proximal stomach. Although in an unadjusted analysis of OS, the NA + S group had improved survival compared to the S group (HR = 0.81, 95% CI 0.67-0.99, P < 0.0001), this was not maintained in a propensity adjusted analysis (HR = 0.89, 95% CI 0.68-1.18, P = 0.42). Similarly, propensity adjusted analyses accounting for potential bias from clinical misstaging or treatment effect from NAC did not show any OS benefit from NAC.

Conclusion

Based on the largest cohort of clinically staged T2N0 gastric adenocarcinoma, there was no OS benefit derived from NAC compared to surgery alone. For select patients with reliable preoperative staging, NAC may be omitted.

http://ift.tt/2ABt9Jw

Critical evaluation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with Hepatocellular Carcinoma (HCC): A Surveillance, Epidemiology, End Results (SEER) analysis

Background

Recently, the American Joint Committee on Cancer (AJCC) released its 8th edition changes to the staging system for hepatocellular cancer (HCC). We sought to validate the 8th edition staging system and compare the performance to the 7th edition using a population-based data set.

Methods

Using the Surveillance, Epidemiology and End Results (SEER) database (1998-2013), patients undergoing resection or transplant for non-metastatic HCC were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-indices) were calculated from Cox proportional hazards models to evaluate discriminatory power.

Results

The study included 8918 patients resected (63%) or transplanted (37%) for HCC. Nodal staging was performed in 19%, of whom 5% had positive nodes. The c-index for the AJCC 8th edition staging system was 0.60, similar to that for the 7th edition (0.59). Survival was better for solitary tumors >2 cm with vascular invasion than for multifocal tumors <5 cm (median not reached vs 57 months, P < 0.0001), although the staging system groups these tumors together as T2. For multifocal tumors ≤5 cm, those with vascular invasion had worse survival than those without (median 42 vs 50 months, P < 0.001), although the staging system draws no such distinction.

Conclusion

The AJCC 8th edition staging system for HCC performs similarly to the 7th edition. Future revisions should consider substratification of early HCC, specifically by distinguishing solitary tumors >2 cm from multifocal tumors ≤5 cm, and by considering the prognostic impact of vascular invasion in multifocal tumors ≤5 cm. Future studies should aim to validate these findings.

http://ift.tt/2ysrAMe

Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma

Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising.

http://ift.tt/2Azfqmm

The impact of preoperative magnetic resonance imaging and lumpectomy cavity shavings on re-excision rate in pure ductal carcinoma in situ—A single institution's experience

Background and Objectives

The impact of preoperative magnetic resonance imaging (pMRI) and cavity shave margins (CSM) on re-excision rate (RR) in DCIS is unclear. We investigated whether either modality was associated with RR in DCIS.

Methods

This is a single-institution retrospective study of 295 women undergoing breast conservation surgery for pure DCIS (2010-2013). CSM were the systematic resection of 4-6 margins during lumpectomy whereas selective shave margins (SSM) were the selective resection of 1-3 margins. Patient demographics and clinical characteristics were abstracted. RR was analyzed according to the use of pMRI, SSM, or CSM with respect to three high-volume breast surgeons at our institution.

Results

RR was not associated with the use of pMRI (P = 0.87). Any shave margins (P = 0.05), DCIS size (P < 0.001), and DCIS grade (P = 0.14) associated with a lower RR. Of our high-volume surgeons, RR was lower for Surgeon A (P = 0.02). Multivariate analyses showed larger DCIS (OR 1.35, P = 0.005) and practices specific to surgeons B (OR 3.23, P = 0.04) and C (OR 3.57, P = 0.04) increased re-excision odds.

Conclusions

SSM/CSM and pMRI use varied among surgeons. Our results suggested the routine use of CSM, not pMRI, could lower re-excision rate, which highlighted a quality improvement opportunity at our institution.

http://ift.tt/2yv401p

Management of the “Other” retroperitoneal sarcomas

The focus of this review is on the management of the less common sarcomas occurring in the retroperitoneal space, including solitary fibrous tumor (SFT), malignant peripheral nerve sheath tumor (MPNST), perivascular epithelioid cell tumor (PEComa), and undifferentiated pleomorphic sarcoma (UPS) of the psoas muscle. As for other retroperitoneal sarcomas, surgical resection is the mainstay of curative therapy, and multidisciplinary preoperative assessment, including percutaneous needle biopsy for histologic confirmation, is the basis for personalized management, as the surgical management, and the integration of systemic therapy and radiation therapy is unique to each histologic subtype.

http://ift.tt/2ABtw6L

The maximum standardized uptake value of preoperative positron emission tomography/computed tomography in lung adenocarcinoma with a ground-glass opacity component of less than 30 mm

Background and Objectives

This study evaluated the relationship between the maximum standardized uptake value (SUVmax) of preoperative positron emission tomography/computed tomography (PET/CT) and the characteristics of lung adenocarcinoma featuring ground-glass opacity nodules (GGN).

Methods

The association of the SUVmax of preoperative PET/CT with ground-glass opacity (GGO) proportion on CT, subtypes of adenocarcinoma (minimally invasive adenocarcinoma, invasive adenocarcinoma), predominant types of invasive adenocarcinoma, and size of the total and invasive components of pathology were evaluated in 190 patients who underwent resection for lung adenocarcinoma featuring GGN.

Results

The mean SUVmax of non-solid GGN and partly solid GGN were 0.53 and 1.32, respectively (P = 0.029). The mean SUVmax of the main masses in 38 patients with MIA and 152 with invasive adenocarcinoma were 0.86 and 1.36, respectively (P = 0.029). The mean SUVmax of acinar, lepidic, papillary, and solid tumors were 1.61, 0.87, 0.98, and 1.60, respectively. The mean SUVmax of invasive components measuring ≤10 mm, 11-20 mm, and >20 mm were 0.84, 1.66, and 2.09, respectively (P < 0.001).

Conclusions

The SUVmax of lung adenocarcinoma featuring GGN can vary depending on the GGO proportion. A higher SUVmax can be expected in invasive adenocarcinoma than in MIA, and solid and acinar-predominant invasive adenocarcinoma showed a higher SUVmax.

http://ift.tt/2yv3YXl

Retroperitoneal sarcomas: Big tumors that involve more than just “Getting it Out”

http://ift.tt/2AzfmmC

Inspiring hope—A physician's responsibility, translating the science into clinical practice

Giving hope to patients is our responsibility. It is the essence of a meaningful practice in medicine. Science now allows us to understand this complex and multidimensional human dynamic, and translate it into clinical practice. Quantitative research has shown hope is strong even in terminal illness. Through qualitative methodology hope fostering strategies and hope hindering behaviors have been identified. This exciting new knowledge facilitates the challenging task of disclosure of bad news while enabling hope.

http://ift.tt/2ys5Ksk

In reply: Management of thin melanoma

http://ift.tt/2ABd5XV

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer

Background and Objectives

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established.

Methods

Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals.

Results

Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction.

Conclusion

Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

from Cancer via ola Kala on Inoreader http://ift.tt/2yv42Gz
via IFTTT

Does neoadjuvant/perioperative vhemotherapy improve overall survival for T2N0 gastric adenocarcinoma?

Background

The purpose of this study was to determine whether neoadjuvant and/or perioperative chemotherapy (NAC) has an overall survival (OS) benefit for patients with T2N0 gastric adenocarcinoma.

Study Design

We performed retrospective analyses using the National Cancer Data Base, 2004-2013. Patients with T2N0 gastric adenocarcinoma were divided into two treatment groups: (1) NAC plus surgery (NA + S) and (2) surgery alone (S).

Results

Of 1,704 patients included, 277 (16.3%) received NAC, and 1,427 (83.7%) were treated with surgery alone. Patients in the NA + S group were more likely to be younger, have fewer comorbidities, and have larger tumors located in the proximal stomach. Although in an unadjusted analysis of OS, the NA + S group had improved survival compared to the S group (HR = 0.81, 95% CI 0.67-0.99, P < 0.0001), this was not maintained in a propensity adjusted analysis (HR = 0.89, 95% CI 0.68-1.18, P = 0.42). Similarly, propensity adjusted analyses accounting for potential bias from clinical misstaging or treatment effect from NAC did not show any OS benefit from NAC.

Conclusion

Based on the largest cohort of clinically staged T2N0 gastric adenocarcinoma, there was no OS benefit derived from NAC compared to surgery alone. For select patients with reliable preoperative staging, NAC may be omitted.

from Cancer via ola Kala on Inoreader http://ift.tt/2ABt9Jw
via IFTTT

Critical evaluation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with Hepatocellular Carcinoma (HCC): A Surveillance, Epidemiology, End Results (SEER) analysis

Background

Recently, the American Joint Committee on Cancer (AJCC) released its 8th edition changes to the staging system for hepatocellular cancer (HCC). We sought to validate the 8th edition staging system and compare the performance to the 7th edition using a population-based data set.

Methods

Using the Surveillance, Epidemiology and End Results (SEER) database (1998-2013), patients undergoing resection or transplant for non-metastatic HCC were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-indices) were calculated from Cox proportional hazards models to evaluate discriminatory power.

Results

The study included 8918 patients resected (63%) or transplanted (37%) for HCC. Nodal staging was performed in 19%, of whom 5% had positive nodes. The c-index for the AJCC 8th edition staging system was 0.60, similar to that for the 7th edition (0.59). Survival was better for solitary tumors >2 cm with vascular invasion than for multifocal tumors <5 cm (median not reached vs 57 months, P < 0.0001), although the staging system groups these tumors together as T2. For multifocal tumors ≤5 cm, those with vascular invasion had worse survival than those without (median 42 vs 50 months, P < 0.001), although the staging system draws no such distinction.

Conclusion

The AJCC 8th edition staging system for HCC performs similarly to the 7th edition. Future revisions should consider substratification of early HCC, specifically by distinguishing solitary tumors >2 cm from multifocal tumors ≤5 cm, and by considering the prognostic impact of vascular invasion in multifocal tumors ≤5 cm. Future studies should aim to validate these findings.

from Cancer via ola Kala on Inoreader http://ift.tt/2ysrAMe
via IFTTT

Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma

Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising.

from Cancer via ola Kala on Inoreader http://ift.tt/2Azfqmm
via IFTTT

The impact of preoperative magnetic resonance imaging and lumpectomy cavity shavings on re-excision rate in pure ductal carcinoma in situ—A single institution's experience

Background and Objectives

The impact of preoperative magnetic resonance imaging (pMRI) and cavity shave margins (CSM) on re-excision rate (RR) in DCIS is unclear. We investigated whether either modality was associated with RR in DCIS.

Methods

This is a single-institution retrospective study of 295 women undergoing breast conservation surgery for pure DCIS (2010-2013). CSM were the systematic resection of 4-6 margins during lumpectomy whereas selective shave margins (SSM) were the selective resection of 1-3 margins. Patient demographics and clinical characteristics were abstracted. RR was analyzed according to the use of pMRI, SSM, or CSM with respect to three high-volume breast surgeons at our institution.

Results

RR was not associated with the use of pMRI (P = 0.87). Any shave margins (P = 0.05), DCIS size (P < 0.001), and DCIS grade (P = 0.14) associated with a lower RR. Of our high-volume surgeons, RR was lower for Surgeon A (P = 0.02). Multivariate analyses showed larger DCIS (OR 1.35, P = 0.005) and practices specific to surgeons B (OR 3.23, P = 0.04) and C (OR 3.57, P = 0.04) increased re-excision odds.

Conclusions

SSM/CSM and pMRI use varied among surgeons. Our results suggested the routine use of CSM, not pMRI, could lower re-excision rate, which highlighted a quality improvement opportunity at our institution.

from Cancer via ola Kala on Inoreader http://ift.tt/2yv401p
via IFTTT

Management of the “Other” retroperitoneal sarcomas

The focus of this review is on the management of the less common sarcomas occurring in the retroperitoneal space, including solitary fibrous tumor (SFT), malignant peripheral nerve sheath tumor (MPNST), perivascular epithelioid cell tumor (PEComa), and undifferentiated pleomorphic sarcoma (UPS) of the psoas muscle. As for other retroperitoneal sarcomas, surgical resection is the mainstay of curative therapy, and multidisciplinary preoperative assessment, including percutaneous needle biopsy for histologic confirmation, is the basis for personalized management, as the surgical management, and the integration of systemic therapy and radiation therapy is unique to each histologic subtype.

from Cancer via ola Kala on Inoreader http://ift.tt/2ABtw6L
via IFTTT

The maximum standardized uptake value of preoperative positron emission tomography/computed tomography in lung adenocarcinoma with a ground-glass opacity component of less than 30 mm

Background and Objectives

This study evaluated the relationship between the maximum standardized uptake value (SUVmax) of preoperative positron emission tomography/computed tomography (PET/CT) and the characteristics of lung adenocarcinoma featuring ground-glass opacity nodules (GGN).

Methods

The association of the SUVmax of preoperative PET/CT with ground-glass opacity (GGO) proportion on CT, subtypes of adenocarcinoma (minimally invasive adenocarcinoma, invasive adenocarcinoma), predominant types of invasive adenocarcinoma, and size of the total and invasive components of pathology were evaluated in 190 patients who underwent resection for lung adenocarcinoma featuring GGN.

Results

The mean SUVmax of non-solid GGN and partly solid GGN were 0.53 and 1.32, respectively (P = 0.029). The mean SUVmax of the main masses in 38 patients with MIA and 152 with invasive adenocarcinoma were 0.86 and 1.36, respectively (P = 0.029). The mean SUVmax of acinar, lepidic, papillary, and solid tumors were 1.61, 0.87, 0.98, and 1.60, respectively. The mean SUVmax of invasive components measuring ≤10 mm, 11-20 mm, and >20 mm were 0.84, 1.66, and 2.09, respectively (P < 0.001).

Conclusions

The SUVmax of lung adenocarcinoma featuring GGN can vary depending on the GGO proportion. A higher SUVmax can be expected in invasive adenocarcinoma than in MIA, and solid and acinar-predominant invasive adenocarcinoma showed a higher SUVmax.

from Cancer via ola Kala on Inoreader http://ift.tt/2yv3YXl
via IFTTT

Retroperitoneal sarcomas: Big tumors that involve more than just “Getting it Out”

from Cancer via ola Kala on Inoreader http://ift.tt/2AzfmmC
via IFTTT

Inspiring hope—A physician's responsibility, translating the science into clinical practice

Giving hope to patients is our responsibility. It is the essence of a meaningful practice in medicine. Science now allows us to understand this complex and multidimensional human dynamic, and translate it into clinical practice. Quantitative research has shown hope is strong even in terminal illness. Through qualitative methodology hope fostering strategies and hope hindering behaviors have been identified. This exciting new knowledge facilitates the challenging task of disclosure of bad news while enabling hope.

from Cancer via ola Kala on Inoreader http://ift.tt/2ys5Ksk
via IFTTT

In reply: Management of thin melanoma

from Cancer via ola Kala on Inoreader http://ift.tt/2ABd5XV
via IFTTT

Associations of Calcium and Dairy Products with All-Cause and Cause-Specific Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Prospective Cohort Study.

Associations of Calcium and Dairy Products with All-Cause and Cause-Specific Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Prospective Cohort Study.

Nutr Cancer. 2017 Nov 10;:1-11

Authors: Um CY, Judd SE, Flanders WD, Fedirko V, Bostick RM

Abstract
Associations of calcium and dairy product intakes with cardiovascular disease risk and cancer mortality are controversial. We investigated associations of calcium and dairy product intakes with mortality in the prospective REasons for Geographic and Racial Differences in Stroke study (n = 30,239). Of 2,966 total deaths, 32.3% were from CVD and 28.8% from cancer. For those in the upper relative to the lowest quintile of intakes, from Cox proportional hazards regression models, the multivariable-adjusted hazard ratios (HRs) for all-cause mortality were 1.13 (95% confidence intervals [CI] 0.95-1.35; P-trend 0.004) for whole milk, and 0.75 (CI 0.61-0.93; P-trend 0.001) for nonfat milk; for CVD mortality the corresponding HRs were 0.80 (CI 0.55-1.16; P-trend 0.80) and 0.72 (CI 0.49-1.05; P-trend 0.06); and for cancer mortality they were 1.56 (CI 1.17-2.08; P-trend 0.006) and 0.89 (CI 0.62-1.28; P-trend 0.86). Calcium (total, dietary, supplemental) and total dairy product intakes were not associated with all-cause, cardiovascular, or cancer mortality. These results suggest that whole milk consumption may be directly associated with cancer mortality; non-fat milk consumption may be inversely associated with all-cause and cardiovascular- and cancer-specific mortality; and calcium intake independent of milk product intakes may not be associated with mortality.

PMID: 29125314 [PubMed - as supplied by publisher]

from Cancer via ola Kala on Inoreader http://ift.tt/2zPiAoR
via IFTTT

Associations of Calcium and Dairy Products with All-Cause and Cause-Specific Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Prospective Cohort Study.

Associations of Calcium and Dairy Products with All-Cause and Cause-Specific Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Prospective Cohort Study.

Nutr Cancer. 2017 Nov 10;:1-11

Authors: Um CY, Judd SE, Flanders WD, Fedirko V, Bostick RM

Abstract
Associations of calcium and dairy product intakes with cardiovascular disease risk and cancer mortality are controversial. We investigated associations of calcium and dairy product intakes with mortality in the prospective REasons for Geographic and Racial Differences in Stroke study (n = 30,239). Of 2,966 total deaths, 32.3% were from CVD and 28.8% from cancer. For those in the upper relative to the lowest quintile of intakes, from Cox proportional hazards regression models, the multivariable-adjusted hazard ratios (HRs) for all-cause mortality were 1.13 (95% confidence intervals [CI] 0.95-1.35; P-trend 0.004) for whole milk, and 0.75 (CI 0.61-0.93; P-trend 0.001) for nonfat milk; for CVD mortality the corresponding HRs were 0.80 (CI 0.55-1.16; P-trend 0.80) and 0.72 (CI 0.49-1.05; P-trend 0.06); and for cancer mortality they were 1.56 (CI 1.17-2.08; P-trend 0.006) and 0.89 (CI 0.62-1.28; P-trend 0.86). Calcium (total, dietary, supplemental) and total dairy product intakes were not associated with all-cause, cardiovascular, or cancer mortality. These results suggest that whole milk consumption may be directly associated with cancer mortality; non-fat milk consumption may be inversely associated with all-cause and cardiovascular- and cancer-specific mortality; and calcium intake independent of milk product intakes may not be associated with mortality.

PMID: 29125314 [PubMed - as supplied by publisher]

http://ift.tt/2zPiAoR

Cetuximab/TPF/radiotherapy in oesophageal cancer

Abstract

Background

Pre-operative chemoradiotherapy using a 5-fluorouracil (5-FU)/cisplatin backbone is widely used to improve surgical outcomes in locoregional oesophageal cancer patients, despite a non-negligible failure rate.

Objective

We evaluated intensification of this approach to improve patient outcomes by adding cetuximab to induction 5-FU/cisplatin/docetaxel (TPF) and to chemoradiotherapy in a phase II study.

Patients and Methods

Between November 2006 and April 2009, 50 patients with stage II–IVa squamous cell carcinoma (SCC) or adenocarcinoma of the oesophagus or gastro-oesophageal junction initiated three TPF/cetuximab cycles. Six weeks later, patients with response or stabilisation initiated 6 weeks of cisplatin/cetuximab/radiotherapy, followed by surgery. The primary objective was the clinical complete response (cCR) rate after induction therapy plus chemoradiotherapy in intent-to-treat patients.

Results

Thirty-eight patients were evaluable after chemoradiotherapy, 84% of whom showed disease control. Six patients (12%) achieved a cCR, with a 54% overall response rate. Twenty-seven patients underwent surgery, 11 of whom (22%; nine SCC, two adenocarcinoma) had a pathological CR (41%). Fifteen patients were alive after a median follow-up of 23.2 months. Median progression-free survival was 12.2 months (95% confidence interval [CI] 1.7–22.8). Median overall survival was 23.4 months (95% CI 12.2–36.6) and was significantly longer among the 22 patients with complete resection than in the five patients without (42.1 vs. 24.9 months; p = 0.02, hazard ratio: 3.6, 95% CI 1.1–11.6). The toxicity profile was acceptable.

Conclusions

Neoadjuvant cetuximab/TPF followed by chemoradiotherapy in locoregional oesophageal carcinoma patients is feasible and offers a modest response rate in this trial. The results of combining trimodality neoadjuvant treatment with cetuximab are consistent with the literature.

Registration: The study is registered at ClinicalTrials.gov (NCT00733889).

http://ift.tt/2ABmj6H

PD-1-PD-L1 immune-checkpoint blockade in malignant lymphomas

Abstract

Tumor cells can evade immune surveillance through overexpressing the ligands of checkpoint receptors on tumor cells or adjacent cells, leading T cells to anergy or exhaustion. Growing evidence of the interaction between tumor cells and microenvironment promoted the emergence of immune-checkpoint blockade. By targeting programmed cell death-1 (PD-1) pathway, cytotoxic activity of T cell is enhanced significantly and tumor cell lysis is induced subsequently. Currently, various antibodies against PD-1 and programmed death-ligand 1 (PD-L1) are under clinical studies in lymphomas. In this review, we outline the rationale for investigation of PD-1-PD-L1 immune-checkpoint blockade in lymphomas and discuss their prospect of applications in clinical treatment.

http://ift.tt/2AA9t8P

Early recurrence in patients undergoing curative resection of colorectal liver oligometastases: identification of its clinical characteristics, risk factors, and prognosis

Abstract

Purpose

Oligometastatic disease can potentially be cured when an optimal approach is performed. Early recurrence after liver resection is an intractable problem, and the clinical implications remain unknown in colorectal liver oligometastases (CLOM) patients. This study aimed to investigate the clinical characteristics, risk factors, and prognosis related to early recurrence in these patients.

Methods

A total of 307 consecutive patients with CLOM undergoing curative liver resection were retrospectively reviewed between September 1999 and June 2016. Early recurrence was defined as any recurrence or death from CLOM that occurred within 6 months of liver resection.

Results

With a median follow-up time of 31.7 months, the 3-year overall survival (OS) and recurrence-free survival rates were 68.7 and 42.5%, respectively. Forty-nine (16.0%) patients developed early recurrence and showed a poorer 3-year OS than those with non-early recurrence (22.3 vs. 75.8%, P < 0.001) or later recurrence (22.3 vs. 52.8 vs. 63.2%, P < 0.001). Moreover, early recurrence was identified as an independent predictor of 3-year OS [hazard ratio (HR) 6.282; 95% confidence interval (CI) 3.980–9.915, P < 0.001]. In multivariate analysis, a node-positive primary tumor [odds ratio (OR) 2.316; 95% CI 1.097–4.892, P = 0.028) and metastatic diameter > 3 cm (OR 2.560; 95% CI 1.290–5.078; P = 0.007) were shown to be risk factors for early recurrence. The salvage liver resection rate for patients with early recurrence was significantly lower than that for patients with later recurrence (4.1 vs. 19.7%, P = 0.010).

Conclusions

Early recurrence should be investigated in routine clinical practice, even in patients with CLOM after curative liver resection. Detailed preoperative comprehensive measurements might help stratify high-risk patients, and a non-surgical treatment for early recurrence might represent an effective alternative.

http://ift.tt/2i5HtCc

Early recurrence in patients undergoing curative resection of colorectal liver oligometastases: identification of its clinical characteristics, risk factors, and prognosis

Abstract

Purpose

Oligometastatic disease can potentially be cured when an optimal approach is performed. Early recurrence after liver resection is an intractable problem, and the clinical implications remain unknown in colorectal liver oligometastases (CLOM) patients. This study aimed to investigate the clinical characteristics, risk factors, and prognosis related to early recurrence in these patients.

Methods

A total of 307 consecutive patients with CLOM undergoing curative liver resection were retrospectively reviewed between September 1999 and June 2016. Early recurrence was defined as any recurrence or death from CLOM that occurred within 6 months of liver resection.

Results

With a median follow-up time of 31.7 months, the 3-year overall survival (OS) and recurrence-free survival rates were 68.7 and 42.5%, respectively. Forty-nine (16.0%) patients developed early recurrence and showed a poorer 3-year OS than those with non-early recurrence (22.3 vs. 75.8%, P < 0.001) or later recurrence (22.3 vs. 52.8 vs. 63.2%, P < 0.001). Moreover, early recurrence was identified as an independent predictor of 3-year OS [hazard ratio (HR) 6.282; 95% confidence interval (CI) 3.980–9.915, P < 0.001]. In multivariate analysis, a node-positive primary tumor [odds ratio (OR) 2.316; 95% CI 1.097–4.892, P = 0.028) and metastatic diameter > 3 cm (OR 2.560; 95% CI 1.290–5.078; P = 0.007) were shown to be risk factors for early recurrence. The salvage liver resection rate for patients with early recurrence was significantly lower than that for patients with later recurrence (4.1 vs. 19.7%, P = 0.010).

Conclusions

Early recurrence should be investigated in routine clinical practice, even in patients with CLOM after curative liver resection. Detailed preoperative comprehensive measurements might help stratify high-risk patients, and a non-surgical treatment for early recurrence might represent an effective alternative.

from Cancer via ola Kala on Inoreader http://ift.tt/2i5HtCc
via IFTTT

Prevalence of oral HPV infection among healthy individuals and head and neck cancer cases in the French West Indies

Abstract

Purpose

Human papillomavirus (HPV) is known to play a role in the development of head and neck squamous cell carcinomas (HNSCC) and to date, no study has reported on the association between oral HPV infection and HNSCC in the Caribbean. The objective was to determine the prevalence of oral HPV infection in the French West Indies (FWI), overall and by HPV genotype, among HNSCC cases and healthy population controls.

Method

We used data from a population-based case–control study conducted in the FWI. The prevalence of oral HPV was estimated separately among 100 HNSCC cases (mean age 59 years) and 308 population controls (mean age 57 years). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using a logistic regression adjusting for age, sex, tobacco, and alcohol consumption, to assess the association between oral HPV infection and HNSCC.

Results

Prevalence of oral HPV infections was 26% in controls (30% in men and 14% in women) and 36% in HNSCC cases (36% in men, 33% in women). HPV52 was the most commonly detected genotype, in cases and in controls. The prevalence of HPV16, HPV33, and HPV51 was significantly higher in cases than in controls (p = 0.0340, p = 0.0472, and 0.0144, respectively). Oral infection with high-risk HPV was associated with an increase in risk of HNSCC (OR 1.99, 95% CI 0.95–4.15). HPV16 was only associated with oropharyngeal cancer (OR 16.01, 95% CI 1.67–153.64).

Conclusion

This study revealed a high prevalence of oral HPV infection in this middle-aged Afro-Caribbean population, and a specific distribution of HPV genotypes. These findings may provide insight into HNSCC etiology specific to the FWI.

from Cancer via ola Kala on Inoreader http://ift.tt/2y2PxgC
via IFTTT

Experience with curative radiotherapy for cervix cancer in the Bahamas for 2006–2016

Abstract

Background

Cervix cancer is a significant health problem. As access to quality care in Small Island Developing States improves, and cancer centers become established, providers of care can summarize local experience to benchmark system quality and look for ways to further improve value.

Methods

This is a retrospective study of all cases of cervix cancer managed 2006–2016 at The Cancer Centre Bahamas, in conjunction with Princess Margaret Hospital, Nassau, affiliated with The University of West Indies. Seventy-two women received curative radiotherapy or chemoradiotherapy. Herein are reported presenting characteristics, treatments, waiting and overall treatment times, plus outcomes of recurrence, survival, and adverse events.

Results

For 68 newly diagnosed cases, median waiting time (diagnosis to commencing treatment) was 110 days. It was 90 days for those 47 cases who had no prior surgery or neoadjuvant chemotherapy. Overall, 99% of intended external radiotherapy fractions, 74% of brachytherapy sessions, and 79% of concurrent weekly chemotherapy were administered. For all 72 cases, median overall treatment time was 63 days; and for the 47 case sub-group, it was 78 days during 2006–2010 and 65 days during 2011–2016 (p = 0.005), so improving over calendar time. Four cases experienced grade 3–4 toxicities. Twelve had urological complications from disease or treatment. Five cases experienced local failure; eight experienced distant failure. Newly diagnosed stage 2B (26/72) had a 2-year survival of 71%.

Conclusion

This report demonstrates the impact of providing curative radiation-based treatments for cervical cancer in a small state. It suggests ways to further improve operations and justifies additional research.

from Cancer via ola Kala on Inoreader http://ift.tt/2xqReDN
via IFTTT

Prostate cancer clinical presentation, incidence, mortality and survival in Guadeloupe over the period 2008–2013 from a population-based cancer registry

Abstract

Purpose

The Caribbean population of Guadeloupe has one of the highest incidence rates of prostate cancer worldwide. In 2008, a population-based cancer registry was set up for the monitoring of cancer incidence in the aftermath of the environmental pollution with chlordecone, a persistent organochlorine insecticide formerly used in banana plantations. We describe the clinical presentation, incidence, mortality and survival of prostate cancer for the period 2008–2013.

Methods

The Guadeloupe cancer registry has been routinely collecting all incident cases of cancer since 2008. We compared age-specific incidence rates between different populations, and calculated incidence and mortality rates standardized to the world population. Kaplan–Meier observed survival and estimated age-standardized net survival were calculated by category for age, PSA level, and Gleason score using the Pohar-Perme method.

Results

Overall, 3,295 cases of prostate cancer were recorded. World-standardized incidence and mortality were respectively 184.1 [177.8–190.4] and 23.9 [21.9–25.7] per 100,000 person-years. At diagnosis, the mean age of patients was 68 ± 9.6 years old and 22% were aged over 75. Median PSA level was 8.9 [IQR: 6.0–16.0] and 13.6% of the patients had a Gleason ≥ 8. Five-year observed and net survivals were, respectively, 79.6% [77.9–81.2] and 90.7% [88.6–92.8].

Conclusion

The incidence of prostate cancer in Guadeloupe is among the highest in the world, along with those of the neighboring Caribbean countries and US African-Americans. We observed no decrease in incidence rates, and a decreasing but non-significant trend in mortality rates, which nonetheless remain higher than in high-income countries. Many Genome-Wide Association Studies are conducted to identify genetic markers involved in prostate cancer risk. In the Caribbean, complementary studies on both lifestyle and behavioral factors should highlight potential common risks among populations who share both genetic and environmental characteristics.

from Cancer via ola Kala on Inoreader http://ift.tt/2hcDjHt
via IFTTT

Prevalence of oral HPV infection among healthy individuals and head and neck cancer cases in the French West Indies

Abstract

Purpose

Human papillomavirus (HPV) is known to play a role in the development of head and neck squamous cell carcinomas (HNSCC) and to date, no study has reported on the association between oral HPV infection and HNSCC in the Caribbean. The objective was to determine the prevalence of oral HPV infection in the French West Indies (FWI), overall and by HPV genotype, among HNSCC cases and healthy population controls.

Method

We used data from a population-based case–control study conducted in the FWI. The prevalence of oral HPV was estimated separately among 100 HNSCC cases (mean age 59 years) and 308 population controls (mean age 57 years). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using a logistic regression adjusting for age, sex, tobacco, and alcohol consumption, to assess the association between oral HPV infection and HNSCC.

Results

Prevalence of oral HPV infections was 26% in controls (30% in men and 14% in women) and 36% in HNSCC cases (36% in men, 33% in women). HPV52 was the most commonly detected genotype, in cases and in controls. The prevalence of HPV16, HPV33, and HPV51 was significantly higher in cases than in controls (p = 0.0340, p = 0.0472, and 0.0144, respectively). Oral infection with high-risk HPV was associated with an increase in risk of HNSCC (OR 1.99, 95% CI 0.95–4.15). HPV16 was only associated with oropharyngeal cancer (OR 16.01, 95% CI 1.67–153.64).

Conclusion

This study revealed a high prevalence of oral HPV infection in this middle-aged Afro-Caribbean population, and a specific distribution of HPV genotypes. These findings may provide insight into HNSCC etiology specific to the FWI.

http://ift.tt/2y2PxgC

Experience with curative radiotherapy for cervix cancer in the Bahamas for 2006–2016

Abstract

Background

Cervix cancer is a significant health problem. As access to quality care in Small Island Developing States improves, and cancer centers become established, providers of care can summarize local experience to benchmark system quality and look for ways to further improve value.

Methods

This is a retrospective study of all cases of cervix cancer managed 2006–2016 at The Cancer Centre Bahamas, in conjunction with Princess Margaret Hospital, Nassau, affiliated with The University of West Indies. Seventy-two women received curative radiotherapy or chemoradiotherapy. Herein are reported presenting characteristics, treatments, waiting and overall treatment times, plus outcomes of recurrence, survival, and adverse events.

Results

For 68 newly diagnosed cases, median waiting time (diagnosis to commencing treatment) was 110 days. It was 90 days for those 47 cases who had no prior surgery or neoadjuvant chemotherapy. Overall, 99% of intended external radiotherapy fractions, 74% of brachytherapy sessions, and 79% of concurrent weekly chemotherapy were administered. For all 72 cases, median overall treatment time was 63 days; and for the 47 case sub-group, it was 78 days during 2006–2010 and 65 days during 2011–2016 (p = 0.005), so improving over calendar time. Four cases experienced grade 3–4 toxicities. Twelve had urological complications from disease or treatment. Five cases experienced local failure; eight experienced distant failure. Newly diagnosed stage 2B (26/72) had a 2-year survival of 71%.

Conclusion

This report demonstrates the impact of providing curative radiation-based treatments for cervical cancer in a small state. It suggests ways to further improve operations and justifies additional research.

http://ift.tt/2xqReDN