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Li S, Zhao Y, Huang H. Clinical characteristics and prognostic factors of adult brainstem gliomas: A retrospective analysis of histologically-proven 40 cases. Medicine (Baltimore) 2024; 103:e37910. [PMID: 38701282 PMCID: PMC11062748 DOI: 10.1097/md.0000000000037910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
To illustrate the clinical characteristics and prognostic factors of adult patients pathologically confirmed with brainstem gliomas (BSGs). Clinical data of 40 adult patients pathologically diagnosed with BSGs admitted to Beijing Shijitan Hospital from 2009 to 2022 were recorded and retrospectively analyzed. The primary parameters included relevant symptoms, duration of symptoms, Karnofsky performance status (KPS), tumor location, type of surgical resection, diagnosis, treatment, and survival. Univariate and multivariate analyses were evaluated by Cox regression models. The gliomas were located in the midbrain of 9 patients, in the pons of 14 cases, in the medulla of 5 cases, in the midbrain and pons of 6 cases and invading the medulla and pons of 6 cases, respectively. The proportion of patients with low-grade BSGs was 42.5%. Relevant symptoms consisted of visual disturbance, facial paralysis, dizziness, extremity weakness, ataxia, paresthesia, headache, bucking, dysphagia, dysacousia, nausea, dysphasia, dysosmia, hypomnesia and nystagmus. 23 (57.5%) patients accepted stereotactic biopsy, 17 (42.5%) patients underwent surgical resection. 39 patients received radiotherapy and 34 cases were treated with temozolomide. The median overall survival (OS) of all patients was 26.2 months and 21.5 months for the median progression-free survival (PFS). Both duration of symptoms (P = .007) and tumor grading (P = .002) were the influencing factors for OS, and tumor grading was significantly associated with PFS (P = .001). Duration of symptoms for more than 2 months and low-grade are favorable prognostic factors for adult patients with BSGs.
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Affiliation(s)
- Shan Li
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Zhao
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongyan Huang
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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McNair K, Botticello A, Stubblefield MD. Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation. Arch Phys Med Rehabil 2024; 105:947-952. [PMID: 38232794 DOI: 10.1016/j.apmr.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DESIGN An exploratory, observational design was used to analyze retrospective data from electronic medical records. SETTING Data were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. PARTICIPANTS Medical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. RESULTS One in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). CONCLUSIONS These findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients' performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.
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Affiliation(s)
- Keara McNair
- Kessler Institute for Rehabilitation, West Orange, NJ; Rutgers, Department of Rehabilitation and Movement Sciences, School of Health Professions, Newark, NJ.
| | - Amanda Botticello
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael D Stubblefield
- Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
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Wang M, Ge J, Ha N, Shui AM, Huang CY, Cullaro G, Lai JC. Clinical Characteristics Associated With Posttransplant Survival Among Adults 70 Years Old or Older Undergoing Liver Transplantation. J Clin Gastroenterol 2024; 58:516-521. [PMID: 37279205 PMCID: PMC10700658 DOI: 10.1097/mcg.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/24/2023] [Indexed: 06/08/2023]
Abstract
GOALS We sought to identify pre-liver transplantation (LT) characteristics among older adults associated with post-LT survival. BACKGROUND The proportion of older patients undergoing deceased-donor liver transplantation (DDLT) has increased over time. STUDY We analyzed adult DDLT recipients in the United Network for Organ Sharing registry from 2016 through 2020, excluding patients listed as status 1 or with a model of end-stage liver disease exceptions for hepatocellular carcinoma. Kaplan-Meier methods were used to estimate post-LT survival probabilities among older recipients (age ≥70 y). Associations between clinical covariates and post-LT mortality were assessed using Cox regressions. RESULTS Of 22,862 DDLT recipients, 897 (4%) were 70 years old or older. Compared with younger recipients, older recipients had worse overall survival ( P < 0.01) (1 y: 88% vs 92%, 3 y: 77% vs 86%, and 5 y: 67% vs 78%). Among older adults, in univariate Cox regressions, dialysis [hazards ratio (HR): 1.96, 95% CI: 1.38-2.77] and poor functional status [defined as Karnofsky Performance Score (KPS) <40] (HR: 1.82, 95% CI: 1.31-2.53) were each associated with mortality, remaining significant on multivariable Cox regressions. The effect of dialysis and KPS <40 at LT on post-LT survival (HR: 2.67, 95% CI: 1.77-4.01) was worse than the effects of either KPS <40 (HR: 1.52, 95% CI: 1.03-2.23) or dialysis alone (HR: 1.44, 95% CI: 0.62-3.36). Older recipients with KPS >40 without dialysis had comparable survival rates compared with younger recipients ( P = 0.30). CONCLUSIONS While older DDLT recipients had worse overall post-LT survival compared with younger recipients, favorable survival rates were observed among older adults who did not require dialysis and had poor functional status. Poor functional status and dialysis at LT may be useful to stratify older adults at higher risk for poor post-LT outcomes.
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Affiliation(s)
| | - Jin Ge
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Nghiem Ha
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Amy M Shui
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Giuseppe Cullaro
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine
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Michalopoulos GD, Katsos K, Grills IS, Warnick RE, McInerney J, Attia A, Timmerman R, Chang E, Andrews DW, D'Ambrosio AL, Cobb WS, Pouratian N, Spalding AC, Walter K, Jensen RL, Bydon M, Asher AL, Sheehan JP. Stereotactic radiosurgery in the management of non-small cell lung cancer brain metastases: a prospective study using the NeuroPoint Alliance Stereotactic Radiosurgery Registry. J Neurosurg 2024; 140:1223-1232. [PMID: 37948684 DOI: 10.3171/2023.8.jns23308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The literature on non-small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry. METHODS The SRS Registry of the NeuroPoint Alliance was used for this study. This registry included patients from 16 enrolling sites who underwent SRS from 2017 to 2022. Data are prospectively collected without a prespecified research purpose. The main outcomes of this analysis were overall survival (OS), out-of-field recurrence, local progression, and intracranial progression. All time-to-event investigations included Kaplan-Meier analyses and multivariable Cox regressions. RESULTS Two hundred sixty-four patients were identified, with a mean age of 66.7 years and a female proportion of 48.5%. Most patients (84.5%) had a Karnofsky Performance Status (KPS) score of 80-100, and the mean baseline EQ-5D score was 0.539 quality-adjusted life years. A single lesion was present in 53.4% of the patients, and 29.1% of patients had 3 or more lesions. The median OS was 28.1 months, and independent predictors of mortality included no control of primary tumor (hazard ratio [HR] 2.1), KPS of 80 (HR 2.4) or lower (HR 2.4), coronary artery disease (HR 2.8), and 5 or more lesions present at the time of SRS treatment (HR 2.3). The median out-of-field progression-free survival (PFS) was 24.8 months, and the median local PFS was unreached. Intralesional hemorrhage was an independent risk factor of local progression, with an HR of 6.0. The median intracranial PFS was 14.0 months and was predicted by the number of lesions at the time of SRS (3-4 lesions, HR 2.2; 5-14 lesions, HR 2.5). CONCLUSIONS In this real-world prospective study, the authors used a national quality registry and found favorable OS in patients with NSCLC BMs undergoing SRS compared with results from previously published RCTs. The intracranial PFS was mainly driven by the emergence of new lesions rather than local progression. A greater number of lesions at baseline was associated with out-of-field progression, while intralesional hemorrhage at baseline was associated with local progression.
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Affiliation(s)
- Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Konstantinos Katsos
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Inga S Grills
- 3Department of Neurological Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Ronald E Warnick
- 4Department of Neurosurgery, The Jewish Hospital, Cincinnati, Ohio
| | - James McInerney
- 5Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Albert Attia
- 6Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Timmerman
- 7Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Eric Chang
- 8Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David W Andrews
- 9Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Nader Pouratian
- 7Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Aaron C Spalding
- 11Norton Cancer Institute, Norton Healthcare, Louisville, Kentucky
| | - Kevin Walter
- 12Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Randy L Jensen
- 13Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 14Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; and
| | - Jason P Sheehan
- 15Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Lin C, Huang H, Song L, Zhao X, Zeng J, Li L, Ge Q, Li R, Wu Z. Treatment of malignant airway obstruction with Y-shape sigma stent loaded with I 125 seeds installed via rigid bronchoscopy. BMC Pulm Med 2024; 24:201. [PMID: 38658897 PMCID: PMC11040968 DOI: 10.1186/s12890-024-03012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To summarize and analyze the safety and efficacy of a Y-shape Sigma stent loaded with I125 in patients with inoperable malignant main airway obstruction. METHODS This study was approved by the Institutional Ethics Committee, and a written informed consent was obtained from each participant. A Y-shape Sigma stent loaded with I125 was placed under vision from rigid bronchoscopy. The primary endpoint was alleviation of symptoms and improvement of Karnofsky Performance Status (KPS) score, and the secondary endpoint was complications and technical success. RESULTS From November 2018 through June 2023, total 33 patients with malignant airway obstruction were palliatively treated by installing Y-shape Sigma stents loaded with I125. The airway lumen was immediately restored and the average airway opening significantly increased to 70 ± 9.4% after the procedure from baseline 30.2 ± 10.5% (p < 0.05). Average KPS score was improved from baseline 30.0 ± 10.0 to 70.0 ± 10.0 (p < 0.05) as well as PaO2 from baseline 50.1 ± 15.4 mmHg to 89.3 ± 8.6 mmHg (p < 0.05). The technical success rate of placing the stent in this study was 73%, and adverse events or complications including bleeding, I125 loss, and airway infection occurred during or after the procedure. CONCLUSION Placement of Y-shape Sigma stents under vision from rigid bronchoscopy in the patients with malignant airway obstruction is feasible and it immediately alleviates dyspnea and significantly improves quality of life.
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Affiliation(s)
- Chunlong Lin
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China.
| | - Hesong Huang
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lixia Song
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Xixi Zhao
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Jialing Zeng
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lun Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Qilong Ge
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Rui Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Zhiyuan Wu
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
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Zhou J, Ye D, Zhang S, Ding J, Zhang T, Chen Z, Xu F, Ren S, Hu Z. The impact of Karnofsky performance status on prognosis of patients with hepatocellular carcinoma in liver transplantation. BMC Gastroenterol 2024; 24:85. [PMID: 38408903 PMCID: PMC10895807 DOI: 10.1186/s12876-024-03161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Functional performance as measured by the Karnofsky Performance Status (KPS) scale has been linked to the outcomes of liver transplant patients; however, the effect of KPS on the outcomes of the hepatocellular carcinoma (HCC) liver transplant population has not been fully elucidated. We aimed to investigate the association between pre-transplant KPS score and long-term outcomes in HCC patients listed for liver transplantation. METHODS Adult HCC candidates listed on the Scientific Registry of Transplant Recipients (SRTR) database from January 1, 2011 to December 31, 2017 were grouped into group I (KPS 80-100%, n = 8,379), group II (KPS 50-70%, n = 8,091), and group III (KPS 10-40%, n = 1,256) based on percentage KPS score at listing. Survival was compared and multivariable analysis was performed to identify independent predictors. RESULTS Patients with low KPS score had a higher risk of removal from the waiting list. The 5-year intent-to-treat survival was 57.7% in group I, 53.2% in group II and 46.7% in group III (P < 0.001). The corresponding overall survival was 77.6%, 73.7% and 66.3% in three groups, respectively (P < 0.001). Multivariable analysis demonstrated that KPS was an independent predictor of intent-to-treat survival (P < 0.001, reference group I; HR 1.19 [95%CI 1.07-1.31] for group II, P = 0.001; HR 1.63 [95%CI 1.34-1.99] for group III, P < 0.001) and overall survival(P < 0.001, reference group I; HR 1.16 [95%CI 1.05-1.28] for group II, P = 0.004; HR 1.53 [95%CI 1.26-1.87] for group III, P < 0.001). The cumulative 5-year recurrence rates was higher in group III patients (7.4%), compared with 5.2% in group I and 5.5% in group II (P = 0.037). However, this was not significant in the competing regression analysis. CONCLUSIONS Low pre-transplant KPS score is associated with inferior long-term survival in liver transplant HCC patients, but is not significantly associated with post-transplant tumor recurrence.
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Affiliation(s)
- Jie Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Afliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Danni Ye
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Afliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Siyao Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Jiawei Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Tao Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zheng Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Fangshen Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Shenli Ren
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zhenhua Hu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Afliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China.
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Moreno Villares JM, Virgili-Casas MN, Ashbaugh Enguídanos R, Wanden-Berghe C, Cantón Blanco A, Álvarez Hernández J, Bretón I, Del Olmo D, Ferrero López I, Lozano Fuster FM, Molina Soria JB. [Home parenteral nutrition in patients with malignant bowel obstruction. Ethical considerations]. NUTR HOSP 2024; 41:255-261. [PMID: 38095086 DOI: 10.20960/nh.05042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Introduction Background: patients with cancer are one of the main group of patients on home parenteral nutrition (HPN). Patients with malignant bowel obstruction (MBO) represent a challenging group when considering HPN. At the Ethics Working Group of SENPE ethical considerations on this subject were reviewed and a guidelines proposal was made. Methods: a literature search was done and a full set of questions arose: When, if ever, is HPN indicated for patients with MBO? How should the training program be? When withdrawal of HPN should be considered? Other questions should be also taken into consideration. May any Oncologist send home a patient with HPN? The educational program could be shortened? When considering to withdraw parenteral nutrition? Results: HPN in MBO has better outcomes when patients have a good functional status (Karnofsky ≥ 50 or ECOG ≤ 2), expected survival > 2-3 months, and low inflammatory markers. Very few data have been reported on quality of life, but HPN allows a valuable time at home albeit with a considerable burden for both patients and their families. Proposal: once a patient is considered for HPN, there is a need for a deep talk on the benefits, complications and risks. In this initial talk, when HNP should be stopped needs to be included. The palliative care team with the help of the nutrition support team should follow the patient, whose clinical status must be assessed regularly. HPN should be withdrawn when no additional benefits are achieved. Conclusion: HPN may be considered an option in patients with MBO when they have a fair or good functional status and a desire to spend their last days at home.
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Affiliation(s)
| | | | - Rosana Ashbaugh Enguídanos
- Unidad de Nutrición Clínica y Dietética. Servicio de Endocrinología y Nutrición. Hospital Universitario Príncipe de Asturias
| | | | - Ana Cantón Blanco
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)
| | - Julia Álvarez Hernández
- Unidad de Nutrición Clínica y Dietética. Servicio de Endocrinología y Nutrición. Hospital Universitario Príncipe de Asturias
| | - Irene Bretón
- Nutrition Unit. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón
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Blum M, Zeng L, Gelfman LP. Prognostic performance of the Karnofsky Performance Status for predicting in-hospital mortality among unselected patients who receive palliative care consultations. Palliat Med 2024; 38:279-280. [PMID: 38253579 DOI: 10.1177/02692163231220824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Zeng
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Bronx, NY, USA
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Liu F, Peng W, Zhou R, Huang X, Yang H, Wen M, Zhang L, Tong F, Yang D, Jiang L, Yi L, Liu X. Desire for hastened death in advanced cancer: cross-sectional study in China. BMJ Support Palliat Care 2024; 13:e859-e862. [PMID: 36357163 PMCID: PMC10850830 DOI: 10.1136/spcare-2022-003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the incidence of desire for hastened death (DHD) among patients with advanced cancer and to identify factors associated with DHD. METHODS This was a cross-sectional study of 227 patients with advanced cancer in Hunan Cancer Hospital. The patients were assessed using Chinese version of the Schedule of Attitudes toward Hastened Death, Karnofsky Performance Scale, Quality of Life (QOL), MD Anderson Symptom Inventory and Patient Health Questionnaire Depression Module-9. RESULTS The number of patients with or without DHD were 71 (31.3%) and 156 (68.7%), respectively. Follow-up visits and average and high QOL were protective factors for DHD; severely disturbed sleep, symptoms that severely interfered with mood, and symptoms that severely interfered with relations with other people were risk factors for DHD. CONCLUSIONS The incidence of the DHD in patients with advanced cancer at home is high. Those who have low QOL, severely disturbed sleep, symptoms that severely interfered with mood, or symptoms that severely interfered with relations with other people should be paid attention to. These data provide a theoretical basis for the early detection and diagnosis of the desire to accelerate death of patients with advanced cancer.
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Affiliation(s)
- Feng Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Wanglian Peng
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Ran Zhou
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Xufen Huang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Hui Yang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Minni Wen
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Lemeng Zhang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Fei Tong
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Desong Yang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Ling Jiang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Lili Yi
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiaohong Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
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Cheng Y, Song Y, Yang W, Wang L, Li X, Bai J, Xiao X. The Evolution of Anterior Transpetrosal Approach for the Treatment of Petroclival Meningiomas: A Single-Center 128-Case Experience. World Neurosurg 2024; 181:e35-e44. [PMID: 37088415 DOI: 10.1016/j.wneu.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The profound understanding of anterior transpetrosal approach (ATPA) is increasingly used to treat petroclival meningiomas (PCMs). We introduce the evolution of ATPA and the outcomes of PCMs treatment. METHODS Between January 2013 and December 2019, 128 patients with PCMs underwent surgery. According to tumor extension, we classified the 128 patients into 5 types (I-V), introduced key technologies of ATPA into different types for the first time, and achieved a supreme surgical technology. Clinical data, radiological findings, surgical treatments, complications, and patient outcomes were retrospectively analyzed. RESULTS A total of 22 (17.2%), 44 (34.4%), 25 (19.5%), 29 (22.7%), and 8 (6.3%) patients had type I, II, III, IV, and V disease, respectively. Tumors were gross totally removed (Simpson I and II) in 100 patients (78.1%), subtotally removed (Simpson III) in 20 patients (15.6%), and partially removed (Simpson IV) in 8 patients (6.3%). The progression or recurrence rates were 5% (5/100) for gross totally removed, 22.3% (6/20) for subtotally removed, and 62.5% (5/8; 1 died) for partially removed. According to the Karnofsky Performance Scale and Glasgow Outcome Scale, 108 patients had good recovery (84.4%, 108/128) and 115 were independent (89.8%, 115/128) at the end of follow-up. CONCLUSIONS Because some key technologies were used in ATPA, the application of ATPA was extended, and greater tumor resection and nerve function protection could be achieved in the treatment of PCMs.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yiming Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- Department of Neurosurgery, Sichuan Science City Hospital, Mianyang, China
| | - Leiming Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoran Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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11
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Rades D, Delikanli C, Yu NY, Janssen S. Distress Scores in Elderly Cancer Patients During Radiotherapy. In Vivo 2024; 38:313-320. [PMID: 38148066 PMCID: PMC10756429 DOI: 10.21873/invivo.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM When assigned to radiotherapy (RT), elderly patients may experience distress. We investigated distress during RT and potential risk factors in these patients. PATIENTS AND METHODS Six-hundred-and-nineteen patients completed pre-RT and post-RT distress thermometers. Seven characteristics were investigated including age, sex, Karnofsky performance score (KPS), grouped KPS, tumor type, intent of RT, and previous RT. Additional analyses were performed in 358 patients with pre-RT scores ≤5. RESULTS Mean change of distress was -0.5 (±2.7) points and associated with KPS (p=0.005) and grouped KPS (p<0.001). Male sex (p=0.035), KPS 90-100 (p=0.001), and curative intent (p=0.037) were associated with increased distress on univariable analyses, and KPS 90-100 (odds ratio=1.92, p=0.004) on multivariable analysis. In patients with baseline scores ≤5, mean change was +0.5 (±2.5) points and associated with KPS (p=0.040) and grouped KPS (p=0.025). CONCLUSION Psychological assistance should be considered for all patients including those with baseline scores ≤5 and KPS 90-100. Patients with risk factors for increased distress would especially benefit.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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12
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Khalaveh F, Cho A, Shaltout A, Untersteiner H, Kranawetter B, Hirschmann D, Göbl P, Marik W, Gatterbauer B, Rössler K, Dorfer C, Frischer JM. Concomitant radiosurgical and targeted oncological treatment improves the outcome of patients with brain metastases from gastrointestinal cancer. Radiat Oncol 2023; 18:197. [PMID: 38071299 PMCID: PMC10710706 DOI: 10.1186/s13014-023-02383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND So far, only limited studies exist that evaluate patients with brain metastases (BM) from GI cancer and associated primary cancers who were treated by Gamma Knife Radiosurgery (GKRS) and concomitant immunotherapy (IT) or targeted therapy (TT). METHODS Survival after GKRS was compared to the general and specific Graded Prognostic Assessment (GPA) and Score Index for Radiosurgery (SIR). Further, the influence of age, sex, Karnofsky Performance Status Scale (KPS), extracranial metastases (ECM) status at BM diagnosis, number of BM, the Recursive Partitioning Analysis (RPA) classes, GKRS1 treatment mode and concomitant treatment with IT or TT on the survival after GKRS was analyzed. Moreover, complication rates after concomitant GKRS and mainly TT treatment are reported. RESULTS Multivariate Cox regression analysis revealed IT or TT at or after the first Gamma Knife Radiosurgery (GKRS1) treatment as the only significant predictor for overall survival after GKRS1, even after adjusting for sex, KPS group, age group, number of BM at GKRS1, RPA class, ECM status at BM diagnosis and GKRS treatment mode. Concomitant treatment with IT or TT did not increase the rate of adverse radiation effects. There was no significant difference in local BM progression after GKRS between patients who received IT or TT and patients without IT or TT. CONCLUSION Good local tumor control rates and low rates of side effects demonstrate the safety and efficacy of GKRS in patients with BM from GI cancers. The concomitant radiosurgical and targeted oncological treatment significantly improves the survival after GKRS without increasing the rate of adverse radiation effects. To provide local tumor control, radiosurgery remains of utmost importance in modern GI BM management.
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Affiliation(s)
- Farjad Khalaveh
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Wolfgang Marik
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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13
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Ribeiro LM, Bomtempo FF, Rocha RB, Telles JPM, Neto EB, Figueiredo EG. Development and adaptations of the Graded Prognostic Assessment (GPA) scale: a systematic review. Clin Exp Metastasis 2023; 40:445-463. [PMID: 37819546 DOI: 10.1007/s10585-023-10237-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
The Graded Prognostic Assessment (GPA) score has the best accuracy among prognostic scales for patients with brain metastases (BM). A wide range of GPA-derived scales have been established to different types of primary tumor BM. However, there is a high variability between them, and their characteristics have not been described altogether yet. We aim to summarize the features of the existent GPA-derived scales and to compare their predictor factors and their uses in clinical setting. Medline was searched from inception until January 2023 to identify studies related to the development, update, or validation of GPA. The initial search yielded 1,083 results. 16 original studies and 16 validation studies were included, comprising a total of 33,348 patients. 13 different scales were assessed, including: GPA, Diagnosis-Specific GPA, Extracranial Score, Lung-molGPA, Updated Renal GPA, Updated Gastrointestinal GPA, Modified Breast GPA, Integrated Melanoma GPA, Melanoma Mol GPA, Sarcoma GPA, Hepatocellular Carcinoma GPA, Colorectal Cancer GPA, and Uterine Cancer GPA. The most prevalent prognostic predictors were age, Karnofsky Performance Status, number of BM, and presence or absence of extracranial metastases. Treatment modalities consisted of whole brain radiation therapy, stereotactic radiosurgery, surgery, cranial radiotherapy, gamma knife radiosurgery, and BRAF inhibitor therapy. Median survival rates with no treatment and with a specific treatment ranged from 6.1 weeks to 33 months and from 3.1 to 21 months, respectively. Original GPA and GPA-derived scales are valid prognostic tools, but with heterogeneous survival results when compared to each other. More studies are needed to improve scientific evidence of these scales.
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Affiliation(s)
| | | | | | | | - Eliseu Becco Neto
- Division of Neurosurgery, University of São Paulo, São Paulo, Brazil
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14
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Lenga P, Dao Trong P, Papakonstantinou V, Kiening K, Unterberg AW, Ishak B. Reevaluating age restrictions of spinal metastasis surgery in elderly groups with over 2-year follow-up. Neurosurg Rev 2023; 46:309. [PMID: 37987881 PMCID: PMC10663192 DOI: 10.1007/s10143-023-02217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/21/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
This study aimed to compare and assess clinical outcomes of spinal metastasis with epidural spinal cord compression (MESCC) in patients aged 65-79 years and ≥ 80 years with an acute onset of neurological illness who underwent laminectomy. A second goal was to determine morbidity rates and potential risk factors for mortality. This retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Data on patient demographics, surgical characteristics, complications, hospital clinical course, and 90-day mortality were also collected. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). A total of 99 patients with an overall mean age of 76.2 ± 3.4 years diagnosed with MESCC within a 16-year period, of which 65 patients aged 65-79 years and 34 patients aged 80 years and older were enrolled in the study. Patients aged 80 and over had higher age-adjusted CCI (9.2 ± 2.1) compared to those aged 65-79 (5.1 ± 1.6; p < 0.001). Prostate cancer was the primary cause of spinal metastasis. Significant neurological and functional decline was more pronounced in the older group, evidenced by Karnofsky Performance Index (KPI) scores (80+ years: 47.8% ± 19.5; 65-79 years: 69.0% ± 23.9; p < 0.001). Despite requiring shorter decompression duration (148.8 ± 62.5 min vs. 199.4 ± 78.9 min; p = 0.004), the older group had more spinal levels needing decompression. Median survival time was 14.1 ± 4.3 months. Mortality risk factors included deteriorating functional status and comorbidities, but not motor weakness, surgical duration, extension of surgery, hospital or ICU stay, or complications. Overcoming age barriers in elderly surgical treatment in MSCC patients can reduce procedural delays and has the potential to significantly improve patient functionality. It emphasizes that age should not be a deterrent for spine surgery when medically necessary, although older MESCC patients may have reduced survival.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Vassilios Papakonstantinou
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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15
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Delikanli C, Janssen S, Yu NY, Rades D. Development of Distress During a Radiotherapy Course in Patients Irradiated for Breast Cancer. In Vivo 2023; 37:2755-2759. [PMID: 37905616 PMCID: PMC10621448 DOI: 10.21873/invivo.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Breast cancer patients receiving radiation therapy (RT) may experience considerable distress. We investigated the course of distress during an RT-course for breast cancer. PATIENTS AND METHODS Three-hundred-and-thirty breast cancer patients completed Distress Thermometers before and directly after RT. Distress was evaluated in the entire cohort and different groups of age, sex, Karnofsky performance score (KPS), intent of RT, and previous RT. RESULTS Mean change of distress scores was - 0.4 points, which was significantly associated with KPS. Decrease of distress was more pronounced in patients with KPS ≤80 or age <64 years. Deterioration (yes vs. no) was non-significantly associated with no previous RT. In patients with pre-RT distress scores ≤5 points, mean score increased by +0.5 points; no significant associations between characteristics and investigated endpoints were found. CONCLUSION Psychological assistance should be offered to all patients irradiated for breast cancer, particularly to those with risk factors, regardless of the pre-RT distress score.
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Affiliation(s)
- Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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16
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Wang Z, Chen H, Chen Q, Zhu Y, Li M, Jia Z. 'Sandwich treatment' for posterior fossa brain metastases with volume larger than 4cm 3: a multicentric retrospective study. Clin Exp Metastasis 2023; 40:415-422. [PMID: 37439900 DOI: 10.1007/s10585-023-10220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
Single stereotactic radiosurgery (SRS) for posterior fossa brain metastases (BM) larger than 4cm3 is dangerous. 'Sandwich treatment' strategy was developed for these BMs. The strategy was one week treatment course which includes 2-stage SRS and using Bevacizumab once during SRS gap. Patients from four gamma knife center were retrospectively analyzed. The changes of tumor and peri-tumor edema volume were studied. The Dizziness Handicap Inventory (DHI) Vomiting Score (VS) and Glasgow Coma Scale (GCS) were used to evaluate patients' clinical symptom changes. Karnofsky performance scale (KPS) and Barthel Index (BI) were used to evaluate patients' overall fitness status and physical activity rehabilitation. Tumor local control (TLC) and patients' overall survival (OS) rate were also calculated. Forty patients with 45 LBMs received 'Sandwich treatment'. The mean edema volume reduced remarkably at the course of therapy and 3 months later (P < 0.01). The mean tumor volume greatly decreased 3 months later (P < 0.01). Patients' clinical symptoms that reflected by median score of DHI, VS, GCS were improved dramatically at the course of therapy and 3 months later (P < 0.01). Similar changes happened in median score of KPS and BI that reflected patients' overall fitness status and physical activity rehabilitation (P < 0.01). Patients' median OS was 14.3 months, with 95.4%, 76.2%, and 26.3% survival rate at 6, 12, 24 months. The TLC rate at 6, 12, 24 months was 97.5%, 86.0% and 62.2%.The 'Sandwich treatment' is safe and effective for patients with LBM over 4cm3 in the posterior fossa. The strategy could quickly improve patients' symptoms, well control tumor growth, prolong patient's OS, and has controllable side effects.
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Affiliation(s)
- Zheng Wang
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Haining Chen
- Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China
| | - Qun Chen
- Gamma Knife Treatment Center, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yucun Zhu
- Gamma Knife Treatment Center, Ming ji Hospital Affiliated to Nanjing Medical University, Nanjing, 210009, China
| | - Min Li
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Zhou Jia
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.
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17
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Delikanli C, Janssen S, Tvilsted S, Yu NY, Rades D. Final Results of a Study Evaluating the Course of Distress Scores During Radiotherapy for Malignant Diseases. Anticancer Res 2023; 43:4143-4148. [PMID: 37648300 DOI: 10.21873/anticanres.16604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND/AIM Patients who receive radiotherapy (RT) may experience significant distress. This study investigated distress scores during RT for a variety of malignancies. PATIENTS AND METHODS Distress thermometers (scores of 0-10 points) were completed by 927 patients at baseline and end of RT. Six characteristics were evaluated for changes of distress scores including age, sex, Karnofsky performance score (KPS), tumor type, intent of treatment, and previous RT. RESULTS Mean distress scores were 4.9 (±2.7) at baseline and 4.6 (±2.7) at the end of RT; mean change was -0.3 (±2.8) points. On univariable analysis, increased distress (≥2 points) was significantly associated with KPS 90-100 (p<0.001) and curative intent (p=0.040). Trends were found for age ≤64 years (p=0.062), head-and-neck cancer (p=0.076), and no prior RT (p=0.055). In patients with baseline scores ≤5 points, deterioration rates were 30-47%. CONCLUSION Psychological support should be offered to all patients undergoing RT. This would benefit particularly patients with risk factors for increased distress.
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Affiliation(s)
- Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Søren Tvilsted
- Research Department, Zealand University Hospital, Køge, Denmark
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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18
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Verhaak E, Schimmel WCM, Sitskoorn MM, Hanssens PEJ, Butterbrod E, Gehring K. The long-term course and relationship with survival of multidimensional fatigue in patients with brain metastases after Gamma Knife radiosurgery. J Cancer Res Clin Oncol 2023; 149:9891-9901. [PMID: 37249646 PMCID: PMC10423137 DOI: 10.1007/s00432-023-04857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The aims of this study were to evaluate long-term multidimensional fatigue in patients with brain metastases (BM) up to 21 months after Gamma Knife radiosurgery (GKRS) and (change in) fatigue as predictor of survival. METHODS Patients with 1 to 10 BM, expected survival > 3 months, and Karnofsky Performance Status ≥ 70, and Dutch non-cancer controls were included. Fatigue was measured with the Multidimensional Fatigue Inventory. Levels of fatigue between patients and controls were compared using independent-samples t-tests. Linear mixed models were used to evaluate fatigue within the patient group up to 21 months after GKRS. Pre-GKRS fatigue and minimal clinically important (MCI) changes in fatigue in the first three months (defined as a 2-point difference) after GKRS were evaluated as predictors of survival time. RESULTS Prior to GKRS, patients with BM (n = 92) experienced significantly higher fatigue on all subscales than controls (n = 104). Over 21 months, physical fatigue increased, and mental fatigue decreased significantly. More specifically, general, and physical fatigue increased significantly between pre-GKRS and 3 months, followed by stable scores between 3 (n = 67) and 6 (n = 53), 6 and 12 (n = 34) and 12 and 21 (n = 21) months. An MCI increase in general or physical fatigue over the first 3 months after GKRS was a significant predictor of shorter survival time. CONCLUSION Except for mental fatigue, all aspects of fatigue remained elevated or further increased up to 21 months after treatment. Furthermore, an increase in general or physical fatigue within three months after GKRS may be a prognostic indicator for poorer survival. CLINICALTRIALS GOV IDENTIFIER NCT02953756, November 3, 2016.
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Affiliation(s)
- Eline Verhaak
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.
| | - Wietske C M Schimmel
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Margriet M Sitskoorn
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Patrick E J Hanssens
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Elke Butterbrod
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Janssen S, Delikanli C, Yu NY, Rades D. Comparison of Distress Scores Before and After Radiotherapy for Prostate Cancer. In Vivo 2023; 37:2173-2177. [PMID: 37652476 PMCID: PMC10500539 DOI: 10.21873/invivo.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Prostate cancer patients undergoing radiotherapy (RT) may experience distress. This study evaluated the course of distress during RT. PATIENTS AND METHODS Four distress characteristics were analyzed for change of distress in 136 patients irradiated for prostate cancer, including age, Karnofsky performance score, intent of RT, and previous RT. RESULTS Mean distress scores were 4.3 (±2.9) at baseline and 4.2 (±2.7) at the end of RT. Associations with increased distress were found for KPS >80 (p<0.001) and curative intent RT (p=0.072). When evaluating increased distress as binary variable (yes vs. no), KPS >80 was significant on univariable (p<0.001) and multivariable (p=0.016) analyses. In patients with baseline scores ≤5 points, KPS >80 was associated with mean change of distress (p=0.009) and increased distress (p=0.029). CONCLUSION Many patients receiving RT for prostate cancer do not experience increased distress during their treatment course. Patients at higher risk of increased distress may require early psychological assistance.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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20
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Rades D, Delikanli C, Yu NY, Janssen S. Development of Distress During a Radiotherapy Course for Head-and-neck Cancer. Anticancer Res 2023; 43:4149-4153. [PMID: 37648327 DOI: 10.21873/anticanres.16605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND/AIM Radiotherapy (RT) is a standard treatment for head-and-neck cancer, which can be associated with patient distress. This study provides data investigating distress during head-and-neck RT. PATIENTS AND METHODS Fifty-six patients completed the Distress Thermometer before and on the last day of their RT-course. Mean changes of distress scores and increase of distress were evaluated. Age, sex, Karnofsky performance score (KPS), tumor type, intent of RT, and previous RT were analyzed for associations with course of distress. RESULTS Mean pre-RT and post-RT distress scores were 5.1 (±2.6) and 5.0 (±2.7) points, respectively (mean change: ±0.0 points). Mean change of distress scores was significantly associated with age (p=0.042) and KPS (p<0.001). On multivariable analysis, increased distress (by ≥2 points) was associated with KPS 90-100 (p=0.011) and palliative intent of RT (p=0.036). CONCLUSION Mean pre-RT and post-RT distress scores were almost identical. Patients with risk factors for increased distress during their RT-course should be offered immediate psychological support.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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Park H, Chung HT, Kim JW, Dho YS, Lee EJ. A 3-month survival model after Gamma Knife surgery in patients with brain metastasis from lung cancer with Karnofsky performance status ≤ 70. Sci Rep 2023; 13:13159. [PMID: 37573417 PMCID: PMC10423256 DOI: 10.1038/s41598-023-40356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
Gamma Knife surgery (GKS) for brain metastasis (BM) has been generally advocated for patients with a Karnofsky performance status (KPS) scale of ≥ 70. However, some patients with a poor KPS scale of < 70 are recoverable after GKS and show durable survival. A purpose of this study is to devise a 3-month survival prediction model to screen patients with BM with a KPS of ≤ 70 in whom GKS is needed. A retrospective analysis of 67 patients with a KPS scale of 60-70 undergoing GKS for BM of non-small cell lung cancer (NSCLC) from 2016 to 2020 in our institute was performed. Univariate and multivariate logistic regression analyses were performed to investigate factors related to survival for more than 3 months after GKS. The probability (P) prediction model was designed by giving a weight corresponding to the odds ratio of the variables. The overall survival was 9.9 ± 12.7 months (range 0.2-53.2), with a 3-month survival rate of 59.7% (n = 40). In multivariate logistic regression analysis, extracranial disease (ECD) control (p = .033), focal neurological deficit (FND) (p = .014), and cumulative tumor volume (∑ TV) (p = .005) were associated with 3-month survival. The prediction model of 3-month survival (Harrell's C index = 0.767) was devised based on associated factors. In conclusion, GKS for BMs is recommended in selected patients, even if the KPS scale is ≤ 70.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Gamma Knife Radiosurgery Center, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Gamma Knife Radiosurgery Center, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun-Sik Dho
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Republic of Korea
| | - Eun Jung Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Gamma Knife Radiosurgery Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Seoul National University College of Medicine, Seoul, Republic of Korea.
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22
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Shafizadeh M, Farzaneh F, Kankam SB, Jangholi E, Shafizadeh Y, Khoshnevisan A. Effects of Postoperative Intravenous Cyclosporine Treatment on the Survival and Functional Performance Status of Patients With Glioblastoma: A Randomized, Triple-Blinded, Placebo-Controlled Clinical Trial. World Neurosurg 2023; 176:e548-e556. [PMID: 37268192 DOI: 10.1016/j.wneu.2023.05.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Glioblastoma is associated with low median survival time irrespective of maximal treatment. Previous in vitro studies have revealed tumor inhibitory effect of cyclosporine A. However, whether the addition of cyclosporine could improve survival among patients with glioblastoma is unknown. This study aimed to determine the impact of postoperation treatment with cyclosporine on the survival and performance status. METHODS In this randomized, triple-blinded, placebo-controlled trial, 118 patients with glioblastoma who underwent surgery were treated with standard chemoradiotherapy regimen. Patients were randomized to receive intravenous cyclosporine for 3 days postoperatively or placebo during the same period. The primary endpoint was the short-term effect of intravenous cyclosporine on survival and Karnofsky performance scores. Secondary endpoints were chemoradiotherapy toxicity and neuroimaging features. RESULTS The overall survival (OS) in the cyclosporine (17.03 ± 5.8, 95% confidence interval: 11-17.37 months) group was statistically lower than in the placebo (30.53 ± 4.9, 95% confidence interval: 8-32.3 months) groups (P = 0.049). However, compared to the placebo group, a statistically higher percentage of patients in the cyclosporine group were alive at 12 months follow-up. Also, progression-free survival in the cyclosporine group was significantly prolonged than in the placebo group (6.3 ± 4.07 months vs. 3.4 ± 2.98 months, P < 0.001). In the multivariate analysis, age <50 years (P = 0.022) and gross total resection (P = 0.03) were significantly associated with OS. CONCLUSIONS Our study results demonstrated that administering postoperative cyclosporine does not improve OS and functional performance status. Notably, the survival rate was significantly dependent on the patient age and the extent of glioblastoma resection.
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Affiliation(s)
- Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; International Neurosurgery Group, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farshid Farzaneh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; International Neurosurgery Group, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ehsan Jangholi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Shafizadeh
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, Florida, USA
| | - Alireza Khoshnevisan
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; International Neurosurgery Group, Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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23
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Grossenbacher B, Lareida A, Moors S, Roth P, Kulcsar Z, Regli L, Le Rhun E, Weller M, Wolpert F. Prognostic assessment in patients operated for brain metastasis from systemic tumors. Cancer Med 2023; 12:12316-12324. [PMID: 37039262 PMCID: PMC10278502 DOI: 10.1002/cam4.5928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Established models for prognostic assessment in patients with brain metastasis do not stratify for prior surgery. Here we tested the prognostic accuracy of the Graded Prognostic Assessment (GPA) score model in patients operated for BM and explored further prognostic factors. METHODS We included 285 patients operated for brain metastasis at the University Hospital Zurich in the analysis. Information on patient characteristics, imaging, staging, peri- and postoperative complications and survival were extracted from the files and integrated into a multivariate Cox hazard model. RESULTS The GPA score showed an association with outcome. We further identified residual tumor after surgery (p = 0.007, hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.1-2.3) steroid use (p = 0.021, HR 1.7, 95% CI 1.1-2.6) and number of extracranial metastasis sites (p = 0.009, HR 1.4, 95% CI 1.1-1.6) at the time of surgery as independent prognostic factors. A trend was observed for postoperative infection of the subarachnoid space (p = 0.102, HR 3.5, 95% CI 0.8-15.7). CONCLUSIONS We confirm the prognostic capacity of the GPA score in a cohort of operated patients with brain metastasis. However, extent of resection and steroid use provide additional aid for the prognostic assessment in these patients.
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Affiliation(s)
- Bettina Grossenbacher
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Anna Lareida
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Selina Moors
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Patrick Roth
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Luca Regli
- Department of NeurosurgeryUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Emilie Le Rhun
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
- Department of NeurosurgeryUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
| | - Fabian Wolpert
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital of Zurich, University of ZurichZurichSwitzerland
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24
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Bschorer M, Ricklefs FL, Sauvigny T, Westphal M, Dührsen L. Multiple craniotomies in a single surgery - the resection of scattered brain metastases. Neurosurg Rev 2023; 46:70. [PMID: 36920624 PMCID: PMC10017615 DOI: 10.1007/s10143-023-01976-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Patients with brain metastases (BM), who can benefit from resection of multiple scattered lesions, often will not be offered a procedure involving multiple craniotomies in one session due to the overall poor prognosis. However, carefully selected candidates may well benefit from the resection of multiple lesions using multiple craniotomies through a significantly shortened hospital stay, aggressive decompression, and rapid eligibility for adjuvant therapies. In this retrospective analysis, the records of patients, who were treated for multiple BM using one surgical session involving multiple craniotomies, were reviewed. A group of patients with multiple BM, whose surgery only involved one craniotomy, were assigned to a control group. Clinical and surgical characteristics, preoperative and postoperative Karnofsky Performance Scale (KPS), complication rate, preoperative tumor size, number of lesions, number of craniotomies, skin incisions, and intraoperative repositioning of patients were recorded. Thirty-three patients were included in the multiple-craniotomy group. Thirty patients underwent two craniotomies, while three cases involved three craniotomies. Seven patients (21%) were intraoperatively repositioned from a prone to a supine position, which required an average of 23.3 ± 9.3 min from wound closure to the following skin incision. Thirty-six patients with multiple BM and matching characteristics, who received only one craniotomy for the dominant lesion, served as the control group. No difference was detected in postoperative KPS (p = 0.269), complication rate (p = 0.612), rate of new postoperative neurological deficits (p = 0.278), length of intensive care unit (ICU) (p = 0.991), and hospital stay (p = 0.913). There was a significant difference in average preoperative tumor size (p = 0.002), duration of surgery (p < 0.001), and extent of resection (p = 0.002). In the age of personalized medicine, selected patient may benefit from a single surgery for BM using multiple craniotomies. This study shows no significant increase of the perioperative complication rate for surgeries with multiple craniotomies.
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Affiliation(s)
- Maximilian Bschorer
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Daoud AMO, Khalaf M, Nassar M. Limitations of the Karnofsky Performance Status Scale in kidney transplant recipients. Ann Med 2022; 54:1328-1329. [PMID: 35533048 PMCID: PMC9103498 DOI: 10.1080/07853890.2022.2068806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ahmed Mahmoud Osman Daoud
- Nephrology Division, Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Khalaf
- Gastroenterology Division, Internal Medicine Department, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Mahmoud Nassar
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai/NYC H+H Queens, New York, NY, USA
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26
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Sass D, Vera E, Choi A, Acquaye A, Briceno N, Christ A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers JL, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler BJ, Wu J, Gilbert MR, Armstrong TS, Leeper H. Evaluation of the key geriatric assessment constructs in primary brain tumor population - a descriptive study. J Geriatr Oncol 2022; 13:1194-1202. [PMID: 36041994 DOI: 10.1016/j.jgo.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite an increasing aging population, older adults (≥ 65 years) with primary brain tumors (PBTs) are not routinely assessed for geriatric vulnerabilities. Recent reports of geriatric assessment (GA) in patients with glioblastomas demonstrated that GA may serve as a sensitive prognosticator of overall survival. Yet, current practice does not include routine evaluation of geriatric vulnerabilities and the relevance of GA has not been previously evaluated in broader cohorts of PBT patients. The objective of this descriptive study was to assess key GA constructs in adults with PBT dichotomized into older versus younger groups. MATERIALS AND METHODS A cross-sectional analysis of data collected from 579 participants with PBT recruited between 2016 and 2020, dichotomized into older (≥ 65 years, n = 92) and younger (≤ 64 years, n = 487) from an ongoing observational trial. GA constructs were evaluated using socio-demographic characteristics, Charlson Comorbidity Index (CCI), polypharmacy (>5 daily medications), Karnofsky Performance Status (KPS), Neurologic Function Score (NFS), and patient-reported outcome assessments including general health, functional status, symptom burden and interference, and mood. Descriptive statistics, t-tests, chi-square tests, and Pearson correlations were used to evaluate differences between age groups. RESULTS Older participants were more likely to have problems with mobility (58% vs. 44%), usual activities (64% vs 50%) and self-care (38% vs 26%) compared to the younger participants (odds ratios [ORs] = 1.3-1.4, ps < 0.05), while older participants were less likely to report feeling distressed (OR = 0.4, p < 0.05). Older participants also had higher CCI and were more likely to have polypharmacy (OR = 1.7, ps < 0.05). Increasing age strongly correlated with worse KPS score (r = -0.232, OR = 1.4, p < 0.001) and worse NFS (r = 0.210, OR = 1.5, p < 0.001). No differences were observed in overall symptom burden, symptom interference, and anxiety/depression scores. DISCUSSION While commonly used GA tools were not available, the study employed patient- and clinician-reported outcomes to identify potential future research directions for the use of GA in the broader neuro-oncology population. Findings illustrate missed opportunities in neuro-oncology practice and underscore the need for incorporation of GA into routine care of this population. Future studies are warranted to further evaluate the prognostic utility of GA and to better understand functional aging outcomes in this patient population.
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Affiliation(s)
- Dilorom Sass
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Huang YM, Yeh KY, Chen PY, Hsieh TY, Hsu LS, Wu CE, Yang CH, Zheng YC. Primary intracranial malignant melanomas in solitary type: a tertiary center experience. J Clin Neurosci 2022; 101:37-46. [PMID: 35526362 DOI: 10.1016/j.jocn.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Solitary type primary intracranial malignant melanoma (PIMM) is extremely rare but fatal. The optimal treatment algorithm according to clinical relevance of symptoms and outcomes is unclear. This series emphasized the prognostic factors of solitary PIMM and established the treatment algorithm for this rare disease. METHODS Patients with solitary PIMMs were pathologically verified and treated with neurosurgical tumor resection. All solitary PIMMs recruited at our institute received multidisciplinary team care. We analyzed the clinical findings and prognostic factors. RESULTS The study cohort included 10 patients. PIMMs in solitary type impacted middle-aged populations with male predominance in Taiwan. Most patients (80%) presented a single tumor initially. Six patients had progressed to multiplicity after the initial treatment. Rates of tumor bleeding and leptomeningeal metastasis seeding (LS) are high in solitary PIMMs. Patients who had gross-total resection (GTR) had better survival than those who had incomplete resection, with median overall survival (OS) rates of 170.4 months vs. 5.23 months (p = 0.004). Multiplicity, eloquent area involvement, initial tumor bleeding, LS, hydrocephalus, and Karnofsky Performance Score < 80 at diagnosis were associated with negative outcomes in progression-free survival and OS. Adjuvant radiotherapy for patients who had LS and for those who cannot undergo grossly total tumor removal resulted in a good outcome. CONCLUSIONS GTR demonstrated better outcomes for solitary PIMM. For recurrent tumors, aggressively repeated surgical resection remained beneficial for selected cases. Adjuvant radiotherapy was a treatment option for LS following operation. We proposed a possible treatment algorithm for solitary PIMM.
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Affiliation(s)
- Yen-Min Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Kun-Yun Yeh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Pin-Yuan Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taiwan.
| | - Tsan-Yu Hsieh
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Li-Sung Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Cheng-Han Yang
- Departments of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou.
| | - Yun-Cong Zheng
- Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taiwan.
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28
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Lund JL, Duberstein PR, Loh KP, Gilmore N, Plumb S, Lei L, Keil AP, Islam JY, Hanson LC, Giguere JK, Vogel VG, Burnette BL, Mohile SG. Life expectancy in older adults with advanced cancer: Evaluation of a geriatric assessment-based prognostic model. J Geriatr Oncol 2022; 13:176-181. [PMID: 34483079 PMCID: PMC8882125 DOI: 10.1016/j.jgo.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/06/2021] [Accepted: 08/25/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Oncologists estimate patients' prognosis to guide care. Evidence suggests oncologists tend to overestimate life expectancy, which can lead to care with questionable benefits. Information obtained from geriatric assessment may improve prognostication for older adults. In this study, we created a geriatric assessment-based prognostic model for older adults with advanced cancer and compared its performance to alternative models. MATERIALS AND METHODS We conducted a secondary analysis of a trial (URCC 13070; PI: Mohile) capturing geriatric assessment and vital status up to one year for adults age ≥ 70 years with advanced cancer. Oncologists estimated life expectancy as 0-6 months, 7-12 months, and > 1 year. Three statistical models were developed: (1) a model including age, sex, cancer type, and stage (basic model), (2) basic model + Karnofsky Performance Status (≤50, 60-70, and 80+) (KPS model), and (3) basic model +16 binary indicators of geriatric assessment impairments (GA model). Cox regression was used to model one-year survival; c-indices and time-dependent c-statistics assessed model discrimination and stratified survival curves assessed model calibration. RESULTS We included 484 participants; mean age was 75; 48% had gastrointestinal or lung cancer. Overall, 43% of patients died within one year. Oncologists classified prognosis accurately for 55% of patients, overestimated for 35%, and underestimated for 10%. C-indices were 0.61 (basic model), 0.62 (KPS model), and 0.63 (GA model). The GA model was well-calibrated. CONCLUSIONS The GA model showed moderate discrimination for survival, similar to alternative models, but calibration was improved. Further research is needed to optimize geriatric assessment-based prognostic models for use in older adults with advanced cancer.
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Affiliation(s)
- Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paul R Duberstein
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Nikesha Gilmore
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Sandy Plumb
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica Y Islam
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura C Hanson
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey K Giguere
- NCORP of the Carolinas (Greenville Health System NCORP), Greenville, SC, USA
| | | | - Brian L Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Grand Rapids, MI, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY, USA
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Deng GC, Lv Y, Yan H, Sun DC, Qu TT, Pan YT, Han QL, Dai GH. Nomogram to predict survival of patients with advanced and metastatic pancreatic Cancer. BMC Cancer 2021; 21:1227. [PMID: 34781928 PMCID: PMC8594118 DOI: 10.1186/s12885-021-08943-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nomograms are rarely employed to estimate the survival of patients with advanced and metastatic pancreatic cancer (PC). Herein, we developed a comprehensive approach to using a nomogram to predict survival probability in patients with advanced and metastatic PC. METHODS A total of 323 patients with advanced and metastatic PC were identified from the Chinese People's Liberation Army (PLA) General Hospital. A baseline nomogram was constructed using baseline variables of 323 patients. Additionally, 233 patients, whose tumors showed initial responses to first-line chemotherapy, were enrolled in the chemotherapy response-based model. 128 patients and 108 patients with advanced and metastatic PC from January 2019 to April 2021 were selected for external validating baseline model and chemotherapy response-based model. The 1-year and 2-year survival probability was evaluated using multivariate COX regression models. The discrimination and calibration capacity of the nomograms were assessed using C-statistic and calibration plots. The predictive accuracy and net benefit of the nomograms were evaluated using ROC curve and DCA, respectively. RESULTS In the baseline model, six variables (gender, KPS, baseline TB, baseline N, baseline WBC and baseline CA19-9) were used in the final model. In the chemotherapy response-based model, nine variables (KPS, gender, ascites, baseline N, baseline CA 19-9, baseline CEA, change in CA 19-9 level at week, change in CEA level at week and initial response to chemotherapy) were included in the final model. The C-statistics of the baseline nomogram and the chemotherapy response-based nomogram were 0.67 (95% CI, 0.62-0.71) and 0.74 (95% CI, 0.69-0.77), respectively. CONCLUSION These nomograms were constructed to predict the survival probability of patients of advanced and metastatic PC. The baseline model and chemotherapy response-based model performed well in survival prediction.
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Affiliation(s)
- G C Deng
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Y Lv
- School of Medicine, Nankai University, Tianjin, China
| | - H Yan
- School of Medicine, Nankai University, Tianjin, China
| | - D C Sun
- School of Medicine, Nankai University, Tianjin, China
| | - T T Qu
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Y T Pan
- School of Medicine, Nankai University, Tianjin, China
| | - Q L Han
- School of Medicine, Nankai University, Tianjin, China.
| | - G H Dai
- School of Medicine, Nankai University, Tianjin, China.
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
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Mikic N, Poulsen FR, Kristoffersen KB, Laursen RJ, Guldberg TL, Skjøth-Rasmussen J, Wong ET, Møller S, Dahlrot RH, Sørensen JCH, Korshøj AR. Study protocol for OptimalTTF-2: enhancing Tumor Treating Fields with skull remodeling surgery for first recurrence glioblastoma: a phase 2, multi-center, randomized, prospective, interventional trial. BMC Cancer 2021; 21:1010. [PMID: 34503460 PMCID: PMC8427888 DOI: 10.1186/s12885-021-08709-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND OptimalTTF-2 is a randomized, comparative, multi-center, investigator-initiated, interventional study aiming to test skull remodeling surgery in combination with Tumor Treating Fields therapy (TTFields) and best physicians choice medical oncological therapy for first recurrence in glioblastoma patients. OptimalTTF-2 is a phase 2 trial initiated in November 2020. Skull remodeling surgery consists of five burrholes, each 15 mm in diameter, directly over the tumor resection cavity. Preclinical research indicates that this procedure enhances the effect of Tumor Treating Fields considerably. We recently concluded a phase 1 safety/feasibility trial that indicated improved overall survival and no additional toxicity. This phase 2 trial aims to validate the efficacy of the proposed intervention. METHODS The trial is designed as a comparative, 1:1 randomized, minimax two-stage phase 2 with an expected 70 patients to a maximum sample size of 84 patients. After 12-months follow-up of the first 52 patients, an interim futility analysis will be performed. The two trial arms will consist of either a) TTFields therapy combined with best physicians choice oncological treatment (control arm) or b) skull remodeling surgery, TTFields therapy and best practice oncology (interventional arm). Major eligibility criteria include age ≥ 18 years, 1st recurrence of supratentorial glioblastoma, Karnofsky performance score ≥ 70, focal tumor, and lack of significant co-morbidity. Study design aims to detect a 20% increase in overall survival after 12 months (OS12), assuming OS12 = 40% in the control group and OS12 = 60% in the intervention group. Secondary endpoints include hazard rate ratio of overall survival and progression-free survival, objective tumor response rate, quality of life, KPS, steroid dose, and toxicity. Toxicity, objective tumor response rate, and QoL will be assessed every 3rd month. Endpoint data will be collected at the end of the trial, including the occurrence of suspected unexpected serious adverse reactions (SUSARs), unacceptable serious adverse events (SAEs), withdrawal of consent, or loss-to-follow-up. DISCUSSION New treatment modalities are highly needed for first recurrence glioblastoma. Our proposed treatment modality of skull remodeling surgery, Tumor Treating Fields, and best practice medical oncological therapy may increase overall survival significantly. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0422399 , registered 13. January 2020.
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Affiliation(s)
- N Mikic
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 165, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark.
| | - F R Poulsen
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark
- Clinical Institute BRIDGE (Brain Research InterDisciplinary Guided Excellence), University of Southern Denmark, Winsløwparken 19, 5000, Odense, Denmark
| | - K B Kristoffersen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark
| | - R J Laursen
- Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - T L Guldberg
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - J Skjøth-Rasmussen
- Department of Neurosurgery, Rigshospitalet, Inge Lehmanns Vej 6, 2100, København Ø, Denmark
| | - E T Wong
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - S Møller
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark
| | - R H Dahlrot
- Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000, Odense, Denmark
| | - J C H Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 165, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
| | - A R Korshøj
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 165, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
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Mercadante S, Adile C, Ricci M, Maltoni M, Bonanno G, Casuccio A. The Role of Religiosity in Symptom Expression of Advanced Cancer Patients. Am J Hosp Palliat Care 2021; 39:705-709. [PMID: 34493072 DOI: 10.1177/10499091211041349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. METHODS A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. RESULTS Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. CONCLUSION The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.
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Affiliation(s)
| | - Claudio Adile
- Private Hospital La Maddalena Palermo, Sicilia, Italy
| | - Marianna Ricci
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Chu NM, Chen X, Bae S, Brennan DC, Segev DL, McAdams-DeMarco MA. Changes in Functional Status Among Kidney Transplant Recipients: Data From the Scientific Registry of Transplant Recipients. Transplantation 2021; 105:2104-2111. [PMID: 33449609 PMCID: PMC8273213 DOI: 10.1097/tp.0000000000003608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With stressors of dialysis prekidney transplantation (KT) and restoration of kidney function post-KT, it is likely that KT recipients experience a decline in functional status while on the waitlist and improvements post-KT. METHODS We leveraged 224 832 KT recipients from the national registry (SRTR, February 1990-May 2019) with measured Karnofsky Performance Status (KPS, 0%-100%) at listing, KT admission, and post-KT. We quantified the change in KPS from listing to KT using generalized linear models. We described post-KT KPS trajectories using adjusted mixed-effects models and tested whether those trajectories differed by age, sex, race, and diabetes status using a Wald test among all KT recipients. We then quantified risk adverse post-KT outcomes (mortality and all-cause graft loss [ACGL]) by preoperative KPS and time-varying KPS. RESULTS Mean KPS declined from listing (83.7%) to admission (78.9%) (mean = 4.76%, 95% confidence interval [CI]: -4.82, -4.70). After adjustment, mean KPS improved post-KT (slope = 0.89%/y, 95% CI: 0.87, 0.91); younger, female, non-Black, and diabetic recipients experienced greater post-KT improvements (Pinteractions < 0.001). Lower KPS (per 10% decrease) at admission was associated with greater mortality (adjusted hazard ratio [aHR] = 1.11, 95% CI: 1.10, 1.11) and ACGL (aHR = 1.08, 95% CI: 1.08, 1.09) risk. Lower post-KT KPS (per 10% decrease; time-varying) were more strongly associated with mortality (aHR = 1.93, 95% CI: 1.92, 1.94) and ACGL (aHR = 1.84, 95% CI: 1.83, 1.85). CONCLUSIONS Functional status declines pre-KT and improves post-KT in the national registry. Despite post-KT improvements, poorer functional status at KT and post-KT are associated with greater mortality and ACGL risk. Because of its dynamic nature, clinicians should repeatedly screen for lower functional status pre-KT to refer vulnerable patients to prehabilitation in hopes of reducing risk of adverse post-KT outcomes.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ito K, Ogawa H. Stereotactic Body Radiation Therapy for Patients With Sacral Chordoma Who Previously Received Carbon Ion Therapy. Int J Radiat Oncol Biol Phys 2021; 110:1263-1264. [PMID: 34273319 DOI: 10.1016/j.ijrobp.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Bunevicius A, Fribance S, Pikis S, Lee JYK, Buch LY, Moran M, Yang AI, Bernstein K, Mathieu D, Perron R, Liscak R, Simonova G, Patel S, Trifiletti DM, Martínez Álvarez R, Martínez Moreno N, Lee CC, Yang HC, Strickland BA, Zada G, Chang EL, Kondziolka D, Sheehan J. Stereotactic Radiosurgery for Differentiated Thyroid Cancer Brain Metastases: An International, Multicenter Study. Thyroid 2021; 31:1244-1252. [PMID: 33978475 DOI: 10.1089/thy.2020.0947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. Methods: From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). Results: We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm3 (range: 0.003-38.18 cm3), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452, p = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904; p = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945; p = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. Conclusion: The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sarah Fribance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Love Y Buch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Moran
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology and NYU Langone Health, New York University, New York, New York, USA
| | - David Mathieu
- Department of Neurological Surgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Rémi Perron
- Department of Neurological Surgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Roman Liscak
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gabriela Simonova
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | | | - Roberto Martínez Álvarez
- Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Nuria Martínez Moreno
- Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Ben A Strickland
- Department of Neurosurgery and University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery and University of Southern California, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York University, New York, New York, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Cheng S, Qu B, Qiu X, Li N, Wang X, Hao J. Efficacy and safety of Kanglaite injection combined with chemotherapy for women breast cancer: A protocol for systematic review and meta-analysis of randomized clinical trials. Medicine (Baltimore) 2021; 100:e26245. [PMID: 34087912 PMCID: PMC8183730 DOI: 10.1097/md.0000000000026245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Breast cancer was the second cause of cancer death and approximately accounted for 30% of all newly diagnosed cancer in American women. Adjuvant chemotherapy is the preferred treatment approach for breast patients. Kanglaite injection (KI) was commonly used as adjuvant chemotherapy combined with chemotherapy for women breast cancer which could increase chemotherapy efficacy and alleviate chemotherapy drugs induced adverse events, however, the efficacy and safety for KI combined western medicine remains controversial. Thus, we conducted this protocol of systematic review and meta-analysis to estimate the efficacy and safety of KI combined with western medicine for women breast cancer. METHODS This study will search electronic database included English medicals databases and Chinese databased up to May 2021. The main outcomes of this study include clinical efficacy rate. Adverse reaction rate, Karnofsky Performance Status and immune function were defined as the secondary outcomes. RESULTS This protocol study will comprehensively evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer. CONCLUSION This protocol for systematic review and meta-analysis will evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer, aiming to provide optimal therapy for women breast cancer patients.
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Affiliation(s)
- Shengli Cheng
- Anhui Medical University, School of Public Health
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province
| | - Biao Qu
- Macau University of Science and Technology, Taipa, Macau (SAR)
| | - Xiaoxia Qiu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
| | - Nannan Li
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province
| | - Xiaoli Wang
- Qinghai Province Cardiovascular and Cerebrovascdular Disease Specialist Hospital, Xining, Qinghai Province
| | - Jiahu Hao
- Anhui Medical University, School of Public Health
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Just J, Schmitz MT, Grabenhorst U, Joist T, Horn K, Engel B, Weckbecker K. Factors influencing length of survival in ambulatory palliative care - a cross sectional study based on secondary data. BMC Palliat Care 2021; 20:69. [PMID: 34001099 PMCID: PMC8130350 DOI: 10.1186/s12904-021-00762-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of life and patient self-determination are key elements in successful palliative care. To achieve these goals, a robust prediction of the remaining survival time is useful as it can provide patients and their relatives with information for individual goal setting including appropriate priorities. The Aim of our study was to assess factors that influence survival after enrollment into ambulatory palliative care. METHODS In this cross-sectional, multicenter study (n = 14 study centers) clinical records of all palliative care patients who were treated in 2017 were extracted and underwent statistical analysis. The main outcome criterion was the association of survival time with clinical characteristics such as age, type of disease, symptoms and performance status. RESULTS A total of 6282 cases were evaluated. Median time of survival was 26 days (95 % CI: 25-27 days). The strongest association for an increased hazard ratio was found for the following characteristics: moderate/severe weakness (aHR: 1.91; 95 % CI: 1.27-2.86) Karnofsky score 10-30 (aHR: 1.80; 95 % CI: 1.67-1.95), and age > 85 (aHR: 1.50; 95 % CI: 1.37-1.64). Surprisingly, type of disease (cancer vs. non-cancer) was not associated with a change in survival time (aHR: 1.03; 95 % CI: 0.96-1.10). CONCLUSIONS In this cross-sectional study, the most relevant predictor for a short survival time in specialized ambulatory palliative care was the performance status while type of disease was irrelevant to survival.
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Affiliation(s)
- Johannes Just
- Institute of General Practice and Interprofessional Care Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58453, Witten, Germany.
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ulrich Grabenhorst
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Thomas Joist
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Kirsten Horn
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Bettina Engel
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, 26129, Oldenburg, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Interprofessional Care Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58453, Witten, Germany
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Lee JH, Kim IY, Kim YD, Lee SY, Jung JY. Navigation-guided percutaneous pelvic cementoplasty for metastatic bone pain: A case report. Medicine (Baltimore) 2021; 100:e25521. [PMID: 33847672 PMCID: PMC8052009 DOI: 10.1097/md.0000000000025521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Percutaneous cementoplasty is a minimally invasive procedure that can provide immediate pain relief and improve range of motion in patients with metastatic bone pain. Conventionally, this procedure is guided by computed tomography (CT). However, to minimize exposure to radiation, we performed percutaneous cementoplasty under the guidance of a navigation system. PATIENT CONCERNS A 60-year-old man presented with left hip pain for several months due to bone metastasis in the left ilium. DIAGNOSES The patient was diagnosed with lung cancer and multiple bone metastases including ileum. INTERVENTIONS The puncture needle was placed under the guidance of a navigation system with pre-procedure CT images, and bone cement was injected into the osteolytic lesion in the left ilium. OUTCOMES Bone cement placement was confirmed by post-procedure radiography, and its distribution was satisfactory. The patient's Karnofsky Performance Scale and Brief Pain Inventory scores showed improvement in pain and mobility without complications. LESSONS Percutaneous cementoplasty guided by a navigation system is a safer and more effective method with less radiation compared with conventional CT-guided methods.
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Affiliation(s)
| | | | - Young Don Kim
- Department of Neurosurgery, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea
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Franco P, Delev D, Cipriani D, Neidert N, Kellner E, Masalha W, Mercas B, Mader I, Reinacher P, Weyerbrock A, Fung C, Beck J, Heiland DH, Schnell O. Surgery for IDH1/2 wild-type glioma invading the corpus callosum. Acta Neurochir (Wien) 2021; 163:937-945. [PMID: 33095353 PMCID: PMC7966629 DOI: 10.1007/s00701-020-04623-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Glioblastoma of the corpus callosum (ccGBM) are rare tumors, with a dismal prognosis marked by a rapid clinical deterioration. For a long time, surgical treatment was not considered beneficial for most patients with such tumors. Recent studies claimed an improved survival for patients undergoing extensive resection, albeit without integration of the molecular profile of the lesions. The purpose of this study was to investigate the effect of biopsy and surgical resection on oncological and functional outcomes in patients with IDH wild-type ccGBM. METHODS We performed a retrospective analysis of our institution's database of patients having been treated for high-grade glioma between 2005 and 2017. Inclusion criteria were defined as follows: patients older than 18 years, histopathological, and molecularly defined IDH wild-type glioma, major tumor mass (at least 2/3) invading the corpus callosum in the sagittal plane with a uni- or bilateral infiltration of the adjacent lobules. Surgical therapy (resection vs. biopsy), extent of resection according to the remaining tumor volume and adjuvant treatment as well as overall survival and functional outcome using the Karnofsky Performance Score (KPS) were analyzed. RESULTS Fifty-five patients were included in the study, from which the mean age was 64 years and men (n = 34, 61.8%) were more often affected than women (n = 21, 38.2%). Thirty (54.5%) patients were treated with stereotactic biopsy alone, while 25 patients received tumor resection resulting in 14.5% (n = 8) gross-total resections and 30.9% (n = 17) partial resections. The 2-year survival rate after resection was 30% compared to 7% after biopsy (p = 0.047). The major benefit was achieved in the group with gross-total resection, while partial resection failed to improve survival. Neurological outcome measured by KPS did not differ between both groups either pre- or postoperatively. CONCLUSIONS Our study suggests that in patients with corpus callosum glioblastoma, gross-total resection prolongs survival without negatively impacting neurological outcome as compared to biopsy.
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Affiliation(s)
- Pamela Franco
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany.
| | - Daniel Delev
- Department of Neurosurgery, University of Aachen, Aachen, NRW, Germany
| | - Debora Cipriani
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Elias Kellner
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Department of Radiology, Medical Centre - University of Freiburg, Freiburg, BW, Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Bianca Mercas
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Irina Mader
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Specialist Centre for Radiology, Schoen Clinic, Vogtareuth, BY, Germany
| | - Peter Reinacher
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
- Department of Neurosurgery, Division Stereotactic and Functional Neurosurgery, Medical Center- University of Freiburg, Freiburg, BW, Germany
| | | | - Christian Fung
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, BW, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, BW, Germany
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Chen H, Li C, Zheng L, Lu W, Li Y, Wei Q. A machine learning-based survival prediction model of high grade glioma by integration of clinical and dose-volume histogram parameters. Cancer Med 2021; 10:2774-2786. [PMID: 33760360 PMCID: PMC8026951 DOI: 10.1002/cam4.3838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/02/2020] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Glioma is the most common type of primary brain tumor in adults, and it causes significant morbidity and mortality, especially in high-grade glioma (HGG) patients. The accurate prognostic prediction of HGG is vital and helpful for clinicians when developing therapeutic strategies. Therefore, we propose a machine learning-based survival prediction model by analyzing clinical and dose-volume histogram (DVH) parameters, to improve the performance of the risk model in HGG patients. METHODS Eight clinical variables and 39 DVH parameters were extracted for each patient, who received radiotherapy for HGG with active follow-up. Ninety-five patients were randomly divided into training and testing cohorts, and we employed random survival forest (RSF), support vector machine (SVM), and Cox proportional hazards (CPHs) models to predict survival. Calibration plots, concordance indexes, and decision curve analyses were used to evaluate the calibration, discrimination, and clinical utility of these three models. RESULTS The RSF model showed the best performance among the three models, with concordance indexes of 0.824 and 0.847 in the training and testing sets, respectively, followed by the SVM (0.792/0.823) and CPH (0.821/0.811) models. Specifically, in the RSF model, we identified age, gross tumor volume (GTV), grade, Karnofsky performance status (KPS), isocitrate dehydrogenase (IDH), and D99 as important variables associated with survival. The AUCs of the testing set were 92.4%, 87.7%, and 84.0% for 1-, 2-, and 3-year survival, respectively. According to this model, HGG patients can be divided into high- and low-risk groups. CONCLUSION The machine learning-based RSF model integrating both clinical and DVH variables is an improved and useful tool for predicting the survival of HGG patients.
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Affiliation(s)
- Haiyan Chen
- Department of Radiation OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Zhejiang University Cancer CenterHangzhouZhejiangChina
| | - Chao Li
- Department of Radiation OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Lin Zheng
- Department of Radiation OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Department of Radiation OncologyTaizhou Tumor HospitalTaizhouZhejiangChina
| | - Wei Lu
- Zhejiang University Cancer CenterHangzhouZhejiangChina
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Yanlin Li
- College of ScienceHangzhou Normal UniversityHangzhouZhejiangChina
| | - Qichun Wei
- Department of Radiation OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Zhejiang University Cancer CenterHangzhouZhejiangChina
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Zhang X, Wei X, Liu J, Yang J, Jin P. Up-regulation of long non-coding RNA BLACAT1 predicts aggressive clinicopathologic characteristics and poor prognosis of glioma. Medicine (Baltimore) 2021; 100:e20722. [PMID: 33725920 PMCID: PMC7982219 DOI: 10.1097/md.0000000000020722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/18/2020] [Accepted: 05/10/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Bladder cancer-associated transcript 1 (BLACAT1) is one of the most common cancer-associated long non-coding RNAs (lncRNAs), which has been reported as a tumor promotor in several malignancies. Previously, BLACAT1 was found to be overexpressed in glioma tissues and cell lines. Functional assays determined that BLACAT1 promoted glioma cell proliferation, migration, invasion and epithelial-mesenchymal transition, suggesting that BLACAT1 might serve as an oncogene in glioma. In the present study, we aimed to investigate its clinical significance and prognostic value in glioma patients.A total of 137 paired glioma tissue samples and adjacent normal brain tissue samples were collected from 137 glioma patients who underwent surgery from May 2014 to February 2019. The Student t test was applied to determine the statistical significance of the observed differences between 2 groups. Survival curves were constructed and differences among groups were calculated using the Kaplan-Meier method.The relative expression of BLACAT1 in glioma samples was significantly higher than that of matched normal tissues (P < .001). The expression level of tissue BLACAT1 was statistically correlated with tumor size (P = .04), Karnofsky Performance Status (KPS) (P = .006), and WHO grade (P = .017). Kaplan-Meier analysis with the log-rank test revealed that BLACAT1 up-regulation was correlated with shorter overall survival time of patients with glioma (Log Rank test, P = .012). In multivariate Cox analysis, BLACAT1 expression was found to be an independent prognostic factor for overall survival in patients with glioma (HR = 2.739; 95% CI: 1.785-8.229; P = .035). Our study demonstrates that up-regulation of BLACAT1 is able to predict aggressive clinicopathologic characteristics and poor prognosis of glioma patients. These findings may have significant implications for potential treatment options and prognosis for patients with glioma.
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Affiliation(s)
- Xiaojue Zhang
- Department of Craniocerebral Surgery, People's Hospital of Lanling County, Lanling, Linyi
| | - Xiuchuan Wei
- Department of Craniocerebral Surgery, People's Hospital of Lanling County, Lanling, Linyi
| | - Jie Liu
- Department of Craniocerebral Surgery, People's Hospital of Lanling County, Lanling, Linyi
| | - Jiaying Yang
- Department of Craniocerebral Surgery, People's Hospital of Lanling County, Lanling, Linyi
| | - Peng Jin
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Stenman M, Benmakhlouf H, Wersäll P, Johnstone P, Hatiboglu MA, Mayer-da-Silva J, Harmenberg U, Lindskog M, Sinclair G. Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery. Acta Neurochir (Wien) 2021; 163:333-342. [PMID: 32902689 DOI: 10.1007/s00701-020-04537-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The effects of single-fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA) and immune checkpoint inhibitors (ICI) are insufficiently studied. METHODS AND MATERIALS Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n = 43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60 to 100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE). RESULTS One hundred and ninety-four targets were irradiated. The median number of targets at first sf-GKRS was two. The median prescription dose was 22.0 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC rates at 12 and 18 months were 97% and 90%. Median OS from the first sf-GKRS was 15.7 months. Low serum albumin (HR for death 5.3), corticosteroid use pre-sf-GKRS (HR for death 5.8) and KPS < 80 (HR for death 9.1) were independently associated with worse OS. No further prognostic information was gleaned from MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases. Other prognostic scores for BM radiosurgery, including DS-GPA, renal-GPA, LLV-SIR and CITV-SIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sf-GKRS. CONCLUSIONS We identified albumin, corticosteroid use and KPS as independent prognostic factors for sf-GKRS of clear cell RCC BM. Studies focusing on the prognostic significance of albumin in sf-GKRS are rare. Further studies with a larger number of patients are warranted to confirm the above analytical outcome. Also, in keeping with previous studies, our data showed optimal rates of local tumour control and limited toxicity post radiosurgery, rendering GKRS the tool of choice in the management of RCC BM.
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Affiliation(s)
- M Stenman
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - H Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - P Wersäll
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - P Johnstone
- Department of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - M A Hatiboglu
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - J Mayer-da-Silva
- Centro Gamma Knife, CUF Infante Santo Hospital, Lisbon, Portugal
| | - U Harmenberg
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Lindskog
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - G Sinclair
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Oncology, North Middlesex University Hospital NHS Trust, London, UK.
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Zhu X, Wu Z, Cao Y, Gao R, Zhang X, Li J. Efficacy and safety of TCM therapies combined with hyperthermic intraperitoneal chemotherapy for peritoneal metastasis of gastric cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24337. [PMID: 33530226 PMCID: PMC7850690 DOI: 10.1097/md.0000000000024337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) has high incidence and mortality worldwide, and peritoneal metastasis is a primary cause of mortality in patients. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a feasible and effective treatment. Traditional Chinese Medicine (TCM) therapies have been combined with HIPEC for certain therapeutic advantages, but there is a lacking of evidence of evidence-based medicine. Therefore, we provide a protocol to evaluate the efficacy and safety of TCM therapies combined with HIPEC in the treatment for peritoneal metastasis of GC. METHODS AND ANALYSIS From inception until December 2020, a systematic and comprehensive literature search will be conducted in both 3 English databases and 4 Chinese databases. Randomized controlled trials (RCTs) will be included related to TCM therapies combined with HIPEC in the treatment for peritoneal metastasis of GC. Two researchers independently conducted data extraction and literature quality evaluation. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS This study assessed the efficacy and safety of TCM therapies combined with HIPEC in the treatment of peritoneal metastasis of GC by effective rate, Karnofsky Performance Status (KPS), Carcinoemybryonic Angtigen remission rate, and incidence of adverse reactions etc. CONCLUSIONS This study will provide reliable evidence-based evidence for the clinical application of TCM therapies combined with HIPEC in the treatment for peritoneal metastasis of GC. ETHICS AND DISSEMINATION Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print. REGISTRATION NUMBER INPLASY2020120048.
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Saraceni F, Labopin M, Forcade E, Kröger N, Socié G, Niittyvuopio R, Cornelissen JJ, Labussière‐Wallet H, Blaise D, Choi G, Byrne JL, Guillerm G, Marchand T, Esteve J, Bazarbachi A, Savani B, Olivieri A, Nagler A, Mohty M. Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT). Cancer Med 2021; 10:23-33. [PMID: 33242374 PMCID: PMC7826477 DOI: 10.1002/cam4.3593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 01/22/2023] Open
Abstract
Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) with a reduced performance status. We herein present the results of a registry study on 2,936 AML patients undergoing allo-SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two-year leukemia-free survival (LFS), overall survival (OS) and graft-versus-host disease (GVHD)-free, and relapse-free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non-relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% (p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced-intensity conditioning (RIC) regimen was associated with an increased risk of relapse (p = 0.002) and lower GRFS (p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM (p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS (p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III-IV acute GVHD (p < 0.01) and NRM (p < 0.01) in comparison to other donor types. In conclusion, allo-SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment.
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Affiliation(s)
- Francesco Saraceni
- Hematology and Stem Cell TransplantUniversità Politecnica delle MarcheAnconaItaly
| | - Myriam Labopin
- EBMT Paris Study OfficeSaint Antoine HospitalParisFrance
| | | | - Nicolaus Kröger
- Bone Marrow Transplantation CentreUniversity Hospital EppendorfHamburgGermany
| | - Gerard Socié
- Department of Hematology ‐ BMTHopital St. LouisParisFrance
| | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer CenterStem Cell Transplantation UnitHelsinkiFinland
| | - Jan J. Cornelissen
- Department of HematologyErasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | - Didier Blaise
- Programme de Transplantation & Therapie CellulaireCentre de Recherche en Cancérologie de MarseilleInstitut Paoli CalmettesMarseilleFrance
| | - Goda Choi
- University Medical Center Groningen (UMCG)Department of HematologyUniversity of GroningenGroningenThe Netherlands
| | | | | | - Tony Marchand
- Service d`Hematologie Clinique AdulteCentre Hospitalier Universitaire de RennesRennesFrance
| | | | - Ali Bazarbachi
- Bone Marrow Transplantation ProgramDepartment of Internal MedicineAmerican University of BeirutBeirutLebanon
| | - Bipin Savani
- Vanderbilt University Medical CenterNashvilleTNUSA
| | - Attilio Olivieri
- Hematology and Stem Cell TransplantUniversità Politecnica delle MarcheAnconaItaly
| | - Arnon Nagler
- Department of Bone Marrow TransplantationChaim Sheba Medical CenterTel‐HashomerIsrael
| | - Mohamad Mohty
- EBMT Paris Study OfficeSaint Antoine HospitalParisFrance
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Li W, Guo J, Wang Q, Tang J, You F. The efficacy of Chinese herbal medicine as an adjunctive therapy for colorectal cancer: A protocol for systematic review of randomized controlled trials. Medicine (Baltimore) 2020; 99:e23216. [PMID: 33371062 PMCID: PMC7748206 DOI: 10.1097/md.0000000000023216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a public health problem and the world's leading cancer killer. It is a disease with high incidence and mortality. Although chemotherapy has achieved some success in the treatment of CRC, drug resistance and tumor metastasis caused by chemotherapy are still the main causes of death in patients with CRC. Notably, many side effects associated with chemotherapy, such as nausea, vomiting, and peripheral neurotoxicity, are major challenges in the treatment of patients with CRC. Chinese herbal medicine (CHM) has been widely used as an adjunctive therapy for CRC, but its efficacy and safety are still uncertain. The aim of this systematic review is to assess the efficacy and safety of CHM for the treatment of CRC. METHODS A comprehensive retrieval will be performed in the following electronic databases: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, SinoMed, VIP, and Wan Fang Data. The methodologic quality of randomized controlled trials will be assessed using the Cochrane risk assessment tool. Review Manager 5.3 software will be used for data synthesis and analysis. Funnel plot analysis and Egger test will be used to assess publication bias. The Grading of Recommendations Assessment, Development and Evaluation standard will be used to generate summary of finding table. RESULTS The results of this systematic review will be used to summarize and evaluate the evidence from randomized controlled clinical trials of CHM as adjuvant therapy for CRC. CONCLUSION This review will provide a detailed summary of the evidence to assess the efficacy and safety of CHM for CRC. OSF REGISTRATION DOI 10.17605/OSF.IO/X2SKJ.
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Affiliation(s)
- Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine
- Evidence-Based Traditional Chinese Medicine Center of Sichuan Province, No.39 Shi-er-qiao Road, Chengdu, Sichuan Province, P.R. China
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Qiaoling Wang
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jianyuan Tang
- Hospital of Chengdu University of Traditional Chinese Medicine
- Evidence-Based Traditional Chinese Medicine Center of Sichuan Province, No.39 Shi-er-qiao Road, Chengdu, Sichuan Province, P.R. China
| | - Fengming You
- Hospital of Chengdu University of Traditional Chinese Medicine
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Seidel S, Pels H, Schlömer S, Kowoll A, Fliessbach K, Engert A, Vogt-Schaden M, Egerer G, Reichmann H, Schackert G, Kroschinsky F, Deckert M, Herrlinger U, Klockgether T, Fimmers R, Bode U, Schmidt-Wolf IGH, Schlegel U. Twenty-year follow-up of a pilot/phase II trial on the Bonn protocol for primary CNS lymphoma. Neurology 2020; 95:e3138-e3144. [PMID: 32989105 PMCID: PMC7734926 DOI: 10.1212/wnl.0000000000010949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether a fraction of patients with primary CNS lymphoma (PCNSL) had been cured by systemic and intraventricular methotrexate- and cytarabine-based chemotherapy (Bonn protocol) after a very long-term follow-up of nearly 20 years. METHODS Sixty-five patients (median age 62 years, range 27-75; median Karnofsky performance score 70, range 20-90) had been treated with systemic and intraventricular polychemotherapy without whole brain radiotherapy from September 1995 until December 2001. All patients still alive in 2019 were contacted and interviewed on their current life situation. RESULTS Median follow-up for surviving patients was 19.6 years (17.5-23.3 years). Out of 65 patients, 11 (17%) were still alive. Six of those never experienced any relapse. For the whole study population, median overall survival (OS) was 4.4 years (95% confidence interval [CI] 2.9-5.9); for patients ≤60 years, 11.0 years (95% CI 4.8-17.0). The 10-year OS rate for the entire cohort was 29% and the estimated 20-year OS rate was 19%. Four late relapses were observed after 9.8, 10.3, 13.3, and 21.0 years. CONCLUSION At a median follow-up of 19.6 years, 17% of patients were alive and free of tumor; however, even after response for decades, an inherent risk of relapse, either systemic or cerebral, characterizes the biology of PCNSL. CLASSIFICATION OF EVIDENCE This work provides Class III evidence that PCNSL treatment with methotrexate-based polychemotherapy including intraventricular therapy is associated with long-term disease control in some patients.
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Affiliation(s)
- Sabine Seidel
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany.
| | - Hendrik Pels
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Sabine Schlömer
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Annika Kowoll
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Klaus Fliessbach
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Andreas Engert
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Marlies Vogt-Schaden
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Gerlinde Egerer
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Heinz Reichmann
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Gabriele Schackert
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Frank Kroschinsky
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Martina Deckert
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Ulrich Herrlinger
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Thomas Klockgether
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Rolf Fimmers
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Udo Bode
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Ingo G H Schmidt-Wolf
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
| | - Uwe Schlegel
- From the Departments of Neurology (S. Seidel, S. Schlömer, U.S.) and Radiology (A.K.), Knappschaftskrankenhaus University of Bochum; Department of Neurology (H.P.), Hospital Barmherzige Brüder, Regensburg; Department of Neurology (K.F., U.H., T.K.), Institute of Biostatistics (R.F.), Department of Pediatrics (U.B.), and Department of Integrated Oncology, CIO Bonn (I.G.H.S.-W.), University of Bonn; Department of Internal Medicine (A.E.) and Department of Neuropathology, Faculty of Medicine and University Hospital Cologne (M.D.), University of Cologne; Departments of Neurology (M.V.-S.) and Internal Medicine (G.E.), University of Heidelberg; and Departments of Neurology (H.R.), Neurosurgery (G.S.), and Internal Medicine (F.K.), University of Dresden, Germany. A.K. is currently affiliated with Radiology, Medneo, Dortmund, Germany
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46
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Arita H, Matsushita Y, Machida R, Yamasaki K, Hata N, Ohno M, Yamaguchi S, Sasayama T, Tanaka S, Higuchi F, Iuchi T, Saito K, Kanamori M, Matsuda KI, Miyake Y, Tamura K, Tamai S, Nakamura T, Uda T, Okita Y, Fukai J, Sakamoto D, Hattori Y, Pareira ES, Hatae R, Ishi Y, Miyakita Y, Tanaka K, Takayanagi S, Otani R, Sakaida T, Kobayashi K, Saito R, Kurozumi K, Shofuda T, Nonaka M, Suzuki H, Shibuya M, Komori T, Sasaki H, Mizoguchi M, Kishima H, Nakada M, Sonoda Y, Tominaga T, Nagane M, Nishikawa R, Kanemura Y, Kuchiba A, Narita Y, Ichimura K. TERT promoter mutation confers favorable prognosis regardless of 1p/19q status in adult diffuse gliomas with IDH1/2 mutations. Acta Neuropathol Commun 2020; 8:201. [PMID: 33228806 PMCID: PMC7685625 DOI: 10.1186/s40478-020-01078-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
TERT promoter mutations are commonly associated with 1p/19q codeletion in IDH-mutated gliomas. However, whether these mutations have an impact on patient survival independent of 1p/19q codeletion is unknown. In this study, we investigated the impact of TERT promoter mutations on survival in IDH-mutated glioma cases. Detailed clinical information and molecular status data were collected for a cohort of 560 adult patients with IDH-mutated gliomas. Among these patients, 279 had both TERT promoter mutation and 1p/19q codeletion, while 30 had either TERT promoter mutation (n = 24) or 1p/19q codeletion (n = 6) alone. A univariable Cox proportional hazard analysis for survival using clinical and genetic factors indicated that a Karnofsky performance status score (KPS) of 90 or 100, WHO grade II or III, TERT promoter mutation, 1p/19q codeletion, radiation therapy, and extent of resection (90-100%) were associated with favorable prognosis (p < 0.05). A multivariable Cox regression model revealed that TERT promoter mutation had a significantly favorable prognostic impact (hazard ratio = 0.421, p = 0.049), while 1p/19q codeletion did not have a significant impact (hazard ratio = 0.648, p = 0.349). Analyses incorporating patient clinical and genetic information were further conducted to identify subgroups showing the favorable prognostic impact of TERT promoter mutation. Among the grade II-III glioma patients with a KPS score of 90 or 100, those with IDH-TERT co-mutation and intact 1p/19q (n = 17) showed significantly longer survival than those with IDH mutation, wild-type TERT, and intact 1p/19q (n = 185) (5-year overall survival, 94% and 77%, respectively; p = 0.032). Our results demonstrate that TERT promoter mutation predicts favorable prognosis independent of 1p/19q codeletion in IDH-mutated gliomas. Combined with its adverse effect on survival among IDH-wild glioma cases, the bivalent prognostic impact of TERT promoter mutation may help further refine the molecular diagnosis and prognostication of diffuse gliomas.
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Affiliation(s)
- Hideyuki Arita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita-City, Osaka 565-0871 Japan
| | - Yuko Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Ryunosuke Machida
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kai Yamasaki
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
- Department of Pediatric Hematology and Oncology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka-City, Osaka 534-0021 Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-City, Fukuoka 812-8582 Japan
| | - Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo-City, Hokkaido 060-8638 Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-City, Hyogo 650-0017 Japan
| | - Shota Tanaka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655 Japan
| | - Fumi Higuchi
- Department of Neurosurgery, Dokkyo Medical University, 880, Kitakobayashi, Mibu-City, Tochigi 321-0293 Japan
| | - Toshihiko Iuchi
- Division of Neurological Surgery, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba-City, Chiba 260-8717 Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka-City, Tokyo 181-8611 Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi 980-8574 Japan
| | - Ken-ichiro Matsuda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, 2-2, Iida-Nishi, Yamagata-City, Yamagata 990-9585 Japan
| | - Yohei Miyake
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama 350-1298 Japan
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama-City, Kanagawa 236-0004 Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Sho Tamai
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa-City, Ishikawa 920-8641 Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama-City, Kanagawa 236-0004 Japan
| | - Takehiro Uda
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-5-7, Asahi-machi, Abeno-ku, Osaka-City, Osaka 545-8586 Japan
| | - Yoshiko Okita
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka-City, Osaka 540-0006 Japan
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-City, Osaka 541-8567 Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama 641-0012 Japan
| | - Daisuke Sakamoto
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya-City, Hyogo 663-8501 Japan
| | - Yasuhiko Hattori
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-City, Okayama 700-8558 Japan
| | - Eriel Sandika Pareira
- Department of Neurosurgery, Keio University School of Medicine, 35, Shinano-machi, Tokyo, Shinjuku-ku 160-8582 Japan
| | - Ryusuke Hatae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-City, Fukuoka 812-8582 Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo-City, Hokkaido 060-8638 Japan
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-City, Hyogo 650-0017 Japan
| | - Shunsaku Takayanagi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655 Japan
| | - Ryohei Otani
- Department of Neurosurgery, Dokkyo Medical University, 880, Kitakobayashi, Mibu-City, Tochigi 321-0293 Japan
- Department of Neurosurgery, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 Japan
| | - Tsukasa Sakaida
- Division of Neurological Surgery, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba-City, Chiba 260-8717 Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka-City, Tokyo 181-8611 Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi 980-8574 Japan
| | - Kazuhiko Kurozumi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-City, Okayama 700-8558 Japan
| | - Tomoko Shofuda
- Department of Biomedical Research and Innovation Research, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-City, Osaka 540-0006 Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka-City, Osaka 540-0006 Japan
- Department of Neurosurgery, Kansai Medical University, 3-1, Shinmachi 2 Chome, Hirakata-City, Osaka 573-1191 Japan
| | - Hiroyoshi Suzuki
- Department of Pathology and Laboratory Medicine, National Hospital Organization, Sendai Medical Center, 2-11-12, Miyagino, Miyagino-ku, Sendai-City, Miyagi 983-8520 Japan
| | - Makoto Shibuya
- Central Clinical Laboratory, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji-City, Tokyo 193-0998 Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo 183-0042 Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, 35, Shinano-machi, Tokyo, Shinjuku-ku 160-8582 Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-City, Fukuoka 812-8582 Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita-City, Osaka 565-0871 Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa-City, Ishikawa 920-8641 Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, 2-2, Iida-Nishi, Yamagata-City, Yamagata 990-9585 Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi 980-8574 Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka-City, Tokyo 181-8611 Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama 350-1298 Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka-City, Osaka 540-0006 Japan
- Department of Biomedical Research and Innovation Research, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-City, Osaka 540-0006 Japan
| | - Aya Kuchiba
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
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Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto WA, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJ, Bryant J, Chuong M, An Y, Chiang V, Nakano T, Aoyama H, Mehta MP. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J Clin Oncol 2020; 38:3773-3784. [PMID: 32931399 PMCID: PMC7655019 DOI: 10.1200/jco.20.01255] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
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Affiliation(s)
- Paul W. Sperduto
- Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, MN
| | | | - Jing Li
- MD Anderson Cancer Center, Houston, TX
| | | | - Ayal Aizer
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Jason Chan
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Diana Shi
- Massachusetts General Hospital, Boston, MA
| | | | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Emil Lou
- University of Minnesota, Minneapolis, MN
| | | | | | - Laura Masucci
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | - Yi An
- Yale University, New Haven, CT
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Hilkens NA, Enting RH, Hendriks LEL, Lagerwaard FJ, de Vos FYFL, Gijtenbeek JMM. [Revised guideline 'Brain metastases': More treatment options]. Ned Tijdschr Geneeskd 2020; 164:D5233. [PMID: 33331719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The guideline on brain metastasis from the Netherlands Society of Neurology has been updated. Important changes have been made, particularly with regard to treatment of brain metastases. Treatment of patients with brain metastases is complex and requires a multidisciplinary approach to formulate an optimal, individualized treatment plan. Neurosurgical resection may also be considered in patients with multiple brain metastases and one dominant, symptomatic lesion, if the patient is in good clinical condition. Stereotactic radiosurgery is a treatment option for patients with a maximum of 10 brain metastases, depending on the size and number of metastases. The indication for whole brain radiotherapy is relatively limited. Doctors should be cautious with whole brain radiotherapy in patients with a Karnofsky Performance Status <70. In patients with small, asymptomatic brain metastases, targeted therapy or immune therapy may be considered without locoregional therapy.
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Affiliation(s)
- Nina A Hilkens
- Radboudumc, afd. Neurologie, Nijmegen
- Contact: Nina A. Hilkens
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49
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Mao W, Fan Y, Cheng C, Yuan X, Lan T, Mao K, Wang J. Efficacy and safety of Kanglaite injection combined with chemotherapy for colorectal cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22357. [PMID: 32991451 PMCID: PMC7523838 DOI: 10.1097/md.0000000000022357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The incidence and mortality of colorectal cancer are high. Chemotherapy is currently the commonly used therapeutic scheme, but there are drug resistance and toxic and side effects. Kanglaite (KLT) injection is a broad-spectrum anticancer drug extracted from Semen Coicis (Yi Yi Ren), which has been widely used in the treatment of colorectal cancer. Clinical practice shows that KLT injection combined with chemotherapy has certain therapeutic advantages, but there is a lacking of evidence of evidence-based medicine. The purpose of this study is to systematically investigate the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer. METHODS Randomized controlled trials of KLT injection combined with chemotherapy in the treatment of colorectal cancer were retrieved from English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, Wanfang, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database), as well as searching Baidu academic and Google academic manually, and the retrieval time was from their establishment to August 2020. Two researchers independently conducted data extraction and literature quality evaluation on the quality of the included literatures, and meta-analysis was conducted on the included literatures using RevMan 5.3 (developed by the UK's International Cochrane Collaboration). RESULTS This study assessed the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer by effective rate, Karnofsky Performance Status, Carcinoemybryonic Angtigen remission rate, pain remission rate, and incidence of adverse reactions etc. CONCLUSIONS:: This study will provide reliable evidence-based evidence for the clinical application of KLT injection combined with chemotherapy in the treatment of colorectal cancer. ETHICS AND DISSEMINATION The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/EKVAF.
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Affiliation(s)
- Weili Mao
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Yihua Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Chao Cheng
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xingyu Yuan
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tian Lan
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Kaili Mao
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Jun Wang
- People's Hospital of QuZhou, Quzhou, Zhejiang province
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50
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Lin Z, Jiang M, Gao L, Zhang H. The clinical efficacy of traditional Chinese medicine in the treatment of malignant pleural effusion: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22403. [PMID: 32991466 PMCID: PMC7523851 DOI: 10.1097/md.0000000000022403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this meta-analysis was to summarize and identify the available evidence from studies to estimate the clinical value of traditional Chinese medicine (TCM) in the treatment of malignant pleural effusion (MPE). And provides clinicians with evidence on which to base their clinical decision making. METHODS This review will include all studies comparing clinical efficacy of TCM in the treatment of MPE. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the July, 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is clinical efficacy, QLQ-C30 questionnaire and safety. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS This study will summarize current evidence to assess the efficacy and safety of TCM in the treatment of MPE. CONCLUSION The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as studying the value of TCM.
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