Pelvic Radiation Improves Local Control After Hysterectomy for Uterine Leiomyosarcoma: A 20-Year Experience

2009 ◽  
Vol 19 (6) ◽  
pp. 1080-1084 ◽  
Author(s):  
Ali Mahdavi ◽  
Bradley J. Monk ◽  
Jennifer Ragazzo ◽  
Mark I. Hunter ◽  
Scot E. Lentz ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
High Rate ◽  
Entire Group ◽  
Adjuvant Radiation ◽  
Uterine Leiomyosarcoma ◽  
Modest Improvement ◽  
Adjuvant Radiation Therapy

Background:Uterine leiomyosarcoma (LMS) is associated with high rate of recurrence after surgical resection. The role of adjuvant radiation therapy in improving survival in women with uterine LMS is unclear.Methods:All cases of LMS treated from 1985 to 2005 at 11 regional medical centers were identified. Kaplan-Meier survival curves were constructed and compared with log-rank testing. Multivariate analysis was performed to account for the potential influence of confounding factors.Results:One hundred forty-seven patients with LMS were identified. The median age of diagnosis was 51 years with the stage distribution of stage I (n = 87), II (n = 9), III (n = 25), IV (n = 25), and unknown (n = 1). One hundred forty-three underwent total abdominal hysterectomy and bilateral salpingoophorectomy. Twenty-four (17%) of these patients received adjuvant pelvic irradiation, and 63 (44%) received adjuvant and/or palliative chemotherapy. With a median follow-up of 24 months (range, 1-249 months), the median survival for the entire group was 37 months. Cox proportional hazards modeling demonstrated the presence of high tumor grade and advanced stage adversely affected survival. Although the 5-year survival for patients who received adjuvant radiotherapy was significantly higher than those who did not (70% vs 35%), this survival advantage was not sustained as the curves crossed at 90-month follow-up. Pelvic recurrence rate was lower in the radiation group (18% vs 49%; P = 0.02).Conclusions:Adjuvant radiation therapy was associated with decreased pelvic failure and a modest improvement in 5-year survival, but did not impact overall survival with extended follow-up.

Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up

2004 ◽  
Vol 130 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Hans Geinitz ◽  
Frank B. Zimmermann ◽  
Reinhard Thamm ◽  
Monika Keller ◽  
Raymonde Busch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Long Term Follow Up

scholarly journals Neuroendoscopic resection of posterior third ventricular ependymoma

2005 ◽  
Vol 18 (6) ◽  
pp. 1-2 ◽  
Author(s):  
Neal Luther ◽  
Mark M. Souweidane
Keyword(s):  
Radiation Therapy ◽  
Solid Tumors ◽  
Endoscopic Resection ◽  
Adjuvant Radiation ◽  
Radiographic Evidence ◽  
Adjuvant Radiation Therapy ◽  
Cystic Tumors ◽  
Intraventricular Tumors ◽  
Definitive Management

✓ The practice of neuroendoscopy in the definitive management of cystic tumors and hydrocephalus has been well established. Resection of solid intraventricular tumors by a primary endoscopic technique, however, has rarely been demonstrated. The authors present the case of a 31-year-old woman in whom endoscopic resection of a posterior third ventricular ependymoma was successfully accomplished. Metastatic workup yielded no sites of dissemination, adjuvant radiation therapy was deferred, and the patient has been without radiographic evidence of disease after 6 months of follow up. Endoscopic resection of solid tumors appears feasible in select patients and warrants further evaluation.

Hypofractionated adjuvant radiation therapy of soft tissue sarcoma in elderly patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e21521-e21521
Author(s):  
Ofer Merimsky ◽  
Viacheslav Soyfer ◽  
Benjamin W. Corn ◽  
Solomon Dadia ◽  
Yehuda Kollender
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Acute Toxicity ◽  
Elderly Patients ◽  
Metastatic Disease ◽  
Ambulatory Setting ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Local Recurrences

e21521 Background: Adjuvant radiation therapy is an essential part of combined limb sparing treatment of STS. The recommended dose of radiation lies in the range of 60 Gy in standard fractionation of 1.8-2 Gy. Elderly or medically unfit patients often have difficulty in completing 6-7w of daily treatment. A prolonged course of radiation may be interrupted by acute side effects, which sometimes demands further extension of the overall course or even discontinuation of treatment. We intended to evaluate the efficacy of a hypofractionated adjuvant approach with radiation therapy for STS in the elderly and debilitated patients. Methods: 21 elderly patients were treated with a short course of adjuvant RT (39 to 48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for the local or distant recurrence and side effects of RT. Results: Overall, the hypofractionated irradiation regimen of 39-48 Gy in 13-16 fractions was well tolerated with only 3 patients developing Grade 2-3 acute toxicity (mainly dermatitis). Three patients suffered from delayed Grade 2-3 toxicity (chronic pain, skin atrophy, teleangiectasiae) scaled according to CTSC. The mean time from the surgery until the initiation of RT was 65 days (SD 21.6). Mean RT time was 18.4 (SD 3) days. No delay of treatment due to acute toxicity was registered. All patients except for one were able to receive RT in the ambulatory setting. With a mean follow-up of 532 days (SD: 325), three local recurrences (14%) were detected. Three of eight patients with distant metastases died of sarcoma (graph 1). One patient with metastatic disease in the lung received salvage stereo tactic radiation therapy and was still alive 6 month after completion of SBRT with no evidence of disease. At a mean 532 days of follow up three local recurrences (14%) were detected .Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long term side effects. Conclusions: Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients.

Patterns of failure after radical cystectomy for pT3-4 bladder cancer: Implications for adjuvant radiation therapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 370-370
Author(s):  
Abhinav V. Reddy ◽  
Joseph J. Pariser ◽  
Shane M. Pearce ◽  
Ralph R. Weichselbaum ◽  
Norm D. Smith ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radiation Therapy ◽  
Radical Cystectomy ◽  
Multivariable Analysis ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Risk Patients ◽  
Pn Stage

370 Background: In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods: Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariable analysis for association with LF and overall survival. Results: 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 and median follow up was 11 months. On univariate analysis, margin status, pT stage, pN stage, and gender were all associated with LF (p < 0.05), however, on multivariable analysis, only pT and pN stage were significantly associated with LF (p < 0.01). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external/internal iliac LNs and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions: Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

scholarly journals Efficacy of Adjuvant Radiation Therapy in the Treatment of Soft Tissue Sarcoma of the Extremity: 20-year Follow-Up of a Randomized Prospective Trial

2014 ◽  
Vol 21 (8) ◽  
pp. 2484-2489 ◽  
Author(s):  
Joal D. Beane ◽  
James C. Yang ◽  
Donald White ◽  
Seth M. Steinberg ◽  
Steven A. Rosenberg ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Prospective Trial ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Randomized Prospective Trial

scholarly journals High rate of stroke and low rate of atrial fibrillation in low socioeconomic strata and blacks: the atrial fibrillation paradox

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.B Kostis ◽  
S Zinonos ◽  
J Cabrera ◽  
W.J Kostis
Keyword(s):  
Atrial Fibrillation ◽  
Low Socioeconomic Status ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
High Rate ◽  
Low Ses ◽  
Low Socioeconomic ◽  
Socioeconomic Strata ◽  
One Year

Abstract Background and introduction Persons living in areas of low socioeconomic status (SES) usually have higher rates of adverse cardiovascular events (CVE) including stroke. Also, atrial fibrillation (AF) is associated with higher rate of CVEs. One would expect that both the rate of stroke and the occurrence of AF would be higher in areas of low SES. Purpose and methods Using MIDAS, a validated statewide data base of all hospitalizations for cardiovascular disease in NJ with follow up of more than 25 years, we examined the rate of hospitalization for AF by SES in patients with history of myocardial infarction for the years 1995 to 2015 (n=258,339). Zip codes in New Jersey were aggregated into 4 categories representing quarters of the distribution of SES areas. Results At one-year follow-up, patients in the lowest SES (lowest 25th percentile) and Blacks were more likely to suffer a stroke (p&lt;0.0001). During one-year follow-up, patients in the lowest 25th percentile (Figure) were significantly less likely (p&lt;0.0001) to be readmitted with a diagnosis of AF. Blacks had lower rate of admission with a diagnosis AF compared to Whites (p&lt;0.0001) (Figure). Cox proportional hazards regression adjusting for demographics and co-morbidities confirmed the validity of these differences. In this analysis patients in the lowest SES quartile and Blacks were less likely to be admitted with AF than those in the highest quartile (HR 0.95, 95% CI 0.92–0.99). Also, Blacks were less likely to be admitted with AF than Whites (HR 0.76, 95% CI 0.71–0.82). This phenomenon (AF paradox) of lower incidence of AF in low SES and in Blacks has been attributed to under-ascertainment of AF in these groups, that may lead to underuse of anticoagulation and result in the occurrence of stroke. Conclusion Atrial fibrillation is underdiagnosed in patients at low socioeconomic strata and in Blacks and may lead to underuse of anticoagulation and the occurrence of stroke. Special efforts are warranted in detecting AF in these groups. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical characteristics and outcomes of null-cell versus silent gonadotroph adenomas in a series of 1166 pituitary adenomas from a single institution

2020 ◽  
Vol 48 (6) ◽  
pp. E13
Author(s):  
Alexander F. Haddad ◽  
Jacob S. Young ◽  
Taemin Oh ◽  
Matheus P. Pereira ◽  
Rushikesh S. Joshi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Clinical Outcomes ◽  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Adjuvant Radiation ◽  
Single Institution ◽  
Null Cell ◽  
Adjuvant Radiation Therapy ◽  
Patient Demographics

OBJECTIVENonfunctioning pituitary adenomas present without biochemical or clinical signs of hormone excess and are the second most common type of pituitary adenomas. The 2017 WHO classification scheme of pituitary adenomas differentiates null-cell adenomas (NCAs) and silent gonadotroph adenomas (SGAs). The present study sought to highlight the differences in patient characteristics and clinical outcomes between NCAs and SGAs.METHODSThe records of 1166 patients who underwent transsphenoidal surgery for pituitary adenoma between 2012 and 2019 at a single institution were retrospectively reviewed. Patient demographics and clinical outcomes were collected.RESULTSOf the overall pituitary adenoma cohort, 12.8% (n = 149) were SGAs and 9.2% (n = 107) NCAs. NCAs were significantly more common in female patients than SGAs (61.7% vs 26.8%, p < 0.001). There were no differences in patient demographics, initial tumor size, or perioperative and short-term clinical outcomes. There was no significant difference in the amount of follow-up between patients with NCAs and those with SGAs (33.8 months vs 29.1 months, p = 0.237). Patients with NCAs had significantly higher recurrence (p = 0.021), adjuvant radiation therapy usage (p = 0.002), and postoperative diabetes insipidus (p = 0.028). NCA pathology was independently associated with tumor recurrence (HR 3.64, 95% CI 1.07–12.30; p = 0.038), as were cavernous sinus invasion (HR 3.97, 95% CI 1.04–15.14; p = 0.043) and anteroposterior dimension of the tumor (HR 2.23, 95% CI 1.09–4.59; p = 0.030).CONCLUSIONSThis study supports the definition of NCAs and SGAs as separate subgroups of nonfunctioning pituitary adenomas, and it highlights significant differences in long-term clinical outcomes, including tumor recurrence and the associated need for adjuvant radiation therapy, as well as postoperative diabetes insipidus. The authors also provide insight into independent risk factors for these outcomes in the adenoma population studied, providing clinicians with additional predictors of patient outcomes. Follow-up studies will hopefully uncover mechanisms of biological aggressiveness in NCAs and associated molecular targets.

Adenoid Cystic Carcinoma of the Gingiva: A Case Report and Literature Review

2021 ◽  
pp. 000348942110555
Author(s):  
Gabriella T. Seo ◽  
Monica H. Xing ◽  
Neil Mundi ◽  
Ammar Matloob ◽  
Azita S. Khorsandi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Literature Review ◽  
Adenoid Cystic Carcinoma ◽  
Salivary Glands ◽  
Adjuvant Radiation ◽  
Minor Salivary Glands ◽  
Adjuvant Radiation Therapy ◽  
Adenoid Cystic ◽  
Left Mandible

Objectives: Adenoid cystic carcinoma (ACC) is a commonly encountered salivary gland malignancy. However, it rarely occurs in the gingiva, an area generally thought to be devoid of minor salivary glands. We present a case occurring in this unusual site and review other reported cases. Methods: A 56 year-old male presented with a right-sided mandibular toothache for 1 year and underwent dental extraction. Due to persistent pain, follow up examination revealed a large gingival lesion. A biopsy was positive for adenoid cystic carcinoma. Results: The patient underwent a complete right segmental mandibulectomy and was reconstructed with a fibular osteocutaneous free flap. Three months postoperatively, during the planning for adjuvant radiation therapy, the patient developed pain in the left mandible. Imaging revealed extensive involvement of the left native mandible. Deep bone biopsies in several areas of the left mandible revealed ACC. He then underwent a complete left hemi-mandibulectomy and reconstruction with a fibular osteocutaneous free flap. Tensor fascia lata suspension slings were placed due to concern for an open mouth deformity attributable to disruption of bilateral masticator slings. He will undergo adjuvant radiation therapy. Our review of the literature revealed 50 cases of gingival ACC published since 1972. Disease recurrence and distant metastases were noted in several patients, occurring at the latest after 30 years follow-up. Conclusions: Given its indolent behavior, high proclivity for late recurrence and metastasis, and overall infrequency, ACC represents a pathology that requires early diagnosis and comprehensive long-term surveillance. While ACC is well described in oral cavity sites with high densities of minor salivary glands, it is not commonly seen in the gingiva. As such, gingival ACC may display a unique biological and/or clinical character. We offer the first literature review of this rare entity.

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