scholarly journals Incidence and impact of stroke following surgery for low-grade gliomas

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Assaf Berger ◽  
Gali Tzarfati ◽  
Matias Costa ◽  
Marga Serafimova ◽  
Akiva Korn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Strong Predictor ◽  
Performance Status ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Motor Deficits ◽  
Low Grade ◽  
Neurocognitive Functions ◽  
Ischemic Complications ◽  
And Performance

OBJECTIVEIschemic complications are a common cause of neurological deficits following low-grade glioma (LGG) surgeries. In this study, the authors evaluated the incidence, risk factors, and long-term implications of intraoperative ischemic events.METHODSThe authors retrospectively evaluated patients who had undergone resection of an LGG between 2013 and 2017. Analysis included pre- and postoperative demographic, clinical, radiological, and anesthetic data, as well as intraoperative neurophysiology data, overall survival, and functional and neurocognitive outcomes.RESULTSAmong the 82 patients included in the study, postoperative diffusion-weighted imaging showed evidence of acute ischemic strokes in 19 patients (23%), 13 of whom (68%) developed new neurological deficits. Infarcts were more common in recurrent and insular surgeries (p < 0.05). Survival was similar between the patients with and without infarcts. Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced motor deficits (p = 0.024), decreasing to 16% (p = 0.082) and 37% (p = 0.024), respectively, at 1 year. Neurocognitive functions before and 3 months after surgery were generally stable for the two groups, with the exception of a decline in verbal rhyming ability among patients with infarcts. Confusion during awake craniotomy was a strong predictor of the occurrence of an ischemic stroke. Mean arterial pressure at the beginning of surgery was significantly lower in the infarct group.CONCLUSIONSRecurrent surgeries and insular tumor locations are risk factors for intraoperative strokes. Although they do not affect survival, these strokes negatively affect patient activity and performance status, mainly during the first 3 postoperative months, with gradual functional improvement over 1 year. Several intraoperative parameters may suggest the impending development of an infarct.

scholarly journals NCMP-05. THE INCIDENCE AND IMPACT OF POST-OPERATIVE STROKE IN SURGERY FOR LGG

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi180-vi180
Author(s):  
Asaf Berger ◽  
Garry Tzarfati ◽  
Mathias Costa ◽  
Marga Serafimova ◽  
Akiva Korn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Performance Status ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Motor Deficit ◽  
Low Grade ◽  
Post Surgery ◽  
One Year

Abstract BACKGROUND Postoperative neurological deficits may outweigh the benefit conferred by maximal resection of gliomas. We evaluated the incidence of ischemic events in patients undergoing surgery for low-grade gliomas (LGG) and the long-term neurological and cognitive sequelae. METHODS Between 2013–2017, 168 patients underwent surgical resection or biopsy for LGG at our center. A full dataset, including pre- and postoperative magnetic resonance imaging (MRI) and long-term clinical evaluation findings, was available for 82 patients (study group). Ischemic complications, overall and progression-free survival, and functional and neurocognitive outcomes were evaluated. RESULTS The immediate postoperative MRI revealed an acute ischemic stroke adjacent to the tumor resection cavity in 19 patients (23%), 13 of whom developed new neurological deficits due to the ischemic event. Infarcts were more common in patients with recurrent tumors, especially those involving the Sylvian fissure (p< 0.05). Surgery for insular gliomas had the strongest association with postoperative infarcts. Survival of patients w/wo a postoperative infarct was the same. The median Karnofsky-Performance Status was lower for the infarct group vs. the non-infarct group at 3 months post-surgery (p=0.016), with a gradual significant improvement for the former over one year (p=0.04). Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced a new motor deficit (p=0.037), decreasing to 16% (p=0.028) and 37% (p=0.001), respectively, at one year. Neurocognitive analysis findings before and 3 months after surgery were unchanged, but patients with an infarct had a significant decrease in naming (p=0.04). Confusion during awake craniotomy was a strong predictor of an ischemic stroke. CONCLUSIONS Intraoperative strokes are more prevalent among patients who undergo recurrent surgeries, especially in the insula. Although they do not affect survival, these strokes negatively impact the patients’ activity and performance status, especially during the first 3 postoperative months, with gradual functional improvement over one year.

scholarly journals P04.06 The incidence and impact of post-operative stroke in surgery for LGG

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii29-iii30
Author(s):  
A berger ◽  
G Tzarfati ◽  
M Costa ◽  
M Serafimova ◽  
A Korn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Performance Status ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Study Cohort ◽  
Low Grade ◽  
Ischemic Complications ◽  
One Year

Abstract BACKGROUND: INTRODUCTION Postoperative neurological deficits may outweigh the benefit conferred by maximal resection of gliomas. Ischemic complications are a common cause of such deficits. In this study, we evaluated the incidence of ischemic events in patients undergoing surgery for low-grade gliomas (LGG) and the long-term neurological and cognitive implications of those events. METHODS Between 2013–2017, 168 patients underwent surgical resection or biopsy for LGG at our center. A full dataset, including pre- and postoperative magnetic resonance imaging (MRI) and long-term clinical evaluation findings, was available in 82 patients that underwent resection, and they comprised our study cohort. We retrospectively analyzed pre- and postoperative demographic, clinical, radiological, anesthetic, and intraoperative neurophysiology data to characterize associated ischemic complications. Overall and progression-free survival, as well as functional and neurocognitive outcomes were evaluated as well. RESULTS The immediate postoperative MRI showed evidence of an acute ischemic stroke adjacent to the tumor resection cavity in 19 patients (23%), 13 of whom developed new neurological deficits as a result of the ischemic event. Infarcts were more common in patients undergoing surgery for a recurrent tumor, especially those involving the Sylvian fissure (p<0.05). Surgery for insular gliomas had the strongest association with postoperative infarcts (multivariate analysis: odds ratio =12.4, 95% confidence interval 2.21–69.8). There was no difference in survival between patients with or without a postoperative infarct. The median Karnofsky Performance Status was lower for the infarct group compared to the non-infarct group at 3 months after surgery (p=0.016), with a gradual significant improvement for the former over one year of follow-up (p=0.04). Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced a new motor deficit (p=0.037), decreasing to 16% (p=0.028) and 37% (p=0.001), respectively, at one year. Neurocognitive analysis findings before and 3 months after surgery were unchanged, but there was a significant decrease in naming in patients who experienced an infarct (NeuroTrax computerized battery score of 100±9 and 83±19, p=0.04 respectively). Confusion during awake craniotomy was a strong predictor of the occurrence of an ischemic stroke. CONCLUSIONS Intraoperative strokes are more prevalent among patients who undergo recurrent surgeries, especially procedures in the insula. Although they do not affect survival, these strokes negatively affect the patients’ activity and performance status, especially during the first 3 postoperative months, with gradual functional improvement over one year.

Preoperative neuropsychological and behavioral evaluation of children with thalamic tumors

2014 ◽  
Vol 13 (5) ◽  
pp. 507-513 ◽  
Author(s):  
Daniela Chieffo ◽  
Gianpiero Tamburrini ◽  
Massimo Caldarelli ◽  
Concezio Di Rocco
Keyword(s):  
Cognitive Processing ◽  
Right Hemisphere ◽  
Histological Finding ◽  
Neurological Deficits ◽  
Low Grade ◽  
Neuropsychological Evaluation ◽  
Thalamic Tumor ◽  
Significant Difference ◽  
And Performance ◽  
Thalamic Tumors

Object Functional involvement of the thalamus in cognitive processing has been only anecdotally reported in the literature, and these cases are mostly related to thalamic hemorrhages; there is no available information on cognitive development in children with thalamic tumors. Methods All children admitted with a diagnosis of thalamic tumor at the authors' institution between January 2008 and January 2011 were considered for the present study. Exclusion criteria were age less than 18 months and the presence of severe neurological deficits, both of which prevented a reliable neuropsychological evaluation. A complete preoperative neuropsychological evaluation was performed. Results Twenty children were selected (mean age 102.4 months). Total IQ was in the normal range in all patients (mean 90.1, SD 13.87) with a significant difference between verbal IQ (mean 97.70, SD 17.77) and performance IQ (mean 84.82, SD 17.01). A significant correlation was found between global cognitive impairment and a histological finding of low-grade tumors (p < 0.001). Children with a mesial thalamic tumor had a higher working memory deficit and delayed recall disorders (p < 0.001). Naming disorders were related to the presence of a bilateral (p < 0.001) or mesial (p < 0.001) thalamic tumor, without a significant difference between left or right hemisphere involvement. A significant correlation was also found between the presence of neurolinguistic disorders and mesially located tumors (p < 0.001). Children with right-sided tumors more frequently had constructional apraxia and executive function disorders (p < 0.001). Conclusions The present study suggests that thalamic tumors in different locations might have specific neuropsychological profiles.

scholarly journals Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Patients with Therapy-Related Myeloid Neoplasm: A Study from the Chronic Malignancies Working Party of the EBMT

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Marie Robin ◽  
Junfeng Wang ◽  
Linda Koster ◽  
Dietrich W. Beelen ◽  
Martin Bornhäuser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Solid Tumor ◽  
Research Funding ◽  
Performance Status ◽  
Primary Cancer ◽  
Research Support ◽  
Karnofsky Score ◽  
Adjusted Risk ◽  
And Performance

Patients with t-MN have a poor prognosis with median overall survival &lt; 1 year due to high risk features of the disease and refractoriness to chemotherapy. HSCT represents the only curative treatment. Outcome after HSCT has progressively improved over time with a last EBMT study showing a 2-year OS at 44% in patients with secondary leukemia (79% post MPN or MDS) (BBMT 2018: 1406). Previous large studies showed survival &lt; 30% in patients transplanted for t-MN (Blood. 2010:1850; Haematologica 2009:542). We recently reported in patients transplanted for a leukemia arising from MDS, MPN and CMML that the primary disease impacts the outcome, particularly patients with a previous MPN had the worst outcome (BJH, 2019: 725). We report here outcome of patients who received HSCT for a t-MN (excluding post MDS, MPN and CMML) with the hypothesis that the primary cancer impacts the outcome. From EBMT registry, patients with MDS or AML occurring after a primary cancer who received a HSCT between 01/06 and 12/16 were included. OS and RFS were analyzed using Kaplan Meier curves and log-rank test, relapse and NRM were analyzed as competing risks with cumulative incidence curves and Gray's test. 2334 patients were identified. Primary cancers were CLL in 102, non-Hodgkin lymphoma (NHL) in 668, Hodgkin lymphoma (HL) in 235, plasma cell disease (PCD) in 111, breast cancer in 643 and other solid tumor (ST) in 575. 981 patients had MDS and 1353 had AML at time of transplantation. Performance status by Karnofsky score was 90 or higher in 1376 (59%) patients. 722 (31%) patients were transplanted from HLA matched sibling donor (SIB) and 843 (36%) received a myelo-ablative conditioning regimen (MAC). 1307 patients were in remission at time of transplantation: 29% of MDS and 76% of AML patients. Three-year OS and RFS were 34 and 32% respectively. OS was significantly better in patients with AML in CR (43%) than not in CR (21%). OS and DFS were impacted by the primary cancer: post NHL (30 and 27%), post HL (29 and 28%), post ST (34% for both), post breast cancer (41 and 37%), post CLL (34 and 31%) and post PCD (32 and 25%) (p&lt;0.001). CR status at HSCT did not impact outcome in MDS patients (30%). Patients with normal cytogenetics (n=397) had a better OS than patients with abnormal cytogenetics (n=1036) (43% vs. 33%, p&lt;0.001). OS was significantly better using SIB (38% vs 32%, p=0.05) and in patients with better Karnofsky score (38 vs. 28%, p&lt;0.01). NRM was lower in patients with breast cancer (24% post breast cancer, 36% post NHL, 33% post HL, 29% post ST, 34% post CLL, 26% post PCD p&lt;0.001). NRM was higher after non SIB (34% vs 23%, p&lt;0.001) and after MAC (33 vs. 23%, p&lt;0.001). Relapse rate was higher after RIC (33 vs. 28%, p=0.014) but was not influenced by the primary type of cancer. The multiple variables models includes age, regimen intensity, donor type, Karnofsky score, t-MN category (AML in CR, AML not in CR, MDS) and the primary type of cancer. Patients with HL (HR: 1.36, p=0.005) or NHL (HR: 1.31, p=0.001) had a higher adjusted risk for OS than patients with other primary diseases. Other risk factors for OS were t-MN type (AML not in CR, HR: 1.45, AML in CR, HR: 0.76, MDS = reference, p&lt;0.001), type of donor (no SIB, HR: 1.20, p=0.004) and performance status (karnofsky &lt; 90, HR: 1.34, p&lt;0.001). Patients with HL (HR: 1.24, p=0.05) or NHL (HR: 1.21, p=0.01) had also a higher adjusted risk for DFS than patients with other diseases. Other risk factors for DFS were t-MN (AML not in CR, HR: 1.42, AML in CR: HR:0.76, p&lt;0.001) and performance status (HR: 1.24, p&lt;0.001). Adjusted post-HSCT t-MN relapse risk was not influenced by the primary cancer but was influenced by age (HR: 0.92, p=0.02), MAC (HR: 0.76, p=0.002), t-MN (AML not in CR, HR: 1.51, p&lt;0.001; AML in CR, HR:0.74, p=0.03) and performance status (HR: 1.28, p=0.002). NRM risk was significantly higher in patients with NHL (HR: 1.52, p&lt;0.001), HL (HR:1.58, p=0.007) and CLL (HR: 1.55, p=0.039) than in patients with primary solid tumor or PCD. Other risk factors for NRM were age (HR: 1.15, p=0.01), MAC (1.29, p=0.006), t-MN (AML in CR, HR: 0.76, p=0.005; AML not in CR, HR:1.29, p=0.05), performance status (HR: 1.22, p=0.03). Conclusion: A quarter to one third of patients with t-MN can be cured by HSCT which was influenced by type of t-MN and performance status. The type of primary cancer influenced also the outcome with lower mortality, especially NRM in patients with previous solid tumor or PCD as compared to patients with lymphoma. Disclosures Robin: Novartis Neovii: Research Funding. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria. Kroeger:DKMS: Research Funding; Neovii: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Riemser: Research Funding; JAZZ: Honoraria; Sanofi-Aventis: Honoraria; Novartis: Honoraria, Research Funding; Medac: Honoraria. Platzbecker:Celgene: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria. Finke:Riemser: Honoraria, Other: research support, Speakers Bureau; Neovii: Honoraria, Other: research support, Speakers Bureau; Medac: Honoraria, Other: research support, Speakers Bureau. Blaise:Pierre Fabre medicaments: Honoraria; Molmed: Consultancy, Honoraria; Sanofi: Honoraria; Jazz Pharmaceuticals: Honoraria. Chevallier:Daiichi Sankyo: Honoraria; Incyte: Consultancy, Honoraria; Jazz Pharmaceuticals: Honoraria.

scholarly journals Clinicopathologic Features and Early Surgical Outcome of Astrocytomas in Eldoret, Kenya

2018 ◽  
Vol 09 (03) ◽  
pp. 363-369
Author(s):  
Clifford C. Mwita ◽  
Florentius Koech ◽  
Titus Sisenda ◽  
Kirtika Patel ◽  
Benson Macharia ◽  
...  
Keyword(s):  
Functional Status ◽  
Tumor Size ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Neurological Deficits ◽  
Low Grade ◽  
Diffuse Astrocytoma ◽  
Short Term ◽  
Duration Of Illness ◽  
Mri Score

ABSTRACT Background: Astrocytomas are primary central nervous system tumors arising from astrocytes and accounting for up to 37.8% of all brain tumors seen in hospital-based studies from Africa. Despite being common, their patterns and short-term outcomes remain poorly studied in Kenya. Materials and Methods: A prospective, descriptive study involving consecutive patients with a histological diagnosis of astrocytoma seen in three hospitals located in Eldoret, Kenya. Clinicopathologic characteristics and outcomes were recorded and patients followed up for 12 weeks. Results: Thirty-one patients were recruited over a 1-year period. Majority of them were female (51.6%). Headache (83.9%) and focal neurological deficits (64.5%) were the most common presenting features. Among patients with high-grade tumors, mean duration of illness was 106.03 ± 162.16 days, median functional status was Karnofsky performance status (KPS) score 50, mean tumor size was 110.22 ± 46.16 cm3, and median magnetic resonance imaging (MRI) score was 17. Among patients with low-grade astrocytomas, mean duration of illness was 213.03 ± 344.93 days, median functional status was KPS score 40, mean tumor size was 53.49 ± 54.96 cm3 and median MRI score was 9. Glioblastoma multiforme (GBM) (71%) and diffuse astrocytoma (22.6%) were the predominant histological subtypes. The median Ki-67 proliferative index was 6% for pilocytic astrocytoma, 1.6% for diffuse astrocytoma, and 60% for GBM. Systemic and regional surgical complications occurred in 6.5% and 38.7% of patients, respectively. In-hospital mortality was 19.4% and increased to 25.8% at 12 weeks. The KPS score at discharge was 50 and improved to 60 at 12 weeks. Only 9.7% of patients had acceptable functional status at 12 weeks follow-up. Conclusions: In this locality, headache, focal neurological deficits, and reduced functional status are the most common presenting features of astrocytomas while GBM is the most common histological subtype. Tumors are highly proliferative and in the short-term, both surgical and functional outcome are suboptimal.

scholarly journals Recent Advances in the Treatment of Gliomas: The Multimodal Care Therapy

2021 ◽  
Vol 9 (B) ◽  
pp. 503-508
Author(s):  
Omar Ibrahim ◽  
Mohamed A. Hafez ◽  
Helmy Abdel Haleem ◽  
Hussein El Maghraby
Keyword(s):  
Surgical Resection ◽  
Surgical Complication ◽  
Strong Predictor ◽  
Performance Status ◽  
Tumor Resection ◽  
Low Grade ◽  
University Hospitals ◽  
Quality Of Data ◽  
Isocitrate Dehydrogenase 1 ◽  
Recent Advances

BACKGROUND: Glioblastoma (GBM) is the most devastating primary malignancy of the central nervous system in adults. At present, standard treatment consists of maximal safe surgical resection followed by radiotherapy (60 Gray) with concomitant daily temozolomide chemotherapy. Low-grade gliomas constitute approximately 15% of the nearly primary brain tumors diagnosed in adults each year. Extent of tumor resection has become a strong predictor of patient outcomes, alongside patient age, performance status, tumor histology, and molecular genetics (isocitrate dehydrogenase-1 and 1p/19q codeletion status). Over the past two decades, surgeons have emphasized the importance of maximizing extent of resection and its impact on overall survival, progression-free survival, and time to malignant transformation. AIM: We aimed to present recent advances in the treatment of gliomas. METHODS: This is a prospective analysis of 50 patients diagnosed with gliomas which are enrolled in a joint supervision between Kasr Al Aini Hospital, Cairo University, Egypt, and Coventry University Hospitals, England. RESULTS: The study included 50 patients, 31 males and 19 females, ages ranged from 21 to 75 years (mean age 47.5 years). Gross total resection was achieved in 28 patients (56%). The most common surgical complication in our series was post-operative transient weakness in 4 patients (8%). Mean true survival of low-grade glioma patients was 40.5 months while the mean true survival for anaplastic astrocytoma (Grade 3) patients was 38 months and that of GBM (Grade 4) patients was 18.8 months. CONCLUSION: Despite persistent limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade gliomas.

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

2021 ◽  
Author(s):  
Zonggang Hou ◽  
Zhenxing Huang ◽  
Zhenye Li ◽  
Gen Li ◽  
Yaokai Xu ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Diffusion Weighted Imaging ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Acute Ischemia ◽  
Critical Ischemia ◽  
Diffusion Weighted ◽  
Ischemic Complications

Abstract Insular gliomas remain surgically challenge due to their complex anatomical position and microvascular supply. The incidence of ischemic complications is a risk that should not be ignored. The goal of this study was to analyze the incidence of ischemia and its risk factors, and also describe a single surgeon's arteries protection experience of insular gliomas resection. The authors studied 75 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Analysis included pre- and postoperative demographic, clinical, radiological including diffusion weighted imaging (DWI), as well as intraoperative neurophysiology data, and functional outcomes. Strategies such as “Residual Triangle”, “Basal Ganglia Reconstruction” and “Sculpting Technique” were used to protect lateral lenticulostriate arteries and main branches of M2 for maximal tumor resection according to the different classification of Berger-Sinai. Postoperative diffusion-weighted imaging showed acute ischemia in 44 patients, only 9 of whom developed new motor deficits. Flat inner edge (OR 0.144 95% CI 0.024, 0.876), and motor evoked potentials (MEPs) (<50%) (OR 18.182, 95% CI 3.311, 100.00) were determined to have significant associations with postoperative Critical Ischemia, which located in the posterior limb of the internal capsule or corona radiata. For insular gliomas resection, the protection of main branches of MCA is important. Insular gliomas resection might be with high incidence of ischemia uncovered by DWI which not always result in neurological deficits. Their own strategies maybe the feasible technical nuances allow the surgeon to achieve a thorough and safe resection. Motor evoked potentials is essential for its resection.

The Joint Role of Comorbidity and Performance Status (PS) in Predicting Morbidity after Allogeneic Nonmyeloablative Hematopoietic Cell Transplantation (HCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 596-596 ◽  
Author(s):  
Mohamed Sorror ◽  
Barry Storer ◽  
Brenda M. Sandmaier ◽  
David G. Maloney ◽  
Michael Pulsipher ◽  
...  
Keyword(s):  
Hematopoietic Cell Transplantation ◽  
Disease Risk ◽  
Strong Predictor ◽  
Performance Status ◽  
Composite Index ◽  
Inverse Correlation ◽  
Risk Groups ◽  
Hematologic Malignancies ◽  
Total Body ◽  
And Performance

Abstract An HCT-specific comorbidity index (HCT-CI) was developed to capture comorbidities among patients (pt) given HCT. Here, we asked whether HCT-CI could provide information independent from current measures, notably PS. PS before and toxicities after HCT were prospectively graded per Karnofsky and Common Toxicity Criteria, respectively, while comorbidities were retrospectively evaluated per HCT-CI. Spearman rank was used to evaluate correlations. This study included pts (n=107) diagnosed with hematologic malignancies and conditioned with nonmyeloablative regimen of 2 Gy total body irradiation alone (15%) or with 90 mg/kg of fludarabine (85%) before related (44%) or unrelated HCT (56%). There were no exclusion criteria for HCT-CI scores but pts with PS of &lt;60% were excluded from HCT. Pretransplant parameters included age (median=56 years); prior regimens (median=4); interval between diagnosis and HCT (median=24.5 months); prior HCT (34%); low, standard, and high disease risks (10%, 63%, and 27%) as described (Kahl et al. Blood-2005).; PS scores (median=90% and range=60–100%); and HCT-CI scores (median=3 and range=0–7). After HCT, 44%, 9%, and 2% of pts developed grades II, III, and IV acute graft-versus-host disease (GVHD) and 24% and 15% developed overall grades III and IV toxicities of solid organs, respectively. There were no correlations between PS and age, prior regimens, interval before HCT, prior HCT, or disease risk. HCT-CI scores had weak correlations with prior regimens (r =0.16, p=0.09) and disease risk (p=0.03) and no correlations with age, interval before HCT, and prior HCT. Pts with high-risk disease and HCT-CI scores of 0–2 vs ≥3 had median prior regimens of 3 vs 5. There was inverse correlation between HCT-CI and PS scores (r = −0.32, p=&lt;0.001). Both higher HCT-CI and PS scores predicted increased incidences of grades II-IV acute GVHD and grades III-IV HCT-related toxicities while only HCT-CI scores predicted increased risks of 1-year NRM and worse survival (Table 1). Table 2 illustrates a composite scale combining the HCT-CI and PS scores and its relationship with short-term morbidity. We conclude that the HCT-CI and PS are only weakly correlated and therefore both should be assessed at HCT. HCT-CI was a strong predictor of morbidity and mortality, while PS predicted morbidity only. The consolidation of both scales could provide a refined stratification of risk groups for HCT-related morbidity. Larger pt cohorts are required to better define such risk groups. Table 1: Impacts of HCT-CI and PS scores on 1-year HCT outcomes HCT-CI scores PS scores 0–2 ≥3 p &gt;80% ≤80% p % % Grades II-IV GVHD 43 67 0.01 48 62 0.02 Grades III-IV toxicities 25 53 0.004 30 52 0.02 Grade IV toxicities 8 23 0.03 12 20 0.2 NRM 11 30 0.01 20 22 0.5 survival 84 50 0.0006 68 64 0.2 Table 2: Composite index of HCT-CI and PS scores Groups Grades II-IV GVHD Grades III-IV toxicities Grade IV toxicities % A HCT-CI=0–2 and PS=≥80% 37 20 6 B HCT-CI=0–2 and PS=&lt;80% 56 37 13 C HCT-CI=≥3 and PS=≥80% 64 44 20 D HCT-CI=≥3 and PS=&lt;80% 69 61 25 p 0.02 0.009 0.1

WP1-17 Risk factors and patterns of progression in a surgical cohort of low grade glioma patients

2019 ◽  
Vol 90 (3) ◽  
pp. e6.2-e6
Author(s):  
S Acharya ◽  
J Lavrador ◽  
R Visagan ◽  
V Narbad ◽  
J Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Neurosurgical Procedures ◽  
Volumetric Change ◽  
Who Grade ◽  
Adjusted Analysis

ObjectivesTo understand the risk factors for and patterns of progression of low grade glioma (LGG).DesignSingle centre retrospective cohort study.SubjectsPatients undergoing at least two neurosurgical procedures for LGG, the first being for diffuse LGG (WHO 2). 22 patients included (14M; 8F); mean age at time of first operation 37.7±2.7 years. 20 patients had a Performance Status (PS) 0–1 and 2 patients had a PS 2.MethodsAll patients with LGG diagnosed in between 2009–2018 were retrospectively evaluated. Variables of interest included demographics, staging, performance status, time to re-operation (TTR), extent of resection, molecular genetics (1p19q co-deletion, IDH status). Tumour volumes were estimated from MRI images by the validated ABC/2 equation. Statistical analyses were performed by Stata13.0.ResultsThe tumour progressed in WHO grade in 18 patients (WHO grade 3 (n=15); WHO grade 4 (n=3). Mean time to re-operation after the first surgery was 7.0±1.2 years following gross total resection (GTR) and 3.2±0.7 years following subtotal resection (STR). Non-adjusted analysis of risk factors for time to re-operation (TTR) showed absence of 1p19q co-deletion as a risk factor (p=0.021). Adjusted analysis revealed that GTR, 1p19q mutation, PS 0 at 1 st surgery and tumour volumetric change decrease the risk for re-intervention (p<0.05). Chemo-radiotherapy was not associated with TTR.ConclusionsIn our cohort, TTR in LGG was influenced by the amount of initial resection, 1p19q deletion, PS and post-operative volumetric change.

Pharmaceutical Care for Patients Undergoing S-1 Plus Cisplatin Therapy for Unresectable Recurrent Gastric Cancer

2013 ◽  
Vol 26 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Michio Kimura ◽  
Eiseki Usami ◽  
Tomoaki Yoshimura ◽  
Tadashi Yasuda ◽  
Yuji Kaneoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Adverse Events ◽  
Nutritional Support ◽  
Performance Status ◽  
Recurrent Gastric Cancer ◽  
Grade 3 ◽  
And Performance ◽  
Treatment Dosage ◽  
Cisplatin Therapy

We examined the adverse gastrointestinal events associated with tegafur/gimeracil/oteracil potassium (S-1) plus cisplatin therapy for unresectable recurrent gastric cancer and risk factors for discontinuing therapy due to adverse events. A total of 65 subjects who had received S-1 plus cisplatin therapy for gastric cancer at Ogaki Municipal Hospital were examined. We found that the risk factors for discontinuation of the therapy due to adverse events were serum albumin (Alb) level less than 3.5 g/dL (odds ratio [OR]: 321.14, P = .0015), creatinine clearance (CrCl) rate less than 78 mL/min (OR: 35.23, P = .0123), and performance status (PS) more than 1 (OR:12.62, P = .0243). Moreover, grade 3 or 4 nonhematological toxicities (including malaise and anorexia) were significantly higher in subjects with Alb less than 3.5 g/dL and CrCl less than 78 mL/min ( P < .01). In conclusion, we should pay attention to the safety and continuity of S-1 plus cisplatin therapy in cases where the Alb level is <3.5 g/dL, CrCl level is <78 mL/min, and PS level is >1. Pharmacists should consider reducing the treatment dosage and providing nutritional support in such cases.

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