Disease Progression-free Survival Rate Research Articles

The impact of metabolic health on non-alcoholic fatty liver disease (NAFLD). A single center experience

BackgroundThe role of patients’ metabolic clinical and biochemical profile in NAFLD has not been extensively explored. AimsThe aim of the study was to assess the role of metabolic health in NAFLD patients and to examine liver disease progression in these populations. MethodsThe medical charts of 569 patients diagnosed with fatty liver were thoroughly reviewed; 344 patients were excluded because of other chronic liver diseases. Metabolically healthy people were defined as those who met none of the following criteria: blood pressure ≥ 130/85 mmHg or under hypertension treatment, fasting glucose ≥ 100 mg/dl or under diabetes treatment, serum triglycerides > 150 mg/dl, high density lipoprotein-cholesterol <40/50 mg/dl for men/women. Study participants were followed-up over a median period of 22 months. ResultsThe present observational case-control study included 225 NAFLD patients; 14 (6.2%) were metabolically healthy. Metabolically healthy participants were younger (p = 0.006), had lower age at diagnosis (p = 0.002), lower levels of γ-GT (p = 0.013), fasting glucose (p <0.001) and triglycerides (p <0.001) and higher HDL-cholesterol (p = 0.005) compared to metabolically non-healthy. By the last follow up assessment, 8 metabolically healthy patients had developed dyslipidemia; 1 patient (14.4%) had presented liver disease progression compared to 8 patients (10.5%) from the unhealthy group (p = 0.567). In multivariate analysis, diabetes mellitus (p = 0.017) and hemoglobin levels (p = 0.009) were the sole independent predictors of disease progression. No significant difference was observed in liver disease progression-free survival rates among the two patient groups (p = 0.503). ConclusionsMetabolically healthy NAFLD patients presented with a favorable biochemical profile; however, they were diagnosed with NAFLD at a younger age and the liver disease progression risk was similar to that of metabolically unhealthy patients. These findings suggest that metabolically healthy NAFLD may not constitute a benign condition and patients could potentially be at increased risk of metabolic syndrome and liver disease progression.

Clinical efficacy of early postoperative intensity-modulated radiotherapy combined with Temozolomide chemotherapy in the treatment of patients with malignant glioma.

Objectives:To evaluate the clinical efficacy of early postoperative intensity-modulated radiotherapy (IMRT) combined with temozolomide chemotherapy in the treatment of patients with malignant glioma.Methods:In this retrospective cohort study 80 patients with glioma surgery admitted to Chengde Central Hospital from January 2019 to January 2021 were selected and divided into two groups according to postoperative treatment: the experimental group and the control group, with 40 cases in each group. Patients in the experimental group received IMRT combined with temozolomide chemotherapy postoperatively, while those in the control group received IMRT alone. The clinical effects of patients were analyzed before treatment and three months after treatment, and the incidence of adverse reactions such as bone marrow suppression, gastrointestinal reactions, fever, and liver dysfunction were analyzed in the two groups within one month after treatment. Before treatment and two months after treatment, MMSE scale, QOL scale and KPS were used to compare the cognitive function and health status of the patients. All patients were followed up for one year after treatment, and the difference of disease progression-free survival and overall survival rate between the two groups was analyzed.Results:The effective rate of the experimental group was 70% after treatment, while that of the control group was 43.3%, with a statistically significant difference (P=0.04). The incidence of adverse reactions was 50% in the experimental group and 40% in the control group, with no statistically significant difference between the two groups (P=0.25). After treatment, MMSE score, QOL score and KPS score of the experimental group were significantly improved compared with those of the control group, with statistically significant differences between the two groups (MMSE score, QOL, P=0.00; KPS, P=0.01). Moreover, the two groups of patients were followed up for one year after treatment. The disease progression-free survival rate of the experimental group was 70% and that of the control group was 47.5%, with a statistically significant difference (P=0.04), and the overall survival rate of the experimental group was significantly higher than that of the control group after treatment, with a statistically significant difference (P=0.03).Conclusion:Early postoperative IMRT combined with temozolomide chemotherapy is an effective treatment regimen for patients with malignant glioma, boasting a variety of advantages such as high efficiency, cognitive function, favorable recovery of health status, significantly improved progression-free survival rate and overall survival rate, and no significant increase in adverse reactions.

Is fractionated robotic stereotactic body radiosurgery optional salvage treatment for the re-irradiation of locally recurrent nasopharyngeal carcinoma?

Recurrent nasopharyngeal carcinoma (NPC) after previous radiation therapy is a significant problem. This study was to determine the potential benefits from re-irradiation by fractionated stereotactic body radiotherapy (FSRT) on survival benefits and effects of severe late toxicities. Between 2009 and 2018, treatment outcomes were evaluated retrospectively in 26 patients with locally recurrent NPC treated using FSRT with CyberKnife. Five patients who had metastatic disease and one who had second recurrence were excluded from the study, and the remaining 20 patients were analyzed. The median age was 52 years (range, 28-80 years); re-treatment T stage was as follows: 6 (30%) - T2, 5 (25%) - T3, and 9 (45%) - T4. The median time from initial RT to recurrence was 22 months (range, 8-159 months). The median re-irradiation FSRT dose was 30 Gy in 5 fractions. The median follow-up was 44 months; the overall survival (OS), local failure-free survival, and disease progression-free survival rates at 3 years were 89%, 73%, and 53%, respectively. All patients were evaluated for response after treatment: 9 (45%) had complete, 3 (15%) had partial, and 6 (30%) had no response. Univariate analysis demonstrated that higher cumulative total radiotherapy dose, gross tumor volume, and recurrent time interval were prognostic factors for local failure-free survival. The recurrent time interval was also an independent factor for progression-free survival and OS. The incidence of temporal lobe necrosis and trismus was 10% and 20%, respectively. One patient had Grade 5 toxicity to treatment-related bleeding. Tumor dose coverage is important for treating recurrent NPC, and treatment-related mortality was vascular in nature. FSRT is a promising treatment modality for recurrent NPC.

Stratifying risk for multiple, recurrent, and large (≥3 cm) Ta, G1/G2 tumors in non-muscle-invasive bladder cancer.

PurposeThe current stratification of risk groups regarding recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) is problematic. We aimed to assess the long-term outcome and risk of multiple, recurrent, and large (≥3 cm) Ta, G1/G2 tumors after transurethral resection of the bladder tumor (TURBT).Materials and MethodsWe categorized 1,621 patients with NMIBC who underwent TURBT into four risk groups according to the European Association of Urology (EAU) guidelines as follows: low-risk, intermediate-risk, high-risk, and study group. The overall, cancer-specific, disease recurrence-free, and disease progression-free survival rates were estimated by using the Kaplan–Meier method. Then, the impact of risk group was assessed by using a multivariable Cox regression model.ResultsThe study group comprised 52 patients (3.2%) within a mean follow-up of 64.8 months. The disease recurred and progressed in 41 (78.8%) and 7 (13.5%) patients, respectively. Among the four groups, the study group showed the highest risk for 10-year recurrence after TURBT. The disease progression risk in the study group was between that of the intermediate- and high-risk groups. Cancer-specific and all-cause deaths occurred in one and four patients in the study group, respectively. The study group had a higher risk for disease recurrence than did the high-risk group; however, it did not have a higher risk for disease progression than in the high-risk group.ConclusionsMultiple, recurrent, and large (≥3 cm) Ta, G1/G2 tumors carry a higher risk for disease recurrence, but not progression, than in the EAU high-risk group of NMIBC.

Reactive Oxygen Species Modulator 1 is Associated with Poor Survival in Patients with Non-Small Cell Lung Cancer After Stereotactic Fractionated Radiosurgery: A Retrospective Pilot Study.

PurposeIt has been reported that the overexpression of reactive oxygen species modulator 1 (Romo1) is significantly associated with poor survival outcomes in patients with lung cancer who received surgical resection, conventional fractionated radiotherapy, and chemotherapy. In this study, we investigated whether Romo1 expression is associated with survival outcomes in patients with early-stage lung cancer who were treated with radiosurgery.MethodsRomo1 protein expression was evaluated and scored in the tumor tissue specimens of 40 patients with non-small cell lung cancer by immunohistochemistry. An optimal cut-off for Romo1 expression was determined and used to allocate patients to low or high Romo1 expression groups. Survival outcomes were compared between the two groups.ResultsRomo1 expression was significantly associated with distant metastasis-free survival. The 1- and 2-year distant metastasis-free survival rates were 96.4% and 92.6% in the low Romo1 expression group and 87.5% and 46.7% in the high Romo1 expression group (P=0.041), respectively. The overall, local recurrence-free, regional recurrence-free, and disease progression-free survival rates were higher in the low Romo1 expression group than the high Romo1 expression group. However, the differences were not statistically significant.ConclusionRomo1 overexpression is associated with poor distant metastasis-free survival in patients with non-small cell lung cancer treated with radiosurgery. Further, large-scale prospective studies are required to identify the clinical efficacy of Romo1 as a potential adverse prognostic factor in lung cancer.

895P - The Role of Metabolic Tumor Volume and Total Lesion Glycolysis on 18F-Fdg Pet/Ct in the Prognosis of Epithelial Ovarian Cancer

ABSTRACT Aim: This study assessed the prognostic value of pre-operative 2-[18F] fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in patients with epithelial ovarian cancer. Methods: A total of 166 patients with epithelial ovarian cancer who underwent 18F-FDG PET/CT and subsequent cytoreductive surgery were retrospectively enrolled. Maximum standardized uptake value (SUVmax), MTV, and TLG on 18F-FDG PET/CT were measured for all patients. Univariate and multivariate analyses were performed to evaluate the prognostic significance of SUVmax, MTV, TLG, and clinicopathological factors for disease progression-free survival. Results: Disease progressed in 78 (47%) of the 166 patients, and the 2-year disease progression-free survival rate was 55.0%. Univariate analysis showed that tumor stage, histopathological type, presence of regional lymph node metastasis, residual tumor after cytoreductive surgery, pre-operative serum carbohydrate antigen 125 (CA125) level, SUVmax, MTV, and TLG were significant prognostic factors (p 100.0). Conclusions: Along with tumor stage, TLG is an independent prognostic factor for disease progression after cytoreductive surgery in patients with epithelial ovarian cancer. By combining tumor stage and TLG, one can further stratify the risk of disease progression for patients undergoing cytoreductive surgery. Disclosure: All authors have declared no conflicts of interest.

Salvage stereotactic body radiotherapy for locally recurrent uterine cervix cancer at the pelvic sidewall: Feasibility and complication.

To determine the feasibility of stereotactic body radiotherapy (SBRT) in patients with pelvic sidewall recurrence of uterine cervical cancer after radical hysterectomy or definitive radiotherapy. We retrospectively reviewed 23 patients with locally recurrent uterine cervical cancer limited to the pelvic sidewall who were treated with SBRT at our institution between January 2003 and May 2010. The SBRT dose ranged from 27 to 45 Gy (median, 39 Gy) in three fractions, and the fractional SBRT dose ranged from 9 to 15 Gy (median, 13 Gy). The 2-year overall survival, local progression-free survival and disease progression-free survival rates were 43%, 65% and 52%, respectively. Patients with small tumors (gross tumor volume <30 cm(3) ) had a significantly longer 2-year overall survival rate and 2-year local progression-free survival rate than did patients with large tumors (overall survival rate: 89% vs 12%; P = 0.0001 and local progression-free survival: 85% vs 0%; P = 0.0199). There were three cases (13%) of severe toxicities (rectovaginal fistula). Pelvic pain relief was achieved in all patients. In particular, 10 of 14 patients (71%) achieved analgesic (nonsteroidal anti-inflammatory drug or narcotic) reduction of 50% or more from baseline. SBRT is a feasible treatment option for women with pelvic sidewall tumors from recurrent uterine cervical cancer, especially for small recurrent tumors. However, SBRT should be used carefully in the treatment of large tumors, as the incidence of severe late toxicity increases with the size of the tumor.

The role of metabolic tumor volume and total lesion glycolysis on ¹⁸F-FDG PET/CT in the prognosis of epithelial ovarian cancer.

This study assessed the prognostic value of pre-operative 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in patients with epithelial ovarian cancer. A total of 175 patients with epithelial ovarian cancer who underwent (18) F-FDG PET/CT and subsequent cytoreductive surgery were retrospectively enrolled. Maximum standardized uptake value (SUVmax) on (18)F-FDG PET/CT was measured for all patients. Because nine patients showed low tumor-to-background uptake ratios, MTV and TLG were measured in 166 patients. Univariate and multivariate analyses were performed to evaluate the prognostic significance of SUVmax, MTV, TLG, and clinicopathological factors for disease progression-free survival. Disease progressed in 78 (44.6 %) of the 175 patients, and the 2-year disease progression-free survival rate was 57.5 %. Univariate analysis showed that tumor stage, histopathological type, presence of regional lymph node metastasis, residual tumor after cytoreductive surgery, pre-operative serum carbohydrate antigen 125 (CA125) level, SUVmax, MTV, and TLG were significant prognostic factors (p < 0.05). Among these variables, tumor stage (p = 0.0006) and TLG (p = 0.008) independently correlated with disease progression-free survival on multivariate analysis. The disease progression rate was only 2.3 % in stage I-II patients with low TLG (≤100.0), compared to 80.0 % in stage III-IV patients with high TLG (>100.0). Along with tumor stage, TLG is an independent prognostic factor for disease progression after cytoreductive surgery in patients with epithelial ovarian cancer. By combining tumor stage and TLG, one can further stratify the risk of disease progression for patients undergoing cytoreductive surgery.

Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.

PurposeTo report the results of stereotactic body radiotherapy (SBRT) for unresectable primary or recurrent cholangiocarcinoma.Materials and MethodsFrom January 2005 through August 2013, 58 patients with unresectable primary (n = 28) or recurrent (n = 30) cholangiocarcinoma treated by SBRT were retrospectively analyzed. The median prescribed dose was 45 Gy in 3 fractions (range, 15 to 60 Gy in 1-5 fractions). Patients were treated by SBRT only (n = 53) or EBRT + SBRT boost (n = 5). The median tumor volume was 40 mL (range, 5 to 1,287 mL).ResultsThe median follow-up duration was 10 months (range, 1 to 97 months). The 1-year, 2-year overall survival rates, and median survival were 45%, 20%, and 10 months, respectively. The median survival for primary group and recurrent group were 5 and 13 months, respectively. Local control rate at 1-year and 2-year were 85% and 72%, respectively. Disease progression-free survival rates at 1-year and 2-year were 26% and 23%, respectively. In univariate analysis, ECOG performance score (0-1 vs. 2-3), treatment volume (<50 vs. ≥50 mL), and pre-SBRT CEA level (<5 vs. ≥5 ng/mL) were significant in overall survival rate. In multivariate analysis, ECOG score (p = 0.037) and tumor volume (p = 0.030) were statistically significant. In the recurrent tumor group, patients with >12 months interval from surgery to recurrence showed statistically significant higher overall survival rate than those with ≤12 months (p = 0.026). Six patients (10%) experienced ≥grade 3 complications.ConclusionSBRT can be considered as an effective local modality for unresectable primary or recurrent cholangiocarcinoma.

Surgical Management of Subungual Melanoma

Optimal surgical management of subungual malignant melanoma (SMM) has been debated. Our tumor registry was reviewed for surgically treated cases of SMM from 1914 to 2010. Resection levels were compared with outcome. During a 96-year period, 124 cases of SMM were identified (65 men and 59 women). Mean age at diagnosis was 58 years. Mean length of symptoms before diagnosis was 2.2 years. Lesions occurred on the hand (n = 79) and foot (n = 45). The thumb (33.8%) and hallux (25.0%) were affected most. At diagnosis, most had local (83.9%) and regional nodal involvement (12.9%). Mean follow-up was 9.4 years.Mean Breslow depth was 3.1 mm. Amputations were most commonly performed on the thumb at the proximal phalanx or metacarpophalangeal joint (43.9%), and on the hallux at the proximal phalanx or metatarsophalangeal joint (69.0%).Disease progression occurred in 61 (49.2%) patients, and most commonly occurred as regional nodal (62.3%) and distant metastasis (42.6%). Disease progression-free survival rates at 5, 10, and 15 years were 57.1%, 49.9%, and 47.0%, respectively. Fifty-three patients died of melanoma-related causes. Disease-specific survival rates at 5, 10, and 15 years after surgery were 59.3%, 49.3%, and 45.2%. Overall survival rates at 5, 10, and 15 years were 60.5%, 43.8%, and 33.1%.In 116 patients who underwent amputation, resection level outcome analysis with univariate and multivariate analysis adjusting for tumor depth and clinical involvement demonstrated that level of resection was not significantly associated with progression-free, overall, or disease-specific survival. Diagnosis of subungual melanoma is often delayed and carries a poor prognosis. Conservative resections are warranted as resection level does not influence outcome when histologically free margins are obtained. Amputation through the proximal phalanx or the metatarsophalangeal joint is required in the hallux and toes. Fingers require resection through the distal interphalangeal joint. For the thumb, although resection through the interphalangeal joint proved adequate, secondary efforts should be directed toward maximizing function and quality of life. Function-preserving resections in the thumb with nail removal, partial distal phalanx resection, and volar flap reconstruction are easily performed and preserve length, maximize joint and sensory function, and improve cosmesis.

Influence of gender and age on the survival of patients with nasopharyngeal carcinoma

BackgroundThe prognostic value of gender and age in the survival of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) is unclear. Several studies have suggested a female advantage in the prognosis of solid tumors. We investigated the relationship between gender differences and disease outcome in NPC patients treated with IMRT in South China.MethodsA total of 299 patients with non-disseminated NPC were analyzed retrospectively. IMRT was delivered with a simultaneous modulated, accelerated radiotherapy boost technique at prescribed doses of 70 Gy/30 fractions/6 weeks to the primary tumor (GTVp) and positive neck nodes (GTVn), 60Gy (2.0 Gy/day) to the clinical target volume (CTV) and upper neck region and 54 Gy (1.8 Gy/day) to the clinically negative low neck. A median boost dose of 9.2 Gy (4–20 Gy) was administered to patients with persistent disease at the primary site.ResultsWith a median follow-up of 52 months, the male patients had a significantly unfavorable 5-year OS (70.7% compared to 94.1%, P < 0.001), DPFS (71.5% compared to 87.3%, P = 0.029) and DMFS (77.2% compared to 89.7%, P = 0.036) than the female patients. In patients younger than 45, the male patients had a poorer 5-year OS (66.8% compared to 91.2%, P = 0.008), DPFS (59.9% compared to 91.2%, P = 0.005) and DMFS (66.4% compared to 94.0%, P = 0.004) than the female patients. For patients older than 45, only the 5-year OS (72.2% compared to 96.0%, P = 0.001) was significantly different.ConclusionsGender and age are strong independent prognostic factors for NPC in this study. We are the first to report that younger male patients were more likely to have distant metastases and exhibited inferior overall survival and disease progression-free survival rates compared to other patients.

Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

Background/AimsThis study reports treatment outcomes after helical intensity-modulated radiotherapy (IMRT) in unresectable hepatocellular carcinoma (HCC) patients for whom transarterial chemoembolization (TACE) was considered ineffective or unsuitable.MethodsFrom January 2008 to December 2011, 22 unresectable HCC patients received helical IMRT. A daily dose of 1.8 to 4 Gy was delivered at five fractions per week to deliver a total dose of 30 to 60 Gy. The most-prescribed dose fractionation was a total dose of 50 to 57.5 Gy, with a daily dose of 2.3 to 2.5 Gy.ResultsIn the entire group, the objective response rate of the primary tumor was 72.7%. In the eight patients with portal vein thrombosis (PVT), the objective response rate of PVT was 50.0%. Median disease progression-free survival was 11.8 months, and the 1-year disease progression-free survival rate was 40.2%. The median overall survival was 14.4 months, and the 1- and 2-year overall survival rates were 86.4% and 69.1%, respectively. PVT and Child-Pugh classifications were significant prognostic factors for overall survival in multivariate analyses.ConclusionsHelical IMRT in patients with unresectable HCC resulted in high treatment response and survival rates. This study suggests helical IMRT is a practical treatment option for HCC patients in whom TACE is unsuitable or ineffective.

1814 SEVEN YEARS OF EXPERIENCE WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR PROSTATE CANCER: ADVANTAGES AND LIMITATIONS

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20121814 SEVEN YEARS OF EXPERIENCE WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR PROSTATE CANCER: ADVANTAGES AND LIMITATIONS Hyun Hwan Sung, Hyung Joon Kim, Bumsoo Park, Bong Hee Park, Sin-Woo Lee, Joong Seo Ahn, Jung Hun Kang, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han Yong Choi, and Hyun Moo Lee Hyun Hwan SungHyun Hwan Sung Seoul, Korea, Republic of More articles by this author , Hyung Joon KimHyung Joon Kim Seoul, Korea, Republic of More articles by this author , Bumsoo ParkBumsoo Park Seoul, Korea, Republic of More articles by this author , Bong Hee ParkBong Hee Park Seoul, Korea, Republic of More articles by this author , Sin-Woo LeeSin-Woo Lee Seoul, Korea, Republic of More articles by this author , Joong Seo AhnJoong Seo Ahn Seoul, Korea, Republic of More articles by this author , Jung Hun KangJung Hun Kang Seoul, Korea, Republic of More articles by this author , Byong Chang JeongByong Chang Jeong Seoul, Korea, Republic of More articles by this author , Seong Il SeoSeong Il Seo Seoul, Korea, Republic of More articles by this author , Seong Soo JeonSeong Soo Jeon Seoul, Korea, Republic of More articles by this author , Han Yong ChoiHan Yong Choi Seoul, Korea, Republic of More articles by this author , and Hyun Moo LeeHyun Moo Lee Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1880AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High-intensity focused ultrasound (HIFU) is one of the minimally invasive surgeries for prostate cancer. The aim of this study was to evaluate oncologic outcomes according to risk stratification as well as complication rates for patients with prostate cancer after treatment by high-intensity focused ultrasound (HIFU). METHODS From February 2004 to August 2010, we identified 157 patients with prostate cancer who underwent a single session of HIFU. BCR was defined as PSA nadir plus 1.2 ng/ml using the Stuttgart definition. Kaplan-Meier analysis was performed to evaluate BCR and disease progression survival according to the National Comprehensive Cancer Network stratification. Predictors for BCR and disease progression were identified using the Cox-proportional hazard method. Postoperative adverse events were recorded. RESULTS A total of 126 patients were included. The overall BCR rate was 59.5%, and median time to BCR was 13.8 months. The 5-year BCR-free survival rates of the low-, intermediate-, and high-risk groups were 66.3%, 40.2% and 21.0% (P = 0.001), respectively, and the 5-year disease progression-free survival rates were 73.5%, 46.0% and 29.2%, respectively (P = 0.008). Significant differences were also found according to the stratification by PSA nadir for BCR- and progression-free survival rates (P < 0.001 in both). Multivariate analysis showed that risk stratification, PSA nadir, and time to PSA nadir were significant predictors of BCR and disease progression. In the first 3 months post-op, 11 patients (8.7%) had complications. There were no patients who required blood transfusions or who had wound problems, stroke, deep vein thrombosis, or bowel dysfunction. At the last evaluation incontinence rate was 6.3%, and impotence rate was 73.7%. CONCLUSIONS A single session of HIFU treatment does not provide effective oncologic outcomes even in low risk patients with prostate cancer as well as in the intermediate or high risk groups. Therefore, patients selected to undergo HIFU treatment for prostate cancer must be very carefully chosen. On the other hand, HIFU treatment for prostate cancer had a very low rate of complications. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e733 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Hwan Sung Seoul, Korea, Republic of More articles by this author Hyung Joon Kim Seoul, Korea, Republic of More articles by this author Bumsoo Park Seoul, Korea, Republic of More articles by this author Bong Hee Park Seoul, Korea, Republic of More articles by this author Sin-Woo Lee Seoul, Korea, Republic of More articles by this author Joong Seo Ahn Seoul, Korea, Republic of More articles by this author Jung Hun Kang Seoul, Korea, Republic of More articles by this author Byong Chang Jeong Seoul, Korea, Republic of More articles by this author Seong Il Seo Seoul, Korea, Republic of More articles by this author Seong Soo Jeon Seoul, Korea, Republic of More articles by this author Han Yong Choi Seoul, Korea, Republic of More articles by this author Hyun Moo Lee Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Seven years of experience with high‐intensity focused ultrasound for prostate cancer: Advantages and limitations

The aim of this study was to evaluate oncologic outcomes and adverse events for patients with prostate cancer after treatment by high-intensity focused ultrasound (HIFU). Between February 2004 and August 2010, patients with prostate cancer who underwent HIFU treatment were reviewed about oncologic outcomes and complications. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) nadir plus 1.2 ng/ml. Kaplan-Meier analysis was performed to evaluate BCR- and disease progression-free survival according to risk stratification. Predictors for BCR and disease progression were identified using the Cox-proportional hazard method. The overall BCR rate was 59.5%, and median time to BCR was 13.8 months. The 5-year BCR-free survival rates of the low-, intermediate-, and high-risk groups were 66.3, 40.2, and 21.0% (P = 0.001), respectively, and the 5-year disease progression-free survival rates were 73.5, 46.0, and 29.2%, respectively (P = 0.008). Multivariate analysis showed that risk stratification, PSA nadir, and time to PSA nadir were significant predictors of BCR and disease progression. In the first 3 months post-op, 11 patients (8.7%) had complications. There were no patients who required blood transfusions or who had wound problems, stroke, deep vein thrombosis, or bowel dysfunction. HIFU treatment does not provide effective oncologic outcomes even in low risk patients with prostate cancer as well as in the intermediate or high risk groups. Therefore, patients selected to undergo HIFU treatment for prostate cancer must be very carefully chosen. On the other hand, HIFU treatment for prostate cancer had a very low rate of complications.

Oncological outcomes of surgery in very high risk pT3b prostate cancer

Background. The aim of the study was to present the oncologic outcomes and to determine the prognostic factors of overall (OS) and cancer-specific survival (CSS) as well as disease-progression-free survival (DPFS) after surgery for pT3b prostate cancer. Materials and methods. In 2002–2007, a pT3b stage after radical prostatectomy was detected in 56 patients. Patients were divided into groups according to the prostate-specific antigen (PSA) level (20 ng/ml), lymph nodes status (N0 vs. Nx vs. N1) and the Gleason score (6–7 vs. 8–10). The Kaplan–Meier analysis was used to calculate OS, CSS and DPFS. The Cox regression was used to identify the predictive factors of survival. Results. Five-year OS, CSS and DPFS rates were 75.1%, 79.6% and 79.3%, respectively. The survival was significantly different when comparing the Gleason 6–7 and 8–10 groups. The 5-year OS, CSS and DPFS were 91.2% vs. 48.6%, 97.1% vs. 51.1% and 93.8 vs. 51.1%, respectively. There was no difference in survival among the groups with a different PSA level. The OS and CSS but not DPFS were significantly different when comparing the N0 and N1 groups. The 5-year OS and CSS was 84.4% vs. 37.5% and 87.3% vs. 47.6%, respectively. The specimen Gleason score was a significant predictor of OS and CSS. The risk of death increased up to 4-fold when a Gleason score 8–10 was present at the final pathology. Conclusions. Radical prostatectomy may offer acceptable CSS, DPFS and OS rates in pT3b PCa. However, outcomes in patients with N1 and specimen Gleason ≥8 were significantly worse, suggesting the need of multimodality treatment in such cases. Keywords: prostate cancer, locally advanced, surgery, outcome

Expression of HAb18G is associated with tumor progression and prognosis of breast carcinoma

HAb18G is a recently identified hepatoma-associated antigen and its association with tumor growth, invasion, and angiogenesis has been studied in a variety of tumors. However, its role in the tumor progression of breast cancer has not been explored. HAb18G expression was examined by immunohistochemistry in pathological sections of 1,637 breast tissue samples and by in situ hybridization in 41 cases of invasive breast carcinomas (BC). While not detected in any cases of tumor-like conditions or benign tumors of breast, and only rarely in normal tissue (4.4%), HAb18G expression was gradually up-regulated from atypical ductal hyperplasia (27.3%), to ductal carcinoma-in situ (59.8%), and to BC (61.4%) (P<0.01). Its expression in BC was correlated positively with C-erbB-2 expression and histologic grade (P<0.001), and negatively with the expression of estrogen and progesterone receptors (P<0.001). Significant differences of expression were also identified among the subgroups of BC examined: in decreasing order from invasive micropapillary carcinoma, ductal carcinoma, lobular carcinoma, papillary carcinoma, medullary carcinoma, to mucinous adenocarcinoma (P=0.001), corresponding to their known clinical aggressiveness. In an expanded group of 186 BC patients with proper follow up, our previous findings were confirmed: HAb18G expression was significantly associated with local recurrence, distant metastasis and tumor mortality (P<0.01). We also demonstrated that up-regulated tumor expression of HAb18G was a significant predictor of reduced disease progression-free survival rate and a shorter overall survival, independent of systemic therapies. In conclusion, this study suggests that HAb18G expression is associated with BC progression and prognosis. Further evaluation of this new marker in breast cancer is indicated.

Snail and Cox-2 expressions are associated with WHO tumor grade and survival rate of patients with gliomas

The transcriptional factor Snail and enzyme cyclo-oxygenase-2 (Cox-2) are suggested to be important effectors of invasiveness and tumorigenesis in various tumors. Tumors of higher grade have the propensity for tumor cell migration and invasiveness. This study was performed in order to evaluate the association between Snail and Cox-2 expressions and their values as prognostic factors in various grades of glioma, Specimens of 56 patients with glioma were used in the study. Univariate analysis showed that WHO tumor grade, and expressions of Snail and Cox-2 were significant prognostic factors affecting overall and disease progression-free survival rates. In the multivariate analysis by Cox regression model, only WHO tumor grade was shown to be a significant independent prognostic factor of overall and progression-free survival rates. In conclusion, Snail and Cox-2 expressions were associated with WHO grade in gliomas and may be used as prognostic indicators.

Stereotactic Body Radiotherapy for Isolated Para-aortic Lymph Node Recurrence after Curative Resection in Gastric Cancer

The aim of this study was to investigate whether stereotactic body radiotherapy (SBRT) can salvage gastric cancer patients with para-aortic lymph node (PALN) recurrence. From January 2003 to December 2006, 7 patients were treated for isolated PALN recurrence from gastric cancer after curative resection. Follow up durations ranged from 19 to 33 months (median; 26 months), and SBRT doses from 45 Gy to 51 Gy (median 48 Gy) in 3 fractions. Disease progression-free and overall survivals and toxicities were recorded. Response to treatment was assessed by computed tomography. Final patient outcomes were as follows: 2 were alive without evidence of disease, 3 remained alive with disease, and 2 patients died of disease. Five of 7 patients showed complete response and 2 patients partial response between 3 and 11 months after SBRT. Three-year overall and disease progression-free survival rates post-SBRT were 43% and 29%, respectively. No severe complication was detected during follow-up. Selected patients with isolated PALN recurrence can be salvaged by SBRT without severe complications.

Myelomatous meningitis

The most frequent nervous system complications of multiple myeloma are peripheral neuropathy and epidural spinal cord compression. Myelomatous meningitis (MM) has been considered rare. The current study was performed to characterize the clinical presentation, treatment, and outcome of MM. The study was a case series of 14 patients with cerebrospinal fluid (CSF)-positive MM who were treated at a tertiary care university medical center. Fourteen patients with advanced multiple myeloma were treated with involved-field radiotherapy (to the brain in 5 patients and the spine in 6 patients) and intra-CSF chemotherapy (ventricular in 10 patients and lumbar in 4 patients). The best response to treatment included 6 partial responses and 8 patients with progressive disease. The median duration of response was 2.5 months (range, 0-6 months). Cause of death was progressive neurologic disease in 6 patients, combined systemic and neurologic disease in 6 patients, and systemic disease progression in 2 patients. MM is rare and morbid entity (6-month neurologic disease progression-free survival rate of 7%), and appears to be no more responsive to treatment than solid tumor carcinomatous meningitis.

2115: Isolated Lymph Node Metastasis From Colorectal Cancer Treated by Stereotactic Radiation Therapy

2115: Isolated Lymph Node Metastasis From Colorectal Cancer Treated by Stereotactic Radiation Therapy