Incidence Of Treatment-related Complications Research Articles

Cannabidiol protects C2C12 myotubes against cisplatin-induced atrophy by regulating oxidative stress.

Cancer and chemotherapy induce a severe loss of muscle mass (known as cachexia), which negatively impact cancer treatment and patient survival. The aim of the present study was to investigate whether cannabidiol (CBD) administration may potentially antagonize the effects of cisplatin in inducing muscle atrophy, using a model of myotubes in culture. Cisplatin treatment resulted in a reduction of myotube diameter (15.7 ± 0.3 vs. 22.2 ± 0.5 µm, P < 0.01) that was restored to control level with 5 µM CBD (20.1 ± 0.4 µM, P < 0.01). Protein homeostasis was severely altered with a ≈70% reduction in protein synthesis (P < 0.01) and a twofold increase in proteolysis (P < 0.05) in response to cisplatin. Both parameters were dose dependently restored by CBD cotreatment. Cisplatin treatment was associated with increased thiobarbituric acid reactive substances (TBARS) content (0.21 ± 0.03 to 0.48 ± 0.03 nmol/mg prot, P < 0.05), catalase activity (0.24 ± 0.01 vs. 0.13 ± 0.02 nmol/min/µg prot, P < 0.01), whereas CBD cotreatment normalized TBARS content to control values (0.22 ± 0.01 nmol/mg prot, P < 0.01) and reduced catalase activity (0.17 ± 0.01 nmol/min/µg prot, P < 0.05). These changes were associated with increased mRNA expression of GPX1, SOD1, SOD2, and CAT mRNA expression in response to cisplatin (P < 0.01), which was corrected by CBD cotreatment (P < 0.05). Finally, cisplatin treatment increased the mitochondrial protein content of NDUFB8, UQCRC2, COX4, and VDAC1 (involved in mitochondrial respiration and apoptosis), and CBD cotreatment restored their expression to control values. Altogether, our results demonstrated that CBD antagonize the cisplatin-induced C2C12 myotube atrophy and could be used as an adjuvant in the treatment of cancer cachexia to help maintain muscle mass and improve patient quality of life.NEW & NOTEWORTHY In an in vitro model, cisplatin treatment led to myotube atrophy associated with dysregulation of protein homeostasis and increased oxidative stress, resulting in increased apoptosis. Cotreatment with cannabidiol was able to prevent this phenotype by promoting protein homeostasis and reducing oxidative stress.

Shunt Dependence after Intraventricular Hemorrhage and Intraventricular Fibrinolysis with uPA versus rt-PA.

We compare the effect of urokinase (urokinase-type plasminogen activator [uPA]) versus alteplase (recombinant tissue plasminogen activator [rt-PA]) for intraventricular fibrinolysis (IVF) in patients with intraventricular hemorrhage (IVH) on ventriculoperitoneal shunt (VPS) dependence, functional outcome, and complications in the management of IVH. We retrospectively reviewed the patients admitted with IVH or intracerebral hemorrhage (ICH) with IVH within 7 years in three different departments and found 102 patients who met the inclusion criteria. The primary end points were VPS dependence and Glasgow outcome score (GOS) at 3 months. Secondary end points were rate of rebleeding under IVF and incidence of treatment-related complications. Patients were divided into three groups: group I comprised patients treated with external ventricular drain (EVD) and IVF with uPA; group II comprised patients treated with EVD and IVF with rt-PA; and group III comprised patients treated with EVD alone. In all, 9.8% patients needed VPS: 12.2% in group I and 15.0% in group II, with no statistically significant difference. VPS patients had higher values of the modified Graeb score (mGS), IVH score, and IVH volume. We saw a trend for a better outcome in group II, with six patients achieving a GOS of 4 or 5 after 3 months. The mortality rate was higher in groups I and III. We found no statistical difference in the complication rate between groups I and II. Logistic regression analysis revealed that higher mGS and age predicted worse prognosis concerning mortality. The risk for death rose by 7.8% for each year of age. Any additional mGS point increased the chances of death by 9.7%. Our data suggest that both uPA and rt-PA are safe and comparable regarding incidence of communicating hydrocephalus, and age and mGS are predictive for mortality.

Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case-matched comparison.

The efficacy and safety of internal carotid artery (ICA) embolization as a treatment strategy in recurrent nasopharyngeal carcinoma (rNPC) patients with tumors invading the ICA remain unclear. We enrolled all rNPC patients with tumors invading the ICA, who underwent salvage endoscopic surgery. Using propensity scores to adjust for specific potential prognostic factors, a well-balanced cohort of 42 patients with limited rNPC was formed by matching each patient who underwent ICA embolization (study group) with one who did not (control group). The survival rates and common treatment-related complications were compared between the 2 groups. The cohort included patients with the following tumor stages: rT2 (n=3), rT3 (n=24), and rT4 (n=15). During a median follow-up of 15 (range, 2-63) months, the 2-year overall survival and progression-free survival rates were significantly higher in the ICA embolization group than in the ICA nonembolization group (90.5%vs 53.3% and 71.3%vs 33.0%, respectively; and p=0.022 and p=0.006, respectively). In addition, the incidence of treatment-related complications, such as nasal obstruction, nasopharyngeal hemorrhage, and nasopharyngeal necrosis, was significantly lower in the ICA embolization group than in the nonembolization group (p=0.001, p=0.014, and p=0.038, respectively). The innovative application of ICA embolization in endoscopic surgery in patients with rNPC invading the ICA significantly improved patient survival and reduced the risk of treatment-related complications. Therefore, this may be a safe and effective method with the potential to improve outcomes in rNPC patients.

Nutritional Care in Patients with Head and Neck Cancer during Chemoradiotherapy (CRT) and Bioradiotherapy (BRT) Provides Better Compliance with the Treatment Plan.

Simple SummaryThe nutritional status of patients with head and neck cancer (HNC) during concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy, BRT) inevitably deteriorates during treatment. Malnutrition is responsible for increased treatment-related toxicity, an increased incidence of infectious complications, the risk of postponing or discontinuing therapy, reduced drug doses (platinum derivatives or cetuximab), deteriorating quality of life (QoL), worse outcome, and increased treatment costs. A nutritional care programme, which included prophylactic dietary counselling and early enteral nutrition, reduced the incidence of complications and prevented drug dose reduction and the deterioration of patients’ anthropometric and laboratory parameters. The study confirmed that nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit.The treatment of locally advanced head and neck cancer (HNC) is based on extensive resections followed by concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy; BRT). Malnutrition, which occurs in up to 60% of patients before treatment commencement, severely increases the risk of CRT/BRT drug dose reductions and the incidence of treatment-related adverse events. A prospective observational study was performed regarding the influence of nutritional care on nutritional status, compliance with the treatment’s planned regimen, and the incidence of treatment-related complications in patients with advanced HNC during CRT and BRT. The study population encompassed 153 patients compared with a retrospective control group of 72 patients treated before nutritional care was included in the standard of oncological care. Patients enrolled in the nutritional care programme received significantly higher doses of platinum derivatives or cetuximab than patients in the control group. A significant difference between the compared populations was observed in patients below 70 years of age (92.8% of the study population), after prior surgery, and with initial weight loss lower than 10%. Nutritional care reduced final weight loss and prevented a decline within the laboratory markers of nutritional status. Weight loss was comparable in both modes of treatment—CRT and BRT. The incidence of treatment-related complications was significantly higher in patients without nutritional support in the subgroups of patients under 70 years of age and after primary surgery. Nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit, defined as preventing down-dosing, weight loss, and the incidence of complications. Platinum derivatives and cetuximab had comparable influence on weight loss.

Clinicopathologic characteristics and treatment patterns of pelvic organ prolapse in South Korea.

IntroductionWe investigated the clinicopathologic features, method of treatment, and complications related to the conservative treatment and surgical treatment of patients with pelvic organ prolapse (POP).MethodsWe retrospectively analyzed 288 patients who were diagnosed with POP from January 2007 to December 2017. The patients were divided into two groups according to the treatment method (Group A received conservative treatment and Group B received surgical treatment). The patients' clinicopathologic characteristics, treatment method, and post-treatment complications were compared between groups A and B.ResultsOf the total 288 patients, 83 and 205 patients were assigned to Groups A and B, respectively. The most common symptom was a bearing-down sensation (n = 205, 71.2%), which was reported in 51 (61.4%) and 154 (75.1%) patients from Groups A and B, respectively. Among underlying diseases, hypertension was the most common in both groups (40 and 102 patients in Groups A and B, respectively). Overall, 205 patients underwent surgery, 23 underwent vaginal pessary, and 60 performed pelvic floor muscle exercises. The incidence of treatment-related complications was not significantly different between Groups A and B (13.3% vs. 17.6%, p = 0.37). Perioperative complications were noted in 20 (17.8%) patients and vault prolapse requiring subsequent surgery was noted in 16 (14.1%) patients.ConclusionAs surgical treatment is associated with recurrence and complications, conservative treatment methods can be initially considered for patients with POP. In this study, there was no difference in the incidence of complications between surgical and conservative treatments. Thus, if required, surgical treatment can be safely performed in patients with POP.

Efficacy of re-resection versus radiofrequency ablation for recurrent Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (HCC) after resection for primary HCC.

BackgroundWhether repeat surgical resection (RSR) or radiofrequency ablation (RFA) is a better option for recurrent hepatocellular carcinoma (HCC) after resection for primary HCC remains controversial. This study was to investigate the clinical efficacy of RSR versus RFA in the treatment of recurrent HCC at Barcelona Clinic Liver Cancer (BCLC) stage 0/A after resection of primary HCC.MethodsThe patients treated by RSR (n=57) or RFA (n=51) for recurrent BCLC stage 0/A HCC in the Affiliated Hospital of Nantong University and Third Affiliated Hospital of Second Military Medical University from January 2008 to March 2018 were included. The general condition, clinicopathological characteristics, and survival were analyzed, and the baseline features and long-term survival were compared between two groups.ResultsThe baseline characteristics were comparable between two groups. The 1-, 3-, and 5-year survival rates were 96.5%, 80.9%, and 60.6% in RSR group, respectively, and 96.1%, 76.8%, and 59.4% in RFA group, respectively (P=0.48). The 1-, 3-, and 5-year overall survival (OS) rates after treatment for recurrent HCC were 78.9%, 50.5%, and 29.7% in RSR group, respectively, and 80.3%, 50.9%, and 26.0% in RFA group, respectively (P=0.67). The 1-, 3-, and 5-year disease-free survival rates were 68.4%, 39.4%, and 26.6% in RSR group, respectively, and 62.8%, 32.8%, and 20.4% in RFA group, respectively (P=0.55). The incidence of treatment-related complications was significantly higher in the RSR than in the RFA group (42.11% vs. 11.76%, P<0.001). The median hospital stay was significantly shorter in the RFA than in the RSR group (3 vs. 9 days, P<0.001).ConclusionsRSR and RFA have similar survival benefits in the treatment of recurrent BCLC stage 0/A HCC. RFA is superior to RSR in terms of hospital stay and incidence of treatment-related complications.

Tinkering in the garage - tuning CARs for safety.

The adoptive transfer of T cells expressing a chimeric antigen receptor (CAR) is an effective therapy for patients with relapsed or refractory CD19+ B cell malignancies, but can cause life-threatening toxicities. Herein we discuss a recent study suggesting that alterations to the design of anti-CD19 CARs can reduce cytokine release and the incidence of treatment-related complications.

Efficacy of re-resection versus radiofrequency ablation for recurrent Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (HCC) after resection for primary HCC

Background: Whether repeat surgical resection (RSR) or radiofrequency ablation (RFA) is a better option for recurrent hepatocellular carcinoma (HCC) after resection for primary HCC remains controversial. This study was to investigate the clinical efficacy of RSR versus RFA in the treatment of recurrent HCC at Barcelona Clinic Liver Cancer (BCLC) stage 0/A after resection of primary HCC. Methods: The patients treated by RSR (n=57) or RFA (n=51) for recurrent BCLC stage 0/A HCC in the Affiliated Hospital of Nantong University and Third Affiliated Hospital of Second Military Medical University from January 2008 to March 2018 were included. The general condition, clinicopathological characteristics, and survival were analyzed, and the baseline features and long-term survival were compared between two groups. Results: The baseline characteristics were comparable between two groups. The 1-, 3-, and 5-year survival rates were 96.5%, 80.9%, and 60.6% in RSR group, respectively, and 96.1%, 76.8%, and 59.4% in RFA group, respectively (P=0.48). The 1-, 3-, and 5-year overall survival (OS) rates after treatment for recurrent HCC were 78.9%, 50.5%, and 29.7% in RSR group, respectively, and 80.3%, 50.9%, and 26.0% in RFA group, respectively (P=0.67). The 1-, 3-, and 5-year disease-free survival rates were 68.4%, 39.4%, and 26.6% in RSR group, respectively, and 62.8%, 32.8%, and 20.4% in RFA group, respectively (P=0.55). The incidence of treatment-related complications was significantly higher in the RSR than in the RFA group (42.11% vs . 11.76%, P vs . 9 days, P Conclusions: RSR and RFA have similar survival benefits in the treatment of recurrent BCLC stage 0/A HCC. RFA is superior to RSR in terms of hospital stay and incidence of treatment-related complications.

Prognostic Value of the Cycle Number of Perioperative Chemotherapy in Locoregionally Advanced Rectal Cancer: a Propensity Score Matching Analysis.

Background: Appropriate cycle number of perioperative chemotherapy for patients with locoregionally advanced rectal cancer (LARC) remains unknown. This study aimed to evaluate how cycle number of perioperative chemotherapy influenced the prognosis of LARC patients.Methodology / Principal Findings: In this study, a total of 388 consecutive patients were enrolled and retrospectively reviewed if they were diagnosed with untreated stage cII-III LARC and treated with neoadjuvant chemoradiotherapy plus radical surgery followed by adjuvant chemotherapy or not. After grouping by the postoperative pathologic stage (yp0-I vs. ypII-III), propensity score matching was performed in each group to balance baseline characteristics between the patients treated with chemotherapy cycle ≤ 7 and those treated with chemotherapy cycle ≥ 8. The chemotherapy cycle was analyzed for its association with the survivals of the matched patients in the 2 groups, respectively. And the incidence of treatment-related complications was also compared. Through analysis, chemotherapy cycle ≥ 8 appeared to predict better overall, disease-free and distant-metastasis-free survivals in the whole cohort of matched patients (P values were 0.003, 0.002 and 0.004, respectively) and the ypII-III group (P values were 0.006, 0.005 and 0.014, respectively). But in the yp0-I group, chemotherapy of 8 cycles or more brought no improvement of survivals but only more acute toxicities (83.5% vs. 57.0%, P < 0.001).Conclusions / Significance: Chemotherapy cycle ≥ 8 was proven associated with improved prognosis of LARC patients, especially those with ypII-III disease. But prolonged chemotherapy should be performed with caution in patients with yp0-I stage.

Exercise promotes bone marrow cell survival and recipient reconstitution post-bone marrow transplantation, which is associated with increased survival

Bone marrow transplantation (BMT) is associated with a high risk of mortality, partially because of the harmful effects of the preconditioning myeloablative regimens. We have recently demonstrated increased bone marrow cell survival and proliferation in response to exercise training, which may be attributable to increased quality of the niche. The purpose of the present study was to determine the extent to which exercise preconditioning of recipients could increase the success of BMT. Recipient mice remained sedentary (SED) or were exercise-trained (EX) on a treadmill (3 d/wk for 8 weeks) before reconstitution with green fluorescent protein (GFP)-labeled donor marrow. Recipient survival, both donor-derived and total (donor- and recipient-derived) blood reconstitution were measured by flow cytometry. The first and fourth day after BMT apoptosis, cellularity and donor cell homing were determined in the recipients' bone marrow cavity by flow cytometry. Whereas only 25% of SED mice survived, 82% of EX recipients survived the BMT. Homing of donor-derived marrow cells to the recipients' marrow cavity acutely after BMT was not altered in EX, but EX mice displayed decreased levels (10%; p < 0.05) of activated caspase-3/-7 one day after BMT, leading to a maintenance of marrow cellularity in mice preconditioned with exercise. The acute inhibition of marrow cell apoptosis in EX mice resulted in increased total blood cell reconstitution at 1 and 3.5 months after BMT in EX mice (42% and 43%, respectively; both p < 0.05). Short- and long-term donor-derived engraftment was not different between EX and SED recipients. Exercise training increases recipient survival after BMT with increased total blood cell reconstitution.

Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma

This study was undertaken to measure survival of patients with multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy through a multi-institutional collaboration. A multi-institutional data registry, established by the Peritoneal Surface Oncology Group, was used to identify patients with peritoneal mesothelioma and the subgroup with multicystic tumours, treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Outcomes for this subgroup are reported. The primary endpoint was overall survival. A secondary endpoint was the incidence of treatment-related complications. Of 405 patients with peritoneal mesothelioma, 26 (6·4 per cent) had multicystic tumours. There were 20 women and six men with a mean(s.d.) age of 42(12) years. The median peritoneal carcinomatosis index (PCI) was 14 (range 6-39). There was no perioperative mortality. Six patients developed grade III or IV complications. After a median follow-up of 54 (range 5-129) months, all 26 patients were still alive. Multicystic peritoneal mesothelioma appears to be a distinct subtype of peritoneal mesothelioma, where long-term survival may be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Definitive radiotherapy in the management of paragangliomas arising in the head and neck: A 35‐year experience

An evaluation of the treatment results for 104 patients with 121 paragangliomas of the temporal bone, carotid body, and/or glomus vagale who were treated with radiation therapy (RT) at the University of Florida between 1968 and 2004. Eighty-nine paragangliomas (86%) were treated with conventional megavoltage techniques, 15 (14%) patients with stereotactic fractionated radiation therapy, 6 (6%) patients with stereotactic radiosurgery (SRS), and 11 (11%) patients with intensity-modulated radiation therapy (IMRT). There were 6 local recurrences. One recurrence was salvaged with additional RT. The actuarial local control and cause-specific survival rates at 10 years were 94% and 95%. The overall local control rate for all 121 lesions was 95%; the ultimate local control rate was 96%. The incidence of treatment-related complications was low. Fractionated RT offers a high probability of tumor control with minimal risks for patients with paragangliomas of the temporal bone and neck.

Clinical Outcome and Ischemic Complication after Treatment of Anterior Choroidal Artery Aneurysm: Comparison between Surgical Clipping and Endovascular Coiling

Although coiling has been favorably comparable with clipping for treatment of most intracranial aneurysms, there is a controversy on which modality is safer for anterior choroidal artery (AchoA) aneurysm. We retrospectively evaluated the clinical outcomes and treatment-related complications after surgical clipping and endovascular coiling of AchoA aneurysms. Seventy-three AchoA aneurysms were recruited from 1895 intracranial aneurysms, which were treated either by surgical clipping or by endovascular coiling in 4 institutions between May 1999 and December 2006. The AchoA aneurysms were dichotomized according to the modality of treatment, the coil group (37 patients; 38 aneurysms) and the clip group (35 patients; 35 aneurysms). Clinical outcomes and incidence of treatment-related complications between 2 groups and the factors influencing the clinical outcomes were evaluated. There was no rebleeding in both groups during follow-up, for 4-72 months (mean, 27 months) in the coil group and for 3-84 months (mean, 34 months) in the clip group. In the coil group, 31 patients (83.8%) had favorable outcome (modified Rankin Scale score [mRS], 0-3). In the clip group, 31 patients (88.6%) had favorable outcome. The complication of coiling was transient contralateral hemiparesis in 2 patients, who recovered completely. The complications of clipping were permanent contralateral hemiparesis due to AchoA infarction in 4 patients and third-nerve palsy in 1 patient. Hunt and Hess grade 4 or 5 and AchoA infarction were significantly correlated with poor outcome (mRS, < or =4). Clipping had significantly higher incidence of AchoA infarction than coiling (P < .05). Coiling of AchoA aneurysms appears comparable with clipping in clinical outcome and prevention of rebleeding, with significantly lower incidence of AchoA infarction than clipping.

Cooling Prevents Induction of Corneal Damage by Argon Laser Peripheral Iridotomy

There are many reports of corneal complications caused by argon laser peripheral iridotomy. In this study, we investigated whether cooling the anterior ocular segment during laser iridotomy prevented corneal damage. A space for cooling the anterior ocular segment by perfusion with ice-cold water was made between the cornea and a contact lens. Dutch pigmented rabbits were excessively irradiated by an argon green laser, aiming at the peripheral iris. We used a contact lens without a cooling system as a control. Temperature in the anterior chamber and intraocular pressure were also monitored throughout the experiment. During laser treatment, the temperature without the cooling system rose to a maximum of 44.5 degrees C in the anterior chamber, whereas use of the cooling system consistently kept this temperature at 11.1 degrees -16.1 degrees C. Although most eyes treated without cooling showed corneal damage, damage was seen in only a few or in no eyes cooled during laser treatment. Argon laser treatment using contact lenses with a cooling system drastically reduced the corneal damage induced by argon laser peripheral iridotomy. This technique may be acceptable for clinical use, considering its technical simplicity and low incidence of treatment-related complications.

The role of stem cell transplantation in the management of Non-Hodgkin's lymphoma

The role of stem cell transplantation has markedly improved the clinical outcomes of patients with aggressive and relapsed Non-Hodgkin's lymphoma (NHL), and has now become the treatment of choice. This paper examines the evidence which is resulting in the changing trends in the management of NHL, in the use of stem cell transplantation. Autologous bone marrow transplantation has been much favoured due to the reduced incidence of treatment related complications. Although allogeneic transplants have had equal success, its use has been hampered by the increasing difficulty in finding suitably matched donors. The use of peripheral blood stem cells continues to increase, although further research is required to improve the effects of priming and purging methods used in order to reduce the risk of myelodysplastic syndrome.

Similar Outcome of Non-Myeloablative and Myeloablative Allogeneic Hematopoietic Cell Transplantation for Patients Greater Than Fifty Years of Age.

Advanced age is a relative contraindication to myeloablative allogeneic transplantation due to the increased incidence of treatment related complications seen in older patients. Therefore, non-myeloablative stem cell transplantation (NST) is increasingly utilized in this population. The impact of the shift from myeloablative to NST upon relapse, transplant complications, and outcome has yet to be examined. We performed a retrospective analysis of 152 patients older than age 50 receiving either NST or myeloablative transplantation over a 5 years period. The decision to pursue non-myeloablative as opposed to myeloablative conditioning during this period was based on patient and physician preference. Seventy-one patients received non-myeloablative conditioning, fludarabine (30 mg/m2/day x 4) and intravenous busulfan (0.8 mg/kg/d x 4). Eighty-one patients received myeloablative conditioning, primarily cyclophosphamide and TBI. All patients received pharmacologic prophylaxis to prevent GVHD with the majority of patients receiving FK 506 and methotrexate in both groups (78% NST, 96% myeloablative) with the remainder receiving cyclosporine and prednisone. 93% of NST patients received mobilized PBSC, the median CD34+ cell count infused was 6.4 x 106 CD34+ cells/kg (range 1.0 to 31.0 x 106 CD34+ cells/kg). 80% of myeloablative patients received marrow. The median age was 58 (range 51–70) years for patients receiving NST and 54 (range 51–66) years for patients receiving myeloablative transplantation. Major disease groups included acute leukemia and MDS (51% NST, 41% myeloblative). Ten percent of non-myeloablative transplant patients were in CR1 or had early stage disease at transplantation compared with 40% of myeloablative transplant patients. Primary indications for NST were advanced age (56%) and prior myeloablative transplant (24%). The median follow-up is 18 months (range 6 to 34 months) for patients receiving non-myeloablative transplantation and 46 months (range 3 to 73 months) for patients receiving myeloablative transplantation. NST patients were more likely to have unrelated donors (58% vs. 36%, p=0.009), prior transplant (25% vs. 4%, p=<0.0001), and active disease at transplantation (85% vs. 59%, p=<0.001). Despite the adverse characteristics, overall survival was improved in the NST group at 1 (51% vs. 39%) and 2 (39% vs. 29%) years (p = 0.056). There was no difference in progression free survival (2 year, 27% vs. 25%, p =0.24). Incidence of 2–4 GVHD was similar, (28% vs. 27%). Non-relapse mortality was lower for NST patients (32% vs. 50%, p=0.01), but relapse was higher (46% vs. 30%, p=0.052). A subset analysis was performed assessing overall and progression free survival in patients with advanced leukemia (beyond CR1) and advanced MDS. This demonstrated marginally improved overall survival and progression free survival for patients receiving NST. Our experience suggests that, in patients over age 50, NST with fludarabine and low dose busulfan leads to an overall outcome at least as good as myeloablative therapy.

Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagale.

To evaluate the results of treatment for 71 patients with 80 chemodectomas of the temporal bone, carotid body, or glomus vagale who were treated with radiation therapy (RT) alone (72 tumors in 71 patients) or subtotal resection and RT (8 tumors) at the University of Florida between 1968 and 1998. Sixty-six lesions were previously untreated, whereas 14 had undergone prior treatment (surgery, 11 lesions; RT, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All three patients who received prior RT had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 66 patients (93%); 5 years, 53 patients (75%); 10 years, 37 patients (52%); 15 years, 29 patients (41%); 20 years, 18 patients (25%); 25 years, 12 patients (17%); and 30 years, 4 patients (6%). There were five local recurrences at 2.6 years, 4.6 years, 5.3 years, 8.3 years, and 18.8 years, respectively. Four were in glomus jugulare tumors and one was a carotid body tumor. Two of the four patients with glomus jugulare failures were salvaged, one with stereotactic radiosurgery and one with surgery and postoperative RT at another institution. Two of the five recurrences had been treated previously at other institutions with RT and/or surgery. Treatment for a third recurrence was discontinued, against medical advice, before receiving the prescribed dose. There were, therefore, only 2 failures in 65 previously untreated lesions receiving the prescribed course of RT. The overall crude local control rate for all 80 lesions was 94%, with an ultimate local control rate of 96% after salvage treatment. The incidence of treatment-related complications was low. Irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone and neck. There were no severe treatment complications.

Effects of Aerobic Exercise on the Physical Performance and Incidence of Treatment-Related Complications After High-Dose Chemotherapy

AbstractLoss of physical performance is a universal problem of cancer patients undergoing chemotherapy. We postulated that this impairment can be partially prevented by aerobic exercise. In a randomized study, 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group, T) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization. Patients in the control group (C, n = 37) did not train. Maximal physical performance was assessed with a treadmill test by admission and discharge. Physical performance of the two groups was not different on admission. The decrement in performance during hospitalization was 27% greater in the control group than in the training group (P = .05); this resulted in a significantly higher maximal physical performance at discharge in the trained patients (P = .04). Duration of neutropenia (P = .01) and thrombopenia (P = .06), severity of diarrhea (P = .04), severity of pain (P = .01), and duration of hospitalization (P = .03) were reduced in the training group. We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance. Based on the potential significance of the observed outcomes, further studies are warranted to confirm our results.

Long-Term Outcome of High-Dose Cytarabine-Based Consolidation Chemotherapy for Older Patients with Acute Myelogenous Leukemia

Despite reports of improved response and leukemia-free survival for adults with acute myelogenous leukemia, advanced age remains a significant adverse prognostic factor for both response to induction therapy and prolonged leukemia-free survival. In addition to a high incidence of treatment-related complications, older patients may have other disease characteristics which predict for brief remission duration despite intensive consolidation chemotherapy. We analyzed the long-term results of high-dose cytarabine-anthracycline consolidation chemotherapy in older patients and examined the effect of major prognostic factors including a history of myelodysplasia, increased age, and cytogenetics. One hundred and ten patients age ± 60 with newly diagnosed acute myelogenous leukemia were enrolled on three sequential studies conducted from 1982 to 1996. Fifty-six patients (51%) achieved a complete remission and were eligible for high-dose cytarabine-based consolidation chemotherapy administered in two to three courses.After a median follow-up of surviving patients for seventeen months, twelve patients remain alive with eleven in continued remission. Median remission duration for all eligible patients is nine months and the actuarial leukemia-free survival is 14 ± 10%. Toxicity of consolidation therapy included treatment-related death in six patients and serious neurotoxicity in five. When compared to younger patients, patients over age 60 sustained a much higher risk of relapse despite successfully completing intensive consolidation therapy, regardless of whether other adverse prognostic features were present.Advanced age in acute myelogenous leukemia is associated with a significantly higher risk of relapse unmodified by the presence or absence of other adverse disease characteristics. Although older patients tolerated intensive therapy designed to address the high risk of relapse, there was no apparent benefit of high-dose cytarabine consolidation alone as post-remission treatment for acute myelogenous leukemia in this population.

Radiotherapy in the Management of Temporal Bone Chemodectoma

Forty patients with 42 temporal bone chemodectomas were treated with radiotherapy alone (37 tumors) or subtotal resection and irradiation (5 tumors) at the University of Florida between 1968 and 1992. Thirty-three lesions were previously untreated, whereas 9 had undergone prior treatment (surgery, 6 lesions; radiotherapy, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All 3 patients who received prior radiotherapy had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 40 patients (100%); 5 years, 31 patients (78%); 10 years, 21 patients (53%); 15 years, 16 patients (40%); 20 years, 9 patients (23%); and 25 years, 2 patients (5%). The local control rate at 20 years, calculated by the Kaplan-Meier product-limit method for the overall group of 42 lesions, was 89%. The likelihood of cause-specific survival at 20 years was 94%. The incidence of treatment-related complications was acceptable. We conclude that irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone.