National Cancer Institute Experience Research Articles

Treatment Outcome and Prognostic Factors for Pediatric Medulloblastoma Patients: The Egyptian National Cancer Institute Experience

Purpose: To evaluate treatment outcomes and prognostic factors of pediatric Medulloblastoma (MB) patients treated by adjuvant post-operative riskadapted radiotherapy (RT) and chemotherapy (CT). Patients and Methods: A retrospective analysis was conducted based on medical records of pediatric patients with pathologically confirmed MB treated between 2006 and 2013 at the National cancer Institute (NCI), Egypt. Various patients’ and disease characteristics, treatment details and outcome data were reviewed. Results: Fifty patients’ records were included in the analysis with a median age of 6 years at diagnosis (range 3 - 18). According to the Chang staging system; 38%, 44%, 4%, and 14% were M0, M1, M2, and M3, respectively. All patients underwent primary surgery; gross total resection (with no residual) in 38%, near total resection (with residual ≤1.5 cm2) in 8%, subtotal resection (with residual > 1.5 cm2) in 34%, and 20% had only biopsy. All patients were treated by riskadapted craniospinal irradiation (CSI); high-risk patients were treated by CSI 36 Gy/20 fractions over 4 weeks followed by posterior fossa (PF) boost 18 Gy/10 fractions over 2 weeks (180 cGy per fraction), while standard-risk patients were treated by CSI 23.4 Gy/13 fractions over 2 and half weeks followed by PF boost 30.6 Gy/17 fractions over 3 and half weeks. Median overall treatment time (OTT) was 52 days. All patients received adjuvant CT; 47 patients (94%) received concomitant chemo radiotherapy (CCRT), while 4 patients (8%) only received neoadjuvant CT (NB: only one patient received all neoadjuvant, concomitant and adjuvant CT). With a median follow up time of 32.5 months, ranging from 6 to 104 months, the whole group estimates of the overall survival (OS) at 1, 3, and 5 years were 83%, 70%, and 64%, respectively, while, the progression-free survival (PFS) rates at 1, 3, and 5 years were 79%, 62%, and 57% respectively. Four patients relapsed. Neural-axis was the commonest site of relapse (3 patients). Both risk groups were equally represented in relapsed patients (2 standard risk & 2 high risk patients) and relapse took place within 2 years. In univariate analysis, performance status,extent of surgery, and post-operative residual tumor size were significant prognostic factors for OS. On the other hand, factors which affected the PFS included gender, extent of surgery, and post-operative residual tumor. Conclusion: Neural-axis relapse was the commonest site of relapse for pediatric MB patients. Extent of surgical resection, post-operative residual tumor, and gender are powerful prognostic factors. Maximal safe resection is the standard surgical approach for MB patients to achieve cure.

325P Preliminary review of computed tomography (CT)-based image-guided brachytherapy (IGBT) in treatment of cervical cancers: The National Cancer Institute (NCI) experience

325P Preliminary review of computed tomography (CT)-based image-guided brachytherapy (IGBT) in treatment of cervical cancers: The National Cancer Institute (NCI) experience

325P Preliminary review of computed tomography (CT)-based image-guided brachytherapy (IGBT) in treatment of cervical cancers: The National Cancer Institute (NCI) experience

325P Preliminary review of computed tomography (CT)-based image-guided brachytherapy (IGBT) in treatment of cervical cancers: The National Cancer Institute (NCI) experience

Breast cancer in women aging 35 years old and younger: The Egyptian National Cancer Institute (NCI) experience

ObjectiveThe aim is to identify the epidemiological and clinicopathological features associated with young breast cancer (BC) patients and to discuss factors affecting tumor recurrence and DFS. Patients & methodsA retrospective analysis was conducted based on medical records from young females patients aged ≤35 years with pathologically confirmed primary breast cancer treated during 2008–2010 at NCI. Cases with non invasive cancer and non carcinoma histology are excluded. ResultsOf the 5408 cases diagnosed with breast cancer, 554 were young. Four hundred & fifty eight patients representing 9.2% were within our inclusion criteria. Almost half of the patients (45.9%) presented with stage III. Axillary nodes involvement was in 63.9%, 83.3% were grade 2. More than one quarter of tumors was hormone receptors negative (28.8%) & Her2 was over-expressed in 30%. Mastectomy was offered in 72% while conservative breast surgery in 26%, 69.2% received chemotherapy either adjuvant, neoadjuvant or both, 82.5% received adjuvant radiotherapy, 68.6% received hormonal therapy. Metastatic disease developed in 51.3%, with 31% having more than one site of metastases. After a median follow up period of 66 months, the median DFS of patients was 60 months. The median DFS was significantly shorter among patients with positive lymph nodes (P < 0.0001), ER negative disease (P = 0.045) and stage III disease (P < 0.0001). ConclusionBreast cancer in young women is aggressive from the time of diagnosis. Our results provide baseline data of young BC in the Middle East & North Africa region; thus, contributing to future epidemiological and hospital-based researches.

Renal functional outcomes after robotic multiplex partial nephrectomy: the National Cancer Institute experience with robotic partial nephrectomy for 3 or more tumors in a single kidney.

To identify renal function outcomes after robotic multiplex partial nephrectomy (RMxPNx), we reviewed our institutional database at the National Institutes of Health, National Cancer Institute. To our knowledge, we present the largest series of RMxPNx renal function outcomes to date. Robotic partial nephrectomy has been employed for oncologic control and to prevent dialysis dependence in hereditary multifocal renal cell carcinoma conditions. We have termed robotic surgery on a single kidney with three or more lesions a RMxPNx. We evaluated patients from a prospectively maintained database at a single institution (NIH/NCI) that underwent RMxPNx from 2007 to 2013. Demographic and operative data were compiled with statistical analysis with T test performed to determine renal function outcomes. A total of 54 patients underwent RMxPNx. Mean number of tumors removed was 8.63 (range 3-52). Mean preoperative creatinine and eGFR were 1.02±0.26mg/dL and 85.4±21.5mL/min, respectively. Postoperatively, creatinine increased from baseline by 0.45mg/dL (p<0.001). Similarly, a mean decrease in eGFR by 24.6mL/min was observed (p<0.001). At 3-month follow-up, the creatinine increase from baseline was 0.05mg/dL (p=0.10) and mean decrease in eGFR was 3.01mL/min (p=0.21). When stratifying based on preoperative CKD stages I-III, similar results were observed. Robotic multiplex partial nephrectomy is a safe and feasible approach to patients with multifocal renal masses. These complex surgeries have a demonstrated learning curve, but this minimally invasive approach for nephron-sparing surgery allows patients to preserve renal function where they would otherwise require open surgery or a radical nephrectomy.

Sunitinib treatment in patients with advanced renal cell cancer: the Brazilian National Cancer Institute (INCA) experience

ABSTRACTPurpose:The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC) treated by the Brazilian Unified Health System (SUS) at a single reference institution.Material and Methods:Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013.Results:Fifty-eight patients were eligible. Most patients were male 41 (71%), with a median age of 58 years. Nephrectomy was performed in 41 (71%) patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2%) patients. In 50 patients (86%), sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%), hypothyroidism (43%), mucositis (33%) and diarrhea (29%). Grade 3 and 4 adverse effects were infrequent: fatigue (12%), hypertension (12%), thrombocytopenia (7%), neutropenia (5%) and hand-foot syndrome (5%). Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months.Conclusion:Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS.

Morbimortality and survival on hepatic metastasis of sarcoma – the Brazilian national cancer institute experience

Morbimortality and survival on hepatic metastasis of sarcoma – the Brazilian national cancer institute experience

Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt

Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, work-up, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.

Breast Cancer in Males (BCM), Does It Really Differ? National Cancer Institute Experience (NCI), Cairo University, Egypt

Background: Carcinoma of the male breast is relatively a rare disease accounting for about 1% of all cancer in men. Its treatments are based mainly on those of Female Breast Cancer (BCF). Materials and Methods: This is a single institution retrospective study including all presenting to the NCI, Cairo University with Breast Cancer in a Male (BCM) in the last 11 years between Jan. 2005 until Jan. 2016. Data were collected from patient’s files from the statistical department then analyzed. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications and outcome of management, with addressing similarities and difference from BCF. Results: 64 patients were included in this cohort. The mean age was 58.6 & the median age was 59 years (range: 31 - 87 years). The main presenting symptomatology was retroareolar breast lump (50 cases, 78.1%). Most of our cases were advanced; 22 cases (34.3%) were stage III & 16 cases (25%) were stage IV. Surgery was performed for 50 patients; MRM for 26 cases (40.6%), RM for 18 cases (28.1%) & toilet mastectomy for 6 cases (9.3%). Primary closure was feasible in 34 patients (68%) while 16 cases (32%) required reconstruction by local or pedicled flaps. Tamoxifen is the most important non-surgical treatment. It was given to all our cases (64 cases, 100%) either postoperatively as adjuvant management (36 cases, 56.2%) or as palliation for metastatic disease (28 cases, 43.8%). Chemotherapy was given to 32 patients (100%) as an adjuvant for 24 cases (75%) and as a palliation for 8 cases (25%). Radiotherapy was given to 26 patients (100%) as adjuvant therapy for 20 cases (76.9%) and as a palliation for 6 cases (23.1%). The only significant factor determining the overall 5 years survival was the stage of the disease. LN status & surgery type were of border line significance (better survival with negative LN & with MRM). The 5-year Overall Survival (OS) & Disease Free Survival (DFS) for the whole group were 66% & 52% respectively. Within the DFS there was no significant variable; however, the stage and type of surgery were of borderline significance, with better survival with early stage disease (I & II) and with MRM (both were 61%). Conclusion: BCM has many similarities to BCF, but it harbours many different genetic and pathologic features. They obtain similar prognostic factors and similar stage-for-stage survival. They are always advanced to T4 stage rapidly due to the lack of breast parenchyma with higher ER expression in BCM than BCF patients.

1042 Breast cancer in women aging 35 years old and younger: The Egyptian National Cancer institute experience

1042 Breast cancer in women aging 35 years old and younger: The Egyptian National Cancer institute experience

Clinicopathologic Profile and Outcome of Extranodal Diffuse Large B-Cell NHL: Egyptian National Cancer Institute Experience

Abstract Background: Primary extranodal diffuse large B-Cell lymphoma (PE-DLBCL) accounts for about one-third of all cases of DLBCL. We reviewed the clinical and pathological characteristics of cases with PE-DLBCL presented to NCI, Egypt. Patients and methods: We retrospectively studied patients with pathologically documented PE-DLBCL presented to the National Cancer Institute between January 2008 and December 2010. Revision of histopathology and sub-classification of patients to germinal centre (GC) DLBCL and non-GC-DLBCL through immunostaining of CD10, BCL-6 and MUM-1 were done. Cases that were CD10+/BCL-6±/ MUM-1- were categorised as GC-DLBCL, while cases that were CD10-/BCL-6±/MUM-1+ were categorised as non-GC-DLBCL. Clinical data regarding baseline characteristics, chemotherapy given and the response to chemotherapy was collected. Results: A total of 57 patients of PE-DLBCL were included in the study. Mean age was 48.9 years (range 21-78), and 32 patients (56.1%) were females. Most frequent locations were gastrointestinal and liver (29.9% and 22.9 %; respectively). Forty-two patients (73.7%) were sub-classified as non-GC-DLBCL. The patients who were stage III/IV were more common (52.6%). Fifty-two patients received CHOP, 5 received CVP, and 6 patients received radiotherapy after finishing chemotherapy. Complete response rate (CR) was 64.9%, there was no difference in the CR (66.7%, 64.3%) and Overall Survival (53.3%, 52.4%) in GC-DLBCL group in comparison to non-GC-DLBCL group (p = 0.24 and 0.6; respectively). The CR and OS for patients with low international prognostic index (IPI) were significantly better than patients with intermediate or high IPI (p = 0.008 and 0.08, respectively). Conclusion: Non-GC-DLBCL is more common than GC-DLBCL in PE-DLBCL in Egyptian population. The most affected sites are gastrointestinal and liver reflecting the association between high frequency of hepatitis B and C and hepatic non-Hodgkin’s lymphoma (NHL). Stage of the disease and IPI remains the most important prognostic factor for PE-DLBCL.

PCA3 in prostate cancer and tumor aggressiveness detection on 407 high-risk patients: a National Cancer Institute experience.

BackgroundProstate cancer (PCa) is the most common male cancer in Europe and the US. The early diagnosis relies on prostate specific antigen (PSA) serum test, even if it showed clear limits. Among the new tests currently under study, one of the most promising is the prostate cancer gene 3 (PCA3), a non-coding mRNA whose level increases up to 100 times in PCa tissues when compared to normal tissues. With the present study we contribute to the validation of the clinical utility of the PCA3 test and to the evaluation of its prognostic potential.Methods407 Italian men, with two or more PCa risk factors and at least a previous negative biopsy, entering the Urology Unit of Regina Elena National Cancer Institute, were tested for PCA3, total PSA (tPSA) and free PSA (fPSA and f/tPSA) tests. Out of the 407 men enrolled, 195 were positive for PCa and 114 of them received an accurate staging with evaluation of the Gleason score (Gs). Then, the PCA3 score was correlated to biopsy outcome, and the diagnostic and prognostic utility were evaluated.ResultsOut of the 407 biopsies performed after the PCA3 test, 195 (48%) resulted positive for PCa; the PCA3 score was significantly higher in this population (p < 0.0001) differently to tPSA (p = 0.87). Moreover, the PCA3 test outperformed the f/tPSA (p = 0.01). The sensitivity (94.9) and specificity (60.1) of the PCA3 test showed a better balance for a threshold of 35 when compared to 20, even if the best result was achieved considering a cutoff of 51, with sensitivity and specificity of 82.1% and 79.3%, respectively. Finally, comparing values of the PCA3 test between two subgroups with increasing Gs (Gs ≤ 6 versus Gs ≥ 7) a significant association between PCA3 score and Gs was found (p = 0.02).ConclusionsThe PCA3 test showed the best diagnostic performance when compared to tPSA and f/tPSA, facilitating the selection of high-risk patients that may benefit from the execution of a saturation prostatic biopsy. Moreover, the PCA3 test showed a prognostic value, as higher PCA3 score values are associated to a greater tumor aggressiveness.

Treatment outcomes of female germ cell tumors: The Egyptian National Cancer Institute experience

IntroductionFemale germ cell tumors (GCTS) are rare tumors that carry a good prognosis. AimTo report the experience of the Egyptian National Cancer Institute (ENCI) in managing female GCTs. MethodsThis retrospective study included 19 females with ovarian GCTs presenting to the ENCI between 2006 and 2010. ResultsThe median age was 23years. Ovaries were the primary site in all patients. Dysgerminoma and teratoma were the predominant pathologies followed by mixed GCT in females. Unilateral ovariectomy or ovarian tumorectomy were the classic surgical procedures with R0 resection being feasible in most cases. Surveillance was adopted in six patients with stage I disease. Chemotherapy was administered in 63% of ovarian GCTs with BEP being the commonest regimen with reasonable tolerability and good response rates. The median OS and EFS were not reached. The projected 5-year OS rate was 93.8%. Both OS and EFS were better in patients responding to chemotherapy than non-responders (p<0.002). Stage of disease did not significantly affect OS or EFS. ConclusionsFemale GCTs rarely affect Egyptian females. They have good prognosis.

Safety profile of poxviral vaccines: NCI experience.

85 Background: Recombinant poxviruses have been developed as therapeutic cancer vaccines. Here, we report the safety data from NCI clinical trials with poxviral vaccines. Methods: We evaluated all vaccine injections from 215 patients in 8 clinical trials involving poxviral viral vaccines. The Office of Biotechnology Activities, National Cancer Institute (NCI) Institutional Review Board, and NCI Scientific Review Committee approved all of these trials. Vaccines were consisted of recombinant vaccinia and recombinant fowlpox encoded with 3 human costimulatory molecules (TRICOM), and prostate specific antigen (PSA), or carcinoembryonic antigen, and/or mucin-1. Vaccines were administered at doses between 1.2x108 to 2x109 pfu, subcutaneously, in all patients. Twenty-one patients were also vaccinated intra-tumorally. 84 patients also received other concurrent treatment modalities, such as radiation, celecoxib, ipilimumab, samarium-153, or flutamide on 4 of these trials. All 8 clinical trials involved granulocyte-macrophage colony-stimulating factor (GM-CSF) 100mcg, or recombinant fowlpox encoding GM-CSF at 1x 108pfu as an immune adjuvant. Here, we report here the grade 2 or higher adverse events given at least a possible attribution to vaccine. Results: A total of 1,348 poxviral injections were given in 215 patients. No contact transmission, inadvertent inoculation, or any serious adverse events (AEs) related to vaccinia was observed. Below is the summary of proportion of vaccine administrations associated with specific AEs. Conclusions: These data demonstrate a favorable safety profile of the poxviral vaccines at a broad range of doses, routes of administration, in combination with other treatments, and in various tumor types. Clinical trial information: NCT00060528, NCT00096551, NCT00088413, NCT00081848, NCT00113984, NCT00450619, NCT00450463. [Table: see text]

Economic Burden of Repeat Renal Surgery on Solitary Kidney—Do the Ends Justify the Means? A Cost Analysis

Despite the high morbidity of repeat renal surgery in patients with multifocal recurrent renal carcinoma, in most patients adequate renal function is preserved to obviate the need for dialysis. To our knowledge the economic burden of repeat renal surgery has not been evaluated. We provide a cost analysis for patients requiring repeat renal surgery on a solitary kidney. We reviewed the charts of patients treated at the National Cancer Institute who required repeat renal surgery from 1989 to 2010. Functional, oncological and surgical outcomes were evaluated and the costs of repeat renal surgery were calculated. We then compared costs in a cohort of 33 patients who underwent repeat renal surgery on a solitary kidney and in a hypothetical patient cohort treated with uncomplicated nephrectomy, fistula placement and dialysis. All costs were calculated based on Medicare reimbursement rates derived from CPT codes. Cost analysis was performed. Despite a high 45% complication rate, 87% of patients maintained renal function that was adequate to avoid dialysis and 96% remained metastasis free at an average followup of 3.12 years (range 0.3 to 16.4). Compared to the hypothetical dialysis cohort, the financial benefit of repeat renal surgery was reached at 0.68 years. Repeat renal surgery is a viable alternative for patients with multifocal renal cell carcinoma requiring multiple surgical interventions, especially when left with a solitary kidney. Despite the high complication rate, renal function is preserved in most patients and they have an excellent oncological outcome. The financial benefit of repeat renal surgery is reached at less than 1 year.

Pulmonary Resection for Metastatic Adrenocortical Carcinoma: The National Cancer Institute Experience

Adrenocortical carcinoma (ACC) is a rare neoplasm with a high propensity for locoregional recurrences and distant metastases for which there are no effective systemic therapies. This study was undertaken to determine outcomes of patients undergoing pulmonary metastasectomy for ACC. A single-institution retrospective review was performed of patients undergoing pulmonary metastasectomy for ACC from 1979 to 2010. Twenty-six patients underwent 60 pulmonary metastasectomies. Fifteen patients (58%) underwent unilateral thoracotomy, 6 (23%) had staged thoracotomies, and 5 (19%) underwent median sternotomy as the initial thoracic procedure. Median number and size of lesions were 6 and 2 cm, respectively. Twenty-three patients (88%) were rendered free of disease in the lung, and 14 (54%) were rendered completely free of disease. Median overall and 5-year actuarial survivals from initial pulmonary metastasectomy were 40 months and 41%, respectively, with a median potential follow-up of 120 months. Median recurrence-free survival (RFS) and 5-year RFS for ipsilateral thoracic recurrences were 6 months, and 25%, respectively. The median RFS in the contralateral thorax was 5 months. Time to first recurrence after adrenalectomy and T stage of the primary tumor, but not adjuvant or neoadjuvant chemotherapy, were associated with increased overall survival after pulmonary metastasectomy. This study represents the most comprehensive review of outcomes of patients undergoing pulmonary metastasectomy for ACC. Given the lack of effective systemic therapies, pulmonary metastasectomy may be beneficial in properly selected patients.

Nephron-sparing surgery for renal tumors

PurposeTo report National Cancer Institute (NCI) experience in managing various benign and malignant renal tumors with nephron sparing surgery (NSS), and to assess its safety and feasibility. Patients and methodsLiterature review for NSS, and reviewing of the patients records who underwent NSS between the period from January-2000 to December-2009 at NCI-Cairo University was done. Tumor related characteristics, indication for NSS, operative techniques, postoperative complications, full histopathological data, and follow up results were reviewed. ResultsThe total number of patients was 15. Median age at surgery was 32 years (range from 1.5 to 65 years). Five patients had bilateral tumors. The mean radiologic tumor size was 4.7±5.2cm. All patients had normal preoperative kidney functions. Six patients had an absolute indication for NSS, while 6 patients had a relative indication, and 3 patients were elective. All 5 patients with bilateral tumors underwent bilateral simultaneous surgery. Cold ischemia was used in 7 patients, 1 patient was exposed to warm ischemia. Manual compression was used in 2 patients, and no vascular control was applied in 5 patients. Complications were encountered in 2 patients, one of them had urinary leakage which needed reoperation, and the other had subcutaneous hematoma which was treated conservatively. Histopathological analysis revealed Wilm’s tumor (7 patients), angiomyolipoma (4 patients), renal cell carcinoma (RCC) (3 patients), and Hydatid cyst (1 patient). All patients had negative surgical margin. For patients with Wilm’s tumor, the median follow up was 24.4 months (range from 5 to 94 months), two patients had local recurrence, and 1 patient had distant metastasis.For patients with RCC, The median follow up was 14.7 months (range from 5 to 33 months) with no local recurrence or distant metastasis. All patients had normal kidney functions during postoperative and follow up periods. ConclusionNSS is a feasible safe procedure that could be done with acceptable complications. It provides a good solution for patients with bilateral benign tumors and early localized RCC.

Cisplatin-etoposide combination in adjuvant therapy for non-small cell lung cancer: A Brazilian experience.

e17530 Background: Adjuvant chemotherapy is generally recommended in most patients with resected non–small cell lung cancer (NSCLC), with some restrictions according to tumor stage and size. However, different cisplatin-doublets were used in phase III trials, and the best choice remains unclear. The purpose of this study is to describe the Brazilian National Cancer Institute (INCA) experience with the cisplatin-etoposide (Cis-Vp) combination in this situation, with special interest to survival data. Methods: We retrospectively evaluated the medical charts of patients receiving adjuvant treatment for NSCLC at INCA between 2004 and 2008. The primary outcome was overall survival (OS) and prognostic factors were analyzed using log-rank. Results: Fifty-one patients were included, all treated with Cis-Vp. Median age was 61 years (40-76), and 53% were female. Adenocarcinoma was the most frequently reported histological subtype (57%), while squamous cell carcinoma was detected in 33%. Forty percent of patients were diagnosed with pathologic stage I, 33% with stage II, and 27% with stage III. Lobectomy was the predominant surgical procedure (80%), whereas pneumectomy was performed in 14%, and bilobectomy in 6%. The median number of cycles was 4 (1-4). Fifty-nine percent of patients received 80 mg/m2 of cisplatin and 76% received 300 mg/m2 of etoposide at the first cycle. Eleven patients (22%) were also treated with adjuvant radiation therapy. After 31 months median follow-up, the median OS was 57 months. In the univariate analysis, survival was inferior in advanced stage (III vs. I-II; median 34 vs. 57 months, respectively; p=0.22) and after RT (median 19 vs. 57 months; p<0.001). No difference was detected for OS according to gender (p = 0.70), histology (p = 0.33), or platinum dose (p = 0.13). Conclusions: The outcomes described in our institution are in line with those reported in the early IALT study publication, in which 57% of patients received Cis-Vp. Nevertheless, recent data suggest more consistent results with cisplatin in combination with novel-generation agent vinorelbine, especially after long-term follow-up. These data support the need for long follow-up in the adjuvancy.

Thymoma and thymic carcinoma: A retrospective analysis of the Brazilian National Cancer Institute (INCA) Experience.

e12043 Background: Thymoma (T) and thymic carcinoma (TC) are exceptionally rare tumors. Most studies of thymic neoplasms are based on small numbers of clinical cases and an optimal treatment remains to be defined. The Brazilian National Cancer Institute (INCA) is a cancer reference center in Brazil, receiving patients from all over the country. The aim of this study was to investigate the clinicopathologic features, treatment modalities, and outcome of T and TC in our population, as a step in further understanding these uncommon neoplasms. Methods: A retrospective review of the medical records of patients who had a pathologic diagnosis of T or CT was performed between January 1996 and December 2007 at a single institution (INCA). Results: A total of 43 patients were included. The mean age at diagnosis was 57 (range: 26–78), and the male/female ratio was 2:3 (18/25). Masaoka stage distribution is presented in the Table. There was a predominance of WHO type A, B1, and AB. Paraneoplastic syndromes were detected in 20.4% of cases. For survival analysis patients were subdivided in initial disease (Masaoka I and II) and advanced disease (Masaoka III and IV). Complete resection was possible in 92.5% of patients with initial disease and 7 patients, all Masaoka stage II, received adjuvant radiotherapy. Only one patient had progressive disease and died. Sixteen (72.7%) patients with advanced disease were treated with a multimodality neoadjuvant approach. Surgical resection was possible in only 8 (50%) of these patients. Five-year survival and progression-free survival rates were estimated respectively in 31.8% and 39.9% for advanced disease. Conclusions: Clinical characteristics, treatment features, and survival rates were in line with previous reports from other countries. Our results, in a 12-year period, show a representative amount of cases, and the poor overall survival for advanced disease suggests the need for new strategies to improve outcomes. Masaoka stage distribution Masaoka stage Frequency (%) I 27.9 II 20.9 III 37.2 IVA 9.3 IVB 4.7 No significant financial relationships to disclose.

Partial Nephrectomy After Previous Radio Frequency Ablation: The National Cancer Institute Experience

Development of new renal tumors or recurrence after radio frequency ablation not amendable for repeat ablation presents a difficult therapeutic dilemma. We report on the outcomes of partial nephrectomy on kidneys previously treated with radio frequency ablation. We performed a chart review of 13 patients who underwent 16 attempted partial nephrectomies following radio frequency ablation. Hospital records and operative reports were reviewed for demographic data, perioperative data and outcomes. The outcomes of the present series were compared to historical controls of published studies in similar patient populations. No cases were converted to radical nephrectomy. Median time from radio frequency ablation to surgery was 2.75 years (range 1 to 7.1). A median of 7 tumors (range 2 to 40) were removed with a median estimated blood loss of 1,500 ml (range 500 to 3,500) and a median operative time of 7.8 hours (range 5 to 10.7). Operative notes commented on the presence of severe fibrosis in the operative field in 12 of 16 cases (75%). There was a modest but statistically significant decrease in renal function. Partial nephrectomy after radio frequency ablation had a higher reoperation rate compared to other series of primary or repeat partial nephrectomies but had the lowest rate of vascular or visceral injuries. Partial nephrectomy on kidneys previously treated with radio frequency ablation is a technically challenging but feasible procedure. Residual or metachronous disease after radio frequency ablation may be salvaged with partial nephrectomy with a modest decrease in renal function. A trend toward a higher chance of reoperation and urine leak after partial nephrectomy after radio frequency ablation may be useful information for the planning and discussion of treatment decisions.