Survival Patterns Of Patients Research Articles

Results of radiation therapy for thymoma based on a review of 27 patients

Background: Radiotherapy has a well recognized role as an adjuvant treatment to surgery in thymoma and remains the only available treatment, with or without chemotherapy, in unresectable tumors. Objective: Our objective is to assess the factors predicting the outcome and the pattern of survival in patients with thymoma treated by radiotherapy in our institution. Methods: Between February 1989 and October 2000, 27 patients underwent radiotherapy for thymoma and were reviewed retrospectively. A follow-up could be obtained on all 27 patients. The parameters assessed were: age, sex, stage, presenting Myasthenia gravis, resectability, treatment modalities and survival. The total radiation dose to the tumor area in the adjuvant setting was 40–60 Gy and in the curative setting: 50–70 Gy. Results: The median follow-up time of the 18 living patients was 74 months (range: 8–144 months). According to the Masaoka classification, there were 8 stage IV, 14 stage III and 5 stage II patients (three patients had relapsed tumors). There were 15 males and 12 females with a median age of 56 years. Ten patients had Myasthenia gravis at the time of presentation, two patients had pure red cell aplasia. Eighteen patients had dyspnea or superior vena caval syndrome (six of them). And five patients had only mild chest discomfort. Sixteen patients had complete surgical resection and 11 patients had partial resection (5) or only biopsy (6). Ten of them received a mean of three courses of chemotherapy with Cisplatin, Doxorubicin, and Cyclophosphamide (CAP). The overall 5 and 10 years survival rates were 65 and 47%, respectively. The 5 years survival rate for patients with complete resection was 81% compared to 44% for patients with partial resection or biopsy ( P=0.01). Patients with Myasthenia had a 5 years survival of 71% compared to 53% for non-myasthenic patients. All patients with Myasthenia had complete surgical resection. Age, sex, presence of anemia, or superior vena caval syndrome were not adverse prognostic factors. There was no difference in terms of survival between relapsed and newly diagnosed tumors or between debulking surgery and biopsy. The 2 years survival for the four patients non-responders to chemotherapy was 0% while the 5 years survival for the responders was 71% ( P=0.005). Conclusion: Resectability and response to chemotherapy for unresectable patients seem to be factors that predict the outcome in thymoma. Myasthenia gravis appears to be important in detecting the tumor when it is still resectable.

Analysis of Outcome and Prognostic Factors in Metastatic Cauda Equina Compression: A 20-Year Single Institution Experience

The object of this study was to statistically analyze the survival patterns in patients with metastatic cauda equina compression and to determine the factors that may be predictive of prognosis. Between 1980 and 1999, 76 patients were diagnosed and treated for metastatic tumors causing cauda equina compression. Pain was the presenting feature in 67% of patients. The most common site for the primary tumor was the lung (21%). All patients received external beam radiation with a dose range of 4 Gy to 38 Gy (mean = 25 Gy). Median length of patient survival was 4.0 ± 0.9 months (range: 1–152 months). The 12-month actuarial survival calculated using the Kaplan-Meier method was 17.52 ± 4.5% (95% confidence interval). Factor analysis of overall survival revealed that an increase in radiation dose (>20 Gy) correlated with longer survival (P < 0.001). Patients with lymphoma had the best prognosis, whereas those with lung and prostate primary cancer faired worst. Primary cancer is the most useful predictor of prognosis in patients with metastatic cauda equina compression. Although radiation remains the treatment of choice, the addition of surgery offers significant improvement in the symptoms and hence increases quality of life for long-term survivors.

Patterns of Outcome Following Recurrence After Myeloablative Therapy With Autologous Bone Marrow Transplantation for Follicular Lymphoma

To assess the patterns of recurrence, management, and survival following recurrence after myeloablative therapy with autologous bone marrow transplantation (ABMT) in patients with follicular lymphoma (FL). Between June 1985 and October 1995, 99 patients with FL received cyclophosphamide and total-body irradiation with ABMT as consolidation of second or subsequent remission. Median length of follow-up was 5 1/2 years, and 33 patients developed recurrent lymphoma a median of 14 months after ABMT. In 26 patients, the recurrence was overt; in seven, it was detected on surveillance investigation. Twenty-six patients presented with recurrence at previous sites of disease. Twenty-two patients (67%) had FL at the time of recurrence; in 11 (33%), there was evidence of transformation to diffuse large B-cell lymphoma. Eight patients were managed expectantly; five were alive 21 to 53 months later. Twenty-five patients have required treatment to date; eight remained alive 6 months to 10 years later, and five were in remission. The Kaplan-Meier estimate of patients alive 5 years after recurrence is 45% (95% confidence interval, 27% to 62%). In univariate and multivariate analyses, survival after recurrence and overall survival after diagnosis were similar to those of a historical control group who received conventional treatment, before the introduction of myeloablative therapy (adjusted hazard ratio [HR], 1.56, P = .3, and HR, 1.34, P = .4, respectively). The survival pattern of patients with FL following recurrence after myeloablative therapy and ABMT suggests that this treatment does not compromise outcome in patients in whom it fails, reflecting the survival pattern of the disease when treated conventionally.

Patterns of survival in patients with recurrent follicular lymphoma: a 20-year study from a single center.

To examine outcome of treatment for patients with recurrent follicular lymphoma. Two hundred twelve newly diagnosed follicular lymphoma patients were studied. One hundred seventy-nine were initially treated successfully. Recurrent or progressive lymphoma developed in 116. Treatment was given according to disease stage and current protocols, mostly with single alkylating agents. A policy of repeated lymph node and bone marrow biopsy was pursued. The overall median survival duration was 9 years, with a median follow-up duration of 12 years. Following recurrence, the median survival duration was 4 1/2 years. Only eight of 116 patients with recurrent disease died of causes unrelated to lymphoma. The overall response rate to first re-treatment was 78% and showed slight decline with successive recurrences, reaching 48% after the fourth treatment. The median duration of second remission was 13 months, (v 31 months for first remission), with the only significant predictive factor being quality of remission. Multivariate analysis showed only age at recurrence and number of prior treatments to correlate with survival after first recurrence. Survival after second remission was only correlated with age and quality of response: Kaplan-Meier estimates gave 53% of patients reaching second complete remission alive 10 years later, compared with 28% in partial remission. Age and previous and continuing responsiveness of follicular lymphoma to therapy are the principal determinants of survival following recurrence. Improvement in survival with new treatments will be demonstrated most readily in older patients, while more intensive approaches should be tested in younger patients in whom remission is achieved with difficulty.

Patterns of survival in patients with Hodgkin's disease: Long follow up in a single centre

Prolonged remission can now be induced in the majority of patients with Hodgkin's disease with chemotherapy and/or irradiation. However, there is a significant proportion of patients in whom this approach fails, either at presentation or subsequently. Survival is the definitive endpoint to assess treatment efficacy. In this study, the survival patterns of a large group of consecutive patients treated in a single institution are presented. The overall median survival was 18.3 years. Clinical remission (complete remission plus good partial remission) was induced in 443 (85%); the median survival of patients in remission has not been reached. Fifty-eight patients achieved responses less than clinical remission with initial therapy (partial response) or had progressive disease, the median survival of this group being 1.4 years. With further therapy, remission was subsequently induced in 10; 5 are still alive, 5 have died between 1.9 years and 14.3 years. Twenty patients died before completion of therapy. Recurrence has been documented in 147 of the patients in remission (following initial therapy) over a median follow up period of 13 years (minimum 5 years). One hundred forty-three of these patients were retreated following recurrence (105 chemotherapy, 28 radiotherapy, 6 combined modality treatment and 4 surgery). Second remission was induced in 109/143 (76%). There was a trend towards better second remission induction in patients whose first remission was longer than 1 year (p = 0.06). The median duration of second remission was inferior to first remission duration (p < 0.001). There was no correlation between duration of first remission and survival following recurrence (p = 0.8) or with duration of second remission (p = 0.54). There was no significant difference in duration of second remission between patients who were initially treated with radiotherapy or chemotherapy (p = 0.3). The median survival following second remission was 12.0 years, being the same for patients with initially localized disease (stages I and II) treated with radiation alone and for patients with advanced Hodgkin's disease (stages III and IV) treated with chemotherapy. Survival after recurrence is significantly better for patients under 50 years at the time of recurrence (p < 0.001). Second recurrence was documented in 46 patients, third remission being reinduced in 22, the median survival of the latter being 5.1 years. These results illustrate the importance of prolonged follow up in defining the clinical course of patients with HD and are vital for planning experimental chemotherapy at the time of treatment failure or recurrence.

Subglottic and Tracheal Malignancies

Subglottic and tracheal malignancies are the least frequently encountered laryngeal cancers. When these tumors are encountered, they have often reached advanced size prior to producing symptoms. Once symptoms are brought to the attention of the otolaryngologist, rapid and accurate diagnosis is essential to effect the earliest possible treatment and to minimize morbidity and mortality associated with this problem. Illustrative cases are presented including a highly unusual case that presented with cardiac-like chest pain. A review of the literature including the pertinent anatomy, pathophysiology, and methods of diagnosis and treatment is presented. Increased familiarity with this disease process and a high index of suspicion on the part of the otolaryngologist may lead to improved survival patterns in patients with these malignancies.

Patterns of survival in patients with advanced Hodgkin's disease (HD) treated in a single centre over 20 years.

A total of 164 consecutive adults with newly confirmed stage IIIB, IVA or IVB Hodgkin's disease (HD) commenced cyclical combination chemotherapy comprising mustine, vinblastine, prednisolone and procarbazine (MVPP) every 6 weeks (145 patients) or minor variants (19) at St Bartholomew's Hospital between 1968 and 1984. The median follow-up period is 14 years. Complete remission (CR) was achieved in 97/164 (59%) and partial remission (PR) in 23/164 (14%) with lesser responses or death being documented in 44. Achievement of CR correlated with stage, serum albumin and serum beta2 microglobulin level at presentation on univariate and multivariate analysis; 55/97 (58%) remain in continuous CR, the median duration of remission not having been reached. Twelve patients died in first remission; there have been 30 recurrences, one occurring after 13 years. Second remission was achieved in 17/30; 6/17 remain in continuous second remission and two have died in second remission. There have been nine second recurrences, third remission being achieved in 6/9. Two continue in third remission, two patients have died in third remission: 82/164 patients are alive with a minimum follow-up of 6 years. Eighty-two patients have died; 66 with evidence of HD, six with second malignancy, one each of haemorrhage and infection, eight of unrelated causes, the cause of death was unknown in one. The overall median survival from presentation is 14 years, being the same for patients in CR and PR with minimal residual abnormality (good partial remission, GPR), and being better for those for whom remission was achieved than those for whom it was not. The median survival following first recurrence is 4 years, being significantly longer for younger patients (less than 50 years). These results emphasise the importance of long-term follow-up to determine the clinical course of HD and are vital for planning experimental chemotherapy at the time of early treatment failure or recurrence.

Biological and clinical implication of cellular DNA content in renal cell carcinomas.

DNA flow cytometric analysis (FCM) was performed on surgical bioptic samples taken from 82 renal cell carcinomas. FCM has evidenced that 35% (29/82) of renal carcinomas resulted diploid, 65% (53/82) aneuploid and of the latter 22% (12/53) multiclonal. Our results do not indicate any relationship among cytometric ploidy, Fuhrman grading, Robson and pTNM staging. A possible interesting increase of aneuploidy frequency was observed between the NMV (66%) subgroup and the no zero NMV (90%) subgroup, while in diploid patients these values were 40% and 10%, respectively. Follow-up data evidence a significant difference in survival pattern of patients between diploid and aneuploid groups. In conclusion, our results show that cytometric ploidy is a potential important prognostic parameter in survival term.

Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphed-ema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

Improved survival with coronary bypass surgery in patients with three-vessel coronary disease and abnormal left ventricular function: Matched case-control study in patients with potentially operable disease

Recent studies have suggested that patients with three-vessel coronary disease and abnormal left ventricular function have better survival rates with bypass surgery than with medical therapy alone. Case-control studies may give accurate survival estimates, but to be valid, selection biases must be taken into account. A matched case-control method was used to compare survival patterns in patients treated medically or surgically during the 1980s. Fifty medical patients with potentially operable coronary disease and 46 surgical patients were matched for significant three-vessel disease and abnormal ventricular function. These two groups had no significant differences with regard to 24 variables, including age (64 ± 8 versus 63 ± 10 years), chest pain class, congestive heart failure signs, ejection fraction (36 ± 8 versus 37 ± 9 percent), segmental wall score, or a coronary score evaluating lesion site and severity. There were slight differences between the two groups with regard to congestive heart failure symptoms (p = 0.04). Patients undergoing bypass surgery had improved four-year survival rates compared with the medical group (89 versus 55 percent; p = 0.01). Thus, this study used an effective case-control method to suggest that, in the 1980s, coronary surgery improves prognosis substantially in surgically approachable patients with severe coronary disease and ventricular dysfunction.

Prognostic significance of serum lactate dehydrogenase in malignant lymphoma.

The pretreatment serum lactate dehydrogenase level (LDH) was the single most important prognostic variable in 30 patients with diffuse histiocytic lymphoma treated between January 1973 and January 1977 with a poly-drug chemotherapy program called the cyclophosphamide L2 protocol at the Memorial Sloan-Kettering Cancer Center. A highly significant difference was found between the survival patterns of patients with LDH levels of 500 U or less and those with LDH levels greater than 500 U. (Two-year survival rates were 67% and 13%, respectively.) A similar trend was observed for 25 patients with diffuse, poorly differentiated lymphocytic lymphoma treated with the same protocol, although this difference was not statistically significant. (Corresponding two-year survival rates were 74% and 33%, respectively.) The association of LDH level with survival was evident even after adjustment for other factors of potential prognostic significance. Pretreatment serum LDH determinations may provide a useful means of stratifying patient populations when comparing treatment programs for advanced stage non-Hodgkin's lymphoma.

The Illinois trauma system: Changes in patient survival patterns following vehicular injuries

To assess the impact of the Illinois Trauma Program on Region 5, Southern Illinois, samples of vehicular injuries and deaths were compared for a four-year study period: two years prior to system implementation (FY 1970-1971) and two years after system initiation (FY 1972-1973). Trauma center hospitals exhibited a statistically significant decrease in mortality rate during FY 1972-9173 while other hospitals (those in the region not designated as trauma centers) had no change in mortality rate. Decreases in mortality rates were statistically significant at trauma hospitals for weekends and patients between the ages of 45 and 64. The methodology of conducting such a study as well as the implications of the study are discussed.

Unusual survival patterns of patients with metastatic melanoma.

Unusual survival patterns of patients with metastatic melanoma.