Prolonged Disease-free Interval Research Articles

Radiotherapy of Orbital and Ocular Adnexa Lymphoma: Literature Review and University of Catania Experience.

Orbital and ocular adnexa lymphomas are rare neoplasms confined to the orbital region. The prognosis is generally favorable, with a high proportion of localized disease, indolent clinical course, prolonged disease-free intervals, and low lymphoma-related mortality rate. We report our experience on eleven patients with confirmed histological diagnosis of lymphoma stage IE-IIE, treated between 2010 and 2021 with radiotherapy alone or in association with chemotherapy or immunotherapy. Eight patients were treated with primary radiotherapy only, while three received previous systemic treatments. Six patients were treated with Proton beam therapy (PBT), and five with external beam radiotherapy (EBRT). The five-year local control rate was 98%; only one patient developed an out-of-field recurrence. We also conducted a comprehensive literature review using electronic databases (PubMed, EMBASE, and Cochrane Library). Articles were selected based on their pertinence to treatment of the ocular and adnexal lymphoma focusing on radiotherapy techniques (electron beam radiotherapy, photon beam radiotherapy, or proton beam radiotherapy), treatment total dose, fractionation schedule, early and late radio-induced toxicities, and patient's clinical outcome. Radiotherapy is an effective treatment option for orbital lymphoma, especially as standard treatment in the early stage of orbital lymphoma, with excellent local control rate and low rates of toxicity.

Is Systemic Chemotherapy Useful in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases? A Propensity-Score Analysis.

Multimodal treatment of colorectal (CRC) peritoneal metastases (PM) includes systemic chemotherapy (SC) and surgical cytoreduction (CRS), eventually with hyperthermic intraperitoneal chemotherapy (HIPEC), in select patients. Considering lack of clear guidelines, this study was designed to analyze the role of chemotherapy and its timing in patients treated with CRS-HIPEC. Data from 13 Italian centers with PM expertise were collected by a collaborative group of the Italian Society of Surgical Oncology (SICO). Clinicopathological variables, SC use, and timing of administration were correlated with overall survival (OS), disease-free survival (DFS), and local (peritoneal) DFS (LDFS) after propensity-score (PS) weighting to reduce confounding factors. A total of 367 patients treated with CRS-HIPEC were included in the propensity-score weighting. Of the total patients, 19.9% did not receive chemotherapy within 6 months of surgery, 32.4% received chemotherapy before surgery (pregroup), 28.9% after (post), and 18.8% received both pre- and post-CRS-HIPEC treatment (peri). SC was preferentially administered to younger (p = 0.02) and node-positive (p = 0.010) patients. Preoperative SC is associated with increased rate of major complications (26.9 vs. 11.3%, p = 0.0009). After PS weighting, there were no differences in OS, DFS, or LDFS (p = 0.56, 0.50, and 0.17) between chemotherapy-treated and untreated patients. Considering SC timing, the post CRS-HIPEC group had a longer DFS and LDFS than the pre-group (median DFS 15.4 vs. 9.8 m, p = 0.003; median LDFS 26.3 vs. 15.8 m, p = 0.026). In patients with CRC-PM treated with CRS-HIPEC, systemic chemotherapy was not associated with overall survival benefit. The adjuvant schedule was related to prolonged disease-free intervals. Additional, randomized studies are required to clarify the role and timing of systemic chemotherapy in this patient subset.

Factors associated with receipt of pulmonary metastasectomy in patients with lung-limited metastatic colorectal cancer: Disparities in care and impact on overall survival

ObjectivesPulmonary metastasectomy (PM) for colorectal cancer may provide respite from systemic therapy and prolonged disease-free intervals. We sought to identify factors associated with PM and to characterize the differential impact on overall survival for those offered lung resection. MethodsThe National Cancer Database was queried for stage IV colorectal cancer patients with lung-limited metastatic disease between 2010 and 2016. Among patients who underwent primary tumor resection, those who underwent PM were compared with those who did not. Penalized regression with the least absolute selection and shrinkage operator was used to determine factors associated with receiving metastasectomy as well as overall survival. ResultsIn total, 867 (15.1%) patients underwent resection of both primary tumor and pulmonary metastases whereas 4864 (84.8%) had primary tumor resection alone. In unadjusted analyses, metastasectomy patents were younger, more often privately insured, more educated, and traveled farther to receive care (all P < .001). In multivariable analyses, younger age, traveling >25 miles, and care at high-volume hospitals were associated with PM (P < .01). In addition, primary site surgery without PM was associated with worse overall survival (hazard ratio, 1.35; confidence interval, 1.23-1.49), even after adjusting for patient, tumor, and hospital-related factors. ConclusionsPatients who were older, who received care closer to home, and who were treated at low-volume hospitals were less likely to receive metastasectomy for lung-limited colorectal cancer after definitive resection of their primary tumor. Failure to receive PM resulted in worse overall survival, emphasizing the strong need for efforts to provide uniform, equitable care to all patients.

Long term survival in patients with bony oligometastatic breast cancer treated with curative intent: An institutional case series.

e12574 Background: Despite recent advances in treatment, metastatic breast cancer is widely recognized as a generally incurable condition. However, oligometastatic disease remains a poorly characterized condition with few clinical trials exploring treatments and outcomes. The term itself lacks a formal definition but is often used to refer to breast cancer displaying ≤5 metastatic sites, not necessarily in the same organ. Surgical management of discrete metastases has failed to demonstrate long-term benefit, while radiotherapy for isolated bone metastases has shown promise in some retrospective studies resulting in prolonged disease-free interval. Metastatic breast tumors overexpressing HER2 represent a category where systemic therapy may offer some prolonged remission or even cure. Methods: We are conducting a retrospective review of breast cancer patients with oligometastatic disease, as defined by ≤5 sites of disease, treated at Fred Hutch Comprehensive Cancer Center (FHCC) from 2000 to 2022; we will characterize FHCC provider practices, therapies delivered, goals of treatment, and long-term outcomes. This larger ongoing effort will be reported in a separate publication. Among a cohort of patients initially identified and undergoing record review, we reviewed all patients with bone-only disease and report their outcomes here. Results: We initially identified 17 cases of oligometastatic breast cancer currently undergoing treatment at FHCC. Of these, we noted that five patients had bone-only metastases and displayed marked similarities in treatment and outcome. All presented with de novo metastatic disease, and all five had ≤2 sites of metastasis, all in the axial skeleton. Four had HER2+ tumors; of these, three were also hormone-receptor positive. The remaining patient had triple-negative disease. All were treated with curative intent, with radiation to isolated bone metastases delivered concurrently with adjuvant radiation to breast/axilla. All are living today, with a median 56 months of follow up. One remains on a systemic metastatic regimen with a CDK4/6 inhibitor, while the rest are off therapy or are completing a standard adjuvant regimen. Conclusions: Oligometastatic breast cancer represents a heterogeneous entity that may in some instances be curable, but we lack sufficient data to identify which patients may benefit from therapy with curative intent. Standard curative treatment combined with radiotherapy to isolated bone metastases produced long-term survival in five current FHCC patients, which is consistent with other reports on patients with a low burden of bone-dominant metastatic disease. Further research is needed to validate curative approaches to therapy for this understudied population.

Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy.

To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR 0.491, IC95% 0.263–0.916), local failure (p = 0.027, HR 0.707, IC95% 0.521–0.961), DFS ≥ 12 months (p = 0.006, HR 0.298, IC95% 0.137–0.812) and post-recurrence medical treatment (p = 0.046, HR 0.101, IC95% 0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.

Real World Observational Study Using Clonoseq® Next Generation Sequencing in Hematologic Malignancies: The ’Watch’ Registry

Real World Observational Study Using Clonoseq® Next Generation Sequencing in Hematologic Malignancies: The ’Watch’ Registry

Patterns of recurrence and impact on survival in patients with clear cell ovarian carcinoma

BackgroundPatients with recurrent clear cell ovarian cancer have poor prognosis and limited effective systemic treatment options.ObjectivesTo characterize patterns of recurrence and compare overall survival and post-recurrence survival parameters in patients...

Abstract P5-11-02: Recurrent ESR1 fusions in primary tumors; a promising predictive factor for outcome to first-line endocrine therapy?

Abstract Introduction: While fusion genes have been identified and are being utilized as prognostic and predictive markers in various types of cancer, their relevance still needs to be established and verified for breast cancer. Recently, recurrent estrogen receptor alpha (ESR1) fusion genes have been identified as putative endocrine resistance markers, but their predictive value for response to endocrine therapy has not yet been independently validated. Here we studied the presence of fusions of ESR1 exon 2 with exons 1 to 11 of CCDC170, resulting in constitutively activated CCDC170, of ESR1 exon 4 with AKAP12, a putative tumor-suppressor gene, and ESR1 exon 1 with C6orf211/ARMT1, a methyltransferase and their association with outcome in a large cohort of ESR1-positive metastatic breast cancer patients. Methods: Fusion gene mRNA levels were measured in 307 ESR1-positive primary tumors by quantitative reverse transcriptase PCR (RT-qPCR). If the RT-qPCR generated a positive Cq value, the expected fusion gene product sizes were validated by MultiNA. All patients in this study were hormone-naïve and all experienced a recurrence and subsequently received 1st line endocrine therapy. The association of the presence of ESR1 fusion genes in the primary tumor with disease-free interval (DFI) before, and progression-free survival (PFS) up to 36 months after start with 1st line tamoxifen (n=219) or aromatase inhibitors (n=88), were evaluated. Results: 74 patients (24.1%) experienced a disease recurrence within one year after removal of the primary tumor (mean DFI; 34.8 months) and 257 patients (83.7%) progressed on 1st-line endocrine therapy within 3 years (mean PFS; 12.5 months). For the tamoxifen cohort, ESR1-CCDC170 fusion transcripts were found in 84 patients, of which fusions restricted to exon 1, 4, 6, 10 and 11 of CCDC170 were present in 18 patients who all but one progressed within 3 years (mean PFS 9.1 months). Of note, overall, these 18 patients also had a reduced DFI. Similarly for the 7 patients with ESR1-AKAP12 fusions and the one patient with an ESR1- ARMT fusion; all these patients progressed within 3 years. But in contrast to the ESR1-CCDC170 fusion positive patients, these patients had a prolonged DFI {see Table). Similar observations were made for the smaller AI cohort, though with the - with respect to their predictive value - most relevant ESR1-CCDC170 fusions restricted to exon 4, 5, 6 and 10 of CCDC170 and here we now also observed a decreased DFI for the 7 patients with ESR1-AKAP12 and the 3 patients with ESR1- ARMT1 fusions (see Table). 1st line tamoxifen (n=219)1st line AI (n=88)Fusion% positiveDFI (months) pos/allPFS (months) pos/allFusion% positiveDFI (months) pos/allPFS (months) pos/allE2-CCDC170 Exon 2 to 1/4/6/10/118.2%19.8/27.99.1/12.0E2-CCDC170 Exon 2 to 4/5/6/1012.5%32.4/51.910.5/13.8E2-AKAP123.2%33.1/27.711.9/12.0E2-AKAP128.0%23.6/54.710.3/12.0E2-ARMT10.5%(n=1)(n=1)E2-ARMT13.4%30.3/52.79.3/12.0 Conclusion: Measuring recurrent ESR1 fusions in primary breast cancer might become a promising tool to identify patients with intrinsic resistance to endocrine therapy or aggressive disease biology. Importantly however, which fusions are relevant appears to depend on the type of endocrine therapy given. Citation Format: Sieuwerts AM, Vitale SR, Bos M, Sleijfer S, Martens JW. Recurrent ESR1 fusions in primary tumors; a promising predictive factor for outcome to first-line endocrine therapy? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-11-02.

Metastasectomy in Advanced Renal Cell Carcinoma: A Systematic Review

Introduction: Metastasectomy for advanced renal cell carcinoma has been practiced for over 80 years. However, there is uncertainty regarding the clinical benefit of this procedure and the optimum selection of appropriate patients. Materials and Methods: A systematic literature search was conducted according to the PRISMA statement to identify studies that reported outcomes in patients who underwent metastasectomy at any time. Primary endpoints were overall and disease-free survival. Radiation therapy studies were not included. Case reports and series with less than 20 patients were not included. Results: Forty-four studies were identified that met the criteria for inclusion, with a total of 4195 patients. No studies that randomized patients to surgery versus no surgery were identified. Disease-free interval, number of metastatic sites and completeness of resection were prognostic for overall survival in many of the included studies. Seventeen studies included patients with lung metastases only (1465 patients in total). Conclusions: Case series have documented patients with prolonged disease-free interval and survival after metastasectomy. However, without randomized data, the impact of metastasectomy on outcomes in patients with metastatic renal cell carcinoma (mRCC) remains unknown, especially in the evolving landscape of systemic therapies.

Abstract IA15: Targeting oligometastatic disease in prostate cancer

Abstract Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, have been noted on occasion historically and termed oligometastasis (OM). The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e., if the primary cancer site (if still present) is controlled or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be possible. Contemporary imaging diagnostics are identifying more and more OM patients. For example, in prostate cancer the use of PSMA-Pyl PET imaging is leading to the diagnosis of many OM patients who have no disease on conventional clinical imaging. It is unclear if these are truly isolated sites of disease (curable) or simply a reflection of more widespread microscopic disease (incurable or at best a bridging therapy). This is especially true in the biochemical recurrence (bcr) space after primary treatment. We will present our experience with identifying and treating prostate cancer OM disease. Citation Format: Kenneth J. Pienta. Targeting oligometastatic disease in prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr IA15.

Laparoscopic extended posterior sectorectomy for metastatic adrenocortical carcinoma: a minimally invasive approach to parenchymal preservation

Background: Parenchymal preservation contributes to improved morbidity and mortality after hepatic resection. Additionally, randomized data supports minimally invasive (MIS) approaches to hepatic resection, resulting in shortened hospitalization, reduced postoperative morbidity, and improved quality of life. The Wakabayashi complexity index for laparoscopic hepatectomy guides patient selection, but the combination of MIS and parenchymal preservation for complex hepatic resections is seldom performed. Methods: A 65-year old male with adrenocortical carcinoma was treated with a laparoscopic left adrenalectomy in 2012. Surveillance MRI 5 years later identified a new 1.7 cm lesion located adjacent to the right hepatic vein in segment 7 (Figure). Percutaneous biopsy was consistent with metastatic adrenocortical carcinoma. Given the prolonged disease-free interval, extended right posterior sectorectomy was recommended. Results: The patient was placed in a split leg French position. A 3-D laparoscope was used and 4 port sites were required. Taking advantage of patient anatomy, the right posterior hepatic artery and portal vein were ligated and divided within the porta hepatis. The translation of open parenchymal transection techniques with crush-clamping, energy, and staplers facilitated safe laparoscopic dissection between the anterior and posterior sectors, with control of intrahepatic vascular structures and ultimate division of the right hepatic vein at its origin. Conclusion: Parenchymal preservation leveraging MIS technique facilitated complete resection of an isolated adrenocortical carcinoma metastasis. Laparoscopic extended posterior sectorectomy allowed for rapid progression through postoperative milestones with early discharge and salvage of the majority of the anterior sector, thereby reducing this patient’s risk for postoperative liver failure and mortality.

Metastasis to the Lung From Carcinomas of Nonpulmonary Sites After Prolonged Disease-free Intervals.

Most carcinomas of nonpulmonary sites that metastasize to the lung do so within 5 years of diagnosis. Although examples of late metastasis to the lung after prolonged disease-free intervals (>5 y) have been reported sporadically, this phenomenon has not been systematically analyzed. The aim of this study was to describe the clinical and pathologic features of metastases to the lung from carcinomas of nonpulmonary origin after prolonged disease-free intervals. We searched our pathology archives to identify lung biopsies/resections containing metastases from carcinomas of nonpulmonary origin. Medical records were reviewed to determine the interval between resection of the nonpulmonary primary and subsequent detection of lung metastasis. Cases were included if the disease-free interval between initial diagnosis and lung metastasis exceeded 5 years and the site of origin could be verified by pathologic examination. Of 195 consecutive lung metastases from carcinomas of nonpulmonary sites, the recurrence-free interval before lung metastasis was >5 years in 20 (10.3%). Primary sites (number of cases, recurrence-free interval) included kidney (5, 6 to 33 y), endometrium (5, 8 to 10 y), colon (3, 6 to 13 y), breast (2, 8 y, 12 y), esophagus (1, 8 y), thyroid (1, 10 y), epiglottis (1, 12 y), prostate (1, 12 y), and ovary (1, 15 y). At diagnosis of lung metastasis, lung nodules/masses were multiple in 12 and solitary in 8. Carcinomas of nonpulmonary sites can metastasize to the lung after prolonged disease-free intervals and present as a solitary lung mass. The most common culprits are carcinomas of the kidney and endometrium.

Clinical Implications of Cytotoxic T Lymphocyte Antigen-4 Expression on Tumor Cells and Tumor-Infiltrating Lymphocytes in Extrahepatic Bile Duct Cancer Patients Undergoing Surgery Plus Adjuvant Chemoradiotherapy.

There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus adjuvant chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

Locally advanced gallbladder cancer: a management dilemma

Gallbladder cancer is an aggressive malignancy that is associated with a poor prognosis. While surgical resection provides the only curative option, the majority of patients are not considered resectable due to the presence of metastatic disease at the time of presentation. As systemic therapeutic options improve, a treatment dilemma can arise in patients treated with upfront chemotherapy with responsive disease and regionally metastatic disease that is resectable. We present a patient with regionally metastatic gallbladder cancer to segment IVb of the liver with responsive disease after gemcitabine/cisplatin treatment who underwent a radical cholecystectomy and central hepatectomy resulting in a prolonged disease-free interval.

A Multicenter Open-Label, Phase 1b/2 Study of Ibrutinib in Combination with Lenalidomide and Rituximab in Patients with Relapsed or Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL)

A Multicenter Open-Label, Phase 1b/2 Study of Ibrutinib in Combination with Lenalidomide and Rituximab in Patients with Relapsed or Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL)

Use of natalizumab in multiple sclerosis: current perspectives

ABSTRACTIntroduction: Natalizumab is an efficacious monoclonal antibody approved for use in relapsing-remitting multiple sclerosis (RRMS). Multiple studies have demonstrated reduced relapse rate, decreased disability progression and prolonged disease-free intervals with natalizumab use. However, natalizumab is associated with an increased risk of progressive multifocal leukoencephalopathy (PML), thus restricting its widespread use with populations at high risk for developing PML. Recently, the effect of natalizumab in secondary-progressive (SPMS) population has been explored.Areas covered: This review highlights the pathophysiology behind disease progression in MS and summarizes various attributes of natalizumab including: its pharmacological properties and global economic impact, results of clinical efficacy studies, its role in SPMS, pregnancy and its adverse events profile including PML and discontinuation protocols.Expert opinion: Despite an established role in reducing RRMS disease activity, natalizumab has found limited use in SPMS due to insufficient evidence of efficacy. Current disease-modifying therapies exert modest overall benefit in SPMS owing to its complex pathophysiology, higher prevalence of comorbidities and increased PML risk with age and lack of reliable outcome measures. Finding more appropriate MRI and clinical outcome measures is quintessential for designing future randomized trials and possibly exploring primary neuroprotective agents for treating SPMS.

Hypermetabolic Calcified Lymph Nodes on 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography in a Case of Treated Ovarian Cancer Recurrence: Residual Disease or Benign Formation?

The contribution of positron emission tomography/computed tomography (PET/CT) with 18F-fludeoxyglucose (FDG) in evaluating ovarian cancer recurrence even after a prolonged disease-free interval, and in therapy response is well-described. Calcifications observed in CT, although usually attributed to benign conditions, may actually represent active disease. Such an example of calcified formations is psammoma bodies. We present a case of 56-y. o. patient with ovarian cancer relapse at the supraclavicular area 18 years after complete response and disease-free interval. The patient received chemotherapy and underwent 18F-FDG-PET/CT for the evaluation of treatment response. Both CT corrected and uncorrected PET images showed hypermetabolism in the massively calcified lymph nodes in the neck, mediastinum, axilla and abdomen, indicative of active residual disease.

Interstitial High Dose Rate (HDR) Brachytherapy with Open Laparotomy for Locally Advanced Primary or Recurrent Gynaecological Cancer: Peter MacCallum Cancer Centre Experience

To report the technique and treatment outcomes of open interstitial brachytherapy performed at the Peter MacCallum Cancer Centre between 2007- 2013. Between June 2007 and December 2013, 11 patients were treated with curative intent using open interstitial implants as a radiotherapy boost (in combination with external beam radiotherapy (EBRT) and weekly platinum chemotherapy. Patients had no evidence of nodal or distant metastasis, and were receiving either upfront treatment for carcinoma of the vagina (n=2) or cervix stump (n=1) or isolated vault recurrence following primary surgery (cervix- 4; endometrium - 3; vagina-1). The main rationale for laparotomy was to minimise toxicity to bowel by allowing 1) placement of a spacer between interstitial needles and the bowel 2) adhesion lysis, if required 3) direct visualization of needle placement. RT planning was performed using MRI and CT. With a minimum follow up of 2 years, 10 of 11 patients were alive and 6 patients were disease-free and remained asymptomatic. These patients were either receiving primary treatment or had a prolonged disease-free interval between their initial primary treatment and presentation with recurrent disease. Of the remaining 5 patients, all had either persistent disease or relapsed at primary site. 1 of them developed distant metastasis and died of disease. 2 of these patients progressed in the inguinal nodes. 4 patients were alive with disease at 12 months, 3.5 years, 3 years and 2 years from the date of implant. Open Interstitial Implant is feasible and tolerated with acceptable toxicity. However, patient selection and adequate expertise are of utmost importance.

Mo1760 Crohn's Disease Recurrence After Ileocolonic Resection: High Expression of TLR2 and TLR4 is Associated to Prolonged Disease Free Interval

Mo1760 Crohn's Disease Recurrence After Ileocolonic Resection: High Expression of TLR2 and TLR4 is Associated to Prolonged Disease Free Interval

Maintenance therapy with toceranib following doxorubicin-based chemotherapy for canine splenic hemangiosarcoma.

BackgroundSpenic hemangiosarcoma (HSA) in dogs treated with surgery alone is associated with short survival times, and the addition of doxorubicin (DOX) chemotherapy only modestly improves outcome. The purpose of this study was to evaluate the impact of toceranib administration on progression free survival in dogs with stage I or II HSA following splenectomy and single agent DOX chemotherapy. We hypothesized that dogs with splenic HSA treated with adjuvant DOX followed by toceranib would have prolonged disease-free interval (DFI) and overall survival time (OS) when compared to historical dogs treated with DOX-based chemotherapy alone.ResultsDogs with stage I or II splenic HSA were administered 5 cycles of single-agent DOX every 2 weeks beginning within 14 days of splenectomy. Dogs were restaged 2 weeks after completing DOX, and those without evidence of metastatic disease began toceranib therapy at 3.25 mg/kg every other day. Forty-three dogs were enrolled in this clinical trial. Seven dogs had evidence of metastatic disease either before or at re-staging, and an additional 3 dogs were found to have metastatic disease within 1 week of toceranib administration. Therefore 31 dogs went on to receive toceranib following completion of doxorubicin treatment. Twenty-five dogs that received toceranib developed metastatic disease. The median disease free interval for all dogs enrolled in this study (n = 43) was 138 days, and the median disease free interval for those dogs that went on to receive toceranib (n = 31) was 161 days. The median survival time for all dogs enrolled in this study was 169 days, and the median survival time for those dogs that went on to receive toceranib was 172 days.ConclusionsThe use of toceranib following DOX chemotherapy does not improve either disease free interval or overall survival in dogs with stage I or II HSA.