Single Oncology Center Research Articles

Transfusion Practice Patterns in Cancer Patients with Anemia: A Retrospective Study from a Single Oncology Center in Najran, Saudi Arabia

Background: Recent studies support the safety of restrictive pretransfusion hemoglobulin thresholds (≤7-8 g/dL) for adult cancer patients on chemotherapy. However, the restrictive transfusion strategies role in decreasing inappropriate red blood cell (RBC) transfusion practice in Saudi Arabia is not yet understood. This study aims to evaluate transfusion practices among oncologic patients at Najran Oncologic Center, Saudi Arabia. Materials and Methods: A retrospective chart review study between January 1, 2020, and December 31, 2022, involving 59 adult cancer patients presented to King Khaled Hospital in Najran, Saudi Arabia. Clinical variables for prescribing RBC transfusions based on liberal (> 7 g/dL) or restricted (Hb < 7 g/dL) baseline hemoglobin levels and number of transfused RBCs were investigated in univariate analysis. Results: The mean age was 65.0 ±10.2 years, and most cases were male (n=40, 67.8%). The common primary tumor location was colorectal cancers (n=27, 45.8%), and most cases were in metastatic stages (n=44, 74.6%). The majority of cases (n=36, 61.0%) had severe anemia (Hb < 7 g/dL) at admission. The mean number of RBC units received was 4.9 ±2.4 RBC. Variables associated with restricted prescribing RBC transfusions were male gender (OR: 3.21; 95% CI: 1.05-10.33, p= 0.044), high ECOG-PS status (OR: 2.95; 95% CI: 1.01-9.03, p=0.048), cardiac disease history (OR: 2.05; 95% CI: 0.69-6.44, p= 0.009), and platinum-based chemotherapy (OR: 233.33; 95% CI: 33.12-5054.45, p <0.001). However, survival status was higher among patients with restrictive strategy (OR: 0.25; 95% CI: 0.08-0.73, p= 0.025). Factors associated with an increased number of transfused RBCs were male gender (OR:1.43; 95% CI: 1.07-1.93, p= 0.012), platinum-based chemotherapy (OR:1.55; 95% CI: 1.18-2.15, p= 0.004), history of bleeding (OR: 1.31, 95% CI: 1.02-1.73, p= 0.032), and history of cardiac disease (OR: 1.31 (1.02-1.73; p= 0.002). Conclusion: The study concluded that factors like male gender, platinum-based chemotherapy, bleeding history, and concurrent cardiac disease were associated with an increased number of RBC transfusions. In addition to that, we found a clear adherence to the clinical practice guidelines among the transfused patients. The study suggests an etiology-based approach to cancer-related anemia and transfusions, enabling clinicians to plan safe, targeted therapy and improve patients’ quality of life by synchronizing chemotherapy efficacy.

Evaluating the Effects of Prostate Radiotherapy Intensified with Pelvic Nodal Radiotherapy and Androgen Deprivation Therapy on Myelosuppression: Single-Institution Experience.

Prostate cancer (PCa) management commonly involves the utilization of prostate radiotherapy (PRT), pelvic nodal radiotherapy (PNRT), and androgen deprivation therapy (ADT). However, the potential association of these treatment modalities with bone marrow (BM) suppression remains inadequately reported in the existing literature. This study is designed to comprehensively evaluate the risk of myelosuppression associated with PRT, shedding light on an aspect that has been underrepresented in prior research. We conducted a retrospective analysis of 600 patients with prostate cancer (PCa) treated with prostate radiotherapy (PRT) at a single oncology center between 2007 and 2017. Patients were categorized into four cohorts: PRT alone (n = 149), PRT + ADT, (n = 91), PRT + PNRT (n = 39), and PRT + PNRT + ADT (n = 321). To assess the risk of myelosuppression, we scrutinized specific blood parameters, such as hemoglobin (HGB), white blood cells (WBCs), neutrophils (NEUT), lymphocytes (LYM), and platelets (PLT) at baseline, mid-treatment (mRT), immediately post-RT (pRT), 1 month post-RT (1M-pRT), and 1 year post-RT (1Y-pRT). The inter-cohort statistical significance was evaluated with further stratification based on the utilized RT technique {3D conformal radiotherapy (3D-CRT), and intensity-modulated radiation therapy (IMRT)}. Significant statistical differences at baseline were observed in HGB and LYM values among all cohorts (p < 0.05). Patients in the PRT + PNRT + ADT cohort had significantly lower HGB at baseline and 1M-pRT. In patients undergoing ADT, BMS had a significant impact at 1M-pRT {odds ratio (OR) 9.1; 95% Confidence Interval (CI) 4.8-17.1} and at 1Y-pRT (OR 2.84; CI 1.14-7.08). The use of 3D-CRT was linked to reduced HGB levels in the PRT + PNRT + ADT group at 1 month pRT (p = 0.015). Similarly, PNRT significantly impacted BMS at 1M-pRT (OR 6.7; CI 2.6-17.2). PNRT increased the odds of decreased WBC counts at 1Y-pRT (OR 6.83; CI: 1.02-45.82). Treatment with any RT techniques (3D-CRT or IMRT), particularly in the PRT + PNRT and PRT + PNRT + ADT groups, significantly increased the odds of low LYM counts at all time points except immediately pRT (p < 0.05). Furthermore, NEUT counts were considerably lower at 1M-pRT (p < 0.05) in the PRT + PNRT + ADT group. PLT counts were significantly decreased by PRT + PNRT + ADT at mRT (OR 2.57; 95% CI: 1.42-4.66) but were not significantly impacted by the RT technique. Treatment with PRT, ADT, PNRT, and 3D-CRT is associated with BMS. Despite this statistically significant risk, no patient required additional interventions to manage the outcome. While its clinical impact appears limited, its importance cannot be underestimated in the context of increased integration of novel systemic agents with myelosuppressive properties. Longer follow-up should be considered in future studies.

803. 2-YEAR RESULTS IN ESOPHAGOGASTRIC JUNCTION CANCER TREATMENT

Abstract Background Esophagogastric junction (EGJ), also known as cardia, tumors have unique characteristics with a widespread of lymph node (LN) metastatic patterns influenced by the extent of esophageal involvement. Besides, there is no worldwide consensus about its classification and the optimal lymphadenectomy and surgical resection extend. Recently, mapping the distribution of LN metastasis in these patients could provide some insights about the extent that should be the target. Furthermore, the balance between resection extension and the procedure safety is also difficult to achieve. This work aims to review the last 2 years of EGJ tumor treatment in a single oncological center. Methods We present a retrospective, single center study that included all the patients with EGJ cancer undergone surgical resection between 2022 and 2023. These tumors were classified using our modified Siewert (mSiewert) classification based on mapping endoscopy with measures of the full extension and not only the tumor’s epicenter. Patient demographics, tumor characterization, neoadjuvant treatment, surgical procedure and postoperative results were assessed, alongside with pathological and oncological metrics as recurrence, disease-free survival (DFS) and overall survival (OS). Results We included 64 cardia cancer patients who underwent a curative treatment strategy, with a median age of 68 years, mostly men (87.5%), with a median BMI of 25 kg/m2. 68.2% were classified as ECOG-PS 0 however 62.5% were classified as ASA III-IV. Most tumors were moderately (39.2%) or poorly (31.4%) differentiated adenocarcinomas. Majority were locally advanced (cT3, 78.1%) and in stage III (85.9%). Regarding tumor location, 49.2% were classified as mSiewert I-II (49.2%), followed by I-II-III (18%) and II-III (18%). 36.1% had esophageal involvement ≥4cm, 87.5% received neoadjuvant treatment split between the CROSS and FLOT protocols. Our resection rate was 85.9%. We mostly performed Mckeown esophagectomy (49.1%) and transhiatal esophagectomy (18.2%). We had a 12.7% admission rate to the intensive care unit and a 27.3% major complication rate (Clavien-Dindo ≥ 3b). Anastomotic dehiscence occurred in 16.4% of cases, with hospital mortality rate of 3.6%. The median hospital stay was 6 days, with a 16.4% readmission rate. Pathological staging revealed that 47.3% were stage III, with a median lymph node yield of 28 and a 98.2% R0 resection rate. Most patients received adjuvant treatment, primarily FLOT protocol or Nivolumab, in 38.2% and 29.1%, respectively. The recurrence rate was 28%, with a median time to recurrence of 26 weeks, mainly occurring as distant metastasis pattern (64.3%). One-year overall survival (OS) was 88.7%, and one-year disease-free survival (DFS) was 66.4%, with a median follow-up time of 48 weeks and only a 3.6% loss to follow-up rate. Conclusion This study highlights the unit’s adaptation of EGJ tumor treatment to new insights, emphasizing the importance of comprehensive classification and multimodal and multidisciplinary approach to enhance patient outcomes.

Pulsed Radiofrequency in the Management of Postsurgical Abdominal Wall Chronic Pain: A Report From a Single Oncological Center.

Chronic postsurgical pain (CPSP) is defined as pain that develops or increases in intensity after a surgical procedure or tissue injury and persists beyond the healing process, lasting at least three months after the precipitating event. Often neuropathic in nature, CPSP can be challenging to manage. CPSP is a common complication, with data suggesting an incidence ranging from 5% to 85%, depending on the type of procedure. Meralgia paresthetica (MP) and ilioinguinal/iliohypogastric neuralgias (IH/IL N) are two possible clinical scenarios of CPSP following lower abdominal procedures. Pulsed radiofrequency (PRF) is a minimally invasive technique of peripheral neuromodulation effective in various pain etiologies; however, evidence is scarce regarding its use in MP and IH/IL N. This case series aims to assess the potential role of PRF in the management of CPSP following abdominal wall procedures. This case series was set in a single oncological center between January 2017 and February 2022 and included adult patients (>18 years old) referred to our unit with a high suspicion of postsurgical MP or IH/IL N refractory to conservative treatment. PRF was performed after a positive diagnostic block in patients whose pain could not be controlled despite optimal medical treatment. The efficacy of PRF was assessed regarding pain intensity using the verbal numeric scale (VNS) and the duration of pain relief in weeks. The follow-up period was from the initial PRF procedure to the end of data collection. Parametric data were presented as mean and standard deviation (SD), and non-parametric data as median (minimum-maximum). Seventeen patients were included: 82.35% (n=14) were female, and the mean age was 58.0 ± 11.35 years. MP was present in 47.1% (n=8) and IH/IL N in 52.9% (n=9). Transverse rectus abdominis muscle flap reconstruction (TRAM) was the most common procedure (n=5, 29.41%). Diagnostic blocks were performed in 88.24% (n=15) of the patients. Initial VNS scores were 7.59 ± 2.62; 2.82 ± 2.62 at 24 hours; and 2.47 ± 1.58 at 15 days. During follow-up, 70.59% (n=12) of patients had no recurrence of initial symptoms. A second PRF was performed in 29.41% (n=5) cases based on the recurrence of symptoms, following a mean period of pain relief of 112 (8-238) weeks. No major or minor complications were identified during early or late follow-up. PRF can be a useful tool to improve the multimodal management of postsurgical abdominal wall chronic pain.

Unlocking the potential: the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) as biomarkers informing immunotherapy outcomes in lung cancer patients — single oncology center experience and literature review

Unlocking the potential: the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) as biomarkers informing immunotherapy outcomes in lung cancer patients — single oncology center experience and literature review

The impact of alpha-fetoprotein (AFP), child-turcotte-pugh (CTP) score and disease staging on the survival of hepatocellular carcinoma (HCC) patients: a retrospective cohort from single oncology center

The impact of alpha-fetoprotein (AFP), child-turcotte-pugh (CTP) score and disease staging on the survival of hepatocellular carcinoma (HCC) patients: a retrospective cohort from single oncology center

Toward Inclusive Oncology: Challenges in the Therapy of Pediatric Non-B Non-Hodgkin Lymphomas.

Non-B non-Hodgkin lymphomas (NHL) represent over 30 T/NK lymphoma types. The majority of them are T-cell lymphoblastic lymphomas (TLL) and anaplastic large cell lymphomas (ALCL). Other rare non-B NHLs represent a diverse group of neoplasms, usually excluded from clinical trials. This study analyzed outcomes in pediatric patients with non-B NHL in a single oncology center with particular emphasis on patients with rare NHLs. We retrospectively analyzed data from patients <18 years with newly diagnosed non-B NHL treated at the Department of Pediatric Hematology and Oncology in Bydgoszcz between 2002 and 2022. The probability of 5-year overall survival (pOS) and event-free survival (pEFS) were calculated for the entire cohort and patients with TLL and ALCL. The clinical course for patients with rare non-B NHL was described in detail. Twenty-six children were eligible for analysis. Fourteen patients were diagnosed with ALCL, nine with TLL, and three with rare NHL types (subcutaneous panniculitis-like T-cell lymphoma, extranodal NK/T-cell lymphoma and hydroa vacciniforme-like lymphoproliferative disease associated lymphoma). For the entire group, the 5-year pOS was 83.7% and the 5-year pEFS was 72.4%. For TLL and ALCL, the outcomes were comparable with those achieved in clinical trials. Patients with rare NHL were treated according to individualized therapy recommendations based on physicians' expertise and available case report descriptions. There is a lack of knowledge on optimal therapeutic strategies for rare NHLs. It is crucial to create trials dedicated to uncommon NHLs and establish therapy guidelines for these patients.

Epidemiological and clinical characteristics of lung cancer in Saudi Arabia: a retrospective study in single oncology center.

Lung cancer (LC) is one of the most common neoplastic diseases and a leading cause of death in Saudi Arabia. Its incidence in Saudi Arabia has increased by more than 3% within two decades. Our study aimed to describe the epidemiological and genetic landscapes of LC in Al-Madinah city in Saudi Arabia. A retrospective analysis was conducted on the medical records of 65 patients diagnosed with lung cancer between 2015 and 2021 at a single medical oncology center in Al-Madinah city of Saudi Arabia. The mean patients' age was 59.2 years, with 50 (76.9%) males and 15 (23.1%) females; 37 (57%) smokers, and 28 (43%) non-smokers. The number of cases per year has increased gradually over six years from 2015 (n = 3) to 2020 (n = 13). The most prevalent histopathological diagnosis was non-small cell lung cancer (NSCLC) (n = 58, 89%) followed by small cell lung cancer (SCLC) (n = 5, 7.8%). NSCLC was frequently more common in smokers while squamous cell carcinoma was more frequent in non-smokers. Around 89% (n = 58) of the cases were diagnosed in late stage IV and the most common metastatic sites were to pleura and lymph nodes (n = 32, 49.2%). Program Death Legend-1 (PDL-1) was fairly expressed in 7/10 (70%) patients. Epidermal Growth Factor Receptor (EGFR) was mutated in 5/17 (29%) patients. Other mutations detected include Anaplastic Lymphoma Kinase (ALK) and phosphatidylinositol 3-kinase (PIK3C) mutations in two patients. Our study revealed that lung cancer is a significant burden in Al-Madinah city of Saudi Arabia. If the risk factors are not controlled, the number of cases may increase considerably. Health education about the risk factors and cancer prevention helps in early lung cancer detection.

Synoptic Operative Reporting in Cervical Cancer Surgeries: Experience From a Single Oncology Center.

Objective In today's era of highly methodological oncological practices in place, we have a huge database to regulate, and it is foreseeable that a humongous load of information is ahead of us that we need to organize and comprehend. With the advancement in surgical equipment and evolving procedures, we need to store the information in a transferrable, understandable, and systematic way to prevent any ebb in the future. The systematic recording of operative data is even more important for patient management, training, and research. Standardized reporting also helps surgical residents have a better understanding of all aspects of the procedure. This study aims to analyze the synoptic operative reporting in cervical cancer patients from December 2009 to February 2020 in asingle tertiary care center dedicated to providing oncology services to patients. This study will analyze the understandability, volume, and ease of transference of data during the given time period. Methodology The Alberta Cancer Registry was contacted to obtain data from the synoptic operative reports. Synoptic Operative Reports of all the patients operated on cervical cancer from December 2009to February 2020. Results The data were obtained for 574 patients. As many as 463 patients were operated on for stage 1 and 2 cervical cancers and 10 patients for advanced and recurrent cervical cancer. A total of 101 patients were operated on for high-grade cervical dysplasia (HSIL). Adenocarcinoma was the most common histology. Laparotomy was performed in 308 patients, whereas others had laparoscopic procedures. Details of the surgery from the beginning of the incision to closure were recorded. The cervical cancer template consisted of 356 questions. There were separate templates for advanced and early-stage cancer. However, even with the meticulously detailed report, an average of only eight minutes was taken by each user to complete the template. Conclusion The computerized synoptic operative report has an upper hand over the dictated documentation report along with the ease of execution without missing essential substance. Its utility as an educational tool is very promising. Therefore, we encourage other facilities, especially cancer centers, to use synoptic operative reports more extensively not only for cervical cancer surgeries but also for other ones.

Relapsed childhood acute myeloid leukemia: prognostic factors and outcomes: experience from a single oncology center

Relapsed childhood acute myeloid leukemia: prognostic factors and outcomes: experience from a single oncology center

Is a radiological score able to predict resection-grade chondrosarcoma in primary intraosseous lesions of the long bones?

The preoperative grading of chondrosarcomas of bone that accurately predicts surgical management is difficult for surgeons, radiologists, and pathologists. There are often discrepancies in grade between the initial biopsy and the final histology. Recent advances in the use of imaging methods have shown promise in the ability to predict the final grade. The most important clinical distinction is between grade 1 chondrosarcomas, which are amenable to curettage, and resection-grade chondrosarcomas (grade 2 and 3) which require en bloc resection. The aim of this study was to evaluate the use of a Radiological Aggressiveness Score (RAS) to predict the grade of primary chondrosarcomas in long bones and thus to guide management. A total of 113 patients with a primary chondrosarcoma of a long bone presenting between January 2001 and December 2021 were identified on retrospective review of a single oncology centre's prospectively collected database. The nine-parameter RAS included variables from radiographs and MRI scans. The best cut-off of parameters to predict the final grade of chondrosarcoma after resection was determined using a receiver operating characteristic curve (ROC), and this was correlated with the biopsy grade. A RAS of ≥ four parameters was 97.9% sensitive and 90.5% specific in predicting resection-grade chondrosarcoma based on a ROC cut-off derived using the Youden index. Cronbach's α of 0.897 was derived as the interclass correlation for scoring the lesions by four blinded reviewers who were surgeons. Concordance between resection-grade lesions predicted from the RAS and ROC cut-off with the final grade after resection was 96.46%. Concordance between the biopsy grade and the final grade was 63.8%. However, when the patients were analyzed based on surgical management, the initial biopsy was able to differentiate low-grade from resection-grade chondrosarcomas in 82.9% of biopsies. These findings suggest that the RAS is an accurate method for guiding the surgical management of patients with these tumours, particularly when the initial biopsy results are discordant with the clinical presentation.

Scalp cooling and chemotherapy: evaluation of quality of life and trichoscopy

Objectives: This study aimed to evaluate the quality of life (QoL) of patients undergoing scalp cooling during chemotherapy and to describe hair density data assessed by trichoscopy. Background: Hair loss during chemotherapy is a common and distressing side effect, and prevention can be done through scalp hypothermia. Methods: A prospective cohort study was conducted at a single oncology center in Brazil. Patients undergoing scalp cooling during chemotherapy were included. QoL and body image satisfaction (BIS) questionnaires were administered at the beginning and end of treatment. Data on alopecia were collected. Trichoscopy with a Fotofinder® device was performed at the beginning, before the second cycle, and at the end of treatment. STROBE guidelines were followed for the development of this study. Results: Twenty-seven patients were included. There was no difference in mean QoL or BIS scores in the comparison of patients with hair loss &lt; 50% with those with hair loss ≥ 50%. Better outcomes in the QoL and BIS scales were found in patients treated with anthracyclines. Hair density described by trichoscopy showed a maximum reduction of up to 16.3%, and loss was more common in the frontal area. Conclusions: Thus, there is no clear evidence of better QoL in patients with a lower grade of alopecia after scalp cooling during chemotherapy. Validated scales can be useful for assessing QoL in this population.

Therapy results in pediatric Hodgkin lymphoma — does less mean better? Experience from a single children’s oncology center

Therapy results in pediatric Hodgkin lymphoma reflect remarkable progress in pediatric oncology. In the last decade, relevant development of new therapeutic options for children with refractory or relapsed disease has been made. In this study, we retrospectively analyzed therapy results and risk factors in children treated in a single oncology center according to five therapeutic protocols. Data from 114 children treated by a single institution between 1997 and 2022 were analyzed. Classic Hodgkin lymphoma therapy results were divided into four therapeutic periods: 1997–2009, 2009–2014, 2014–2019, and 2019–2022. For nodular lymphocyte-predominant Hodgkin lymphoma, data from one therapeutic protocol was analyzed. For the entire group, the 5-year probability of overall survival was 93.5%. There were no statistically significant differences between therapeutic periods. The occurrence of B symptoms at diagnosis and incidence of relapse were risk factors for death (p = 0.018 and p < 0.001). Relapse occurred in 5 cases. The 5-year probability of relapse-free survival for the entire group was 95.2%, without significant differences between groups. Patients treated between 1997 and 2009 had over a sixfold higher risk for events, defined as primary progression, relapse, death, or incidence of secondary malignancies (OR = 6.25, p = 0.086). The 5-year probability of event-free survival for all patients was 91.3%. Five patients died, and the most common cause of death was relapse. Modern therapeutic protocols in pediatric Hodgkin lymphoma are marked by excellent outcomes. Patients with disease relapses have a notably high risk of death, and the development of new therapeutic options for this group remains one of the main goals of current trials.

Malnutrition in Head and Neck Cancer: A Patient-reported Outcome Study.

Head and neck cancer (HNC) is associated with a high risk of malnutrition. Malnutrition is defined as acute weight loss greater than 5% and increases mortality 1.7-fold for HNC patients. The aim of the study was to investigate the social and nutritional impairments that patients face throughout cancer-survivorship. The study was conducted nationwide via the self-help network and in a single oncological center. We analysed 134 patient reported outcome (PRO) questionnaires with a mean age of 65.5±9.4 years, including 88 males, 36 females, and ten participants of undisclosed sex. The questionnaire contained 47 items enquiring about demography, weight development, and how treatment impaired nutrition. The patient data showed a weight loss of 8% after surgery, 13% after (chemo)radiotherapy [(C)RT] and a return to baseline weight in convalescence. However, patients with a baseline weight >100 kilogram (kg), had a 22% weight loss after (C)RT (p<0.0001) and this remained permanent at 11% (p=0.0041). Treatment-associated side-effects gradually decreased in the course compared to the time of treatment: loss of taste (55% to 21%), xerostomia (56% to 42%), dysphagia (57% to 43%), and dental problems (33%/ to 21%). (C)RT immediately led to more loss of taste (p=0.0461) and dysphagia (p=0.0334), and surgery as a singular modality scored the lowest odds ratio for side-effects. Social Impact: mood, supporting networks, and supplement satisfaction were rated "good" (Likert Scale). Malnutrition is common among HNC patients. High baseline weight and extensive multimodal treatment are important risk factors that require enhanced stewardship.

Influence of the COVID-19 pandemic on diagnostic and treatment options for breast cancer patients – assessment from a point of view of a single oncology centre

Influence of the COVID-19 pandemic on diagnostic and treatment options for breast cancer patients – assessment from a point of view of a single oncology centre

Simultaneous Approach of Colo-Rectal and Hepatic Lesions in Colo-Rectal Cancers with Liver Metastasis - A Single Oncological Center Overview.

Introduction: Management of synchronous colorectal cancer with liver metastases (SCLM) is still on debate, regarding timing, indications and complications of the 3 strategies: classic approach (first tumor resection), simultaneous resection and reverse approach (liver first). A retrospective single-centre evaluation of synchronous approach was accomplished, focusing on surgical technique, indications and complications. Material and Methods: Between 2017 and 2020, 31 SCLM patients benefited from synchronously colorectal and hepatic approach: segmental colectomies/rectal resections, simultaneously with liver metastasectomies (associated with radiofrequency ablation). Post-therapeutic imaging monitoring was performed from every 3 - 6 months. There were no perioperative complications related to the combination of the procedures, low morbidity and zero postoperative mortality. Results: The follow-up period was 10 - 40 months: 13 patients had no evidence of recurrence, 10 had hepatic metastases in regression, 4 patients had signs of peritoneal carcinomatosis and 4 showed progression of liver disease; all patients were on chemotherapy. During follow-up 4 patients died. Conclusions: Experience shows that the simultaneous approach of recto-colic and hepatic resections in colo-rectal cancers is a safe procedure, with low morbidity, the limits being dictated by the size of the liver metastases. The results at long-distance must be drawn by further consistent trials.

Improved Outcome in Pediatric Acute Myeloid Leukemia: Progress With Hematopoietic Cell Transplantation.

Pediatric acute myeloid leukemia (AML) is a heterogenous disease; however, development of diagnostic methods has led to a better understanding of its nature and improvement in therapy outcomes. In this study, we evaluated treatment results in children with AML treated in a single oncology center in comparison with international results. Data from 77 children with AML treated in a single oncology center between 1994 and 2020 were analyzed. Patients had been treated according to five consecutive therapy protocols: AML NOPHO 88; ANLL 98; BFM AML 2004; BFM AML 2012, and BFM AML 2019. Five-year overall survival (OS), 5-year event-free survival (EFS) and 5-year relapse-free survival (RFS) were evaluated for each therapy protocol to determine prognostic factors and clarify differences between international and individual center results. During the observational period, 5-year OS increased from 55.6% to 85.7%, 5-year EFS from 45.7% to 87.5% and 5-year RFS from 51.4% to 85.7%. Hematopoietic cells transplantation (HCT) introduction in early 2000' improved treatment outcomes in the high-risk group, what has been mostly seen in the results of 5-year EFS. Treatment-related mortality was the most frequent cause of death in the analyzed group. Despite the significant improvement in therapy of pediatric AML, treatment outcomes remain unsatisfying. Introduction of HCT relevantly improved therapy results, especially in the high-risk group. International cooperation is crucial because of the small patient numbers in individual oncology centers.

Single center experience with alpelisib-fulvestrant in heavily pretreated women with HR(+), HER-2 (−) metastatic breast cancer.

e13034 Background: HR-positive, Her2-negative metastatic breast cancer patients harboring PIK3CA mutations are associated with resistance to endocrine therapy and worse prognosis. Results from the phase III SOLAR-1 trial demonstrate improved PFS for patients treated with Alpelisib-Fulvestrant after failure on first or second line treatment with aromatase inhibitor. Methods: Within an early access program for Alpelisib in a single oncology center, patients diagnosed with metastatic HR-positive, Her2 -negative breast cancer were screened for PIK3CA mutations. New generation sequencing (NGS) was the preferred technique to identify carriers with PIK3CA mutations on soft tissue or liquid biopsy. Patients who progressed and carried PIK3CA mutations received Alpelisib and fulvestrant as subsequent line of therapy. Results: Among 32 patients (pts) screened, 13 (40,6%) had a PIK3CA mutation. In total, 11 pts received alpelisib. Median age at diagnosis was 57.5 years (range, 39-69). Eight pts (72.7%) had been operated for early-stage breast cancer, 6 (54.5%) had received adjuvant chemotherapy and 5 (45.5%) had received adjuvant radiotherapy. Of 11 pts with evaluable histology, 3 pts (27.3%) had high grade tumors at diagnosis. Ten pts (90.9%) had PR positive tumors. Median Ki67 was 20% (range, 2-80). Eight pts (72.7%) had PIK3CA exon 20 and 3 (27.3%) had exon 9 mutations. Six pts (54.5%) had received prior chemotherapy in the metastatic setting and 10 (90.9%) prior CDK4/6 inhibitor. Three pts (27.3%) received Alpelisib as 2nd line and all remaining patients received alpelisib beyond 3rd line treatment. All pts (100%) had metastasis to the bones, 8 pts (72.7%) to the liver, 6 pts (54.5%) to the lungs and 2 pts (18.2%) to the brain. Until the date of last assessment, Alpelisib was administered for a median of 5.1 months (range, 0.4-21.3). Ten pts were evaluable for response to treatment with Alpelisib. One (10%) had CR, 5 (50%) SD and 4 (40%) PD as best response. Median duration of disease control was not reached. Baseline characteristics were not associated with disease control. Adverse events noticed were thrombocytopenia grade II (1/11), diarrhea grade II (2/11), skin rash grade I &amp;II (4/11), weakness grade III (1/11) and hyperglycemia (3/11). Conclusions: Prevalence of PIK3CA mutations is consistent with published data. Furthermore, combination of Alpelisib-Fulvestrant is a highly active line of therapy even in heavily pretreated patients.

Fertility preservation in gynaecology oncology patients: Experience from an Australian tertiary oncology centre.

Management for gynaecological cancers often includes removal of the reproductive organs and/or the use of gonadotoxic therapies resulting in sub-fertility. Oncofertility and discussion of fertility preservation in these patients is critical. To determine the rate of fertility preservation discussion among a cohort of patients with a gynaecological cancer and what determinants impact likelihood of a discussion. A seven-year quantitative retrospective study was conducted at a single oncology centre, including 15-45year old patients with a gynaecological cancer. The primary outcome was if a fertility preservation discussion occurred during a consultation. Secondary outcomes included if a referral was made and what fertility preservation services were undertaken. Determinants that impacted the likelihood of a fertility preservation discussion were analysed. One hundred and twenty-one patients were analysed. There were 84 (69%) patients who had a documented fertility preservation discussion, and 46% were referred to a fertility specialist for consultation. Age was a significant determinant, with patients aged 30-39years of age more commonly having a fertility preservation discussion. Patients with a high-grade cancer compared to patients with a lower-grade cancer (grade one or two) were only a third as likely to have a discussion surrounding their fertility (odds ratio: 0.33, 95% CI: 0.13-0.86; P=0.02). We conclude that rates of discussion around fertility options for patients with cancer are lower than the recommended guidelines. Oncofertility is an important discipline which we believe needs to be emphasised within the gynaecology oncology community and management of patients should include a multi-disciplinary team.

Estimating the risk of malignancy of adnexal masses: validation of the ADNEX model in the hands of nonexpert ultrasonographers in a gynaecological oncology centre in China

BackgroundThis study aims to validate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) the Assessment of Different NEoplasias in the adneXa (ADNEX) model in the preoperative diagnosis of adnexal masses in the hands of nonexpert ultrasonographers in a gynaecological oncology centre in China.MethodsThis was a single oncology centre, retrospective diagnostic accuracy study of 620 patients. All patients underwent surgery, and the histopathological diagnosis was used as a reference standard. The masses were divided into five types according to the ADNEX model: benign ovarian tumours, borderline ovarian tumours (BOTs), stage I ovarian cancer (OC), stage II-IV OC and ovarian metastasis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of the ADNEX model to classify tumours into different histological types with and without cancer antigen 125 (CA 125) results.ResultsOf the 620 women, 402 (64.8%) had a benign ovarian tumour and 218 (35.2%) had a malignant ovarian tumour, including 86 (13.9%) with BOT, 75 (12.1%) with stage I OC, 53 (8.5%) with stage II-IV OC and 4 (0.6%) with ovarian metastasis. The AUC of the model to differentiate benign and malignant adnexal masses was 0.97 (95% CI, 0.96–0.98). Performance was excellent for the discrimination between benign and stage II-IV OC and between benign and ovarian metastasis, with AUCs of 0.99 (95% CI, 0.99–1.00) and 0.99 (95% CI, 0.98–1.00), respectively. The model was less effective at distinguishing between BOT and stage I OC and between BOT and ovarian metastasis, with AUCs of 0.54 (95% CI, 0.45–0.64) and 0.66 (95% CI, 0.56–0.77), respectively. When including CA125 in the model, the performance in discriminating between stage II–IV OC and stage I OC and between stage II–IV OC ovarian metastasis was improved (AUC increased from 0.88 to 0.94, P = 0.01, and from 0.86 to 0.97, p = 0.01).ConclusionsThe IOTA ADNEX model has excellent performance in differentiating benign and malignant adnexal masses in the hands of nonexpert ultrasonographers with limited experience in China. In classifying different subtypes of ovarian cancers, the model has difficulty differentiating BOTs from stage I OC and BOTs from ovarian metastases.