Two-year Survival Rates Research Articles

МУЛЬТИМОДАЛЬНЫЙ ПОДХОД К ЛЕЧЕНИЮ РАКА ПИЩЕВОДА

Objective: To study the effectiveness and tolerability of preoperative chemotherapy (CHT) in combination with radical surgery in patients with esophageal squamous cell carcinoma (ESCC) II-III stages Methods: The results of the combined and surgical treatment of 43 patients with ESCC II-III stages are presented. The main group consisted of 22 patients who were assigned two courses of CHT before surgery (gemcitabine/cisplatin), followed by a radical surgery. The control group included 21 patients who received only surgical treatment. Results: Preoperative CHT in one (4.5±4.6%) patient gave a complete regression of the tumor, incomplete regression was in ten (45.5±11.1%) and stabilization is established in nine (40.9±10.9%) patients. The therapy had satisfactory tolerability and low toxicity, most patients observed the restoration of a full enteral nutrition. Postoperative complications in both groups of observations developed in 18.2±8.6% and 23.8±9.5% respectively (p>0.05). Preoperative CHT in the combined treatment of ESCC II-III stages has significantly improved two-year relapse-free and overall survival (80,9±8,7% and 85,7±7,8%) compared to the control group (35.0±10.6% and 55.0±11.1%) (p<0.05). Conclusion: The multimodal approach in the treatment of patients in II-III stages ESCC has pronounced damaging effect on the tumor and allows to significantly increase two-year relapse-free and overall survival rate compared to patients who have undergone only surgical treatment. Keywords: Esophageal squamous cell carcinoma, combined treatment, preoperative chemotherapy, short-term and long-term results.

Impact of Initial Treatment Regimen on Outcomes for Diffuse Large B-Cell Lymphoma with Dual MYC and BCL-2 or BCL-6 Expression

Introduction:Genetic rearrangements in both the MYC gene and anti-apoptotic genes such as BCL2 or BCL6 in diffuse large B-cell lymphoma (DLBCL) represent a sub-type of lymphoma, termed “double-hit lymphoma” (DHL) that is associated with poor outcomes and a poor response to standard chemoimmunotherapy regimens such as rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (Petrich et al, Blood, 2014). The incidence of DHL is low at approximately 5-10% of DLBCL presentations. Alternatively, DLBCL cases featuring dual expression of both MYC and BCL-2 and/or BCL-6 (as detected by immunohistochemistry [IHC]) occur more frequently with increasing evidence to suggest this lymphoma-subtype, termed “double-expressor lymphoma” (DEL) may also respond poorly to induction therapy with R-CHOP (Green et al, JCO, 2012). Studies examining outcomes for DEL are often limited by an inability to separate DHL from DEL or lack a direct comparison to R-CHOP and, as a result, optimal induction therapy for DEL remains an unanswered question.MethodsWe performed a retrospective review of outcomes in DEL according to initial treatment regimen (R-CHOP vs intensive therapy) for patients diagnosed from 2013-2016 at the University of Wisconsin. We excluded patients lacking IHC or FISH data for MYC or BCL-2, those receiving a non-anthracycline containing regimen, those with concurrent central nervous system presentation, and those with post-transplant lymphoproliferative disorder. Any patients meeting criteria for DHL (i.e. dual gene rearrangements) were coded as DHL and not coded as DEL regardless of MYC, BCL-2, or BCL-6 expression. Intensive therapy included dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R), or rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone (R-hyper-CVAD).ResultsFrom 200 cases of DLBCL, we identified 31 (16%) cases of DEL and 11 (6%) cases of DHL. Twenty-five cases of DEL and 9 cases of DHL were eligible for inclusion in our study. Characteristics were similar between the DHL and DEL cohort, although there were more cases of early stage disease in the DEL cohort (56% vs 11%, P=0.05).For DEL, the median age for the R-CHOP cohort was older compared to the intensive cohort (table 1, 73 vs 63), but both groups had a similar percentage of patients aged >60 years (67 vs 80%, P=0.66). Otherwise, demographics including performance status, stage, and revised international prognostic index score were well balanced between the two treatment groups with the exception of more cases of germinal center B-cell of origin (GCB) within the R-CHOP group (80 v 30%, P=0.03).Complete response rates to induction regimens for DEL were similar between the R-CHOP and intensive group (76 vs 80%, P=0.65). Median progression free survival (PFS) was extended in the intensive cohort although 2 year PFS rates were similar between the two groups (40 vs 50%, P=0.70). Two-year overall survival rates were also similar (80 vs 70%, P=0.65). Kaplan-Meier survival curves (figure 1) illustrate a potential benefit for intensive induction therapy, however this is not statistically significant (hazard ratio 0.69 P=0.65).Compared to patients with DEL, patients with DHL achieved similar complete response rates to induction therapy (76% vs 67%, P=0.67) despite exclusive use of DA-EPOCH-R for all DHL patients. There were more consolidative autologous stem cell transplants (auto-SCT) performed in the DHL group (33% vs 8%, P=0.1). PFS and OS were also similar between DHL and DEL sub-groups (HR 1.09, P=0.91)ConclusionsOur study is amongst the first to compare R-CHOP to more intensive regimens for DEL while also separating DEL from DHL. Our current sample size limits our ability to draw definitive conclusions regarding outcomes by treatment regimen; however, despite lack of statistical significance, there is a trend toward intensive regimens improving PFS and OS in DEL. Our study is also amongst the first to directly compare outcomes for DEL and DHL. Survival for DEL was similar to DHL and may reflect improvements in outcomes for DHL when using intensive regimens or may be related to the increased use of consolidative auto-SCT for DHL. Our sample is part of a planned larger multi-center analysis and an increased sample size may build on the improved survival trend demonstrated for intensive regimens vs R-CHOP observed in our analysis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Hypofractionated Concomitant Chemoradiation in Inoperable Locally Advanced Non-small Cell Lung Cancer: A Report on 100 Patients and a Systematic Review

AimsConcomitant chemoradiation is the standard of care in patients with inoperable non-small cell lung cancer. The purpose of this study was to analyse the survival outcome and toxicity data of using hypofractionated chemoradiation. Materials and methodsOne hundred patients were treated from June 2011 to November 2016. Treatment consisted of 55 Gy in 20 daily fractions concurrently with split-dose cisplatin vinorelbine chemotherapy over 4 weeks followed by two cycles of cisplatin vinorelbine only. Survival was estimated using Kaplan–Meier and Cox regression was carried out for known prognostic factors. A systematic search of literature was conducted using Medline, Embase and Cochrane databases and relevant references included. ResultsIn total, 97% of patients completed radiotherapy and 73% of patients completed all four cycles of chemotherapy. One patient died of a cardiac event during consolidative chemotherapy. There were two cases of grade 4 toxicities (one sepsis, one renal impairment). Grade 3 toxicities included nausea/vomiting (17%), oesophagitis (15%), infection with neutropenia (12%) and pneumonitis (4%). Clinical benefit was seen in 86%. Two-year progression-free survival and overall survival rates were 49% and 58%, respectively. The median progression-free survival and overall survival were 23.4 and 43.4 months, respectively. The only significant prognostic factor was the number of chemotherapy cycles received (P = 0.02). The systematic review identified 13 relevant studies; a variety of regimens were assessed with variable reporting of outcomes and toxicity but with overall an improvement in survival over time. ConclusionOur experience compared with the original phase II trial showed improved treatment completion rates and survival with acceptable morbidity. With appropriate patient selection this regimen is an effective treatment option for locally advanced non-small cell lung cancer. This study helps to benchmark efficacy and toxicity rates while considering the addition of new agents to hypofractionated concurrent chemoradiotherapy. The agreement of a standard regimen for assessment in future trials would be beneficial.

Survival and associated factors among patients with oral squamous cell carcinoma (OSCC) in Mulago hospital, Kampala, Uganda

BackgroundDespite improvements in diagnosis and patient management, survival and prognostic factors of patients with oral squamous cell carcinoma (OSCC) remains largely unknown in most of Sub Saharan Africa.ObjectiveTo establish survival and associated factors among patients with oral squamous cell carcinoma treated at Mulago Hospital Complex, Kampala.MethodsWe conducted a retrospective cohort study among histologically confirmed oral squamous cell carcinoma (OSCC) patients seen at our centre from January 1st 2002 to December 31st 2011. Survival was analysed using Kaplan-Meier method and comparison between associated variables made using Log rank-test. Cox proportional hazards model was used to determine independent predictors of survival. P-values of less than 0.05 were considered statistically significant.ResultsA total of 384 patients (229 males and 155 females) were included in this analysis. The overall mean age was 55.2 (SD 4.1) years. The 384 patients studied contributed a total of 399.17 person-years of follow-up. 111 deaths were observed, giving an overall death rate of 27.81 per 100 person-years [95% CI; 22.97–32.65]. The two-year and five-year survival rates were 43.6% (135/384) and 20.7% (50/384), respectively. Tumours arising from the lip had the best five-year survival rate (100%), while tumours arising from the floor of the mouth, alveolus and the gingiva had the worst prognosis with five-year survival rates of 0%, 0% and 15.9%, respectively. Independent predictors of survival were clinical stage (p = 0.001), poorly differentiated histo-pathological grade (p < 0.001), male gender (p = 0.001), age > 55 years at time of diagnosis (p = 0.02) and moderately differentiated histo-pathological grade (p = 0.027). However, tobacco & alcohol consumption, tumour location and treatment group were not associated with survival (p > 0.05).ConclusionsThe five-year survival rate of OSCC was poor at 20.7%. Male gender, late clinical stage at presentation, poor histo-pathological types and advanced age were independent prognostic factors of survival. Early detection through screening and prompt treatment could improve survival.

Impact of performance status and transfusion dependency on outcome of patients with myelodysplastic syndrome, acute myeloid leukemia and chronic myelomonocytic leukemia treated with azacitidine (PIAZA study).

Azacitidine (Vidaza® ) is the standard treatment for patients with higher-risk myelodysplastic syndromes (MDS) not eligible for allogeneic stem cell transplantation. In the noninterventional study PIAZA, we evaluated the effectiveness and safety of azacitidine treatment in 149 patients with higher-risk MDS, chronic myelomonocytic leukemia (CMML) and acute myeloid leukemia (AML) in routine clinical practice. Patients were treated according to physician's discretion. Besides evaluation of safety and effectiveness, impact of covariates on progression-free survival (PFS) was assessed. Median age of patients was 75years. 61.1% of patients were diagnosed with MDS, 31.5% with AML and 7.4% with CMML. Patients were treated with azacitidine for a median of seven cycles. Median PFS was 10.9months. Median OS was 14.1months. Two-year survival rate was 28.9%. 45.9% of patients showed CR or PR. Stable and progressive disease were observed in 37.2% and 8% of patients, respectively. Transfusion independence was reported in 64 of 89 patients. Eastern cooperative oncology group (ECOG) performance status (PS) and red blood cell (RBC) transfusion before azacitidine therapy were identified as predictive factors for PFS. In conclusion, we estimated the duration of PFS in a real-world setting and identified ECOG PS and RBC transfusion as predictive factors for PFS. The safety of azacitidine showed a similar profile as demonstrated in the pivotal clinical trials.

A Clinical Analysis of Systemic Chemotherapy Combined with Radiation Therapy for Advanced Gastric Cancer

This study aims to investigate the clinical efficacy of systemic chemotherapy combined with radiotherapy for advanced gastric cancer. A total of 194 advanced gastric cancer patients treated from 2006 to 2016 were included into this study. These patients were divided into two groups: chemotherapy group (n =92) and combined chemoradiotherapy group (n =102). The clinical efficacy of these two groups was compared and analyzed to explore the advantageous population and intervention time of radiotherapy. ( 1) The remission rates in the chemotherapy group and combined chemoradiotherapy group were 73.5% and 90.6%, respectively, and median survival time was 6.7 months vs . 10.6 months. Furthermore, the 6-month, one-year and two-year survival rates were 62% vs . 83.3%, 22.8% vs . 38.2%, and 7.6% vs . 13.7%, respectively. All the differences were statistically significant (P <0.05). (2) In patients with distant lymph node metastasis, local advanced cancer and organ metastasis, who underwent chemotherapy+radiotherapy, the median survival time was 12.6, 11.1 and 9.8 months, respectively; and the differences were statistically significant compared with the chemotherapy group (P <0.05). (3) The median survival time in patients who received concurrent chemoradiotherapy and sequential chemoradiotherapy was 11 and 9.5 months, respectively, and the difference was not statistically significant (P >0.05). Combined chemoradiotherapy significantly improved the clinical remission rate, median survival time, and the 6-month, 1-year, and 2-year survival rates in patients with advanced gastric cancer. Furthermore, the survival rate of patients with simple distant lymph node metastasis was better. Concurrent chemoradiotherapy did not significantly improve survival rate compared with sequential chemoradiotherapy.

Characteristics of Lung Cancer in Patients Younger than 40 Years: A Prospective Multicenter Analysis in France

Objectives: The aim of this study was to describe the demographic and clinico-pathological characteristics of lung cancer in patients younger than 40 years. Materials and Methods: This was a prospective study performed within the Groupe Français de Pneumo-Cancérologie. Consecutive patients diagnosed with lung cancer before the age of 40 years were eligible. Data on demographics, medical history, clinico-pathological characteristics, treatment and overall survival were analysed. Results: In total, 146 patients were included from January 2011 to December 2013. Median age was 38 years (IQR: 34–40). Women accounted for 41%. Main histological type was adenocarcinoma (77%). Only 3% had a prior history of cancer, but a family history (first- or second-degree relatives) of cancer was reported in 80 (55%) patients; 85 and 50% were current or past smokers of tobacco and cannabis, respectively; 82% had stage IIIB/IV at diagnosis. Median overall survival was 15.3 (95% CI: 8.1–24.0) months in the whole population, 10.3 (95% CI: 12.5–14.2) months in stage IV and 15 (95% CI: 8.7–35.2) months in stage III. One- and two-year overall survival rates were 57% (95 CI: 49–65) and 31.5% (95 CI: 27–43), respectively. Compared to smokers, non-smokers were significantly younger and more often females. Median overall survival was not statistically different between smokers and non-smokers.

Radiotherapy of pancreatic cancer in older patients: A systematic review.

Pancreatic cancer (PaC) will soon be one of the main causes of cancer mortality. Furthermore, its incidence is higher in the older population and radiotherapy (RT) represents a treatment option. The aim of this review was to evaluate feasibility and outcome of RT in older patients with PaC. A systematic literature review of patients aged ≥65 years with PaC treated with RT was performed using the PRISMA methodology. Eleven papers (1830 patients) fulfilled our inclusion criteria and were analyzed. RT was prescribed either alone or as an adjuvant treatment. Prescribed RT dose ranged from 22.0 to 70.0 Gy with conventional fractionation or hypo-fractionated schedule and delivered by three-dimensional conformal RT, intensity modulated RT or stereotactic body RT. Grade ≥ 3 acute and grade ≥ 2 late toxicity rates ranged between 0.0% and 52.6% (median: 0.5%) and between 0.0% and 15.0% (median: 0%), respectively. Median overall survival and two-year survival rate were 11.3 months (range: 6.4-69.0 months) and 49.0% (range 6.6-75.5%), respectively. RT in older patients seems to be tolerable and safe particularly in terms of late toxicity irrespective of the treatment settings. Therefore, RT can represent a treatment option in PaC even in an older population. Further analyses and prospective trials enrolling older patients are needed to better define the risk/benefit ratio in different treatment settings.

PS02.116: FEASIBILITY OF DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF) VERSUS RADIOTHERAPY WITH DCF (DCF-RT) AS PREOPERATIVE THERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER

Abstract Background In Japan, preoperative chemotherapy with cisplatin plus 5-fluorouracil (CF) followed by radical surgery has been accepted as the standard therapeutic approach for resectable esophageal squamous cell carcinoma (ESCC) result from a Japan Clinical Oncology Group randomized control trial. Whether preoperative chemoradiotherapy (CRT) followed by radical surgery is effective for Japanese ESCC patients has yet to be established. Some trials have reported usefulness of CF plus docetaxel therapy (DCF) for advanced or metastatic ESCC. Here, we have launched a randomized controlled trial to compare preoperative DCF versus DCF plus radiotherapy (DCF-RT) followed by surgery in locally advanced esophageal cancer. Methods Patients with clinical stage II/III (Japanese Classification of Esophageal Cancer, 11th Edition) are randomized to 2 groups. Patients in DCF group receive 2 courses of preoperative DCF (docetaxel, 60 mg/m2/day, day 1; cisplatin, 70 mg/m2/day, day 1; 5-FU, 700 mg/m2/day, days 1–5) repeated every 3 weeks. Patients in DCF-RT group receive preoperative chemoradiotherapy (40Gy/20fr) with 2 courses of DCF (docetaxel, 30 mg/m2/day, day 1, 15; cisplatin, 7 mg/m2/day and 5-FU, 350 mg/m2/day, days 1–5, days 8–12, days 15–19, days 22–26). The primary endpoint is overall survival and the secondary endpoints include adverse events, response rate and pathologic complete response rate. Results Twenty-seven patients were assigned to the DCF group and 26 patients to the DCF-RT group. Grade 3/4 leukopenia and febrile neutropenia occurred 37% and 19% in the DCF group, 35% and 12% in the DCF-RT group. The clinical response rates were 16.0% and 64.0% in the DCF and DCF-RT group. Twenty patients and 23 patients underwent surgery in the DCF and DCF-RT group, and the R0 resection rate was 80.0% and 91.3%. With regard to the surgical complications, the incidence of anastomotic leakage was significantly higher in the DCF-RT group compared with the DCF group. The histological effects of DCF-RT were significantly higher than those of DCF. Two-year survival rate was 46% in the DCF group and 70% in the DCF-RT group. Conclusion The DCF and DCF-RT were found to be feasible as neoadjuvant therapy, and DCF-RT demonstrated higher efficacy than DCF in clinical stage II/III esophageal cancer patients. Disclosure All authors have declared no conflicts of interest.

Vascular resection for locally advanced pancreatic malignancies: time-trend and outcome analysis from 100 consecutive resections at a high-HPB volume center

Introduction: Involvement of major vascular structures has been considered a limiting factor for resectable advanced tumors. The aim of this study is to investigate the clinical outcomes of patients with advanced APA with vascular resection and to identify significant survival predicting variables. Material and methods: We retrospectively reviewed our experience of consecutive pancreatic surgeries with VR, achieved at Sanchinarro University Hospital (Madrid, Spain) from 2007 to December 2017. Results: A total of 100 patients underwent VR for locally advanced pancreatic cancer. The average age of all patients was 60 years and the mean operating time (560 min, range 400–900). We performed 38 pancreaticoduodenectomies (PD), 20 distal-pancreatectomies (DP), 42 total pancreatectomy (TP). Furthermore, the patients were classified according to the type of VR: venous vascular resection (72 patients); arterial vascular resection (16 patients); arterial and venous vascular resection (12 patients)). The mean hospital stay was 16 days in PD group, 12 days in DP group and 15 days in TP group. Major vascular reconstruction was accomplished through Goretex® patch (n = 17), primary end-to-end anastomosis (n = 61), tangential resection (n = 22). In 30 % histopathologic examination revealed cancer invasion of the vessel, whereas the remainder had peritumoral inflammation extending to the vessel wall. Two-year survival rate were 22%. Conclusion: Major arterial vascular resection to achieve macroscopic tumor clearance can be performed safely with acceptable operative morbidity and mortality. Nevertheless it is justified only in carefully selected cases.

Overall survival before and after centralization of gastric cancer surgery in the Netherlands.

Centralization of surgery has been shown to improve outcomes for oesophageal and pancreatic cancer, and has been implemented for gastric cancer since 2012 in the Netherlands. This study evaluated the impact of centralizing gastric cancer surgery on outcomes for all patients with gastric cancer. Patients diagnosed with non-cardia gastric adenocarcinoma in the intervals 2009-2011 and 2013-2015 were selected from the Netherlands Cancer Registry. Clinicopathological data, treatment characteristics and mortality were assessed for the periods before (2009-2011) and after (2013-2015) centralization. Cox regression analyses were used to assess differences in overall survival between these intervals. A total of 7204 patients were included. Resection rates increased slightly from 37·6 per cent before to 39·6 per cent after centralization (P =0·023). Before centralization, 50·1 per cent of surgically treated patients underwent gastrectomy in hospitals that performed fewer than ten procedures annually, compared with 9·2 per cent after centralization. Patients who had gastrectomy in the second interval were younger and more often underwent total gastrectomy (29·3 per cent before versus 41·2 per cent after centralization). Thirty-day postoperative mortality rates dropped from 6·5 to 4·1 per cent (P =0·004), and 90-day mortality rates decreased from 10·6 to 7·2 per cent (P =0·002). Two-year overall survival rates increased from 55·4 to 58·5 per cent among patients who had gastrectomy (P =0·031) and from 27·1 to 29·6 per cent for all patients (P =0·003). Improvements remained after adjustment for case mix; however, adjustment for hospital volume attenuated this association for surgically treated patients. Centralization of gastric cancer surgery was associated with reduced postoperative mortality and improved survival.

Prognostic factors for local recurrence, metastasis and survival for sebaceous carcinoma of the eyelid: observations in 100 patients

Background/aimsTo validate the predictive value of the American Joint Committee on Cancer (AJCC) 8th-edition classification for local recurrence, metastasis and survival in patients with eyelid sebaceous carcinoma.MethodsWe performed a retrospective...

Surgical Treatment of Cardiac Metastases: Analysis of a 13-Year Single-Center Experience.

Cardiac metastases are more common than primary malignant tumors of the heart and are usually treated surgically as a palliative approach. In this study, we reviewed our experience with the surgical treatment of patients with cardiac metastases of various types of malignant tumors. Between 2003 and 2016, 10 patients underwent surgery for cardiac metastases at our institution. The mean age was 53.5 ± 19 years. Female patients made up 60% (n = 6) of the collective. The cohort included cardiac metastases of diverse origins (peripheral sarcomas, melanoma, rectal carcinoma, and hepatocellular carcinoma). The left side of the heart was more frequently affected (n = 7). In only six patients, the primary malignancy was known at the time of cardiac surgery. The interval between the first diagnosis of the primary tumor and cardiac metastases ranged from simultaneous diagnosis to up to 19 years. At the time of the diagnosis of the cardiac metastases, seven patients already had multiple metastases: all seven patients had pulmonary metastases, and three of them additionally had hepatic, cerebral, or osseous metastases. Only four patients were symptomatic (atrial fibrillation, pericardial effusion, tachycardia with chest pain, dyspnea). There was no in-hospital death. The postoperative course was uneventful overall. The one- and two-year survival rates were similar, that is, 76%. The median follow-up time was 5.4 years. Surgical intervention for treating cardiac metastases is associated with uneventful clinical outcome and acceptable survival in this critically ill population. Control of the primary malignancy, and maybe other metastases, determines the survival.

Abstract CT081: Tumor treating fields in combination with Bevacizumab in recurrent or progressive meningioma in a phase II study

Abstract Meningioma is the most common primary brain tumor with a prevalence of about 170,000 in the United States. For patients with WHO grade II meningioma, the two-year and five-year overall survival was 93% and 73%, respectively. Patients with malignant meningioma (grade III) had significantly worse outcomes, with two-year and five-year overall survival rates of 57% and 42%. The recurrence rate remains high and in the case of grade 3 meningioma overall survival is as low as 3 years after diagnosis. The current treatment for high grade and recurrent meningioma includes maximal safe surgical resection and radiation. Tumor treating fields (TTFields) and Bevacizumab (BEV) have been reported to show activity in recurrent and high-grade meningioma. The combination of TTFields and BEV may provide a viable treatment option for patients with recurrent and high grade meningioma. This Phase 2 Simon two-staged, non-randomized, open-label, phase II, single arm clinical trial [NCT02847559] will investigate the combination of TTFields and BEV in recurrent or progressive meningioma. The primary endpoint will be progression free survival (PFS) at 6 months (PFS-6). Secondary endpoints will include overall survival (OS); Tumor Response Rate (TRR), Objective Response Rate (ORR); and Quality of Life (QOL) using FACT-Br questionnaire. Patients (N=27), including those who have failed prior BEV therapy, will receive BEV IV 10 mg/kg over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV 15 mg/kg every 3 weeks or remain on the every 2-week schedule. Patients will receive TTFields 200 KHz (1-3 V/cm) daily via the Optune device for at least 18 hours/day. This study is powered to detect a true PFS-6 rate of 20% with 80% probability (80% power) and to detect a true PFS-6 rate of 5% with 90% probability (alpha=0.10). We planned for 27 patients in total to have 24 evaluable patients. For patients who are unable to obtain commercial BEV, the study has been amended to include a monotherapy arm of TTFields alone to increase the pool of eligible patients. Citation Format: Priya Kumthekar, Timothy Kruser, Sean Sachev, Jeffrey Raizer, Sean Grimm, Karan Dixit. Tumor treating fields in combination with Bevacizumab in recurrent or progressive meningioma in a phase II study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT081.

Patient-related quality of life after pelvic ring fractures in elderly.

Pelvic ring fractures, occurring in elderly patients are a challenging problem. Little known is about the patient-related outcome after these injuries. The primary objective of this study is to evaluate the quality of life after pelvic ring injuries in patients aged over 60years. Patients (≥60years) with pelvic ring fractures treated in our trauma department between 2004 and 2014 were included. Next to patient data, injury-related details as well as treatment details were assessed. After a follow-up of at least twoyears, the survival rate and the patient-related outcome were evaluated using the SF-36 and the EQ-5D score. One hundred ninety-six patients (138 women; 58 men; mean age 75.3 ± 7.8years) were identified. Ninety-six patients were treated operatively, 100 patients conservatively. The overall complication rate was significantly lower for conservatively compared to operatively treated patients (conservatively 18% vs. operatively 33%; p= 0.014). The total mortality rate over 2years is 29% with no significant difference of the two-year survival rate (2-year survival rate: operatively 77% vs. non-operatively 65%; p= 0.126). Fifty-five patients completed the SF-36 and EQ-5D score after a mean follow-up of 4.2 ± 2.9years. The mean physical component score of the SF-36 is 33.6 ± 8.3, and the mean mental component score is 45.3 ± 8.4. The mean EQ-5D VAS reached 62.5 ± 27.9. Elderly patients with pelvic ring fractures show a high mortality rate and a limited patient-related outcome. While the complication rate of conservatively treated patients is lower compared to operated patients, the twoyear survival rate is steady.

Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches for cervical cancer

Objective: To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy. Methods: The clinicopathologic data of the patients with stage ⅠA2~ⅡB cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed. Results: A total of 99 patients received laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% (6/99). The average age of these 93 patients was 44.4±8.2 years (range 25~61 years) and there was one case of stage ⅠA2, 84 stage ⅠB1, 2 stage ⅠB2, 5 stage ⅡA1 and 1 stage ⅡB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4.1±0.5 h, the average amount of intraoperative blood loss was 103.8±84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow-up time was 20 months (rang 5~44 months), the long-term bladder dysfunction rate was 8.6% (8/93). The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% (2/93). The two-year disease-free survival and overall survival rate were 97.6% and 96.2%, respectively. Conclusion: Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches is a safe and feasible treatment method for cervical cancer and it provides a new approach for simplifying the surgical procedures of laparoscopic type C1 hysterectomy.

Second course of stereotactic radiosurgery for locally recurrent brain metastases: Safety and efficacy.

In the present study, we have evaluated the efficacy and toxicity of repeated brain metastases (BM) stereotactic radiosurgery (SRS2) following local failure of a prior radiosurgical procedure (SRS1). Between December 1996 and August 2015, 30 patients with 36 BM underwent SRS2 with a median dose of 18Gy. All BM were located outside critical structures. Following SRS2, local control at 6 months and one year were respectively 82.9% (IC 95%: 67.6–91.9) and 67.8% (IC 95%: 51–81). On multivariate analysis, planning target volume (PTV) < 3cc (HR: 0.19 (0.1–0.52)) and whole brain radiotherapy (WBRT) prior to SRS2 (HR: 0.25 (0.1–0.64)) were significantly associated with a better local control. One- and two-year overall survival rates after SRS2 were respectively 65.5% (IC 95%: 47.3–80%) and 27.6% (IC 95%: 14.7–45.7). Median overall survival following SRS2 was 14.2 months (range 1–106). Nineteen (63%) patients died from progressive systemic disease. Three (10%) patients died from out-field progressive brain disease and 8 (27%) in-field. Concerning toxicities, edema, radionecrosis, and hemorrhages were identified in 5 (12.8%), 4 (10.2%), and 5 (12.8%) patients respectively. No toxicity resulted in a neurological deficit. On univariate analysis, toxicities were significantly associated with PTV > 7cc (p = 0.02) and all patients had a WBRT before SRS2. A second course of SRS for locally recurrent brain metastases showed encouraging rates of local control. This treatment led to acceptable toxicities, especially for brain metastases smaller than 7cc, in our selected cohort of patients with BM located outside critical structures. Further studies are needed.

Soft Tissue Sarcoma of the Hand and Wrist: Epidemiology and Management Challenges.

Soft tissue sarcomas (STSs) of the hand and wrist are rare and confer a unique set of management challenges. We present a 15-year review and discussion of the epidemiology, tumor characteristics, treatment, and reconstructive strategies for such cases presenting to our regional sarcoma service. Three case examples are described. Of 218 STSs of the upper limb, 17 involved the hand or wrist. Alveolar rhabdomyosarcoma, synovial, and myxofibrosarcoma were the most common ones. Two patients required amputation for recurrence. Eight patients required flap reconstruction, of which five were free flaps with no failures or wound healing complications. Two-year overall survival rate was 92%. Local recurrence occurred in 12%. Limb-sparing surgery is possible in most patients, although there is often a degree of functional loss due to the surgical resection, and complex multistage reconstruction may be required. These lesions are still often incidental or unexpected findings when patients are treated for a presumed benign swelling. Clinicians treating localized swellings of the hand and wrist should maintain vigilance toward the possibility of a sarcoma diagnosis, to avoid delays in definitive treatment.

COMBINED TREATMENT FOR KLATSKIN NON-RESECTABLE TUMOR USING INTRA-FLOW PHOTODYNAMIC THERAPY AND REGIONAL CHEMOTHERAPY

The experience of treatment of 28 patients with Klatskin tumor is summarized. Bile ducts tumor of stages III-IV was diagnosed in 25 patients. A total of 97 sessions of intra-flow photodynamic therapy and 74 courses of regional chemotherapy were conducted. One patient due to a full response to treatment there was performed orthotopic liver transplantation from a cadaver donor. In all observations the diagnosis was confirmed morphologically by means of intraflow biopsy or after investigation of the removed specimen. All patients at the time of the beginning of treatment underwent percutaneous cholangiodrainage. Intra-flow photodynamic therapy was performed in the dose-fractionation mode by the “LAKHTA-MILON” diode laser device using quartz optic fiber systems and a catheter with a cylindrical diffuser at a radiation power at the fiber output of one watt. The density of the supplied energy was 200 J/cm2. Radachlorin or Photon preparations were used as photosensitizers. Subsequently, in 2-4 days, visceral angiography of the hepatopancreatoduodenal zone with the arterial catheter inserted into the celiac trunk or the common hepatic artery to carry out regional chemotherapy by GemOx mode was performed. 21 (71,4%) patients died at the time from 8 to 42 months. 7 (28.6%) patients who undergo repeated courses of combined treatment at intervals of 1,5 to 3 months are alive and under observation from 10 to 26 months. The median survival is 21 months, the average life span is 15,4 + 0,8 months. A one-year survival rate is 78%, a two-year survival rate - 18%, a three-year survival rate - 4%. Survival of patients (according to Kaplan-Meier) is 18 months.

MP47-15 MULTICENTRIC COMPARISON OF SURGICAL OUTCOMES OBTAINED AFTER OPEN RADICAL CYSTECTOMY AND ROBOT-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2018MP47-15 MULTICENTRIC COMPARISON OF SURGICAL OUTCOMES OBTAINED AFTER OPEN RADICAL CYSTECTOMY AND ROBOT-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER Louis Lenfant, Jérôme Parra, Gregory Verhoest, Alexandra Masson-Lecomte, Alexandre De la Taille, Mathieu Roumiguie, Lionel Taksin, Guillaume Ploussard, and Morgan Roupret Louis LenfantLouis Lenfant More articles by this author , Jérôme ParraJérôme Parra More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Alexandra Masson-LecomteAlexandra Masson-Lecomte More articles by this author , Alexandre De la TailleAlexandre De la Taille More articles by this author , Mathieu RoumiguieMathieu Roumiguie More articles by this author , Lionel TaksinLionel Taksin More articles by this author , Guillaume PloussardGuillaume Ploussard More articles by this author , and Morgan RoupretMorgan Roupret More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1494AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the outcomes obtained after open and robotic-assisted radical cystecomy (RARC) for muscle invasive bladder cancer (MIBC). METHODS All clinical and operative data were prospectively collected from six french academic centres over the last 6 years. We included MIBC patients who underwent either an open or a RARC. The following data were considered: age, BMI, TNM, operative time, length of hospital stay, complications (Clavien-Dindo), pathologic assessment and oncologic outcomes. Pre-, intra-, and postoperative data were compared between both groups. RESULTS Overall 251 Patients were included in the study with a median age of 67.3 years. Of them, 133 underwent RARC (51.3%) and 118 underwent an ORC (48.7%). The median follow-up for both groups was 30 months (IQR 19-50).. The following criteria were significantly lower in the RARC group: median intraoperative Estimated blood loss (400 [IQR 300;600] vs 700 [IQR 400;1100] mL; p < 0.001), blood transfusion (17 (14%) vs. 42 (43.3%); p <0.0001), and median length of stay (LOS) (13 [IQR 9;17] vs. 16 [IQR 13;22] days; p <0.0001), major complications (= Clavien 3) [18 (20.45%) vs.30 (37.04%) p=0.034]. Two-year cancer specific survival rates mo were 74 % and 87% (p= 0.01) for ORC and RARC, respectively. In multivariate analysis, the two following criteria had a negative influence on recurrence: stage, surgical margins but nor the surgical approach. CONCLUSIONS RARC was feasible and the perioperative outcomes. were promising compared to the open approach. However we lack a longer follow-up and a prospective design to make a strong statement regarding the oncological outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e621 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Louis Lenfant More articles by this author Jérôme Parra More articles by this author Gregory Verhoest More articles by this author Alexandra Masson-Lecomte More articles by this author Alexandre De la Taille More articles by this author Mathieu Roumiguie More articles by this author Lionel Taksin More articles by this author Guillaume Ploussard More articles by this author Morgan Roupret More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...