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1.
Purpose of Review
The purpose of the review was to provide a contemporary update of novel agents and targets under investigation in myelofibrosis in the Janus kinase (JAK) inhibitor era.Recent Findings
Myelofibrosis (MF) is a clonal stem cell disease characterized by marrow fibrosis and a heterogeneous disease phenotype with a variable degree of splenomegaly, cytopenias, and constitutional symptoms that significantly impact quality of life and survival. Overactive JAK/STAT signaling is a hallmark of MF. The only approved therapy for MF, JAK1/2 inhibitor ruxolitinib, can ameliorate splenomegaly, improve symptoms, and prolong survival in some patients. Therapeutic challenges remain, however. Myelosuppression limits the use of ruxolitinib in some patients, eventual drug resistance is common, and the underlying malignant clone persists despite therapy. A deeper understanding of the pathogenesis of MF has informed the development of additional agents.Summary
Promising targets under investigation include JAK1 and JAK2 and downstream intermediates in related signaling pathways, epigenetic modifiers, pro-inflammatory cytokines, and immune regulators.2.
3.
Franz Romeder MD Richard Greil Alexander Egle MD 《memo - Magazine of European Medical Oncology》2013,6(2):109-113
Purpose
Myelofibrosis (MF) is currently the myeloproliferative disorder with the most severe prognosis. A mutation of the JAK2 (V617F) enzyme is present in about 65?% of patients. Inhibition of JAK-kinases was therefore a proposed treatment for the disease. The purpose of this article is to give an updated overview about the recent developments in the therapy of MF with JAK-inhibitors.Materials and methods
We did a research through the literature to identify the JAK 1/2 inhibitors which are already approved for treating MF or currently undergoing clinical trials. The most important clinical data concerning ruxolitinib, TG101348, SAR302503, CYT387, and SB1518 are described in more detail.Results
Most of the relevant data documented clinical benefits of JAK inhibitors, particularly in terms of reducing splenomegaly and constitutional symptoms. However, there might also be a trend for better overall survival. The efficacy of ruxolitinib has been demonstrated in two large Phase III trials. In September 2012, the European Medicines Agency (EMA) approved ruxolitinib for the treatment of patients with intermediate or high-risk MF. The other drugs discussed here are still investigated in Phase II or III studies.Conclusion
There is emerging evidence that supports the use of JAK-inhibitors for MF in clinical practice, especially for patients with splenomegaly and constitutional symptoms. Nevertheless, possible side effects such as anemia and thrombopenia must be considered when prescribing these substances. 相似文献4.
Leah Drost Nim Li Danny Vesprini Arneet Sangha Justin Lee Eric Leung Eileen Rakovitch Caitlin Yee Edward Chow Mark Ruschin 《Clinical breast cancer》2018,18(5):e789-e795
Background
Despite clear benefits of radiotherapy (RT) for breast cancer, there are numerous side effects. Radiation dermatitis has a significant impact on quality of life and can result in treatment interruptions or cessation. The purpose of this study was to prospectively follow breast radiation dermatitis and determine trends including peak toxicity.Patients and Methods
Upon initiation of RT treatment, to assess skin reaction, each patient was seen weekly by the healthcare team, or contacted via telephone to assess patient-reported symptoms. Weekly progression of radiation dermatitis was assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 4.03. Patients were stratified for analysis of radiation dermatitis based on RT technique and dosage.Results
A total of 148 patients with 2 or more skin assessments were analyzed. The majority of patients received 2-field tangential RT (64.2%) with a dose of 5000 cGy in 25 fractions. Overall, patients experienced the most Grade 2 CTCAE toxicity (61.9%) 2 weeks after completion of RT; Grade 3 toxicity also peaked at this time (8.3%). Regardless of stratification by RT technique or by dosage of RT, Grade 2 and 3 toxicities consistently peaked at 1 or 2 weeks after RT.Conclusions
Breast radiation dermatitis appears to peak approximately 2 weeks after RT. Treatment factors such as technique or dosing regimen do not appear to have a substantial effect on radiation dermatitis, but our study was limited by small sample size. This study provides additional evidence that radiation dermatitis should continue to be followed closely, especially in the 2 weeks following RT. 相似文献5.
Kriti Mittal Lisa Derosa Laurence Albiges Laura Wood Paul Elson Timothy Gilligan Jorge Garcia Robert Dreicer Bernard Escudier Brian Rini 《Clinical genitourinary cancer》2018,16(3):e663-e667
Introduction
Tyrosine kinase inhibitor (TKI) therapy in metastatic renal-cell carcinoma (mRCC) is noncurative and may be associated with significant toxicities. Some patients may receive treatment breaks as a result of TKI-related adverse effects or planned drug holidays.Patients and Methods
In this retrospective study, mRCC patients who underwent drug holidays during TKI therapy at 2 different institutions were analyzed. A drug holiday was defined as a period of drug cessation for ≥ 3 months for reasons other than progressive disease.Results
Of the 112 patients, the median duration of the first drug holiday for the overall cohort was 16.8 months (95% confidence interval, 12.5-26.4), and 40 patients (36%) remain on the first drug holiday. Overall, patients received a median of 2 lines of treatment. Complete response before the initial drug holiday (n = 14) was associated with a longer surveillance period (P = .0004). The observed median survival of this cohort was 71.7 months (range, 1.3 to 93+ months).Conclusion
Some selected mRCC patients with a favorable response to TKIs may be eligible for drug holidays. The cohort evaluated in this retrospective study represents a highly selected group of patients with indolent disease biology. 相似文献6.
Purpose
In this proof-of-concept study, we proposed 3-D–printed mold–guided breast-conserving surgery (BCS) in breast cancer patients.Patients and Methods
Pathologically confirmed and eligible breast cancer patients received magnetic resonance imaging examinations before BCS. The information on the shape, size, and location of the tumor relative to the nipple was extracted and analyzed. We used a 3-D printing technique to produce a mold to guide BCS for breast cancer patients.Results
We performed 3-D–printed mold–guided BCS in 8 breast cancer patients. All of the patients had negative surgical margins, confirmed by intraoperative and postoperative pathologic examinations.Conclusion
The 3-D–printed mold–guided BCS approach is a feasible way to achieve negative surgical margins. A prospective designed cohort study, with more patients included and a longer follow-up, is needed to further confirm its long-term oncologic safety. 相似文献7.
Yusuf Karakas Omer Dizdar Sercan Aksoy Mutlu Hayran Kadri Altundag 《Clinical breast cancer》2018,18(4):320-327
Background
In this study, we aimed to assess the prognostic performance of determining the T stage according to the total size of lesions compared with the size of the largest lesion in the breast in patients with multifocal/multicentric (MF/MC) breast cancer.Patients and Methods
The charts of the patients with MF/MC breast cancer who were diagnosed between 2003 and 2014 were reviewed. The T stage of MF/MC tumors was determined according to the largest lesion size (Tmax) as well as the sum of the longest diameters of the lesions (Tsum) in the breast.Results
Multifocal/multicentric tumors were identified in 323 of 3890 patients (8.3%) with breast cancer. Ten-year rates of overall survival (OS; 75% and 74%; P = .965) and disease-free survival (DFS; 66% and 61%; P = .817) were similar in patients with unifocal and MF/MC tumors, respectively. When the T stage was determined by summing the sizes of the lesions, the T stage of 67 (20.7%) and 63 (19.5%) patients advanced from T1 to T2 and from T2 to T3, respectively. Thus, the T stage increased in 130 patients (40.2%) according to American Joint Committee on Cancer. Discriminatory ability of Tsum was better than Tmax in terms of OS and DFS, as shown with higher Royston D and Harrel C statistics and Schemper V values.Conclusion
The new T classification proposed in this report stands out as a better predictive classification particularly in patients with low disease burden. 相似文献8.
T. Wieldraaijer L.A.M. Duineveld K.M. van Asselt A.A.W. van Geloven W.A. Bemelman H.C.P.M. van Weert J. Wind 《European journal of surgical oncology》2017,43(1):118-125
Background
Colon cancer survivors experience physical and psychosocial problems that are currently not adequately addressed. This study investigated distress in patients after curative surgery for colon cancer and studied how this corresponds with the need for supportive care.Methods
Prospective cohort of patients with stage I–III colon carcinoma, treated with curative intent, currently in follow-up at 6 different hospitals. A survey recorded symptoms, experienced problems, and (un)expressed needs. Satisfaction with supportive care was recorded.Results
Two hundred eighty four patients were included; 155 males and 129 females, with a mean age of 68 years (range 33–95), and a median follow-up of 7 months. 227 patients completed the survey.Patients experienced a median of 23 symptoms in the week before the survey, consisting of a median of 10 physical, 8 psychological and 4 social symptoms. About a third of these symptoms was felt to be a problem. Patients with physical problems seek supportive care in one in three cases, while patients with psychosocial problems only seek help in one in eight cases.Patients who recently finished treatment, finished adjuvant chemotherapy, or had a stoma, had more symptoms and needed more help in all domains.Patients most frequently consulted general practitioners (GPs) and surgeons, and were satisfied with the help they received.Conclusion
Colon cancer survivors experience many symptoms, but significantly fewer patients seek help for a psychosocial problem than for a physical problem. Consultations with supportive care are mainly with GPs or surgeons, and both healthcare providers are assessed as providing satisfying care. 相似文献9.
Benoit M. Cyrenne Juliet Fraser Gibson Antonio Subtil Michael Girardi Iris Isufi Stuart Seropian Francine Foss 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(1):e85-e93
Background
Primary cutaneous aggressive epidermotropic cytotoxic CD8 positive T-cell lymphoma (CD8+ PCAETL) is a rare subtype of peripheral T-cell lymphoma with poor outcomes and without a standardized treatment strategy. Allogeneic hematopoietic stem cell transplantation (HSCT) has been suggested as a potential curative therapy.Patients and Methods
We conducted a retrospective case series. We identified 8 patients with the diagnosis of CD8+ PCAETL, 4 of whom also underwent allogeneic HSCT.Results
Eight patients were treated at our center with combination chemotherapy and several novel agents, including histone deacetylase inhibitors, brentuximab, and pralatrexate. Patients underwent a median of 8.5 treatments before HSCT. Six of the 8 patients examined, including all 4 who received an HSCT, were alive at their last follow-up.Conclusion
Allogeneic HSCT is a promising treatment modality for CD8+ PCAETL. Because of the aggressive nature of this disease and lack of sustained remission with currently available therapies, HSCT should be considered early in the course of treatment. Two novel agents, brentuximab and pralatrexate, showed significant activity against CD8+ PCAETL, and may be incorporated earlier in the treatment course. 相似文献10.
Chandler S. Cortina Surbhi Agarwal Laurel L. Mulder Jennifer Poirier Ruta Rao David A. Ansell Andrea Madrigrano 《Clinical breast cancer》2018,18(6):e1289-e1292
Background
The Cancer and Leukemia Group B (CALGB) 9343 clinical trial proved that omission of radiotherapy (RT) in patients 70 and older with T1cN0M0, estrogen receptor-positive tumors who undergo breast conservation therapy (BCT) and receive 5 years of endocrine therapy (ET) had no change in overall survival, distant disease-free survival, or breast preservation. We examined our institution’s practice with this patient subset.Patients and Methods
A single-institution retrospective chart review was performed on patients 70 years and older with T1N0M0, estrogen receptor-positive tumors, and who underwent BCT between April 2010 and October 2015.Results
A total of 123 patients met inclusion criteria: 46% received RT and 73% received ET. The ET group had a mean age of 76.2 years, whereas the non-ET group had a mean age of 80.2 years (P = .00006). Race did not influence if patients received ET (P = .4). In patients who received ET, mean age at time of diagnosis for those that completed 5 years of therapy was 75.5 years, whereas those who stopped therapy early had a mean age of 77.6 years (P = .053). In patients who received ET but stopped early, reasons for cessation included side-effect profile (67%), death (22%), and noncompliance (11%). Of the 27% of patients that did not receive ET, 62% were not offered therapy, 24% refused, and 14% were lost to postoperative follow-up.Conclusion
Increasing age showed significant association to not receive ET. Contraindication to ET and provider’s assessment of minimal benefit are the most common reasons why patients are not prescribed ET. If patients are non-compliant with ET, RT should be reconsidered. 相似文献11.
Ajeet Gajra Tyler J. Zemla Aminah Jatoi Josephine L. Feliciano Melisa L. Wong Hongbin Chen Ronald Maggiore Ryan P. McMurray Arti Hurria Hyman B. Muss Harvey J. Cohen Jacqueline Lafky Martin J. Edelman Rogerio Lilenbaum Jennifer G. Le-Rademacher 《Journal of thoracic oncology》2018,13(7):996-1003
Introduction
Time-to-treatment-failure (TTF) is the interval from chemotherapy initiation to premature discontinuation. We evaluated TTF based on age.Methods
Pooled analyses were conducted with first-line chemotherapy trials for advanced NSCLC (CALGB 9730, 30203, and 30801). Comparisons among patients who were 65 years and older and 70 years and older were performed for TTF (primary endpoint), reasons for early chemotherapy cessation, grade 3+ adverse events, and overall survival.Results
Among 1006 patients, 460 (46%) were older than 65 years of age. One hundred forty-five older patients (32% of this age cohort) completed all six planned chemotherapy cycles as did 170 (32%) younger patients. Median TTF was 2.9 months (95% confidence interval: 2.7– 3.2) in older patients and 3 months (95% confidence interval: 2.9–3.5) in younger patients; adjustment for performance status and stratification by chemotherapy by trial yielded no statistically significant age-based difference in TTF. However, reasons for early chemotherapy cessation differed between age groups (multivariate p = 0.004). Older patients were less likely to discontinue from cancer progression (41% versus 55%) and more likely from toxicity or patient choice (16% and 15%, respectively) compared to younger patients (13% and 6%, respectively). Older patients were more likely to experience grade 3+ adverse events (86% versus 79%) with no statistically significant difference in survival. An age cutpoint of 70+ years showed no difference in TTF, a lower trend of early cessation due to cancer progression, and somewhat shorter older patient survival.Conclusions
TTF was comparable between older and younger patients; but different, age-based, and potentially modifiable reasons account for it. 相似文献12.
M. Dosani W.J. Morris S. Tyldesley T. Pickles 《Clinical oncology (Royal College of Radiologists (Great Britain))》2017,29(10):696-701
Aims
This study describes the proportion of men who experienced hot flashes (flashes), and the testosterone level at onset, peak frequency and cessation of flashes after 12 months of androgen deprivation therapy (ADT) in men undergoing curative-intent external beam radiation therapy (± brachytherapy boost). We also aimed to characterise testosterone recovery in this population.Materials and methods
This was a pre-specified secondary analysis of the ASCENDE-RT clinical trial. Three hundred and ninety-eight men were randomised. All received 12 months of ADT. The presence and frequency of flashes were patient reported. Cessation of flashes was defined as the first date a patient reported resolution of this symptom. Testosterone recovery was defined as any single serum testosterone above the threshold of 5, 7.5 or 10 nmol/l.Results
The median age and follow-up were 68 years and 6.1 years. Flashes were reported in 93% of men. Flashes began and reached peak frequency at a median time of 4.0 months from the first luteinizing hormone-releasing hormone injection when testosterone levels had fallen to castrate. The median time to cessation of flashes was 7.6 months after the cessation of ADT (last injection + 3 months), when the median testosterone had risen to 5.7 nmol/l. A resolution of flashes was reported in 99% of patients. Baseline testosterone was available in 338 patients (85%). The median baseline testosterone was 13.2 nmol/l. The median (95% confidence interval) time of testosterone recovery to thresholds of 5 nmol/l, 7.5 nmol/l and 10 nmol/l were 9 (9–10) months, 13 (10–15) months and 18 (17–19) months from the cessation of ADT. At the time of censor, 96, 94 and 91% of patients had recovered testosterone to thresholds of 5, 7.5 and 10 nmol/l.Conclusion
Flashes occur at castrate levels of testosterone, with cessation of hot flashes antedating full recovery of testosterone in most patients. Rates of testosterone recovery after 12 months of ADT exceed 90%, although it can be delayed. 相似文献13.
Francesca De Felice Karen Llange Filippo Rubini Nadia Bulzonetti Rossella Caiazzo Daniela Musio Vincenzo Tombolini 《Clinical colorectal cancer》2018,17(1):e77-e81
Introduction
We report the treatment compliance, toxicity rates, and long-term clinical outcomes of elderly patients who received intensified neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC).Patients and Methods
We identified a retrospective cohort of patients aged ≥ 70 years with LARC who received intensified neoadjuvant CRT, followed by surgery and adjuvant chemotherapy, from 2007 to 2014. Intensified neoadjuvant CRT consisted of radiotherapy (total dose, 50.4/54 Gy) with concomitant oxaliplatin (50 mg/m2/wk) and 5-fluorouracil (200 mg/m2 in 5 daily continuous infusion).Results
A total of 26 patients were included. All patients completed the programmed CRT. Severe acute toxicity was recorded in 19.2% of cases. Conservative surgery was performed in 16 patients, and a pathologic complete response was achieved in 19.2%. Overall, 26.9% of the patients died. The 5-year overall survival and disease-free survival rates were 70.6% and 65.5%, respectively.Conclusions
Intensified neoadjuvant CRT is an efficacious and safe treatment option for LARC in elderly patients. 相似文献14.
Background
Nivolumab is a novel immunotherapy that was recently approved for treatment of advanced non–small-cell lung cancer (NSCLC). Patients treated with checkpoint inhibitors may show variable computed tomography (CT) features on follow-up imaging, and it is unclear how reliable conventional response criteria are to determine patient management and outcomes. We report the spectrum of sequential CT findings in patients with advanced stage lung cancer who received nivolumab in an effort to better inform appropriate imaging strategies.Materials and Methods
We identified all patients at our institution with advanced NSCLC who received nivolumab. Pre- and posttreatment CT scans were reviewed and categorized based on radiographic response to therapy. Demographic data as well as survival data were recorded.Results
There were 34 patients with advanced NSCLC who received nivolumab with sufficient follow-up data. Nineteen patients were classified as responders to treatment; 6 (32%) of 19 showed improvement on their initial follow-up CT and had an average survival of 11.2 months, whereas 13 (68%) of 19 responders initially had stable or progressive disease on CT with an average survival of 11.6 months. Fifteen patients were classified as nonresponders to treatment with an average survival of 3.4 months.Conclusion
Novel immunotherapies such as nivolumab mechanistically differ from conventional chemotherapy. Some patients have improved survival despite initial radiographic progression of disease. Our findings underscore the heterogeneous radiographic appearance at follow-up CT in patients with lung cancer who ultimately respond to nivolumab. 相似文献15.
Sylvain Carras Benjamin Dubois Delphine Senecal Jean-Philippe Jais Michel Peoc&#x;h Philippe Quittet Charles Foussard Krimo Bouabdallah Thomas Gastinne Eric Jourdan Laurence Sanhes Marjan Ertault Thierry Lamy Lysiane Molina 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(3):191-198
Background
Patients with advanced stage Hodgkin lymphoma still present unsatisfactory outcomes.Patients and Methods
The Groupe d’étude des Leucémies Aigues et des Maladies du Sang (GOELAMS) group conducted a prospective multicentric trial (NCT00920153) for advanced stage Hodgkin lymphoma to evaluate a positron emission tomography (PET)-adapted strategy. Patients received an intensive regimen (VABEM [vindesine, doxorubicin, carmustine, etoposide, and methylprednisolone]) in front-line and interim 18FFDG-PET evaluation after 2 courses (PET-2). Patients with negative PET-2 findings received 1 additional course. Patients with positive PET-2 findings underwent early salvage therapy followed by high-dose therapy/autologous stem cell transplantation.Results
Fifty-one patients were included. The final complete remission rate was 88%. With a median follow up of 5.3 years, 5-year event-free survival and overall survival rates were 75.3% and 85.3%, respectively, for the whole cohort. Patients who were PET–2-negative had 5-year event-free survival and overall survival rates of, respectively, 77.8% and 88.2% versus 85.1% and 91.7% for patients who were PET–2-positive.Conclusion
A PET-guided strategy with early salvage therapy and high-dose therapy/autologous stem cell transplantation for patients with interim PET–2-positive findings is safe and feasible and provide similar outcome as patients with a negative PET-2. 相似文献16.
Mike R. Sung Milan V. Patel Sarvar Djalalov Lisa W. Le Frances A. Shepherd Ronald L. Burkes Ronald Feld Stephanie Lin Roxana Tudor Natasha B. Leighl 《Clinical lung cancer》2017,18(3):274-280.e6
Introduction
Lung cancer is associated with higher levels of symptom distress and unmet needs than other cancer types. We assessed changes in symptoms, function, understanding, and preferences of patients with advanced lung cancer over a 10-year period.Materials and Methods
A 26-item self-administered questionnaire was used to assess symptom burden, functional impairment, knowledge of disease and treatment, and information preferences. The survey was administered to consecutive outpatients with advanced lung cancer first in 2002 and a second cohort in 2012.Results
A total of 108 patients with advanced lung cancer were surveyed in 2002, and 100 in 2012. Rates of severe physical symptoms were similar over the 10-year period. The most common symptoms remained fatigue, cough, and dyspnea. One-third perceived major impairment of daily activities from lung cancer. Significant anxiety was reported by at least 20%; nearly a quarter reported being unable to meet family needs. More patients in 2012 received information on treatment benefits, side effects, and clinical trials. Only 40% reported having end-of-life wishes, and fewer than half had discussed these with their oncologist. Over time, more patients expressed a preference for treatment associated with increased survival even if it compromised quality of life. Half were interested in Internet-based resources, most in print media, and a growing number in telephone support.Conclusion
Patients with advanced lung cancer continue to experience significant symptom distress and unmet needs despite advances in treatment. Comprehensive assessment and symptom, psychological, financial, and information support remain key areas for improvement in the care of patients with advanced lung cancer. 相似文献17.
Gesa Isensee Anne Péporté Joachim Müller Sabine Schmid Silke Gillessen Aurelius Omlin 《Clinical genitourinary cancer》2018,16(5):349-354
Introduction
Radium-223 is an approved survival-prolonging treatment option in men with castration-resistant prostate cancer (mCRPC) and bone metastases. In the registration trial (ALSYMPCA), no regular imaging was mandated. We aimed to analyze men with metastatic mCRPC treated with radium-223 who had bone scintigraphy for staging and treatment monitoring.Patients and Methods
Retrospective chart review was performed of mCRPC patients who received 6 cycles of radium-223 and who underwent bone scintigraphy before start of radium-223 and after 3 and 6 cycles of treatment.Results
Nineteen patients with a median age of 74 years met the selection criteria and were included in the analysis. On bone scintigraphy, 4 of 19 patients showed a total of ≥ 2 new lesions after 3 cycles of radium-223 therapy, but 3 of 4 patients did not have ≥ 2 new lesions after 6 cycles, meeting the criteria for bone scintigraphy flare. Of these 4 patients, 2 received radium-223 before docetaxel therapy, and all 4 had concomitant treatment with denosumab. In the entire cohort, 3 of 19 patients showed soft tissue progression on computed tomography after 3 cycles of radium-223.Conclusion
Bone scintigraphy flare in patients undergoing therapy with radium-223 was observed. Bone scintigraphy data acquired during treatment with radium-223 should be interpreted with caution, and treatment should not be changed according to increase in number of lesions on bone scintigraphy alone after 3 cycles of radium-223. 相似文献18.
Paolo Strati Nathan Fowler Sergio Pina-Oviedo L. Jeffrey Medeiros Michael J. Overman Jorge E. Romaguera Loretta Nastoupil Michael Wang Fredrick B. Hagemeister Alma Rodriguez Yasuhiro Oki Jason Westin Francesco Turturro Sattva S. Neelapu Luis Fayad 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(1):e103-e108
Background
The optimal management of patients with follicular lymphoma Grade 3 (FLG3) is controversial.Patients and Methods
This is a case series of 45 patients with FLG3 treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and observed for an extended time interval.Results
The overall response rate was 100% and the median progression-free survival (PFS) has not been reached, with a 3-year PFS of 70%; 14 (31%) patients relapsed, nearly all within 3 years. The baseline characteristic more strongly associated with a shorter PFS were lymph >4 node sites and presence of B symptoms. Three patients later progressed to diffuse large B cell lymphoma, all had baseline elevated serum lactate dehydrogenase level and high International Prognostic Index score. Median overall survival has not been reached. All 4 patients who later developed acute myeloid leukemia were older than 60 years at the time of start of therapy.Conclusion
R-CHOP is an effective first-line treatment for patients with FLG3, and might provide extended PFS, comparable with outcomes observed in diffuse large B-cell lymphoma, particularly in subgroups with limited nodal disease. 相似文献19.
Gretchen Taylor Nina Karlin Thorvardur R. Halfdanarson Kyle Coppola Axel Grothey 《Clinical colorectal cancer》2018,17(2):e183-e187
Background
Leptomeningeal metastasis (LM) is an uncommon form of metastatic disease in many cancers. There remains a paucity of literature with regard to the course and management of LM in colorectal cancers (CRCs). The aim of this study was to estimate the incidence of LM in patients with CRC seen at our institution over a 15-year period, and to describe the clinical course and outcome of these cases.Methods
LM in CRC primary cases between 2000 and 2014 were identified in the Mayo Clinic databases. The charts were retrospectively reviewed.Results
Of 17,095 CRC primaries, we identified 10 patients with LM (0.058%) in this 15-year period. Nine cases were included in the analysis. Four had metastatic disease at the time of their initial CRC diagnosis. Median overall survival after CRC diagnosis was 25.7 months (range, 4.7-74.8 months). Median time to diagnosis of LM after CRC diagnosis was 25.3 months (range, 0-68.1 months). All patients had magnetic resonance imaging findings consistent with LM: 3 patients with spinal LM, 5 patients with intracranial LM, and 1 with both. Neurologic symptoms correlated with site of the lesions, with headache, cranial nerve palsy, lower extremity weakness, and gait disturbance among the most frequently reported. However, not all patients had neurologic findings, with LM lesions found incidentally in 2 cases. Seven patients (78%) had palliative radiotherapy for LM. Three patients continued to receive systemic chemotherapy after diagnosis of LM. Median survival after LM diagnosis was 7 weeks (range, 2-39 weeks).Conclusions
LM is an exceedingly rare development in the natural course of CRC. It confers a poor prognosis with limited treatment options. At our institution, most patients had their disease addressed by palliative means, with many receiving radiotherapy to control their neurologic symptoms. Based on our series, supportive care remains a sensible approach to the management of LM in CRC. 相似文献20.
H. Hasegawa M. Ando Y. Yatabe S. Mitani K. Honda T. Masuishi Y. Narita H. Taniguchi S. Kadowaki T. Ura K. Muro 《Clinical oncology (Royal College of Radiologists (Great Britain))》2018,30(10):667-673