Intralesional PV‐10 for the treatment of in‐transit melanoma metastases—Results of a prospective,non‐randomized,single center study

Background

Patients with in‐transit melanoma metastases frequently experience high rates of recurrence, limited overall survival and reduced quality of life. After promising results within a Phase II, multi‐center study, PV‐10 treatment was continued at our institution for patients with in‐transit disease.

Methodology

An open‐label, non‐randomized, prospective study was performed at the Princess Alexandra Hospital, Queensland, Australia. Patients were treated with PV‐10 in accordance with the treatment protocol established during a previous Phase II study. The primary outcome was the complete response of treated lesions.

Results

Forty‐five patients were enrolled over a total of 82 treatment episodes from July 2008 to December 2015. With sequential PV‐10 treatments the complete response rate was 42% and overall response rate 87% on an intention to treat analysis. The median follow‐up duration was 22 months and the median overall survival was 25 months from first PV‐10 treatment. Having fewer than 15 metastases at the time of treatment was associated with a complete response (P = 0.03).

Conclusions

Intralesional PV‐10 provided rapid lesion‐specific ablation of melanoma metastases with well‐tolerated local effects and minimal systemic adverse events. This therapy should be considered for patients with multiple accessible deposits within the spectrum of low to moderate disease volume.     

The value of local registry data for describing cervical cancer management and outcomes over three decades in Australia

Registry data on invasive cervical cancers (n = 1,274) from four major hospitals (1984‐2012) were analysed to determine their value for informing local service delivery in Australia. The methodology comprised disease‐specific survival analyses using Kaplan‐Meier product‐limit estimates and Cox proportional hazards models and treatment analyses using logistic regression. Five‐ and 10‐year survivals were 72% and 68%, respectively, equating with relative survival estimates for Australia and the USA. Most common treatments were surgery and radiotherapy. Systemic therapies increased in recent years, generally with radiotherapy, but were less common for residents from less accessible areas. Surgery was more common for younger women and early‐stage disease, and radiotherapy for older women and regional and more advanced disease. The proportion of glandular cancers increased in‐step with national trends. Little evidence of variation in risk‐adjusted survival presented over time or by Local Health District. The study illustrates the value of local registry data for describing local treatment and outcomes. They show the lower use of systemic therapies among residents of less accessible areas which warrants further investigation. Risk‐adjusted treatment and outcomes did not vary by socio‐economic status, suggesting equity in service delivery. These data are important for local evaluation and were not available from other sources.     

New scans from old: digital reformatting knee MRI

Purpose: To determine the accuracy of cartilage volume and bone areas measured from a 3D knee MRI sequence reformatted in different planes.Methods: MRI of 16 adult subjects (9 females, 7 males, age range 45–68 years) were acquired in the sagittal plane using a 3D T1-weighted fat suppressed spoiled gradient echo sequence. Medial and lateral tibial cartilage volumes were determined by processing images acquired in the sagittal plane and from the same image data reformatted in the coronal plane. Tibial plateau areas were determined by processing images acquired in the sagittal plane and reformatted in the axial plane.Results: Cartilage volumes calculated from the original sagittal acquisition and data reformatted into the coronal plane were similar. The average over- or under-estimation of the lateral and medial cartilage volume from the reformatted coronal scans compared to the sagittal sequences was 4.6% and 9.8% respectively. Similar medial and lateral tibial plateau areas were obtained when the sagittal data was reformatted in the axial plane. The average over- and under-estimate of lateral and medial tibial plateau areas from the reformatted axial scans compared to the originally acquired sagittal sequences was 6.5% and 6.8% respectively.Conclusion: Knee data acquired via MRI in one plane can be reformatted into different planes, providing comparable cartilage volumes and bone areas. As different planes through the knee may provide better visualization of different joint structures, this method may be useful clinically and as a research tool, while avoiding the cost associated with the prolonged scanning times associated with acquiring multiple planes.