Long-term outcome of patients with spinal myxopapillary ependymoma: treatment results from the MD Anderson Cancer Center and institutions from the Rare Cancer Network

Background Spinal myxopapillary ependymomas (MPEs) are slowly growing ependymal gliomas with preferential manifestation in young adults. The aim of this study was to assess the outcome of patients with MPE treated with surgery, radiotherapy (RT), and/or chemotherapy. Methods The medical records of 183 MPE patients (male: 59%) treated at the MD Anderson Cancer Center and 11 institutions from the Rare Cancer Network were retrospectively reviewed. Mean patient' age at diagnosis was 35.5 ± 15.8 years. Ninety-seven (53.0%) patients underwent surgery without RT, and 86 (47.0%) were treated with surgery and/or RT. Median RT dose was 50.4 Gy. Median follow-up was 83.9 months. Results Fifteen (8.2%) patients died, 7 of unrelated cause. The estimated 10-year overall survival was 92.4% (95% CI: 87.7-97.1). Treatment failure was observed in 58 (31.7%) patients. Local failure, distant spinal relapse, and brain failure were observed in 49 (26.8%), 17 (9.3%), and 11 (6.0%) patients, respectively. The estimated 10-year progression-free survival was 61.2% (95% CI: 52.8-69.6). Age (<36 vs ≥36 y), treatment modality (surgery alone vs surgery and RT), and extent of surgery were prognostic factors for local control and progression-free survival on univariate and multivariate analysis. Conclusions In this series, treatment failure of MPE occurred in approximately one third of patients. The observed recurrence pattern of primary spinal MPE was mainly local, but a substantial number of patients failed nonlocally. Younger patients and those not treated initially with adjuvant RT or not undergoing gross total resection were significantly more likely to present with tumor recurrence/progressio

Combining radiotherapy with immunotherapy

WOS: 000430063900008It has long been known that radiation destroys the tumors by killing cells. However, immunotherapy is developing rapidly, combination of immunotherapy with chemotherapy and radiotherapy seems to be a viable option. Preclinical studies combining immunotherapy with radiotherapy resulted in promising data, where manipulating immune response enhances the effects of radiation. There are many ways of immunotherapy-radiotherapy combination, and the field is open for clinical research. This paper reviews the current situation on this topic

Daily subcutaneous amifostine administration during irradiation of pediatric head and neck cancers

WOS: 000245195200018PubMed ID: 16395679Five pediatric patients with head and neck cancers were treated with radiotherapy. Subcutaneous injections of 200 mg flat dose amifostine were given 30 min prior to radiation fractions. A total of 129 amifostine injections were done. Grade 3 nausea occurred three times and emesis only once. Hypotension, hypocalcemia, or allergic reactions following injections were not recorded. No grade 3 or 4 mucosal or skin reactions occurred. After 16 months, all patients were alive and disease-free. There were no grade 3 or 4 side effects of radiotherapy on follow-up. Further studies with more patients are required to determine the role of amifostine in pediatric radiation oncology, but these data should contribute to the clinical spectrum of amifostine use in pediatric oncology

The Pain Relief and Recalcification Results of Radiotherapy for Plasma Cell Tumors

WOS: 000465618700001Multiple Myeloma (MM) and Solitary Plasmocytoma (SP) are given as Plasma Cell Neoplasms (PCNs). Radiotherapy (RT) is used for definitive and/or palliative purposes. We aimed to evaluate the role of RT upon pain relief, recalcification and local disease control for the patients with PCNs. From January 2009 to December 2016, total 80 patients were evaluated. Eleven (13.8%) patients were classified as SP, and 69 (86.3%) were as MM. The total treatment dose was 45 Gy with 1.8 Gy per fraction for the SP and total 30 Gy with 2.5-3 Gy per fraction for the MM. Numerical Rating Pain Scale (NRS) was used for pain level detection and the international consensus on palliative RT criteria was used for recalcification level classification before and after RT. Prior to RT, 56 (70%) patients suffered from severe pain, 19 (23.8%) patients suffered from moderate pain and only 5 (6.3%) patients reported mild pain. After RT, complete pain relief was achieved in 59 (73.8%) and partial pain relief was reported remaining 14 (17.5%) patients. We identified some kind of radiologic recalcification response in 77 (96.3%) patients. Complete and partial radiological response was recorded in 41 (51.3%) and 36 (45%) patients, respectively. Complete recalcification response was seen in 9 of 11 (82%) SP patients and 32 of 69 (46%) MM patients. The difference of complete recalcification response rates between two groups was significant (p= 0.031).Local disease control was achieved in 75 (94%) patients. The time interval after RT and applied RT doses are important factors for recalcification effect. Unlikely, pain relief can be achieved regardless of dose level. It can be stated that treatment doses over 30 Gy with multiple fractions should be suggested for the patients in good general condition with a life expectancy of > 1year

Role of consolidative radiation therapy for patients with mediastinal diffuse large B-cell lymphoma in the rituximab era

WOS: 000452548200039PubMed ID: 30488862Background: The most common subtype of aggressive non-Hodgkin Lymphomas is diffuse large B-cell lymphoma (DLBCL). Mediastinal DLBCL is a distinct entity with unique clinical, pathologic, and genetic features and accepted as a subtype of DLBCL. The aim of this study is to evaluate the patients treated with consolidative radiotherapy (RT) after rituximab-containing chemotherapy for mediastinal DLBCL regarding treatment outcomes and relapse patterns. Material and Methods: Forty-two patients with the diagnosis of mediastinal DLBCL who were treated at the Ege University Hospital between January 2008 and December 2014 were evaluated. All patients received 2-10 cycles of rituximab-containing chemotherapy schedule (mostly CHOP). RT was delivered to a total dose of 30.6-45 Gy with 1.8 Gy daily fractions in 4-5 weeks. The irradiation fields were designed by using involved lymphatic site technique. Results: The median age at diagnosis was 53 years (range, 18-85 years). Ann Arbor clinical stage at diagnosis was as follows: 8 patients (19%) at Stage I, 20 patients (47.6%) at Stage II, 7 patients (16.7%) at Stage III, and 7 patients (16.7%) at Stage IV. The median follow-up period was 47 months (range, 7-96 months). Complete response was obtained in 27 patients (64.3%), partial response was obtained in 14 patients (33.3%) across all stages. Estimated 5-year overall survival (OS) and progression-free survival (PFS) rates were, respectively, 84% and 77% for all patients, 100% and 92% for the patients without residual disease after chemotherapy. Conclusion: The response to chemotherapy is the most important factor affecting both OS and PFS. The role of consolidative RT is not clear in the rituximab era due to the lack of phase III trial. However, available literature shows that consolidative RT may still have a role in mediastinal DBLCLs