4 research outputs found
Isolated testicular relapse in acute lymphoblastic leukemia - Effective treatment with the modified CCG-112 protocol
BACKGROUND: The testes have been considered a sanctuary site for
leukemic cells and testicular relapses used to account for a major
proportion of the poor outcome of boys with acute lymphoblastic
leukemia. With use of aggressive chemotherapy which includes
intermediate or high dose methotrexate, the incidence of testicular
relapses has declined. However once these patients have received
cranial irradiation as a part of the front line protocol, high dose
methotrexate needs to be avoided because of risk of developing
leucoencephalopathy. AIM: To study the use of non cross resistant
chemotherapeutic agents along with a regimen containing lower doses of
methotrexate in patients of isolated testicular relapse (ITR).
MATERIALS AND METHODS: This is a retrospective analysis of 12
consecutive patients with ITR treated with modified version of the
CCG-112 protocol which consists of intensive systemic chemotherapy,
cranial chemoprophylaxis along with testicular irradiation. RESULTS:
One patient died of regimen related toxicity. Two patients relapsed in
the bone marrow during maintenance. Of the nine patients who completed
treatment, eight are alive and in remission. One patient had a bone
marrow relapse two months after completing treatment. The Kaplan Meier
estimates give us an Event Free Survival (EFS) of 66.7% at 10 yrs.
CONCLUSIONS: Thus, though the incidence is very low, patients with ITR
should be treated aggressively since they have an excellent chance of
achieving a long term EFS
Desmoplastic small round cell tumor: Extra abdominal and abdominal presentations and the results of treatment
BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare
malignant neoplasm of adolescent males. Current multimodality treatment
prolongs life and rarely achieves cure. Aim : To review the presenting
features, histopathology and outcome of 18 patients with DSRCT treated
at a single institution. Setting and Design : This is a retrospective
observational study of patients with DSRCT who presented at the Tata
Memorial Hospital between January 1994 to January 2005. Materials and
Methods: Eighteen patients of DSRCT seen during this period were
evaluated for their clinical presentation, response to chemotherapy and
other multimodality treatment and overall survival. The cohort of 18
patients included 11 males (61%) and 7 females (39%) with a mean age of
16 years (Range 1\ubd - 30 years). Majority (83%) presented with
abdomino-pelvic disease. The others, involving chest wall and
extremities. There were 6 patients (33%) with metastatic disease at
presentation. Results: The treatment primarily included a
multimodality approach using a combination of multiagent chemotherapy
with adjuvant surgery and radiotherapy as applicable. A response rate
of 39% (CR-1, PR-6), with chemotherapy was observed. The overall
response rate after multimodality treatment was 39% (CR-5, PR-2). The
overall survival was poor except in patients who had complete excision
of the tumor. Conclusion: Abdomino-pelvic site was the commonest
presentation, the disease can occur at other non-serosal surfaces also.
Despite aggressive treatment the outcome was poor. However, complete
surgical excision seems to provide a better survival
Desmoplastic small round cell tumor: Extra abdominal and abdominal presentations and the results of treatment
BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare
malignant neoplasm of adolescent males. Current multimodality treatment
prolongs life and rarely achieves cure. Aim : To review the presenting
features, histopathology and outcome of 18 patients with DSRCT treated
at a single institution. Setting and Design : This is a retrospective
observational study of patients with DSRCT who presented at the Tata
Memorial Hospital between January 1994 to January 2005. Materials and
Methods: Eighteen patients of DSRCT seen during this period were
evaluated for their clinical presentation, response to chemotherapy and
other multimodality treatment and overall survival. The cohort of 18
patients included 11 males (61%) and 7 females (39%) with a mean age of
16 years (Range 1½ - 30 years). Majority (83%) presented with
abdomino-pelvic disease. The others, involving chest wall and
extremities. There were 6 patients (33%) with metastatic disease at
presentation. Results: The treatment primarily included a
multimodality approach using a combination of multiagent chemotherapy
with adjuvant surgery and radiotherapy as applicable. A response rate
of 39% (CR-1, PR-6), with chemotherapy was observed. The overall
response rate after multimodality treatment was 39% (CR-5, PR-2). The
overall survival was poor except in patients who had complete excision
of the tumor. Conclusion: Abdomino-pelvic site was the commonest
presentation, the disease can occur at other non-serosal surfaces also.
Despite aggressive treatment the outcome was poor. However, complete
surgical excision seems to provide a better survival
Isolated testicular relapse in acute lymphoblastic leukemia - Effective treatment with the modified CCG-112 protocol
BACKGROUND: The testes have been considered a sanctuary site for
leukemic cells and testicular relapses used to account for a major
proportion of the poor outcome of boys with acute lymphoblastic
leukemia. With use of aggressive chemotherapy which includes
intermediate or high dose methotrexate, the incidence of testicular
relapses has declined. However once these patients have received
cranial irradiation as a part of the front line protocol, high dose
methotrexate needs to be avoided because of risk of developing
leucoencephalopathy. AIM: To study the use of non cross resistant
chemotherapeutic agents along with a regimen containing lower doses of
methotrexate in patients of isolated testicular relapse (ITR).
MATERIALS AND METHODS: This is a retrospective analysis of 12
consecutive patients with ITR treated with modified version of the
CCG-112 protocol which consists of intensive systemic chemotherapy,
cranial chemoprophylaxis along with testicular irradiation. RESULTS:
One patient died of regimen related toxicity. Two patients relapsed in
the bone marrow during maintenance. Of the nine patients who completed
treatment, eight are alive and in remission. One patient had a bone
marrow relapse two months after completing treatment. The Kaplan Meier
estimates give us an Event Free Survival (EFS) of 66.7% at 10 yrs.
CONCLUSIONS: Thus, though the incidence is very low, patients with ITR
should be treated aggressively since they have an excellent chance of
achieving a long term EFS