Zoledronic acid in metastatic chondrosarcoma and advanced sacrum chordoma: two case reports

<p>Abstract</p> <p>Introduction</p> <p>Chondrosarcomas and chordomas are usually chemoresistant bone tumors and may have a poor prognosis when advanced. They are usually associated with worsening pain difficult to control.</p> <p>Patients and Methods</p> <p>Zoledronic acid was used in a 63-year-old man with metastatic chondrosarcoma and in a 66-year-old woman with a diagnosis of sacrum chordoma both reporting severe pain related to tumor.</p> <p>Results</p> <p>In the first case, zoledronic acid was able to maintain pain control despite disease progression following chemotherapy, in the other case, zoledronic acid only produced significant clinical benefit.</p> <p>Conclusion</p> <p>Control of pain associated with bone tumors such as chondrosarcoma and chondroma may significantly improve from use of zoledronic acid, independently from tumor response to other treatments. Evaluation on larger series are needed to confirm the clinical effect of this bisphosphonate on such tumors.</p

Concomitant treatment of brain metastasis with Whole Brain Radiotherapy [WBRT] and Temozolomide [TMZ] is active and improves Quality of Life

BACKGROUND: Brain metastases (BM) represent one of the most frequent complications related to cancer, and their treatment continues to evolve. We have evaluated the activity, toxicity and the impact on Quality of Life (QoL) of a concomitant treatment with whole brain radiotherapy (WBRT) and Temozolomide (TMZ) in patients with brain metastases from solid tumors in a prospective Simon two stage study. METHODS: Fifty-nine patients were enrolled and received 30 Gy WBRT with concomitant TMZ (75 mg/m2/day) for ten days, and subsequently TMZ (150 mg/m2/day) for up to six cycles. The primary end points were clinical symptoms and radiologic response. RESULTS: Five patients had a complete response, 21 patients had a partial response, while 18 patients had stable disease. The overall response rate (45%) exceeded the target activity per study design. The median time to progression was 9 months. Median overall survival was 13 months. The most frequent toxicities included grade 3 neutropenia (15%) and anemia (13%), and only one patient developed a grade 4 thrombocytopenia. Age, Karnofsky performance status, presence of extracranial metastases and the recursive partitioning analysis (RPA) were found to be predictive factors for response in patients. Overall survival (OS) and progression-free survival (PFS) were dependent on age and on the RPA class. CONCLUSION: We conclude that this treatment is well tolerated, with an encouraging objective response rate, and a significant improvement in quality of life (p < 0.0001) demonstrated by FACT-G analysis. All patients answered the questionnaires and described themselves as 'independent' and able to act on their own initiatives. Our study found a high level of satisfaction for QoL, this provides useful information to share with patients in discussions regarding chemotherapy treatment of these lesions

A new schedule of fotemustine in temozolomide-pretreated patients with relapsing glioblastoma

In the present study we investigated the feasibility and effectiveness of a new biweekly schedule of fotemustine (FTM) in patients with recurrent glioblastoma, after at least one previous treatment. The primary endpoint was progression-free survival at 6 months; secondary objectives were clinical response, overall survival, disease-free survival, and toxicity. Forty patients (median age 52.8 years; median Karnofsky Performance Status at progression 90) underwent second-line chemotherapy with FTM. Selected patients were previously treated with a standard radiotherapy course with concomitant temozolomide (TMZ). After tumor relapse or progression proven by magnetic resonance imaging (MRI), all patients underwent chemotherapy with FTM, given intravenously at dose of 80 mg/m2 every 2 weeks for five consecutive administrations (induction phase), and then every 3 weeks at 100 mg/m2 as maintenance. A total of 329 infusions were administered; the median number of cycles administered was 8. All patients completed the induction phase, and 29 patients received at least one maintenance infusion. Response to treatment was assessed using MacDonald criteria. One complete response [2.5%, 95% confidence interval (CI): 0–10%], 9 partial responses (22.5%, 95% CI: 15–37%), and 16 stable diseases (40%, 95% CI: 32–51%) were observed. Median time to progression was 6.7 months (95% CI: 3.9–9.1 months). Progression-free survival at 6 months was 61%. Median survival from beginning of FTM chemotherapy was 11.1 months. The schedule was generally well tolerated; the main toxicities were hematologic (grade 3 thrombocytopenia in two cases). To the best of our knowledge, this is the first report specifically dealing with the use of a biweekly induction schedule of FTM. The study demonstrates that FTM has therapeutic efficacy as single-drug second-line chemotherapy with a favorable safety profile

Physical Fitness Evaluation of Paralympic Winter Sports Sitting Athletes

Objective: To provide normative values of physical fitness in Paralympic winter sports athletes competing in a sitting posture and to identify the components relevant for successful performance. Design: Cross-sectional study with sports. Setting: The Institute of Sports Medicine and Science of the Italian National Olympic Committee (Rome, Italy). Participants: Fifteen Alpine skiers (3 BP), 16 Nordic skiers (2 BP), 10 curlers (2 BP), and 34 ISH players (7 BP). Independent Variables: Curling, Alpine skiing, Nordic skiing, and ice sledge hockey (ISH). Main Outcome Measures: Physical fitness components. Oxygen uptake peak ((V) over dotO(2peak); L.min(-1) and mL.kg(-1.)min(-1)), mechanical work in a high-intensity exhaustion exercise (MW-HIE; kJ and kJ.kg(-1)), upper-body strength (N and N.kg(-1)), mean explosive power (MEP; W and W.kg(-1)) in a 10-second arm cranking ergometer Wingate test, and fat mass (FM) (% body mass) were primary outcome measures when assessed in the whole sport groups and secondary outcome measures when separating the BP from the others. Results: Based on 1-way analysis of variance and Tukey post hoc test (P < 0.05), (V) over dotO(2peak) and MW-HIE were highest in Nordic skiers (2.9 +/- 0.53 L.min(-1) and 18.3 +/- 3.98 kJ) and similar in ISH players and Alpine skiers (2.5 +/- 0.42 and 2.3 +/- 0.44 L.min(-1) and 17.4 +/- 2.62 and 16.8 +/- 7.41 kJ, respectively). Alpine skiers showed the highest absolute strength values (1210.1 +/- 220.92 N). Curlers had the highest FM (26.2% +/- 7.74%) and the lowest (V) over dotO(2peak) (1.8 +/- 0.35 L.min(-1)), MW-HIE (11.4 +/- 2.40 kJ), and MEP (251.1 +/- 67.16 W). Among the BP, Nordic skiers, ISH players, and Alpine skiers showed (V) over dotO(2peak), MW-HIE, and strength equal to 3.4 +/- 0.43, 2.9 +/- 0.38, and 2.8 +/- 0.18 L.min(-1) and 22.6 +/- 4.04, 19.4 +/- 2.84, and 18.4 +/- 7.86 kJ, respectively. Conclusions: Analyzing physical fitness data of athletes competing in the last 4 winter Paralympic Games, normative values are provided. The specific components that are highly developed in the BP are considered relevant for successful performance