Osteosarcoma of the larynx: treatment outcomes and patterns of failure analysis

The incidence of laryngeal sarcoma is exceedingly low with osteosarcomas of the larynx being rarer still, comprising less than 1% of all associated malignancies. To date, only 32 cases have been reported since this pathologic entity was first described in 1942. In this article, we discuss the most recent case of laryngeal osteosarcoma in a patient presenting with respiratory distress found to be due to a tumor mass arising from her cricoid cartilage. We further summarize current knowledge regarding the epidemiology, presentation, and diagnosis of this uncommon disease. Lastly, we synthesize all available information regarding treatment and outcomes of the 32 previously described cases of osteosarcoma of the larynx as well as the presently described case in an attempt to offer some insight regarding optimal treatment in future cases

Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial

Abstract Background This is the first known study examining renal function following stereotactic body radiotherapy (SBRT) for pancreatic head adenocarcinoma. Methods Thirty-eight borderline-resectable/unresectable patients, part of an ongoing prospective trial, underwent 3 cycles of gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5/6/7/8 Gy) and concurrent nelfinavir. Thereafter, in resectable cases, surgery was performed within 4–8 weeks. The last available pre-SBRT creatinine was recorded, along with the highest post-SBRT value. Glomerular filtration rate (GFR) was calculated by the commonly-utilized Modification of Diet in Renal Disease formula. GFR decline was defined as the post-SBRT nadir GFR minus the pre-SBRT GFR. Correlations with the V5–V30, and mean/maximum kidney doses was performed. Statistics included Pearson correlation, Mann-Whitney, and Fisher’s exact tests. Results The median total kidney volume was 355 cm3. Median dosimetric values were as follows: V5 (209 cm3), V10 (103 cm3), V15 (9 cm3), V20 (0 cm3), V25 (0 cm3); and mean (6.7 Gy) & maximum kidney dose (18.3 Gy). Median GFR change was −23 (range, −105 to 25) mL/min/1.73 cm2. Of all dosimetric parameters, only V5 was significantly associated with changes in GFR (Pearson r = −0.40, p = 0.012). In patients with V5 23 mL/min/1.73 cm2. If V5 is kept <210 cm3, median GFR decline was only 11.8 mL/min/1.73 cm2. Further validation is needed to ascertain definite dose-volume parameters and examine late renal decline

Which Prognostic Index is Most Appropriate in the Setting of Delayed Stereotactic Radiosurgery for Brain Metastases?

OBJECTIVES: To determine if five commonly-used prognostic indices (PI)–Recursive Partitioning Analysis (RPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM), graded prognostic assessment (GPA), and the diagnosis-specific GPA (DSGPA)— are valid following delay between diagnosis and treatment of brain metastases. METHODS: In a single-institutional cohort, records of patients that underwent SRS more than 30 days from diagnosis of brain metastases were collected, and five PI scores were calculated for each patient. For each PI, three score-based groupings were made to examine survival differences by means of adjusted log-rank analysis and area under the curve.RESULTS: Of 121 patients with sufficient PI information, 72 underwent SRS more than 30 days after diagnosis. Median age and Karnofsky performance status were 60 years and 80, respectively. Forty-three (60%) patients had lung primaries. Prior to SRS, 38 (52.8%) and 12 (16.7%) patients underwent whole-brain radiotherapy (WBRT) and surgery, respectively. 2 (2.8%) patients underwent both WBRT and surgery prior to SRS. A median of two lesions were treated per SRS course. Median survival of the cohort was 9.0 months. Using adjusted log-rank analysis for pairwise comparison, BSBM and GPA showed significance between two out of three prognostic groups, while the other scores showed either one or no significant differences on comparison. Area under the curve demonstrated good applicability for BSBM, RPA, and GPA, although SIR was statistically less prognostic than the other PIs. CONCLUSIONS: The PIs analyzed in this study were applicable in the setting of delayed SRS. Though these data are hypothesis-generating, they serve to encourage further analyses to validate a PI that is most optimal for these patients

Probability of cardiac death by RT status for long-term survivors of esophageal cancer.

<p>Numbers at risk indicate patients liable to be censored or undergo failure at each time period.</p

Logistic regression analysis of the probability of cardiac death by (A) age at diagnosis and (B) diagnosis year (shading represents 95% confidence interval).

<p>Logistic regression analysis of the probability of cardiac death by (A) age at diagnosis and (B) diagnosis year (shading represents 95% confidence interval).</p

Multivariate logistic regression analysis of the probability of cardiac death by RT, adjusted by age at diagnosis and diagnosis year.

<p>Multivariate logistic regression analysis of the probability of cardiac death by RT, adjusted by age at diagnosis and diagnosis year.</p

Probability of cardiac death (A) and liver disease death (B) by RT status for long-term survivors of esophageal cancer in propensity score matched data.

<p>Probability of cardiac death (A) and liver disease death (B) by RT status for long-term survivors of esophageal cancer in propensity score matched data.</p

1:1 matched patient population by propensity score.

<p>1:1 matched patient population by propensity score.</p

Cox proportional hazards model in the propensity score matched data.

<p>Cox proportional hazards model in the propensity score matched data.</p