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Clinical impact of post-induction resolution of pulmonary lesions in metastatic Ewing sarcoma.

转移性尤文肉瘤诱导后肺部病灶消退的临床影响。

  • 影响因子:2.28
  • DOI:10.1002/pbc.28150
  • 作者列表:"Halalsheh H","Kaste SC","Krasin MJ","Sykes A","Sahr N","Spunt SL","Federico SM","Bishop MW
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Patients with metastatic Ewing sarcoma experience poor outcomes despite intensive systemic and local therapy. Early chemotherapy response of pulmonary metastases has been associated with prognosis in other pediatric malignancies. We reviewed the outcomes of patients with Ewing sarcoma and pulmonary metastases treated at our institution based on therapy received and early pulmonary response. MATERIALS AND METHODS:We retrospectively reviewed patients with newly diagnosed Ewing sarcoma and pulmonary metastases at St. Jude Children's Research Hospital between 1979 and 2015. Data obtained included demographic and treatment characteristics including chemotherapy, local control measures, whole lung irradiation (WLI) administration, autologous stem cell transplantation, and outcomes. Patients were evaluated for radiographic post-induction pulmonary complete response (CR). We estimated event-free survival (EFS) and overall survival (OS) and used Cox proportional hazards regression to examine the effects of clinical and treatment factors on outcomes. RESULTS:Fifty-four patients (median age, 12.9 years) were evaluated. Post-induction pulmonary CR was observed in 33 (61%) patients. WLI was delivered to 16 patients (4/33 with pulmonary CR and 12/21 with non-CR). At median 3.6 years follow-up, five-year EFS and OS were 30.8% ± 6.4% and 49.6% ± 7.1%, respectively. Post-induction pulmonary CR was associated with prolonged EFS (P < 0.001) but not improved OS (P = 0.065). Post-induction pulmonary CR was associated with a lower incidence of lung failure (P = 0.031). CONCLUSIONS:Post-induction pulmonary CR is associated with improved EFS in patients with Ewing sarcoma who present with pulmonary metastases.

摘要

背景: 转移性尤文肉瘤患者尽管进行了强化的全身和局部治疗,但预后不佳。肺转移瘤的早期化疗反应与其他儿童恶性肿瘤的预后相关。我们根据接受的治疗和早期肺反应,回顾了在我们机构治疗的尤文肉瘤和肺转移患者的结局。 材料和方法: 我们回顾性分析了 1979 年至 2015 年圣犹达儿童研究医院新诊断的尤文肉瘤和肺转移患者。获得的数据包括人口统计学和治疗特征,包括化疗、局部控制措施、全肺照射 (WLI) 给药、自体干细胞移植和结局。对患者进行诱导后肺部完全缓解 (CR) 的影像学评价。我们估计了无事件生存率 (EFS) 和总生存率 (OS),并使用Cox比例风险回归来检查临床和治疗因素对结局的影响。 结果: 对 54 例患者 (中位年龄 12.9 岁) 进行了评估。33 例 (61%) 患者观察到诱导后肺CR。16 例患者 (4/33 为肺部CR,12/21 为非CR) 获得WLI。中位 3.6 年随访时,5 年EFS和OS分别为 30.8% ± 6.4% 和 49.6% ± 7.1%。诱导后肺CR与EFS延长相关 (P <0.001),但OS未改善 (P = 0.065)。诱导后肺CR与肺衰竭发生率较低相关 (P = 0.031)。 结论: 诱导后肺CR与表现为肺转移的尤文肉瘤患者EFS改善有关。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
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DOI:10.1007/s00520-019-04843-9
作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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