RESUMEN
PURPOSE: Medulloblastoma (MB) is rarely seen in adults. For adjuvant therapy in adults the same therapy protocols used in pediatric cases are used. The present study retrospectively evaluated the data of MB patients who were treated in different Oncology Centers in Turkey. METHODS: The data of 60 adult patients with MB from 8 Oncology Centers diagnosed between 2005 and 2012 were retrospectively analyzed. RESULTS: The median patient age was 28.8 years (range 16-54). The administered chemotherapy included procarbazine+lomustin+vincristine (group A, N=31) and cyclophosphamide/ifosfamide+vincristine+cisplatin (group B, N=13). Median chemotherapy courses were 4 (range 1-8). Median progression free survival (PFS) was 76 months and median overall survival (OS) has not been reached in both groups. In young female patients and in those who received adjuvant chemotherapy, median PFS and OS were longer but without statistical significance. Mean PFS and OS were 65.9 months and 101.2 months in group A and 113.6 months and 141.6 months in group B, respectively. CONCLUSION: Improved survival results were obtained in women, in patients aged below 25 years, in those who underwent gross total excision (GTE) and in those who received adjuvant therapy with cyclophosphamide/ifosphamide.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Cerebelosas/terapia , Meduloblastoma/terapia , Procedimientos Neuroquirúrgicos , Adolescente , Adulto , Edad de Inicio , Neoplasias Cerebelosas/mortalidad , Neoplasias Cerebelosas/patología , Quimioradioterapia Adyuvante , Quimioterapia Adyuvante , Irradiación Craneana , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Meduloblastoma/mortalidad , Meduloblastoma/secundario , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Turquía , Adulto JovenRESUMEN
PURPOSE: Adding targeted therapies to chemotherapy in metastatic colorectal cancer (CRC) improves response rates and survival. KRAS is a predictive indicator for anti-epidermal growth factor receptor (EGFR) treatments. The most important reasons for KRAS discordance are intratumoral heterogeneity and incorrect mutation analysis. Evaluating the status of KRAS in primary and metastatic lesions becomes even more crucial to ensure efficient usage of anti-EGFR treatments. METHODS: Patients with metastatic CRC, whose primary disease and liver and/or lung metastases were operated, were retrospectively evaluated, and KRAS assessment was performed on 31 patients who were suitable for DNA analysis. Pyrosequencing with polymerase chain reaction (PCR) was used for KRAS analysis. RESULTS: The median age of 31 patients diagnosed with rectal cancer (N=13) and colon cancer (N=18) was 63 years (range 33-73). Metastasectomy locations included the liver (N=27), lung (N=3), and both lung and liver (N=1). KRAS discordance was detected in 22% (7/31) of the patients. While 3 patients with detected discordance had mutated KRAS in the primary material, wild type KRAS was detected in their liver or lung lesions. On the other hand, while 4 patients had wild type KRAS in the primary material, mutated KRAS was determined in their liver or lung lesions. The McNemar test revealed no significant discordance between primary and metastatic disease (p=1.00). No progression free survival (PFS) difference was detected between patients with determined discordance and patients with undetermined discordance (10.6 vs 14.7 months, p=0.719). CONCLUSION: This is the first study to evaluate KRAS discordance between primary and metastasis in CRC patients, who underwent metastasectomy, together with survival data. In the literature and recent studies with large patient numbers in which modern KRAS tests were used, the KRAS discordance rate varies between 3-12%. In our study, a higher KRAS discordance (22%) was detected, and no survival difference was determined between patients with or without discordance. In recent years, the rising interest in borderline resectable disease may bring forward discussions related to which material the KRAS status should be analyzed.
Asunto(s)
Biomarcadores de Tumor/genética , Carcinoma/genética , Carcinoma/secundario , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/secundario , Mutación , Proteínas Proto-Oncogénicas/genética , Proteínas ras/genética , Adulto , Anciano , Carcinoma/mortalidad , Carcinoma/cirugía , Neoplasias Colorrectales/mortalidad , Análisis Mutacional de ADN/métodos , Supervivencia sin Enfermedad , Femenino , Predisposición Genética a la Enfermedad , Hepatectomía , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Metastasectomía/métodos , Persona de Mediana Edad , Fenotipo , Neumonectomía , Reacción en Cadena de la Polimerasa , Proteínas Proto-Oncogénicas p21(ras) , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: In advanced stage renal cell cancer (RCC), overall survival (OS) of patients has been prolonged due to targeted therapies. To date, there are several prognostic risk models that have been developed for metastatic RCC (mRCC). The purpose of this study was to evaluate the outcomes of the sequential therapy (IFN-α, tyrosine kinase inhibitors/TKIs, m-TOR inhibitor) and prognostic factors in patients with mRCC, especially those with bone metastasis. METHODS: We retrospectively examined the data of 82 patients with pathologically proven mRCC who were followed-up and treated at the Medical Oncology Clinic of the Dr A.Y Oncology Hospital between 2005 and 2013. RESULTS: Median OS was 23 months in all patients with mRCC and 20 months in patients treated with TKIs. According to MSKCC and HENG risk classifications, median OS differed between the groups (p=0.02, p<0.001, respectively). Median OS was lower in patients with isolated bone metastasis compared to those with lung metastasis (16 vs 24 months, p=0.25). Median OS improved with increasing number of sequential therapies (p=0.08). CONCLUSION: This study confirmed the correlation between MSKCC and HENG risk models and survival data. Additionally, it was shown that increase of the number of therapeutic lines in sequential therapy prolonged survival and that bone metastases were negative prognostic factors.