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Positron emission tomography-adapted therapy in low-risk diffuse large B-cell lymphoma:results of a randomized,phase Ⅲ,non-inferiority trial

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Cancer Communications 2023年第8期43卷 896-908页

作者： Qing Shi Yang He Hong-Mei Yi Rong-Ji Mu Xu-Feng Jiang Di Fu Lei Dong Wei Qin Peng-Peng Xu Shu Cheng Qi Song Sai-Juan Chen Li Wang Wei-Li Zhao State Key Laboratory of Medical Genomics National Research Center for Translational Medicine at ShanghaiShanghai Institute of HematologyRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP.R.China Department of Pathology Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP.R.China Clinical Research Institute Shanghai Jiao Tong University School of MedicineShanghaiP.R.China Department of Nuclear Medicine Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP.R.China Department of Radiology Ruijin Hospital affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP.R.China Laboratory of Molecular Pathology Pole de Recherches Sino-Francis en Science du Vivant et GénomiqueShanghaiChina

Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)but whether the same efficacy can be achieved with reduced chemotherapy regimen of four cycles for non-bulky DLBCL patients with an IPI of 1 remains unclear.This study compared four cycles versus six cycles of chemotherapy in non-bulky low-risk DLBCL patients with negative interim positron emission tomography with computed tomography(PET-CT,Deauville 1-3),irrespective of age and other IPI risk factors(IPI 0-1).Methods:This was an open-label,randomized,phaseⅢ,non-inferiority trial.Patients aged 14-75 years with newly diagnosed low-risk DLBCL,according to IPI,achieving PET-CT confirmed complete response(CR)after four cycles of R-CHOPwere randomized(1:1)between four cycles of rituximab(4R-CHOP+4R arm)or two cycles of R-CHOP plus two cycles of rituximab(6R-CHOP+2R arm).The primary endpoint was 2-year progression-free survival(PFS),conducted in the intention-to-treat population.Safety was assessed in patients with at least one cycle of assigned treatment.The non-inferiority margin was-8%.Results:A total of 287 patients were included in the intention-to-treat analysis,the median follow-up was 47.3 months,and the 2-year PFS rate was 95%(95%confidence interval[CI],92%to 99%)and 94%(95%CI,91%to 98%)for the 4R-CHOP+4R and 6R-CHOP+2R arm.The absolute difference in 2-year PFS between the two arms was 1%(95%CI,-5%to 7%),supporting the non-inferiority of 4R-CHOP+4R.Grade 3-4 neutropenia was lower in the last four cycles of rituximab alone in the 4R-CHOP+4R arm(16.7%versus 76.9%),with decreased risk of febrile neutropenia(0.0%versus 8.4%)and infection(2.1%versus 14.0%).Conclusions:For newly diagnosed low-risk DLBCL patients,interim PET-CT after four cycles of R-CHOP was effective in identifying patients with Deauville 1-3 who would have a good response and Deauville 4-5 patients who might

关键词： diffuse large B-cell lymphoma low-risk positron emission tomography randomized phaseⅢtrial

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Long-term prognosis of low-risk neuroblastoma treated by surgery alone: an experience from a single institution of China

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World Journal of Pediatrics 2019年第2期15卷 148-152页

作者： Wei Yao Kai Li Kui-Ran Dong Shan Zheng Xian-Min Xiao Department of Pediatric Surgery Children's Hospital of Fudan University399 Wanyuan RoadShanghai 201102China National Children's Medical Center 399 Wanyuan RoadShanghai 201102China

Background low-risk neuroblastomas have favorable biologic characteristics.Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient.We evaluated the long-term prognosis of surgery alone for patients with low-risk neuroblastoma in China.Methods A total of 34 patients with low-risk neuroblastoma were treated in our center between Jan 2009 and Dec 2013.The medical records of these patients were reviewed.Results The primary lesion was located in the adrenal gland in 19 patients,the retroperitoneum in 5,the posterior mediastinum in 9 and the neck in 1.The tumor diameters and volumes were 1.80-10.0 cm (average 5.5 ±2.3 cm) and 1.28-424.10 cm3 (average 58.81 ± 92.00 cm3),respectively.The stages of the patients were as follows:stage Ⅰ in 25,stage Ⅱ in 7,and stage Ⅳs in 2.All patients were in the low-risk group according to COG risk stratification criteria.No patients showed MYCN amplification.The primary tumors of all patients were completely resected.Nine adrenal tumors were completely resected by laparoscopy.All patients were successfully followed for 66-115 (average 89.71 ± 16.17) months.Recurrence was observed in 4 patients.In addition to one local recurrence,another three recurrences were metastases.The lesions were effectively controlled in all patients with recurrences.All patients survived,including 28 cases of tumor-free survival;the 4-year overall and event-free survival rates were both 100%.Conclusions Surgery alone is a safe and effective treatment strategy for low-risk neuroblastoma.Recurrent lesions may be controlled and treated by rescue chemotherapy and surgery.

关键词： low-risk Neuroblastoma Outcome Surgery

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Pathologic and Prognostic Outcomes of Very low- and low-risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy

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Journal of Cancer Therapy 2016年第4期7卷 239-246页

作者： Issei Takizawa Makoto Ohori Yoshio Ohno Jun Nakashima Rie Inoue Toshitaka Nagao Masaaki Tachibana Department of Urology Tokyo Medical University Tokyo Japan Department of Pathology Tokyo Medical University Tokyo Japan

Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.

关键词： Prostate Cancer NCCN Guideline Very low-risk low-risk Active Surveillance

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On the Association between Travel Distance and Treatment Choice for low-risk Prostate Cancer: Results from a Rural State

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Journal of Cancer Therapy 2016年第9期7卷 656-664页

作者： Chris Hellekson Grant Larson Scott Poswilko James Beal Abe Sahmoun J. Kyle Russo The University of North Dakota School of Medicine and Health Sciences Grand Forks ND USA Bismarck Cancer Center Bismarck ND USA

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06;p-value = 0.1794;and p-value = 1.00;respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.

关键词： low-risk Prostate Cancer Rural Brachytherapy Prostatectomy Young Men Travel Distance

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