Presentation is loading. Please wait.

Presentation is loading. Please wait.

Overview of Systemic Px in MS malignancies งานประชุมวิชาการคณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น 2009 ผศ. พญ. เอื้อมแข สุขประเสริฐ ภาควิชาอายุรศาสตร์ คณะ แพทยศาสตร์

Similar presentations


Presentation on theme: "Overview of Systemic Px in MS malignancies งานประชุมวิชาการคณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น 2009 ผศ. พญ. เอื้อมแข สุขประเสริฐ ภาควิชาอายุรศาสตร์ คณะ แพทยศาสตร์"— Presentation transcript:

1 Overview of Systemic Px in MS malignancies งานประชุมวิชาการคณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น 2009 ผศ. พญ. เอื้อมแข สุขประเสริฐ ภาควิชาอายุรศาสตร์ คณะ แพทยศาสตร์ มหาวิทยาลัยขอนแก่น

2 Bone tumors Primary bone tumors - Osteosarcoma : Role of systemic Px Secondary bone tumors - Metastatic bone lesion : Where is the 1 0 and how to manage ?

3 Osteosarcoma ESMO Clinical Recommendations for diag, treatment and follow Standard staging in localized tumors 1. CT scan chest 2. Bone scan 3. Routine CBC, Chemistry (Cr,Electrolytes, Mg, ALP and LDH) 4. Sperm banking should be considered ESMO guideline. Annals Oncol 2007.

4 Treatment Modalities Surgery: local control Radiation: local control (positive margin) Multidrug chemotherapy: systemic control

5 Treatment plan Concept 1. Chemotherapy has significantly  5-yr survival rate for pt with localized tumors from 20% to 60% *** CT is a “must” 2. Surgery is a “must” too ! - Retrospective study, all of the patients who were not surgically treated had disease progression and died within 40 months after 1 st recurrence ESMO guideline. Annals Oncol 2007.

6 Multidrug Chemotherapies in Osteosarcoma First-line chemotherapy High-dose Methotrexate (HD-MTX): gm/m 2 Adriamycin: mg/m 2 Cisplatin: mg/m 2 Ifosfamide: 8-15 gm/m 2 Salvage chemotherapy Ifosfamide 8-15 gm/m 2 alone or combination with Etoposide 100 mg/m 2 /day x 5 days

7 Systemic Chemotherapy in Osteosarcoma BenefitDisadvan tage  OS, DFS Delay surgery Limb- sparing In vitro sense Neo- adjuvant CT Adjuvant CT BenefitDisadvan tage  OS, DFS No organ preserve No delay surg No measura ble lesion

8 Eilber F. et al. JCO 1987; 5:21 T-10: Surgery + Adjuvant Chemotherapy Surgery + Chemo Surgery Surgery + Chemo Surgery

9 Active agents: Methotrexate (HD) Doxorubicin Cisplatin Ifosfamide Etoposide

10 Role of Neo-adjuvant CT in Osteosarcoma Improve DFS and OS (compare to adjuvant CT) Allow limb sparing surgery In vitro chemosensitivity

11 Goorin, AM. et al. J Clin Oncol; 21: POG 8651

12 Neoadjuvant per se did not improve outcome and survival EFS (P = 0.6) Survival (P = 0.8) Goorin, AM. et al. J Clin Oncol; 21:

13 POG yr EFS (P = 0.027) 5-yr Survival (P = 0.896) Goorin, AM. et al. J Clin Oncol; 21: But patients who respond with neoadjuvant improve EFS

14 What is the best “regimen” ? How many drugs ? How much ?

15 Souhami et al, The Lancet 1997; 350: Cisplatin/Doxo Multidrug T10-like

16 * Lewis, I. J. et al. J. Natl. Cancer Inst : Souhami et al. Lancet Cisplatin/Doxo q 2wks  Dose intensity does not improve the outcome !

17

18 MAP regimen Current standard Rx program encourage by EURAMOS (European and American Osteosarcoma Study Group) Children’s Oncology Group (COG) Cooperative Osteosarcoma Study Group (COSS) European Osteosarcoma Intergroup (EOI) Scandinavian Sarcoma Group (SSG)

19

20 Change Rx for poor responder Salvage population did worse

21

22 Biologic Response Modifier & Targeted Therapy in Osteosarcoma Liposome encapsulated muramyl tripeptide phosphatidylethanolamine (MTP-PE, Mifamurtide, Junovan ® ) Interferon-  Pegylated Interferon-  Anti-HER2 antibody Expression of HER2/erb2 correlate with poor survival IGF-1R monoclonal antibody

23 Conclusion for localized osteosarcoma Patient who not fit for limb- sparing surgery - Pathological fracture : Surgery then adjuvant CT Patient who are potentially for limb sparing surgery : Chemo (Cis/A or Cis/A/HDMX in fit < 35 yr) 2-3 cycles : Surgery : Chemo same regimen until finish totally of 6 cycles All patients need full staging : CT chest and Bone scan

24 Bone metastasis of unknown primary

25

26 Cancer of Unknown Primary (CUP)

27 Concepts First rule - Try to establish definite “tissue diagnosis” - LN biopsy- liver biopsy - bone biopsy- sputum cytology, FNA Second rule - search for possible “primary” site of involvement - huge liver mass = possible liver huge pulmonary mass = possible lung 1 0

28 Concepts Third rule - Try to understand several clinicopathological features that help identify patient with “responsive tumors” - Germ cell tumors (especially EGCT) - Lymphoma - Breast cancer, ovarian cancer - Prostate cancer

29 1 Abbruzzese et al, JCO, Vol 13, No 8 (August), Pavlidis et al, Eur. J. Cancer, 39, , 2003 Knowledge of Primary Site Improves Survival 1 Cancers with favorable treatments 2 :  Germ cell carcinomas  Ovarian cancer  Breast cancer  Cervical squamous cancer  Neuroendocrine cancers  Prostate cancer 15 Mon ths 11 Mon ths

30 3. Men with suspected prostate CA metastasis All male with blastic metastasis All male with bone met with histology of adeno CA PSA both in serum and IHC stain in tissue should be performed Px as prostate in case of rising PSA TREATMENT FAVORABLE SUBSETS

31 What (where) is primary malignancy ? Non- hematologic (> 60% up) - Lung cancer (20%) - Breast CA (20%) - Prostate CA (20%) - Unknown (10%) - RCC (5%) - Colorectal (5%) Hematologic ( 20-30%) - MM - Lymphoma

32 Bone metastasis : Approach 1. Suspected hematologic malignancy : MM Hx & PE - fever - bone pain - anemia - hepatospenom egaly - lymphadenopat hy Investigations - ALP (  in MM) - CBC (rouleaux) - Bun/Cr - Globulin - Urine bence jone - Film skull - Ca

33 Bone metastasis : Approach 1. Suspected non- hematologic malignancy Hx & PE - Cough, dyspnea, tightness - GI symptoms - Abdominal mass - Supraclavicular LN - Breast exam - Hematuria Investigations - ALP (  ) - CXR - PSA (all men) - Mammo (women) - CT chest & abdomen

34 Take home messages for bone metastasis of unknown primary 1. All men: PSA 2. All women: breast PE, mammogram 3. All patient: CXR, ALP, Ca, CBC - Normal ALP  Rouleaux, Globulin, Cr, Urine bence -  ALP: solid tumors : if PSA normal, breast and CXR no clue CT chest and whole abdomen


Download ppt "Overview of Systemic Px in MS malignancies งานประชุมวิชาการคณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น 2009 ผศ. พญ. เอื้อมแข สุขประเสริฐ ภาควิชาอายุรศาสตร์ คณะ แพทยศาสตร์"

Similar presentations


Ads by Google