Rhabdomyosarcoma (RMS) is rare in adults and it is generally characterized by poor outcome. In a previous retrospective study, we demonstrated a better prognosis in adults treated with multimodality ...approach resembling pediatric protocols. Thereafter, we developed specific recommendations based on the principles adopted in pediatric oncology. The present analysis reports the results in a subsequent prospective series. The study included 95 consecutive patients (age 18–77 years) treated from 2002 to 2015 for embryonal and alveolar RMS. As in the previous series, patients were stratified by the appropriateness of their treatment according to therapeutic guidelines for childhood RMS. The 5-year event-free survival (EFS) and overall survival (OS) rates were 33.6% and 40.3%, respectively. The 5-year EFS was 40.8% for patients with the highest treatment score, and 15% for those with lower score, while OS was 44.4% and 24.5%, respectively. The developing of specific recommendations enabled an increase in the number of patients treated with intensive multimodal treatment resembling pediatric strategy (69.7% vs. 39.1% in the retrospective series). This study reinforced the idea that adherence to the principles of pediatric protocols, improves adult RMS outcomes. However, treating adults with pediatric-type strategy is not enough to achieve the results obtained in children. Issues in compliance and a more aggressive biology of adult RMS might have a role in the different outcome according to age. Improving the collaboration between pediatric and adult oncologists in promoting specific clinical and biological research is crucial to improve the outcome for this patient population.
Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined.
To test whether severity and mortality from ...COVID-19 among patients with cancer have improved during the course of the pandemic.
OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer.
SARS-CoV-2 infection.
Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021).
At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median IQR age, 68 18-77 years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020; 12.5% (95% CI, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021 (all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 60.3% vs 564 of 1008 56.1%; P = .03), have at least 2 comorbidities (793 of 1626 48.8% vs 427 of 1008 42.4%; P = .001), and have advanced tumors (708 of 1626 46.4% vs 536 of 1008 56.1%; P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 45.4% vs 342 of 1008 33.9%; P < .001) and require hospitalization (969 of 1626 59.8% vs 418 of 1008 42.1%; P < .001) and anti-COVID-19 therapy (1004 of 1626 61.7% vs 501 of 1008 49.7%; P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti-COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio HR, 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak.
The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.
•Angiosarcoma presents unique challenges in clinical management of localized disease, due to its rarity and aggressiveness.•Dedicated clinical recommendations for angiosarcoma are currently lacking ...despite the applicability of ESMO guidelines.•The Italian Sarcoma Group, together with patient’s advocates from “Sofia nel Cuore Onlus”, convened to develop specific recommendations, aiming to standardize and harmonize clinical practices for localized angiosarcoma management.
Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas.
While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials.
The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from “Sofia nel Cuore Onlus” and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein.
Setting
In the last few years, the use of opioids for cancer pain has rapidly increased and new molecules have been developed. Currently, rapid‐onset opioids are widely used in clinical practice for ...breakthrough cancer pain (BTcP). However, the tolerability of these molecules is still a matter of debate.
Patients
We describe two cases of rapid‐onset opioids misuse that have been recently observed at our palliative care unit.
Discussion
The reported cases are explicative as they occurred in patients suffering from different types of cancer and with different causes of BTcP. Further investigations are needed to identify factors predicting addiction to this new class of molecules.
The goal of the current study was to clarify treatment outcomes for adult patients with rhabdomyosarcoma (RMS). Published series have reported definitively worse results for adults with RMS compared ...with children with RMS. This finding casts doubt on whether RMS is the same disease in adults as it is in children.
Of 190 patients with RMS who were age 18 years or older and whose cases were recorded over a 25-year span in the pathology database of the Istituto Nazionale Tumori (Milan, Italy), 171 could be analyzed retrospectively for treatment outcome. The authors attempted to stratify patients according to the degree to which they had been treated appropriately, based on current treatment guidelines for childhood RMS.
The overall rate of response to chemotherapy was 85%. For the entire series, 5-year event-free survival and 5-year overall survival (OS) were 28% and 40%, respectively. Among the 110 patients with embryonal, alveolar, or 'not otherwise specified' RMS, 5-year OS was 46%; however, 5-year OS was 61% for patients within this group (39% of the total) who had high scores for appropriate treatment.
The current series parallels other published series in that it confirms the finding of a relatively poor long-term outcome for adult patients with RMS. However, for patients whose treatment adhered to the current guidelines for treatment of children, outcome was similar to what has been reported in pediatric series. In addition, the rate of response to chemotherapy for the entire series was similar to the rate typically observed among children. These findings suggest that adults and children with RMS should receive similar treatment. Treatment protocols adopted from pediatric programs but tailored to adults could increase adults' chances of receiving appropriate treatment; prospective studies are needed to test this idea.
Abstract Purpose The aim of this study was to describe the Italian Association of Pediatric Hematology and Oncology (AIEOP) and Italian Sarcoma Group (ISG) experience from 1980 to 2009 on 112 ...patients with Ewing sarcoma (ES) occurring in unusual sites such as the craniofacial bones (CF), hands or feet (HF), or the mobile spine. These sites were grouped because their rarity as ES localisations. Patient and methods Twenty-six patients had CF ES (23%), 37 patients had HF ES (33%) and 49 patients had mobile spine ES (44%). A total of 26 patients presented with synchronous metastatic disease (23%). The local treatment with surgery and/or radiotherapy differed among ES sites. Systemic therapy was administrated according to the protocols in use over the years. Results From the data available, the histological/radiological response was higher for HF-patients even not statistical significant (good responders: CF 41%, HF 65% and mobile spine 39%, P = 0.NS) and the probability of achieving complete response was similar among the three sites (CF 87%, HF 83% and spine 74%, P = 0.44). Ten year overall survival (OS) was 61% (95% confidence interval CI 39–82), 63% (95% CI 37–89) and 64% (95% CI 49–79) for CF, HF or vertebral ES, respectively ( P = NS). Ten year OS for non-metastatic patients was 60% (95% CI 36–83), 75% (95% CI 56–94) and 67% (95% CI 47–89) for CF, HF and mobile spine patients respectively ( P = NS). Ten year OS was 45% (95% CI, 31–84) and 70% (95% CI, 61–85, p = 0.01) for metastatic and localised ES, respectively. Conclusions The probability of successful treatment did not differ from ES of the extremities. Furthermore, our series confirm the poor prognosis for patients with metastatic disease. Our data do not strengthen the need for a specific protocol for unusual site ES.
PDF
