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Contemporary Clinical Trials Sep 2016Adrenal tumors are quite rare in infancy and childhood with the exception of neuroblastoma. In fact, adrenocortical tumors (ACT) account for only 0.2% of all malignant... (Review)
Review
Adrenal tumors are quite rare in infancy and childhood with the exception of neuroblastoma. In fact, adrenocortical tumors (ACT) account for only 0.2% of all malignant cancers in children and adolescents. According to a multicenter registry investigation, the median interval between first endocrine symptoms and the diagnosis of ACT is 5months, and death is seen in 38% of patients, who suffer from tumor progression following the diagnosis in about 2½years. The prognosis of pediatric ACC is poor with a 5-year event-free survival of 54%. To face this dreadful scenario, a few decades ago the International Pediatric Adrenocortical Tumor Registry (IPACTR) was established. Moreover, Children's Oncology Group (COG) and National Cancer Institute (NCI) have approved several clinical trials designed to investigate new treatment options in pediatric ACT. In this systematic review, we summarize the diagnostic histopathologic criteria, bio-markers, and clinical trials of this challenging diagnosis. Eleven pediatric ACT trials were reviewed in our investigation. Two out of 11 studies were conducted in Brazil showing apparently an increased rate of germline mutation-related pediatric ACT. A heterogeneous methodology was evident with four non-randomized clinical trials, three prospective cohort studies, and four retrospective case-control studies limiting higher statistical approach. Tumor histology remains the backbone to diagnose ACT creating a common investigative platform and potentially supporting studies aiming to increase international collaborative research, which is crucial for this challenging disease.
Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Biomarkers, Tumor; Child; Clinical Trials as Topic; Humans; Neoplasm Staging; Prognosis; Research Design; Survival Rate
PubMed: 27424218
DOI: 10.1016/j.cct.2016.07.011 -
European Journal of Clinical... Feb 2021Current studies investigating the association between inhaled corticosteroid (ICS) use and risk of lung cancer have yielded inconsistent findings. The aim of this... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Current studies investigating the association between inhaled corticosteroid (ICS) use and risk of lung cancer have yielded inconsistent findings. The aim of this systematic review and meta-analysis was to pool all currently available data to estimate this association.
METHODS
We systematically searched MEDLINE (1946 to July 2020), EMBASE (1974 to July 2020) and the Cochrane Library (June 2020) via Ovid to identify relevant articles investigating the association between the ICS use and the risk of lung cancer. Random-effects analysis was used to calculate pooled relative risks (RRs) with 95% confidence intervals (CIs).
RESULTS
Ten articles including 234 920 patients were analysed. ICS use was identified to have a decreased risk of lung cancer in chronic obstructive pulmonary disease (8 studies, 1806 patients; RR = 0.73, 95% CI: 0.61-0.87, P < .01; I = 60.0 %), asthma (1 study, 41 438 patients; RR = 0.44, 95% CI: 0.34-0.57, P < .01) and mixed (1 study, 46 225 patients; RR = 0.79, 95% CI: 0.69-0.90, P < .01) patients. The findings of reduced risk of lung cancer were consistent in all subgroup analyses except for the short-term follow-up (≤5 years) (RR = 0.94, 95% CI: 0.81-1.07, P = .34) and free of immortal time bias (RR = 0.94, 95% CI: 0.82-1.08, P = .38) subgroups.
CONCLUSIONS
The present study suggested that ICS use was associated with decreased risk of lung cancer. However, our findings should be interpreted with caution because most original studies were judged to be at high risk of immortal time bias.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Asthma; Humans; Lung Neoplasms; Protective Factors; Pulmonary Disease, Chronic Obstructive
PubMed: 33053199
DOI: 10.1111/eci.13434 -
International Urology and Nephrology Mar 2019Organ-sparing surgery (OSS) for the kidney and adrenals has emerged as the need for preservation of function is paramount in patients with poor functional reserve. As...
PURPOSE
Organ-sparing surgery (OSS) for the kidney and adrenals has emerged as the need for preservation of function is paramount in patients with poor functional reserve. As reports increasingly showed that oncological outcomes were equivalent to radical excision, elective OSS became a viable alternative in patients with otherwise normal reserve. In this review, we summarize the current knowledge of OSS for adrenal and renal tumors.
MATERIALS AND METHODS
PubMed, Web of Science and Cochrane Library Central Search were searched for recently published articles up to December 2017. The following keywords were used; "partial adrenalectomy", "adrenal sparing", "partial nephrectomy", "nephron sparing", "kidney/renal cancer".
RESULTS
Partial adrenalectomy became an attractive alternative to total adrenalectomy avoiding adrenal insufficiency. Both minimally invasive surgery and ablative techniques were increasingly reported for adrenal OSS with adequate residual adrenal function and excellent oncological outcome. Radical nephrectomy remained for many years as the gold standard of treatment for organ-confined renal cell carcinoma. As the need to reduce the impact on renal function, more conservative approaches were utilized. Soon, the non-inferiority of nephron-sparing surgery to that of radical excision became evident and elective partial nephrectomy was gaining ground as the standard of care for small renal masses in patients with normal contralateral kidneys.
CONCLUSIONS
Herein, we present a comprehensive review of the current status of OSS in renal and adrenal tumors.
Topics: Ablation Techniques; Adrenal Gland Neoplasms; Adrenal Glands; Adrenalectomy; Humans; Kidney; Kidney Neoplasms; Minimally Invasive Surgical Procedures; Nephrectomy; Organ Sparing Treatments; Treatment Outcome
PubMed: 30623290
DOI: 10.1007/s11255-018-02070-5 -
Cancer Treatment Reviews Aug 2014We systematically reviewed the literature on the use of surgery, stereotactic ablative body radiotherapy (SABR) and percutaneous catheter ablation (PCA) techniques for... (Review)
Review
BACKGROUND
We systematically reviewed the literature on the use of surgery, stereotactic ablative body radiotherapy (SABR) and percutaneous catheter ablation (PCA) techniques for the treatment of adrenal metastases to develop evidence-based recommendations.
METHODS
A systematic review of the MEDLINE database was performed using structured search terms following PRISMA guidelines. Eligible publications were those published from 1990 to 2012, written in English, had at least five patients treated for adrenal metastasis and reported on patient clinical outcomes (local control, survival and treatment related complications/toxicity). Where possible, pooled 2-year local control and overall survival outcomes were analysed.
RESULTS
Our search strategy produced a total of 45 papers addressing the three modalities - 30 adrenalectomy, nine SABR and six PCA (818, 178 and 51 patients, respectively). There was marked heterogeneity in outcome reporting, patient selection and follow-up periods between studies. The weighted 2-year local control and overall survival for adrenalectomy were 84% and 46%, respectively, compared with 63% and 19%, respectively for the SABR cohort. Only one study of PCA with five patients analysed clinical outcomes, reporting an actuarial local control of 80% at 1 year. Treatment related complications/toxicities were inconsistently reported.
CONCLUSION
There is insufficient evidence to determine the best local treatment modality for isolated or limited adrenal metastases from any primary tumour. Published data suggests adrenalectomy to be a reasonable treatment approach for isolated adrenal metastasis in suitable patients. SABR is a valid alternative in cases when surgery is not feasible or the operative risk is unacceptable. PCA cannot be recommended until there are more robust studies which include long-term oncological outcomes.
Topics: Adolescent; Adrenal Gland Neoplasms; Adult; Aged; Aged, 80 and over; Catheter Ablation; Female; Humans; Male; Middle Aged; Radiosurgery; Treatment Outcome; Young Adult
PubMed: 24791623
DOI: 10.1016/j.ctrv.2014.04.001 -
Lung Cancer (Amsterdam, Netherlands) Jan 2012Although patients with stage IV non-small cell lung cancer (NSCLC) have a poor prognosis, a subset of patients with solitary brain or adrenal metastasis have more... (Review)
Review
BACKGROUND
Although patients with stage IV non-small cell lung cancer (NSCLC) have a poor prognosis, a subset of patients with solitary brain or adrenal metastasis have more favorable outcome following surgical resection. Nevertheless, the outcome and predictive factors for survival following metastatectomy for patients with other metastatic sites are not well defined.
METHODS
We performed a systematic review using PUBMED database for all articles which included patients with NSCLC and solitary metastasis to sites other than the adrenal gland or the brain who had undergone resection of their metastasis and definitive treatment of the primary lung cancer. Potential prognostic factors on survival including age, sex, histology, T and N stage of the primary tumor, synchronous vs. metachronous presentation, visceral vs. non-visceral metastasis and the use of perioperative chemotherapy were analyzed using multi-variable Cox proportional hazard model.
RESULTS
62 cases were eligible for the analysis. The 5-year survival rate was 50% for the entire cohort. Mediastinal lymph node involvement was independently predictive of inferior outcome; 5-year survival rate 0% vs. 64% in favor of no involvement, p<0.001. Similarly, patients with intra-thoracic stage III disease had an inferior outcome compared to patients with stage II and stage I disease: 5-year survival rate 0% vs. 77% and 63%, respectively, p<0.001. Other factors have no effect on outcome.
CONCLUSION
Selected patients with distant metastatic NSCLC can achieve long term survival following metastatectomy and definitive treatment of the primary tumor. Mediastinal lymph node involvement is associated with poor prognosis.
Topics: Carcinoma, Non-Small-Cell Lung; Cohort Studies; Humans; Lung Neoplasms; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Proportional Hazards Models; Survival Rate
PubMed: 21864934
DOI: 10.1016/j.lungcan.2011.07.014 -
European Journal of Cancer (Oxford,... May 2022Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival (OS). The primary aim was to identify definitions of esophagogastric OMD. A secondary aim was to perform a meta-analysis of OS after local treatment versus systemic therapy alone for OMD.
METHODS
Studies and study protocols reporting on definitions or OS after local treatment for esophagogastric OMD were included. The primary outcome was the maximum number of organs/lesions considered OMD and the maximum number of lesions per organ (i.e. 'organ-specific' OMD burden). Agreement was considered to be either absent/poor (< 50%), fair (50%-75%), or consensus (≥ 75%). The secondary outcome was the pooled adjusted hazard ratio (aHR) for OS after local treatment versus systemic therapy alone. The ROBINS tool was used for quality assessment.
RESULTS
A total of 97 studies, including 7 study protocols, and 2 prospective studies, were included. OMD was considered in 1 organ with ≤ 3 metastases (consensus). 'Organ-specific' OMD burden could involve bilobar ≤ 3 liver metastases, unilateral ≤ 2 lung metastases, 1 extra-regional lymph node station, ≤ 2 brain metastases, or bilateral adrenal gland metastases (consensus). Local treatment for OMD was associated with improved OS compared with systemic therapy alone based on 6 non-randomized studies (pooled aHR 0.47, 95% CI: 0.30-0.74) and for liver oligometastases based on 5 non-randomized studies (pooled aHR 0.39, 95% CI: 0.22-0.59). All studies scored serious risk of bias.
CONCLUSIONS
Current literature considers esophagogastric cancer spread limited to 1 organ with ≤ 3 metastases or 1 extra-regional lymph node station to be OMD. Local treatment for OMD appeared associated with improved OS compared with systemic therapy alone. Prospective randomized trials are warranted.
Topics: Esophageal Neoplasms; Humans; Metastasectomy; Neoplasm Metastasis; Prospective Studies; Radiosurgery; Stomach Neoplasms
PubMed: 35339868
DOI: 10.1016/j.ejca.2022.02.018 -
Heliyon May 2019Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified,...
OBJECTIVE
Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises.
METHOD
A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases.
RESULTS
Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3-8%. Of all cases of AI (n = 25) the mean pooled baseline cortisol was 318 ± 237 nmol/L and stimulated 423 ± 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 ± 2.8 cm (left) and 5.5 ± 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6-6.5). However, two cases were alive after 12-24 months.
CONCLUSION
The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism.
PubMed: 31193734
DOI: 10.1016/j.heliyon.2019.e01783 -
Interactive Cardiovascular and Thoracic... Jan 2017This systematic review and pooled analysis investigated outcomes and prognostic factors in Non-small-cell lung cancer (NSCLC) patients who underwent surgical treatment... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and pooled analysis investigated outcomes and prognostic factors in Non-small-cell lung cancer (NSCLC) patients who underwent surgical treatment for an isolated adrenal metastasis and the primary NSCLC.
METHODS
A literature search of PubMed, Embase and Cochrane Library databases was conducted for relevant retrospective studies in patients with NSCLC and isolated adrenal metastatic lesions treated with lobectomy or pneumonectomy and adrenalectomy. Outcome measures were overall, 1-, 2- and 5-year survival rates stratified by synchronous versus metachronous adrenal metastasis and according to lymph node status, pathology and relative location of the metastasis to the primary tumour. Kaplan-Meier survival curves were generated and differences in survival were assessed by a log-rank test.
RESULTS
Thirteen studies involving 98 patients were included in this analysis. The median overall survival was 18 months, and the 1-, 2- and 5-year survival rates were 66.5, 40.5 and 28.2%, respectively. Patients with metachronous adrenal metastasis had a significantly better prognosis than patients with synchronous adrenal metastasis (P < 0.05). Patients classified as negative for lymph node metastasis had a significantly better prognosis than patients classified as positive for lymph node metastasis (P < 0.05). Pathology (squamous carcinoma versus adenocarcinoma) and the relative location of the metastasis to the primary tumour (ipsilateral adrenal metastasis or contralateral adrenal metastasis) had no significant influence on prognosis.
CONCLUSIONS
NSCLC patients with isolated adrenal metastasis undergoing surgical treatment for the primary tumour and adrenal metastasis could achieve a significant survival benefit, especially if they have metachronous adrenal metastasis or are negative for lymph node metastasis.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Outcome Assessment, Health Care; Pneumonectomy; Prognosis; Survival Rate
PubMed: 27664424
DOI: 10.1093/icvts/ivw321 -
Frontiers in Psychology 2023Cancer initiation, progression and recurrence are intricate mechanisms that depend on various components: genetic, psychophysiological, or environmental. Exposure to...
INTRODUCTION
Cancer initiation, progression and recurrence are intricate mechanisms that depend on various components: genetic, psychophysiological, or environmental. Exposure to chronic stress includes fear of recurrence that can affect biological processes that regulate immune and endocrine systems, increase cancer risk, and influence the survival rate. Previous studies show that psychological interventions might influence the level of cortisol that has been extensively used as a biomarker for measuring hypothalamic-pituitary-adrenal axis functioning and body's immunity response. This meta-analysis aimed to provide a quantitative scrutiny of the effect of certain types of psychosocial interventions on cortisol as a neuroendocrine biomarker in saliva or blood and might predict breast cancer (BC) progression.
METHODS
A literature search was performed in the following databases: PubMed, The Cohrane Library, Scopus, WOS, PsychInfo, Google Scholar, Ovid Science Direct. After methodical selection of originally generated 2.021 studies, the search yielded eight articles that met inclusion criteria. All these studies explored effects of psychosocial interventions that measured cortisol in total of 366 participants with BC, stages 0-IV, in randomized control trial or quasi experimental study design setting. We applied random effects model to conduct meta-analyses on the parameters of salivary and plasma cortisol and used PRISMA Guidelines as validated methodology of investigation to report the results.
RESULTS
Eight studies selected for meta-analysis have shown the reduction of cortisol level due to applied psychosocial intervention. The random effects model showed that interventions produced large effect sizes in reductions of cortisol in blood (Cohen's d = -1.82, 95% Confidence Interval (CI): -3.03, -0.60) and slightly less in saliva (d = -1.73, 95%CI: -2.68, -0.78) with an overall effect of d = -1.76 (95%CI: -2.46, -1.07).
CONCLUSION
Our study concluded that certain types of psychosocial interventions reduce cortisol (indicator of chronic stress) in patients with BC. Application of specific psychosocial support as adjuvant non-invasive therapy for affected females with BC at all phases of treatment could contribute to more cost-effective health care.
PubMed: 37441329
DOI: 10.3389/fpsyg.2023.1148805 -
International Journal of Hyperthermia :... 2023To evaluate the safety and clinical efficacy of image-guided radiofrequency ablation (RFA) in patients exhibiting adrenal metastatic tumors (AMTs). (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the safety and clinical efficacy of image-guided radiofrequency ablation (RFA) in patients exhibiting adrenal metastatic tumors (AMTs).
METHODS
The PubMed, Web of Science, and Wanfang databases were searched for relevant studies published as of November 2022, and study results were pooled for subsequent analysis. The endpoints of this meta-analysis included primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year overall survival (OS) rates.
RESULTS
This analysis incorporated 11 studies enrolling 351 patients that underwent RFA treatment for 373 AMTs. The pooled primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year OS rates in these patients were 84%, 91%, 4%, 6%, 7%, 19%, 82%, and 46%, respectively. The 1-year OS ( = 75.2%, = 0.003) and 3-year OS ( = 81.4%, = 0.001) endpoints were subject to significant heterogeneity. Subgroup analyses suggested that primary technical success rates were < 80% in patients with tumors exhibiting a mean diameter ≥ 4 cm. Guidance type and tumor size had no impact on a hypertensive crisis or local recurrence rates.
CONCLUSIONS
These data indicate that image-guided RFA represents a safe and effective means of treating AMTs.
Topics: Humans; Pneumothorax; Radiofrequency Ablation; Treatment Outcome; Adrenal Gland Neoplasms; Survival Rate; Catheter Ablation; Liver Neoplasms; Carcinoma, Hepatocellular
PubMed: 36889697
DOI: 10.1080/02656736.2023.2185575