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PubMed1979

Tumor host relations. II. Influence of tumor extent and tumor site on plasma cortisol of patients with malignant diseases.

The increase of plasma cortisol in patients with tumors of five different sites compared with a control group of patients with benign surgical diseases amounted to: +39% (breast), +34% (stomach), +86% (intestine), +60% (skin) and +194% (gall bladder). The first detectable increase of cortisol occurred in patients with tumors classified T 2 according to the TNM scheme (+27% above the control). Highly significant increases were observed for T 3 (+82%) and T 4 (+77%) patients. Patients with palpable lymph nodes showed a most significantly increased cortisol mean value compared with patients without palpable lymph nodes. Similarly, the cortisol mean value of patients with distant metastases was significantly higher than the corresponding value of tumor patients without distant metastases. The question remains open, whether the primary site, the extent of the tumor or the occurrence of metastases is the main determinant for the cortisol increase.

Adult↗
PubMed2006

Geometric shifting of the porta hepatis during posthepatectomy radiotherapy for biliary tract cancer.

PURPOSE: To evaluate geometric shifting of the porta hepatis induced by liver regeneration during radiotherapy (RT) after partial hepatectomy for biliary tract cancer. METHODS AND MATERIALS: Between August 2004 and August 2005, the study enrolled 10 biliary tract cancer patients who underwent hemihepatectomy or more extensive surgery and were scheduled to receive postoperative RT. All patients received 4500 cGy RT in 25 fractions with concurrent 5-fluorouracil. Before RT and in the third and fifth weeks during RT, the liver volume was determined using CT, and geometric location of the porta hepatis was determined using a conventional simulator. RESULTS: The liver volume increase during RT was 246.6 +/- 118.2 cm(3). The overall actual shifting length of the porta hepatis was 9.8 +/- 2.5 mm, with right and left hepatectomy causing a 10.1 +/- 1.7 mm shift to the right or 9.2 +/- 4.3 mm shift to the left, respectively. The actual shifting length of the porta hepatis was proportional to the increase in liver volume during RT (r = 0.742, p = 0.014). CONCLUSION: The results of this study have demonstrated that the porta hepatis can be shifted by liver regeneration after partial hepatectomy. We recommend an additional RT margin or adaptive RT (repeat planning at several intervals during the treatment course) to avoid exclusion of the porta hepatis from the RT target volume after partial hepatectomy for biliary tract cancer.

Adenocarcinoma↗
PubMed2006

Left hepatic trisectionectomy for hepatobiliary malignancies.

BACKGROUND: Left hepatic trisectionectomy is the most extended hepatic resection. To date, few data are available on longterm outcomes after this operation. STUDY DESIGN: Between June 1998 and July 2004, a total of 52 patients underwent left trisectionectomy for primary or secondary hepatobiliary tumors at our institution. Data were analyzed with regard to patient characteristics, intraoperative details, pathologic findings, perioperative morbidity and mortality, and outcomes as determined by survival. RESULTS: Left trisectionectomy was combined with caudate lobectomy and hilar lymph node dissection in 29 and 35 patients, respectively. In addition, 43 procedures were performed in 31 patients: resection of hilar bifurcation (n = 15), bile-duct revision (n = 5), wedge resection of segment VI/VII (n = 10), gastrectomy (n = 1), and resection or reconstruction of hepatic vessels or the inferior vena cava (n = 12). Operative morbidity and mortality were 50% and 11.9%, respectively. By multivariate analysis, additional operative procedures constituted the only positive predictor of postoperative morbidity. One-, 3-, and 5-year survival rates were 65%, 52%, and 33%, respectively. After R0 resection (n = 37), 1-, 3-, and 5-year survival rates were 78%, 68%, and 44% compared with 38%, 15%, and 7% after R1 resection (p = 0.0004). Survival corresponding to the four most frequent tumor types (hepatocellular carcinoma, cholangiocellular carcinoma, hilar cholangiocarcinoma, and colorectal metastases) was comparable with survival data reported in the literature after less-extensive resections. CONCLUSIONS: Left trisectionectomy provides acceptable survival rates in both locally advanced primary hepatobiliary malignancies and large metastatic liver tumors. Despite major progress in surgical technique and perioperative management, left trisectionectomy is still associated with higher operative mortality and morbidity than less-extensive resections. Because selection criteria for this type of procedure are not clearly defined, particular attention should be focused on the oncologic benefits when considering this operation.

Adult↗
PubMed1985

Contribution of radionuclide imaging to radiation oncology.

Radionuclide imaging has been helpful to oncologists in the initial evaluation and follow-up of patients with primary and metastatic disease. With the introduction of ultrasound and computed tomography, there has been some reduction in the number of radionuclide imaging procedures. These imaging modalities should be used to complement one another. With the introduction of single-photon emission computed tomography in clinical nuclear medicine, there will be a significant improvement in the sensitivity, accuracy, and quantitative ability to detect abnormal lesions. There are intensive efforts in the development of tumor imaging using new agents. Specific antibodies for surface tumor antigens can be labeled with radioisotopes and used as tools for screening primary tumors and metastatic lesions. Therefore, for the present, radionuclide imaging will continue to contribute to clinical oncology.

Abdominal Neoplasms↗
PubMed2002

Palliative and postoperative radiotherapy in biliary tract cancer.

Local failure is the primary limitation for cure in patients with BTC. whether or not they have been resected. The use of radiotherapy with or without chemotherapy in the postoperative setting is controversial, but some studies have reported improvement in 5-year survival. In patients with unresectable BTC, EBRT offers effective palliation of symptomatic disease and has resulted in improved median and long-term survival in a small number of patients in most studies. Novel approaches, including neoadjuvant chemoradiotherapy combined with OLT, and escalated conformal irradiation, seem to be promising and warrant further investigation.

Bile Ducts, Extrahepatic↗
PubMed2002

Port site metastases: where are we at the beginning of the 21st century?

Following the introduction of minimal invasive surgery in the field of malignant disease, a number of reports have been published describing the occurrence of tumour deposits in the abdominal or thoracic wall at the sites of trocar placement. These trocar site metastases have caused great concern among minimal invasive surgeons and have put an important restraint on the rapid development of these techniques in oncologic surgery. The present review article focuses on the clinical facts and experimental studies that have been conducted on the problem of port site metastases, more specifically upon their occurrence and pathogenesis. Although most of the port site recurrences are due to technical surgical problems and can be avoided by adapting the same oncologic surgical principles as in open surgery, some features of the minimal invasive techniques facilitate tumour growth and should be kept in mind when performing minimum invasive surgery for malignancy.

Abdominal Neoplasms↗