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PubMed2004

Does rectal washout during anterior resection prevent local tumor recurrence?

PURPOSE: Colorectal cancer is one of the leading causes of cancer deaths in the industrialized nations. Left-sided tumors, especially rectal, rectosigmoid, and sigmoid, account for more than half of these tumors. Among many colorectal surgeons, the practice of rectal washout with cytocidal agents before anastomosis is common. It is widely believed that this practice prevents implantation of free malignant cells. It is unclear whether this translates into a reduction in the incidence of local recurrence. This study was designed to evaluate the effectiveness of cytocidal rectal washout in reducing the incidence of local recurrence. METHODS: Case notes and histology reports of all patients who underwent curative anterior resection for adenocarcinoma of the rectum and rectosigmoid between 1992 and 1994 were reviewed. A total of 141 patients were deemed suitable for the study. Of these, 90 patients underwent rectal washout using cetrimide before anastomosis. Fifty-one patients did not have rectal washout before anastomosis. Local recurrences between the two groups were compared. RESULTS: The two study groups were identical in all respects. Overall, the local recurrence rate for all comers was 5 percent (n = 7). Among the washout group, the local recurrence rate was 4.4 percent (n = 4) compared with 5.9 percent (n = 3) among the no washout group. CONCLUSIONS: Because of the size of the study, we were unable to demonstrate the benefit or lack thereof of cytocidal agents in reducing local recurrence.

Adenocarcinoma↗
PubMed1998

Molecular assessment of tumour stage and disease recurrence using PCR-based assays.

Solid cancers arise as a consequence of the accumulation of genetic and epigenetic alterations within a single cell or group of cells. Their ongoing characterization is providing a range of acid-based molecular markers for neoplasia. This, together with continuous refinements to the polymerase chain reaction (PCR), had led to the emergence of PCR-based assays as potential aids in the clinical management of cancer patients. Although the sensitivity of molecular diagnosis has the potential to aid clinicians in therapeutic decision making, problems with its specificity mean that the predictive value of molecular staging is still unproved. Its role in the identification of minimal residual disease after curative surgical resection requires clinical validation in further prospective studies.

Humans↗
PubMed1994

Chemoradiotherapy of esophageal carcinoma.

BACKGROUND: Chemoradiotherapy has demonstrated efficacy in esophageal cancer but rarely is curative. To improve local control and decrease metastases, a 7-month regimen was used with standard-dose radiotherapy (RT), cisplatin (DDP), and continuous infusion (CI) 5-fluorouracil (5-FU) in patients with locoregional squamous/adenocarcinoma of the esophagus. METHODS: Initial treatment consisted of RT to the esophagus (4000-5000 cGy) for 5-6 weeks, CI 5-FU (300 mg/m2/day) concurrent with RT, and DDP (25 mg/m2/day x 3) for Days 1-3 and 21-23. Two monthly cycles of DDP (75 mg/m2 Day 1) and 5-FU (300 mg/m2 x 21 days) followed. Patients were restaged with endoscopy and computed tomography scan. Patients without evidence of residual disease received three more cycles of chemotherapy (CT); those with persistent tumor underwent esophagectomy or additional CT/RT, and those with disease progression were offered alternative CT. RESULTS: From December 1987 to September 1991, 18 men and 8 women, including 2 with adenocarcinoma, were eligible for inclusion in the study. All were evaluable for toxicity and response. The median age was 61.5 years (range, 50-80 years), the median pretreatment weight loss was 9 lbs, and the median serum albumin level was 4.3 mg%. Therapy was toxic; 19 patients were hospitalized for treatment-related esophagitis, thrombosis, or infection. Grade III and IV leucopenia were seen in 12 patients and 1 patient, respectively. One patient had Grade IV thrombocytopenia. Of 26 patients, 17 (65%) had no tumor on restaging. Five patients had recurrences in the esophagus (1), liver (3), and lung (2). Three patients had second neoplasms. The median survival was 24 months. CONCLUSION: This treatment regimen provides high frequency of local tumor resolution, but with significant toxicity.

Adenocarcinoma↗
PubMedDate not supplied

Radiotherapy in rectal cancer: stage of the disease and therapeutic approach.

Rectal cancer requires treatments tailored according to the stage of the disease at diagnosis. In stage I lesions exclusive surgery is the elective treatment. Radiotherapy is used in those cases where the site of the lesion would sacrifice sphincter function. When the features of neoplasm are favourable (size < 5 cm, grading 1-2, histological type adenocarcinoma) local excision and postoperative radiotherapy enable to achieve results comparable to those of radical surgery. In operable lesions (T3-T4 (vagina) N0-2, M0) at high risk for local recurrence, high dose preoperative radiotherapy in some randomized studies has shown a significant improvement in local control and survival with a low toxicity, especially in patients undergoing radical surgery. Concomitant chemotherapy in postoperative radiotherapy has significantly improved local control and survival as compared to radiotherapy alone. Continuous infusion appears to reduce the toxicity, which is otherwise high. Randomized studies of preoperative radiochemotherapy vs radiation alone or vs postoperative radiochemotherapy are in progress in various Centers. Intensification with radiotherapy alone (IORT, fractionation) is also under study. In lesions unresectable for cure (T4, N0-3, M0) radiotherapy alone or combined with surgery did not show significant results. Intensification with concomitant chemotherapy and/or with IORT has enabled over 70% local control and 50% 5-year survival.

Adenocarcinoma↗
PubMed1987

[Five simultaneous neoplasms].

One case of five independent tumors is reported: Fibrosarcoma of the right thigh, bilateral carcinoma of breast, papillary carcinoma of thyroid, and basalioma below the left clavicula. A synopsis of literature containing the rare cases of more than three primary tumors is presented. The difficulties concerning localization, origin and registration of multiple primary malignancies and their differentiation to recurrencies and metastases are discussed.

Adenocarcinoma↗
PubMed1991

[Rectal cancer: need for radiotherapy in determining the treatment plan].

Postoperative radiotherapy is highly effective in the prevention of local recurrence in rectal cancer. Nevertheless, the results remain disappointing for Locally Advanced Rectal Cancer. New approaches include introduction of chemotherapy to postoperative radiotherapy or combined radiotherapeutic treatment with preoperative irradiation, surgery and intraoperative irradiation, along with elective postoperative treatment in function of surgical and pathological data. Based on recent advances in radiobiology we are able to modify treatment parameters to enhance efficacy without increasing the toxicity. The reduction of dose per fraction, the application of radiosensitizers, the optimal protection of healthy tissue will increase the therapeutic ratio while keeping results constant or even reduce the incidence of local failure.

Combined Modality Therapy↗
PubMed1995

Histopathological study of local residual carcinoma after simulated lumpectomy.

From 1989 to 1991, 24 patients with invasive ductal carcinoma underwent simulated lumpectomy at Tokyo Women's Medical College Daini Hospital. The mastectomy specimens were then examined histopathologically in serial sections for the presence of residual tumors or multicentricity. Lumpectomy specimens from cancer foci at resected margins were also examined. In this study, 23 of 24 patients demonstrated positive resection margins (95.8%). Residual tumors were found in mastectomy specimens from 16 patients (66.7%); unilateral multifocal carcinomas were found in 2 of these patients (8.3%). The incidence and severity of residual tumors did not correlate with primary tumor size or the distance between the nipple and the primary tumor but directly correlated with the severity of intraductal spread of the primary tumor. Tumors with central necrosis were associated with a higher incidence of residual tumors. Our study thus indicates that there is a high risk that some residual tumor will be left in the conserved breast when lumpectomy is performed. Multifocal carcinoma and tumors showing severe intraductal spread and central necrosis are thus associated with extensive residual tumors and are likely to cause local recurrence.

Breast Neoplasms↗
PubMed1983

Local recurrence following curative resection for carcinoma of the rectum.

One hundred ninety-three patients had curative resections for carcinoma of the rectum between January 1971 and December 1979. Nineteen patients developed local recurrence (9.8 per cent): 5/95 after abdominoperineal excision (5.2 per cent) and 14/98 after anterior resection (14.3 per cent). There was no difference in the overall survival rate between the two operations, but there was a trend toward decreased survival for patients who developed local recurrence. Metastatic spread to the lymph nodes increased the risk of local recurrence.

Adenocarcinoma↗
PubMed1987

Cervical adenocarcinoma: tumor implantation in the episiotomy sites of two patients.

The spread of cervical carcinoma associated with parturition through a tumorous cervix is rarely demonstrated. This report details two patients with adenocarcinoma of the cervix who delivered term fetuses vaginally and subsequently presented with tumor nodules in the episiotomy scars. Although both patients appear to have had their recurrences treated successfully, follow-up on one patient has been only 10 months since the completion of therapy. Tumor implantation of the episiotomy wound is a potential risk associated with vaginal delivery in a pregnant patient with cervical carcinoma. However, this iatrogenic mechanism of tumor spread may permit an opportunity for successful treatment of the local recurrence.

Adenocarcinoma↗
PubMed1993

Preservation of ejaculation through a modified retroperitoneal lymph node dissection in low stage testis cancer.

We studied ejaculatory function in 47 patients who underwent modified retroperitoneal lymph node dissection for nonseminomatous germ cell tumors of the testis from 1983 to 1989. Our goal was to assess the effectiveness of a modified node dissection in preserving ejaculatory function while eliminating the risk of retroperitoneal recurrence. There were 13 left and 34 right tumors. Of the patients 45 had clinical stage A cancer, and 2 had clinical stage B2 disease and received preoperative chemotherapy. The template method of dissection was used, which spares the preaortic area below the inferior mesenteric artery, including the sacral promontory. Average operating time was 3 hours 40 minutes. There was no operative mortality. Spontaneous recovery of ejaculation occurred in 38 patients (81%), more commonly with right (88%) than with left dissections (62%). The mean interval to recovery of ejaculation was 5 months (92% within 12 months). Five patients (10%) had recurrence, with a mean followup of 28 months. All recurrences were in the lungs 4 to 8 months after retroperitoneal lymph node dissection, and all patients were salvaged with chemotherapy and are disease-free. We confirmed that a modified template-type retroperitoneal lymph node dissection can be accomplished safely with preservation of ejaculation in more than 80% of the patients without increasing the risk of local recurrence.

Adult↗
PubMed1989

The results of esophagogastrectomy without thoracotomy for adenocarcinoma of the esophagogastric junction.

Between 1980 and 1988, 98 patients with adenocarcinoma of the esophagogastric junction were seen at the University of Western Ontario. Eighty-two patients underwent resection of the celiac lymph nodes, lesser curve and cardia of the stomach, and thoracic esophagus through abdominal and neck incisions avoiding thoracotomy. The esophagus was replaced by a stomach tube in 80 patients or by a colon tube in two patients. Two of 82 patients died while hospitalized. Early postoperative morbidity included anastomotic leaks that closed spontaneously (13), transient hoarseness (10), myocardial infarction (2), pulmonary embolus (6), and atelectasis or pneumonia (13). Late postoperative complications included delayed gastric emptying (4), symptomatic reflux (4), diarrhea (10), and anastomotic strictures (17). The 2-year survival of 30% was significantly affected by the stage of disease (p = 0.003), depth of tumor penetration (p = 0.02), lymph node metastasis (p = 0.001), tumor differentiation (p = 0.008), and tumor DNA ploidy (p = 0.02). Local recurrences appeared initially in 20 patients: anastomotic (3), peritoneal (14), mediastinal (3); distant metastasis occurred in 27 patients: bone (15), liver (5), brain (2), and multiple organs (5). Swallowing was restored and maintained in 75 patients. Esophagogastrectomy without thoracotomy provides a safe, effective method of restoring swallowing in patients with adenocarcinoma of the esophagogastric junction. This technique provides acceptable survival and local recurrence rates.

Adenocarcinoma↗
PubMed1977

The dilemma of stage III breast cancer: a study of preoperative radiotherapy.

The results of treatment of 68 patients with Stage III breast cancer treated by preoperative radiotherapy and subsequent mastectomy have been compared with those in 68 patients treated by more conventional methods, matched individually for age, stage, and year of treatment. Preoperative radiotherapy delayed the time of the first local recurrence, but did not improve overall survival. It is concluded that preoperative radiotherapy may be justified in patients with Stage III breast cancer in an attempt to control local disease, but is unlikely to improve control of systemic recurrence.

Breast Neoplasms↗
PubMed1999

[Surgical management of locoregional recurrence of gastric carcinoma].

About half of the patients with gastric cancer subjected to total gastrectomy in curative intention die of recurrence within a few years. Most of these local recurrences occur in the first 2 years postoperatively. In an historic analysis 133 patients of the years 1985-1997 were investigated. Local recurrence was observed in 29 cases within 60 months on average. An intensive follow-up will not affect the long-term outcome of local recurrence. Improved results may be expected only if more effective therapeutic strategies for local recurrence will be developed.

Adult↗