PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “unresectable recurrence”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed1996

Re-irradiation with concomitant chemotherapy of unresectable recurrent head and neck cancer: a potentially curable disease.

PURPOSE: The purpose of this study was to review the outcome following concomitant chemoradiation therapy in previously irradiated patients with locally or regionally recurrent or persistent head and neck cancer considered unresectable for cure. METHODS AND MATERIALS: We identified 45 patients treated between 1986 and 1993 with unresectable locally or regionally recurrent disease who were treated on one of four concomitant chemoradiotherapy phase I/II studies at the University of Chicago. All patients received hydroxyurea (HU), 5-fluorouracil (5-FU) and concomitant radiation therapy on an alternate week schedule (FHX). Cisplatin was added to FHX in three of the studies. RESULTS: The overall survival, progression-free survival, and local/regional control at 5 years was 14.6%, 13.5% and 20%, respectively, in a cohort of patients whose disease is almost universally fatal. Fatal treatment related complications were observed in 5 (11%) of patients. Two of these complications were related to radiation therapy. Stepwise Cox regression analysis revealed that dose and protocol were significantly correlated with survival, progression-free survival and local/regional control. A direct correlation was observed with radiation dose and an inverse correlation was observed with the initial FHX dose escalation study. The 2-year survival was 35% in patients receiving over 58 Gy compared to 8% for those receiving less than 58 Gy. CONCLUSIONS: Our results show that aggressive re-irradiation with concomitant chemotherapy of recurrent head and neck cancer results in the cure of some patients with acceptable toxicity if tumoricidal doses are applied. These results are in contrast to historical series of chemotherapy alone which results in limited palliation of brief duration and almost no chance of cure. Thus, re-irradiation with concomitant chemotherapy should be further investigated as an alternative to chemotherapy alone in multi-center or cooperative group randomized trials.

Adult↗
PubMed1999

[Present and future of home anti-cancer chemotherapy for unresectable recurrence of colorectal cancer].

Continuous hepatic arterial infusion chemotherapy (HAI) was performed for 100 colorectal cancer patients with unresectable liver metastases in our outpatient clinic. The administration schedule was 5-FU 250 mg/day for 7 days every other week. In this study, 93 cases were evaluable. The average dose of 5-FU was 24 g (3.0-66.5 g). The response rate was 59.1% (CR: 4 cases, PR: 51 cases, NC: 12 cases and PD: 26 cases). The prognostic outcome was significantly prolonged in the effective cases (50% survival duration was as follows: CR: 764 days, PR: 620 days, NC: 255 days and PD: 152 days). The complication rate with HAI was 15.1%, but nobody died from these complications. Hepatectomy after HAI was performed in 19 cases (20.4%) because of the effect of HAI. The three-year survival rate was 35.3% for HAI with hepatectomy and 3.8% for only HAI. There was statistically significant difference (p < 0.0001) between these two groups. Hepatectomy after HAI is a new strategy for unresectable liver metastasis of colorectal cancer. Recently, we performed home systemic chemotherapy using 5-FU for 3 recurrent patients of colorectal cancer and were able to continue this therapy safely for more than 2 months.

Aged↗
PubMedDate not supplied

Pelvic perfusion for locally recurrent unresectable rectal tumors.

BACKGROUND/AIMS: Pelvic perfusion evolved as a palliative and curative treatment modality for advanced pelvic tumors and literature data support its use in different steps of the disease. METHODOLOGY: 15 patients with recurrent rectal tumor, without any systemic metastases were included in the study. Mean age was 49.7 years, 12 males, 3 females. Mean survival was 18 months. RESULTS: 15 unresectable rectal cancer patients were included in this study. Three (20%) complete response, 6 (40%) partial response, 2 stable disease (13.3%) and 4 (26.7%) progression were seen after pelvic perfusion. Mean survival is 26.54 months after perfusion (median=10). In multivariate analysis response rate to isolated perfusion and tumor size are significant factors effecting survival (p<0.05). The patients who did not receive chemotherapy after detection of pelvic recurrence did better (p=0.0086). Response to isolated pelvic perfusion (IPP) is an important factor for survival of locally advanced rectal tumors in log-rank test (p=0.0001). CONCLUSIONS: Isolated pelvic perfusion is a good alternative for non-resectable pelvic malignancies and should be considered as an important part of the multidisciplinary approach for these tumors.

Adenocarcinoma↗
PubMed1993

Results of surgery for malignant bowel obstruction in advanced, unresectable, recurrent colorectal cancer.

When conservative treatment fails in the management of patients with malignant bowel obstruction secondary to advanced, recurrent colorectal cancer, the attitude toward surgery is often less than enthusiastic because of the limited life expectancy. We report a retrospective review of 30 patients with unresectable intra-abdominal disease who underwent laparotomy for the relief of bowel obstruction. Normal bowel function was restored in 19 patients (63 percent). The failures included five patients (17 percent) who died as a result of surgical complications and six patients (20 percent) who despite the surgery had continuing obstruction. Postoperative complications occurred in eight patients (27 percent). The median survival was significantly improved in those who benefited from the operation (192 days vs. 26 days; P = 0.0001). Whether the obstruction occurred at one site or more than one site appeared not to influence the outcome of surgery. Obstruction recurred after a mean symptom-free interval of 120 days in eight of those relieved by the initial operation. Half of these patients responded to conservative treatment, and surgery was again beneficial in three of the remaining four. Our results justify a more positive approach toward this problem, and, when conservatism fails, laparotomy should be undertaken in those who are not terminally ill.

Adult↗
PubMed2006

Fluorine-18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: preliminary results.

OBJECTIVES: We compared the diagnostic value of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with that of computed tomography (CT) following radiofrequency ablation (RFA) of inoperable recurrent or metastatic cancers in the lung. METHODS: Twelve patients (9 males and 3 females; 5 had recurrent lung cancer and the other 7 had metastatic nodules from a variety of primary cancers) were treated by RFA for 17 pulmonary nodules. FDG-PET was performed before and 2 months after RFA, and the mean standardized uptake value (SUV) was calculated. The response evaluation was based on the percent reduction relative to the baseline and the absolute values of SUV on FDG-PET performed at 2 months after RFA. We compared the response evaluations made based on findings of FDG-PET and CT at 2 and > or =6 months (mean 10.2) after RFA. RESULTS: The percent reduction in uptake at 2 months was significantly lower in nodules considered progressive (69.6 +/- 18.6%) than nonprogressive disease (38.7 +/- 12.5%; p < 0.01) based on CT findings at > or =6 months after RFA. The absolute SUV at 2 months was significantly higher in nodules considered progressive (2.61 +/- 0.75) than nonprogressive disease (1.05 +/- 0.67; p < 0.01) based on CT findings at > or =6 months post-RFA. CONCLUSION: Although our pilot study comprised few cases of various histopathological types of cancers in the lung, the results suggest that FDG-PET could predict regrowth on subsequent follow-up CT. Regrowth could be diagnosed earlier by FDG-PET than by CT, and nodules with residual uptake and with <60% reduction of uptake relative to baseline on FDG-PET at 2 months after ablation might require additional therapy.

Adult↗
PubMed2003

Loco-regional perfusions (stop-flow techniques): state of art and future.

The treatment of primary advanced or unresectable recurrent cancers is still one of the main medical challenges. The Stop-flow perfusion has been used as loco-regional chemotherapy based on blood supply blockage of the tumour-bearing area. The aim of the present paper is to report the personal experience in the clinical use of stop-flow perfusions and discuss about future perspectives of research. Since December 1997 more than 400 Stop-flow perfusions have been performed at University of L'Aquila. The following types of indication have been selected: recurrent unresectable rectal cancer, advanced pancreatic cancer, thoracic lymphomas, recurrent non-small cell lung cancer, recurrent pelvic and limb melanoma, and recurrent limb melanoma. In this paper results are presented in terms of median survival. For recurrent rectal cancer median survival was 12.2 months, for advanced pancreatic cancer 9.6 months, for thoracic lymphomas 16 months, for recurrent non-small cell lung cancer 21 months, for recurrent pelvic and limb melanoma 34.4 months, for recurrent limb melanoma 23.8 months. Based on these encouraging results, Stop-flow perfusion should be considered an effective approach to locally advanced cancers. Future fields of research include personalized chemotherapy and perfusion under hyperthermic conditions.

Antineoplastic Agents↗
PubMed2002

Stabilization of disease progression by hydroxyurea in patients with recurrent or unresectable meningioma.

OBJECT: The management of certain meningiomas of the skull base and those involving the dural venous sinuses remains a challenge. In recent reports it has been suggested that hydroxyurea chemotherapy can cause regression of unresectable and recurrent meningiomas. The authors report their experience in using hydroxyurea for the treatment of patients with recurrent or unresectable meningiomas. METHODS: Hydroxyurea was administered at a dosage of approximately 20 mg/kg/day to 11 women and nine men (median age 59 years, range 31-75 years) with recurrent or unresectable intracranial meningiomas (12 basal, two parasagittal, and six multiple). In 16 patients the meningiomas were benign, in three they had atypical features, and in one the meningioma was malignant. All patients had measurable residual disease. Four patients with benign meningiomas had previously received radiotherapy (two were treated with conventional fractionated radiotherapy and two with stereotactic radiosurgery), three with atypical meningiomas received conventional fractionated radiotherapy, and the one with a malignant meningioma received conventional radiotherapy with additional stereotactic radiosurgery. Tumor enlargement was documented in all patients on neuroimages obtained before initiation of hydroxyurea therapy. All patients were evaluable for response to therapy. In 12 patients with benign meningiomas, the disease had stabilized on neuroimages obtained posttreatment (median duration of treatment 122 weeks, range 8-151 weeks), and two of these showed clinical improvement. One patient with a benign meningioma experienced a minor partial response that was noted after 39 weeks of treatment and was confirmed on neuroimaging and clinical evaluations. In three others with benign meningiomas, progression was confirmed on neuroimages obtained after 41, 55, and 66 weeks, respectively: the 1-year freedom from progression rate was 0.93 (standard error 0.07) in patients with benign meningiomas. In three patients with atypical meningiomas, the tumors had progressed on neuroimages obtained after 12, 19, and 45 weeks, respectively. In the patient with a malignant meningioma, progression was confirmed on neuroimages obtained at 24 weeks. Hydroxyurea has been reasonably well tolerated, although one patient discontinued therapy because of moderate myelosuppression. CONCLUSIONS: Although tumor regression appears uncommon, these results indicate that hydroxyurea may arrest progression of unresectable or recurrent benign meningiomas.

Adult↗
PubMedDate not supplied

Isolated pelvic perfusion for the treatment of unresectable primary or recurrent rectal cancer.

Between May 1990 and December 1995, 16 patients with primary or recurrent unresectable rectal cancer were treated by isolated pelvic perfusion. All patients had been previously treated and were considered unsuitable for surgery or further systemic chemotherapy or radiotherapy. The treatment was based on a perfusion lasting 90 min at 40.5 C degrees with 5-fluorouracil, mitomycin-C and mitoxantrone. Whenever technically feasible (10 cases), continuous intraarterial chemotherapy (through a Medtronic device with a catheter in the inferior mesenteric artery) was administered postoperatively. Two complete responses and 2 partial responses were observed; 8 other patients showed stable disease. One patient did not show any response. Finally, 3 patients for various reasons were not assessable. All patients experienced immediate relief of pain. No major side effects directly related to isolated pelvic perfusion were recorded; a transitory bone marrow depletion was observed in all cases. In conclusion, isolated pelvic perfusion is useful in inoperable disease of the pelvis by reliably relieving pain and thereby improving the patients quality of life.

Adult↗
PubMed1997

Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea.

In this paper the authors present the first evidence that meningiomas respond to treatment with hydroxyurea. Hydroxyurea was administered as an adjunct chemotherapeutic treatment in patients with recurrent and unresectable meningiomas. Hydroxyurea was used because experimental data demonstrated that it inhibits growth of cultured human meningioma cells and meningioma transplants in nude mice by inducing apoptosis. The authors therefore treated four selected patients with hydroxyurea. All patients had undergone multiple gross resections and all except one received radiotherapy. Three patients with recurrent Grade I meningiomas assessed according to World Health Organization (WHO) guidelines received hydroxyurea because of an increased tumor growth rate, documented by magnetic resonance (MR) imaging, within a 6- or 12-month interval. A fourth patient with a malignant meningioma (WHO Grade III) began a course of treatment with hydroxyurea immediately after his sixth palliative operation without waiting for another relapse to be demonstrated on MR imaging. Because of their location and invasive growth behavior none of the meningiomas could have been removed completely by surgical intervention. All patients received hydroxyurea at a dosage level of 1000 to 1500 mg/day (approximately 20 mg/kg/day). In a man with a large sphenoid wing meningioma invading the right cavernous sinus and the temporal base, the intracranial tumor mass was reduced by 60% during 6 months of treatment. A woman with a large ball-shaped meningioma of the right sphenoid wing invading the cavernous sinus exhibited a 74% decrease of the initial tumor volume in 10 months of treatment with oral hydroxyurea. Serial MR images obtained monthly revealed that the process of size reduction was continuous and proportionate. The shrinkage of the tumor was accompanied by a complete remission of symptomatic trigeminal neuralgia after 2 months and by improved abducent paresis after 5 months. The third patient had a slowly growing meningioma that exhibited a 15% reduction in mass when reassessed after 5 months of hydroxyurea treatment. The fourth patient with the malignant meningioma in the left cerebellopontine angle has had no recurrence for 24 months. Long-term treatment with hydroxyurea may result in full remission of tumors in meningioma patients. The preliminary data indicate that hydroxyurea provides true medical treatment in patients with unresectable and recurrent meningiomas, replacing palliative surgery and radiotherapy in the management of this disease.

Adult↗
PubMed1994

Effects of hepatic arterial infusion chemotherapy on unresectable or recurrent hepatocellular carcinoma.

We performed hepatic arterial infusion chemotherapy (HAI) on 86 patients with unresectable hepatocellular carcinoma (HCC, 61 patients) or unresectable recurrent HCC after hepatectomy (25 patients). As drug therapy, 250 mg of 5-fluorouracil was injected daily for 14 days using a reservoir embedded in the subcutaneous layer. During this period, 0.4 mg/kg of doxorubicin and 0.12 mg/kg of mitomycin C suspended in Lipiodol Ultra-Fluide were also injected twice intra-arterially. This was defined as one course of HAI, and it was repeated every 3 months. In the patients with unresectable HCC, the 1-, 2-, and 3-year survival rates were 31.5%, 22.4%, and 10.7%, respectively, and the numbers of cases showing a complete response (CR), a partial response (PR), a minor response (MR), no change (NC), and progressive disease (PD) according to the Criteria for the Evaluation of the Clinical Effects of Solid Cancer Chemotherapy established by the Japan Society for Cancer Therapy were 1 (1.6%), 20 (32.8%), 5 (8.2%), 28 (45.9%), and 7 (11.5%), respectively. On the other hand, the 1-, 2-, and 3-year survival rates of the patients with unresectable recurrent HCC were 69.6%, 34.8%, and 14.9%, respectively. The rate of catheter patency after 1 year was 64.1%, and the mean catheter-patency period was 311.9 days. Patients in group A (CR+PR, n = 21) survived significantly longer than those in group B (MR+NC+PD, n = 40; P < 0.05). In conclusion, since responders to HAI achieve longer survival than nonresponders, the selection of effective drugs is important for this therapy.

Adult↗
PubMed1993

[Intraarterial infusion chemotherapy for recurrent or unresectable gastric cancer].

Sixteen patients with recurrent or unresectable gastric cancer were treated by intraarterial infusion chemotherapy. The tip of the catheter was located at the 9-10th Th level in the aorta of 14 patients and in the common hepatic artery of two. The drug combination was methotrexate + 5-fluorouracil (5-FU), cisplatin, mitomycin C (MMC) + etoposide and MMC + 5-FU. Side effects such as bone marrow suppression, diarrhea and appetite loss were seen in 63% (10/16). The response rate was 36% (4/11) in those who were evaluated, and another three showed relief from symptoms. Median survival time was 11 months, and the one year survival rate was 41%, while two patients showing PR have been alive for more than one year.

Adult↗
PubMed2006

Radiotherapy with 8 MHz radiofrequency-capacitive regional hyperthermia for pain relief of unresectable and recurrent colorectal cancer.

PURPOSE: The purpose of this study was to assess the pain relief in patients with unresectable and recurrent colorectal cancer treated with radiation plus 8 MHz radiofrequency-capacitive regional hyperthermia and to identify predictors of the good outcome. METHODS: Between February 1986-May 2003, 41 patients with primarily unresectable and recurrent colorectal cancer that caused pain were treated with thermoradiotherapy at the hospital and retrospectively analysed. Radiotherapy was administered with a mean total radiation dose of 56 Gy. Hyperthermia was usually applied within 30 min after radiotherapy once or twice a week. For cooling of the skin surface, the overlay boluses were applied in addition to regular boluses. The external cooling unit has been used to reinforce the cooling ability of the overlay bolus and achieve strong surface cooling to reduce the preferential heating of the subcutaneous fat tissue and treat with more RF-output in 17 patients since January 1997. RESULTS: Pain relief was obtained in 83% of the patients. Multi-variate analysis by logistic regression to evaluate the effects of certain factors on pain relief (complete response + good response) was strongly correlated with the presence of radiating pain to leg(s) (p < 0.05). The median follow-up was 18 months. The median duration of pain relief was 7.0 months. For the 27 patients in whom the tumour temperature was estimated, the median duration of pain relief was 14.6 months for the patients with a mean average tumour temperature of > 42.5 degrees C and 5.7 months for those of < 42.5 degrees C (p < 0.05). In the 18 patients with radiating pain to leg(s), use of strong superficial cooling and the higher numbers of hyperthermia treatments were better prognostic factors for the duration of pain relief (p < 0.01 and p < 0.05, respectively). CONCLUSIONS: Radiotherapy with 8 MHz radiofrequency-capacitive regional hyperthermia provided an efficient, effective means on pain relief of treating unresectable and recurrent colorectal cancer. The duration of pain relief can be prolonged, if an adequate heating is achieved, especially in the patients with radiating pain to the leg(s).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

[S-1 combined with lentinan in patients with unresectable or recurrent gastric cancer].

Lentinan (LNT) is a beta-glucan known to have a life-prolonging effect in combination with chemotherapy for patients with unresectable or recurrent gastric cancer. Thus, a multi-center trial of chemo-immunotherapy using S-1 combined with LNT may benefit patients with unresectable or recurrent gastric cancer with acceptable toxicity. With such a regimen, the median survival time in 32 patients was 559 days. Regardless of change to second-line chemotherapy, the mean period of using S-1+LNT for patients with long NC above 400 days was 725 days. In subset analyses, the survival period of the patients with G/L ratio of equal to or less than 2 was significantly better than that of the higher one (p<0.0001). The incidence of hematological toxicity (grade 3 leukopenia and thrombocytopenia) was 6.3% (2/32), and non-hematological toxicity (grade 2 dysgeusia) was 6.3% (2/32), while no grade 4 toxicity was observed. S-1 and LNT combination immunotherapy was carried out safely with high QOL and allowed a prolonged administration. S-1+LNT regimen may prolong NC periods in patients with unresectable or recurrent gastric cancer.

Adenocarcinoma↗
PubMed2001

Hypoxic pelvic perfusion with mitomycin C using a simplified balloon-occlusion technique in the treatment of patients with unresectable locally recurrent rectal cancer.

HYPOTHESIS: To evaluate the role of hypoxic pelvic perfusion in providing therapeutic options for palliation without relevant complications in a homogeneous group of patients with unresectable locally recurrent rectal cancer who are nonresponders or have disease progression after the standard treatments. DESIGN: Nonrandomized and noncontrolled phase II experimental study. SETTING: University hospital, L'Aquila, and the National Cancer Institute, Naples and Milan, Italy. PATIENTS: Eleven patients had symptomatic unresectable pelvic recurrent rectal cancer. The mean +/- SD product of the 2 maximum perpendicular diameters of the recurrent cancer was 24.2 +/- 11.0 cm(2) (range, 10-48 cm(2)). Tumor fixation to the pelvic side walls or proximal sacrum were the main criteria for unresectability. All patients were free from extrapelvic disease and had a life expectancy longer than 3 months. INTERVENTION: Patients were submitted to one course of pelvic perfusion with mitomycin C (MMC) (25 mg/m(2)) by means of a simplified balloon occlusion technique. A pharmacokinetic evaluation of the procedure was also performed. MAIN OUTCOME MEASURES: Response rate and time to disease progression were the primary endpoints; overall survival was the secondary endpoint. RESULTS: Mean +/- SD value of the ratios of pelvic MMC area under the plasma concentration curve (0 to 20 minutes) (AUC(0-20)) to systemic MMC AUC(0-20) was 13.30 +/- 6.52. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery or in the postoperative period. The response rate was 36.3% (95% confidence interval [CI], 6.5%-66.1%). Pain response rate was 45.4% (95% CI, 16.6%-76.2%). Median survival was 12.2 months (range, 5.7-19.5 months). Median time to disease progression was 6 months (range, 3-8 months). Two-year overall survival was 9.1%. CONCLUSIONS: Hypoxic pelvic perfusion with MMC is a safe and good palliative treatment for patients with unresectable locally recurrent rectal cancer. Further studies are necessary to establish if a different sequence in the multimodular treatment of these patients could be more useful.

Antibiotics, Antineoplastic↗
PubMed2004

Multimodal treatment of children with unresectable or recurrent desmoid tumors: an 11-year longitudinal observational study.

The primary goal of treatment for desmoid tumors is complete surgical resection to achieve negative margins. In adults with unresectable or recurrent lesions, treatment options include noncytotoxic and cytotoxic drugs, but little is known about nonsurgical treatment in children. Between 1992 and 2003 six children (four girls, two boys) with a median age of 2.5 years (range 11 months to 9 years) received multimodal adjuvant therapy for unresectable or recurrent desmoid tumors. Primary treatment consisted of noncytotoxic treatment with tamoxifen (1 mg/kg orally, twice daily) and diclofenac (2 mg/kg rectally, twice daily), whereas two children with life-threatening tumor progression in addition received treatment intensification with weekly vinblastine (6 mg/m intravenously) and methotrexate (30 mg/m intravenously). Of the four children with unresectable tumors, two achieved remarkable tumor shrinkage and two had stable disease, whereas two patients were disease-free for 3.7 and 2.6 years after nonradical resection. Median observation time was 3.1 years (range 1-11 years). Treatment was generally well tolerated; only one patient developed pubertal acceleration after a duration of tamoxifen treatment of 9.3 years. Because of the potential life-threatening situation, the management of children with unresectable or recurrent desmoid tumors requires a multidisciplinary approach. Nonaggressive therapy with tamoxifen and diclofenac may be the first treatment choice in these patients, but in patients with progressive disease, cytotoxic chemotherapy is indicated. Weekly administration of vinblastine and methotrexate seems to be safe and effective in these children.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Primary malignant schwannoma of the cervical plexus with melanocytic differentiation.

Primary malignant schwannomas are rare neoplasms of nerve sheath origin, especially in the location of the head and neck where few cases are described in the literature. These tumours may pose a diagnostic dilemma in the work-up of a neck mass. The case presented here is of a malignant schwannoma that originated in the cervical plexus with the rare histological feature of melanocytic differentiation. Histopathological examination with immunostaining techniques is essential for the diagnosis of these tumours. The management of these neoplasms is still controversial, although the treatment of choice is radical surgical excision of the lesion. The role of postoperative radiotherapy or chemotherapy is not clear, although some authors recommend its use to prevent local recurrence, for unresectable recurrent tumours or in cases of distant metastases.

Aged↗