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PubMed2005

Histopathological and cell biological characteristics of ductal carcinoma in situ (DCIS) of the breast-a comparison between the primary DCIS and subsequent ipsilateral and contralateral tumours.

The rate of ipsilateral local recurrence after ductal carcinoma in situ (DCIS) varies (between 5% and 30%) and depends on the type of operation (mastectomy vs. breast-conserving operation), and whether postoperative radiotherapy has been used. Ipsilateral local recurrence can either emanate from the primary lesion or be a new primary tumour. Contralateral lesions may also develop after DCIS. We compared histopathological and cell biological characteristics in 37 subsequent ipsilateral tumours (25 DCIS and 12 invasive cancers) and 13 subsequent contralateral invasive breast cancers with their corresponding primary DCIS. The histopathological parameters were re-evaluated and the cell biological factors were analysed using conventional immunohistochemical techniques in paraffin-embedded material. The concordance rate for high grade (nuclear grade 3) vs. non-high grade (nuclear grades 1+2) between the primary DCIS and the subsequent ipsilateral tumour was higher than between the primary DCIS and the subsequent contralateral invasive cancer (68% vs. 31%). Similar patterns in the concordance rates between the primary DCIS and ipsilateral vs. contralateral tumours were also found in the oestrogen receptor status (83% vs. 50%) and the progesterone receptor status (87% vs. 58%). The pattern persisted in the other factors examined (p53, c-erbB2, bcl-2 and Ki67), although it was less pronounced. The overall high rate of concordance in the characteristics between the primary DCIS and the subsequent ipsilateral tumours suggests that, in most cases, they represent true local recurrences. Subsequent contralateral tumours are more likely to be new primary cancers.

Breast Neoplasms↗
PubMed1992

[Prognostic value of histopathological parameters in epidermoid carcinoma of the vocal cords in T-1 stage].

In this paper are studied macro- and microscopically, 14 histopathologic parameters belonging to 37 patients suffering from vocal cord squamous cell carcinoma, stage T-la. All patients were submitted to cordectomy and followed up during a 5 years term, as a minimum. A discriminant analysis was performed in order to establish the relation between histopathologic parameters and local failure. Only two of them were statistically significative (p < 0.01): the structural type and the differential degree of tumor cells. The histopathological study allowed the prediction of 82 percent of local recurrences.

Carcinoma, Squamous Cell↗
PubMed1996

[The clinical significance of metastatic cancer of the larynx to the Delphi node].

Between years 1965-1987, 920 patients with cancer of the larynx were operated on. In this time we identified 9 cases of histologically proven metastasis to the Delphian node. In all patients except one, the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy. Five patients developed metastasis postoperative. Seven of 9 patients have died from their laryngeal cancer. The frequency of neck metastasis and local recurrences is very high in patients with a positive Delphian node.

Adult↗
PubMed1993

Subtotal petrosectomy in the management of advanced parotid neoplasms.

Circumferential growth of parotid neoplasms may involve the external auditory meatus posteriorly, the floor of the middle cranial fossa superiorly, and the neurovascular structures of the jugular foramen medially. Inadequate tumor resection in these anatomically complex regions will result in local disease recurrence at the lateral skull base. A subtotal petrosectomy approach has been combined with a standard total parotidectomy in the management of 27 patients with aggressive parotid tumors. Twenty-two patients had malignant lesions and 10 individuals had recurrent disease. The resultant conductive hearing loss is outweighed by the following advantages of this technique: (1) the ability to obtain tumor-free bony margins, (2) proximal intratemporal facial nerve identification, (3) vascular control of the jugular bulb and petrous carotid artery, and (4) the dissection and protection of cranial nerves IX through XII. Our series of 27 patients will be detailed with an emphasis on surgical technique and overall patient results.

Adult↗
PubMed1999

The pathogenesis of local recurrence of melanoma at the primary excision site.

Local recurrence of melanoma at the primary excision site may imply that the primary excision was incomplete or 'inadequate', and that the recurrence was due to retained primary melanoma cells or occult microsatellites in the adjacent tissue. Pathologists frequently report these tumours in the scar as recurrent or residual melanoma, without further qualification, apparently without considering the possibility that they may be metastases and manifestations of systemic disease. In this study, 17 of 19 cases of locally recurrent melanoma at the primary excision site showed the histological features of metastasis rather than residual incompletely excised primary melanoma. Because the prevention of local recurrence is the main reason given in recommendations for wide excision of melanoma beyond complete excision of the primary tumour itself, it is essential that surgeons and pathologists should classify these neoplasms precisely as either persistent incompletely excised primary melanoma or metastatic melanoma.

Adult↗
PubMed1979

Pattern of recurrences in endometrial carcinoma and their management.

During the period 1961-1971, 177 surgical candidates with clinical Stage I adenocarcinoma of the endometrium were treated. The pattern of recurrence according to the initial mode of treatment and the high risk factors predisposing to recurrence are presented. The incidence of vaginal vault recurrence was reduced from 7.4% with surgery to 1.2% by the use of adjunctive radiotherapy. Management of recurrence according to site is outlined. The local control rate for patients with local recurrence was 44% and the five-year survival rate after recurrence was 33%.

Adenocarcinoma↗
PubMed1999

Familial adenomatous polyposis: efficacy of endoscopic and surgical treatment for advanced duodenal adenomas.

INTRODUCTION: Duodenal and periampullary cancer is the most common cause of cancer death in patients with familial adenomatous polyposis who have undergone colectomy. Endoscopic surveillance of upper gastrointestinal adenomas is recommended for patients with familial adenomatous polyposis but the timing and appropriate treatment of neoplasms is unknown. The purpose of this experiment was to report our experience with endoscopic and surgical treatment of advanced duodenal adenomas in patients with familial adenomatous polyposis. METHODS: The records of all patients with familial adenomatous polyposis who had undergone surgical or endoscopic treatment for duodenal adenomas were identified. Data including endoscopic surveillance findings, type of intervention, pathology, and follow-up of the lesions were reviewed. RESULTS: Ten neoplasms >1 cm were treated in eight patients (mean age at the time of diagnosis was 49 years). Nine lesions were histologically advanced. Five lesions involved the papilla. Endoscopic treatment was performed for six lesions. Four lesions recurred, and three were then treated surgically. Local resection was performed for five lesions. Four lesions recurred and two had further operative intervention. Pancreas-sparing duodenectomy was performed in three patients. At a mean follow-up period of 45.7 months, there has been no recurrence. CONCLUSIONS: Endoscopic eradication is an appropriate initial treatment for histologically advanced, noncancerous neoplasms or for patients who are not surgical candidates. Pancreas-sparing duodenectomy may be the treatment of choice for patients with carcinoma and those who have failed endoscopic therapy.

Adenoma↗
PubMed1998

Sphincter preservation in rectal cancer. Preoperative radiation therapy followed by local excision.

Radiation therapy followed by local excision results in local control rates that appear comparable to those of local excision alone (in highly selected patients) or local excision followed by adjuvant radiation therapy. A significant drawback of this approach, however, is the potential loss of important histological information, such as risk of lymph node metastasis, depth of tumor penetration, and presence of lymphatic or vascular invasion. Radiation therapy followed by local excision may be an option for treatment of more advanced T3 rectal cancers in patients who either refuse radical surgery or are medically unfit. The available data in the literature do not support the routine use of local excision after radiation therapy in otherwise healthy patients with locally advanced rectal cancer.

Anal Canal↗
PubMed2000

The role of brachytherapy for palliation.

The goal of palliative radiation is to alleviate symptoms in a short amount of time and maintain an optimal functional and quality-of-life level while minimizing toxicity and patient inconvenience. Despite advances in multimodality antineoplastic therapies, failure to control the tumor at its primary site frustratingly remains the predominant source of morbidity and mortality in many patients with cancer. Escalation of doses of radiation using external beam irradiation has been shown to improve local tumor control, but limits are imposed by the tolerance of normal surrounding structures. The highly conformal nature of brachytherapy enables the radiation oncologist to accomplish safe escalation of radiation doses to the tumor while minimizing doses to normal surrounding structures. Thus, by enhancing the potential for local control, brachytherapy used alone or as a supplement to external beam radiation therapy retains a significant and important role in achieving the goals of palliation. Proper patient selection, excellent technique, and adherence to implant rules will minimize the risk of complications. The advantages realized with the use of brachytherapy include good patient tolerance, short treatment time, and high rates of sustained palliation. This article reviews various aspects of palliative brachytherapy, including patient selection criteria, implant techniques, treatment planning, dose and fractionation schedules, results, and complications of treatment. Tumors of the head and neck, trachea and bronchi, esophagus, biliary tract, and brain, all in which local failure represents the predominant cause of morbidity and mortality, are highlighted.

Brachytherapy↗
PubMed1989

Mucocutaneous plasmacytomas in dogs: 75 cases (1980-1987).

Mucocutaneous plasmacytomas were diagnosed in 75 dogs. Medical records and communication with owners and referring veterinarians provided information regarding location and description of the tumor, clinicopathologic data, treatment, and postoperative status of the dogs. Males and females were equally represented, and most dogs were aged adults (mean, 9.7 years). Tumors developed most commonly in the mouth, on the feet or trunk, and in the ears. Plasmacytomas were confined to the skin and mucosa in 70 dogs. Two dogs had disseminated lymphoid neoplasia, and 1 dog developed cutaneous plasmacytoma during clinical remission of lymphosarcoma. Two dogs had multiple myeloma, which was diagnosed concurrently or within a few weeks of diagnosis of the cutaneous tumor. Multiple plasmacytomas were found in 10 dogs but were not associated with clinical signs of generalized disease. Tumors did not recur after surgical excision. Clinicopathologic values, when determined, were normal in all dogs with localized plasmacytomas.

Animals↗
PubMed1995

[Primary solid tumors of the mesentery].

The interest for the primary solid tumors of the mesentery (TSPM) is justified by the difficulties of preoperative diagnosis and surgical treatment of these unusual lesions. We analyzed 68 TSPM operated in the Department of General Surgery of Fundeni Hospital between 1960-1993. In the study were included only the lymphoma presented as mesenteric masses (n = 17); the enlarged mesenteric lymph nodes were excluded. The most common malignant tumor was the fibroma (n = 8) and lipoma (n = 10). In the resection of mesenteric tumors exposure of the superior mesenteric vessels is important. The relation between tumoral and superior mesenteric vessels is the necessary criterion of resectability: in 41 cases from 43 unresectable lesions the reason of unresectability was the invasion of the superior mesenteric vein and artery; in only two cases the reason was the presence of liver metastases. The resectability was not influenced by the multiplicity of the lesions: in all cases with multiple mesenteric tumors (6 patients) the resection was performed. The distant metastases of TSPM are rare; on the contrary, the local invasion is common.

Adult↗
PubMed1989

Local control in rectal cancer. A clinical review and meta-analysis.

We reviewed the factors influencing local control of potentially curable rectal cancer in 106 patients. There was improvement in stage-adjusted local control associated with increasing use of adjuvant radiation therapy. A meta-analysis of the English-language literature through 1988 also supported the effectiveness of adjuvant radiation therapy in all but the lowest-risk patients. No effect on survival was identified in either analysis, but a reduction of up to 40% in local recurrence rates may be achieved with doses of 3000 cGy or more.

Humans↗
PubMed1984

Pathologic predictors of early local recurrence in Stage I and II breast cancer treated by primary radiation therapy.

Thirty-four gross and histologic features of the primary tumor in 231 cases of clinical Stage I and II invasive breast cancer were reviewed in an attempt to identify features which might correlate with an increased risk of local recurrence within the breast following biopsy and primary radiation therapy. Local recurrence risk at 5 years was calculated for each feature studied. While results are reported in terms of 5-year actuarial local recurrence risk, not all patients were followed for 5 years (median follow-up period, 44 months). Patients with cases in which the biopsy was less than excisional had a considerably greater actuarial risk of local recurrence at 5 years than those in which the biopsy was excisional (36% versus 8%; P = 0.0005). Among 154 infiltrating ductal carcinomas treated by excisional biopsy prior to radiotherapy, histologic features associated with a significantly increased local recurrence risk at 5 years were the combination of extensive intraductal involvement by carcinoma and high nuclear grade and/or high mitotic index. Twenty-seven tumors demonstrated this constellation of features, and there was a 5-year actuarial local recurrence risk of 39% among this group. The local recurrence risk for the remainder of the population was only 4% (P less than 0.0001). Thus, through pathologic examination of the primary, the authors identified a subgroup of patients with a considerably increased risk of local recurrence following biopsy and primary radiotherapy.

Adult↗
PubMed1982

Surgical treatment of low grade soft tissue sarcomas.

Nineteen patients who have undergone surgical resection of low grade soft tissue sarcomas were retrospectively reviewed. Four patients received additional radiation therapy, and 15 did not. Of the 15 patients treated by surgery alone, 4 had positive margins in the original specimen; all 4 had local recurrence within a mean of 42 months. Eleven patients had negative margins. Ten have had no recurrence in a mean of 40 months. One patient had local recurrence at 36 months. Two of the four patients with positive margins were reoperated on and in achieving negative margins have remained disease-free a mean of 84 months. Three patients receiving additional postoperative radiation therapy had positive margins, and all had recurrence in a mean of 36 months. One patient with negative margins who also received radiation therapy is disease-free at 144 months. It appears that tumor-positive margins are associated with a high likelihood of local recurrence, whereas negative margins appear associated with a long disease-free interval and possible cure. Radiation therapy to positive margins did not prevent local recurrence.

Adolescent↗
PubMed1991

Use of mucin like cancer associated antigen (MCA) in the management of breast cancer.

A study of the epithelial mucin marker MCA was made in 233 patients with breast cancer. Only 6% of 72 patients with Stage I-III disease had a raised MCA (greater than 15 U ml-1) when assessed following surgical treatment of the primary tumour. Raised levels of MCA occurred in one out of 20 (10%) patients with stable local recurrence, and six out of ten (60%) patients with progressive local recurrence. In 115 patients with metastases 89 (77%) had a raised MCA, tumour extent and disease activity both influenced the MCA level. The change of MCA level during the treatment of 11 cases of local recurrence and 55 cases of metastatic disease showed a 64 and 84% concordance respectively with the change in clinical status. Coincidental measurement of MCA and bone scans showed a raised MCA in one out of 63 (1.5%) patients with negative or equivocal scans, and 26 out of 35 (74%) with positive scans. MCA provides a useful marker for the monitoring of the treatment of local recurrence and metastatic disease, and an independent indicator of the effects of changes in treatment.

Antigens, Neoplasm↗
PubMed1988

Does preoperative needle localization lead to an increase in local breast cancer recurrence?

Between 1978 and 1981, 74 women with nonpalpable breast cancer underwent surgery after localization guides were placed. In 72 patients, guides were introduced parallel to the chest wall; in two the needle was positioned anteroposteriorly under computed tomographic guidance. Fifty-six cases (76%) were infiltrating cancer; 13 (17%), intraductal cancers; two (3%), inflammatory; and three (4%), lobular carcinoma in situ. Surgery was not used to treat the latter five patients. In the remaining 69 women, 42 (61%) were treated by means of modified radical mastectomy; six (9%), total mastectomy; 12 (17%), local excision and radiation therapy; and seven (10%), local excision alone; exact therapy for two women (3%) was unknown. At a minimum follow-up of 5 years, none of the 67 women in whom the parallel approach was used had a local recurrence. The authors conclude that preoperative placement of guides parallel to the chest wall does not appear to increase the risk of local breast cancer recurrence.

Breast Neoplasms↗
PubMed2004

Weekly paclitaxel combined with local hyperthermia in the therapy of breast cancer locally recurrent after mastectomy--a pilot experience.

BACKGROUND: The combination of chemotherapy and hyperthermia (HT) is a promising approach in the treatment of malignant tumors. In the present report we evaluate the efficacy and toxicity of a combination of weekly paclitaxel combined with local hyperthermia in breast cancer. PATIENTS AND METHODS: 7 patients were treated for inoperable local recurrence of breast cancer after mastectomy, irradiation, and chemotherapy or hormonal therapy. They weekly received paclitaxel (60-80 mg/m(2)) in 3-h infusions followed by local HT 41-44 degrees C for 45 min for 6-18 cycles. RESULTS: Objective local response was observed in all treated patients (complete response in 4 patients and partial response in 3 patients). There were no grade 3 or 4 toxicities, neurologic toxicity or hypersensitivity reactions. Local tolerance to this regimen was also good, with only 4 patients developing mild transient erythema. CONCLUSION: Our experience indicates that the combination of weekly paclitaxel and HT may be effective in the treatment of locally recurrent breast cancer after mastectomy.

Adenocarcinoma↗