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PubMed1997

The role of surgery in the multimodality management of non-small cell lung cancer.

The majority of patients with lung cancer have disseminated disease at the time of presentation. For the minority of patients with disease localized to the chest, the concept of staging becomes particularly important because it has a major impact on the treatment plan. Guided by findings on the computed tomographic scan, mediastinoscopy remains the definitive invasive staging procedure to document unequivocally the involvement of the mediastinal lymph nodes. Equally as important is the documentation of absence of disease in contralateral lymph nodes. Patients with locally advanced non-small cell lung cancer, especially those with involvement of mediastinal lymph nodes (N2), are candidates for a multimodality approach to treatment involving either chemotherapy alone or in combination with radiation therapy. Surgical excision may be important in the management of these patients after an induction regimen. If surgical excision is performed, complete excision is the single most important factor. Postoperative adjuvant therapy may reduce the incidence of local recurrence but has not been shown to improve survival.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Induction chemotherapy and radiotherapy to avoid mastectomy in stage IIA-IIIA breast cancer.

The aim of the presented protocol was to investigate tumour remission and breast conservation rates with and without flap supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. 101 patients with stage IIA-IIIA breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. 96 patients underwent salvage surgery. Complete pathologic response was not related to tumour diameter at diagnosis, the applied chemotherapy regime, number of chemotherapy cycles, overall radiation treatment time and time interval between radiotherapy and surgery. A breast conserving approach was possible in 55 patients (54%). After a median follow-up of 18 months no patient developed an isolated local recurrence.

Adult↗
PubMed2003

Surgical therapy for anorectal melanoma.

BACKGROUND: Anorectal melanoma is a rare but highly lethal malignancy. Historically, radical resection was considered the "gold standard" for treatment of potentially curable anorectal melanoma. The dismal prognosis of this disease has prompted us to recommend wide local excision as the initial therapeutic approach. The purpose of this study was to review our results in patients who underwent wide local excision or radical surgery (abdominoperineal resection [APR]) for localized anorectal melanoma. STUDY DESIGN: We reviewed the charts of all patients referred for resection of anorectal melanoma between 1988 and 2002. Endpoints included overall survival, disease-free survival, and local, regional, or systemic recurrence. RESULTS: Fifteen patients underwent curative-intent surgery; four underwent APR and 11 underwent wide local excision. Eight patients (53%) are alive; 7 (47%) are disease-free (followup 6 months to 13 years). Of 12 patients who have been followed for more than 2 years, 4 are alive (33%) and 3 are disease-free (25%). Seven patients have been followed for more than 5 years and two are alive and disease-free (29%). All of the longterm survivors underwent local excision as the initial operation. There were no differences in local recurrence, systemic recurrence, disease-free survival, or overall survival between the APR group and the local excision group. Local recurrence occurred in 50% of the APR group and 18% of the local excision group; regional recurrence occurred in 25% versus 27%. Distant metastases were common (75% versus 36%). CONCLUSION: In patients who have undergone resection with curative intent for anorectal melanoma, most recurrences occur systemically regardless of the initial surgical procedure. Local resection does not increase the risk of local or regional recurrence. APR offers no survival advantage over local excision. We advocate wide local excision as primary therapy for anorectal melanoma when technically feasible.

Adult↗
PubMed1983

Patterns of failure following surgery alone for colorectal carcinoma.

Two hundred fifty-one patients with colorectal carcinoma were studied following complete primary resection to determine patterns of failure. Seventy-two patients (29%) subsequently developed failures: Local failure (LF) occurred as the only failure in 49% of the failure group and as some component in 81%; distant metastases (DM) occurred in 19% and 47%, respectively. The groups at highest risk for local failure were those with extension of tumor through the bowel wall whether the nodes were involved or not. Furthermore, those with gross extension of disease through the wall developed a significantly higher incidence of distant metastases compared to those with microscopic extension through the wall (P less than 0.005). The absolute 5-year survival rate for those with tumor through the wall vs within the wall was 40% and 79%, respectively. Adjuvant therapy was discussed in view of the ability to identify subgroups of patients at highest risk for local vs distant failures.

Adenocarcinoma↗
PubMed1999

The use of compensators to optimise the three dimensional dose distribution in radiotherapy of the intact breast.

BACKGROUND AND PURPOSE: Dose heterogeneity in tangential breast irradiation has been shown to be as high as 20% and may lead to problems in local control and cosmesis. In this study, dose heterogeneity in three dimensions (3D) in the breast irradiated with wedged tangential beams is assessed and the improvement which can be made by the use of individualised two dimensional (2D) compensators is established. The compensation required is calculated in two ways: (I) by an iterative technique giving a uniform dose on a plane through the isocentre normal to the central axis of each beam, and (II) by inverse planning using an optimisation technique based on simulated annealing. MATERIALS AND METHODS: A total of 17 patients with histologically proven T0-3, N0, N1, M0 breast cancer undergoing breast irradiation following wide local excision, were CT scanned using contiguous 1 cm slices from approximately 2 cm superior to 2 cm inferior of the irradiated volume. The dose distributions are determined using a 3D algorithm that calculates primary and scatter dose separately using a differential scatter air ratio method and corrects both for the presence of heterogeneities. The iterative technique achieves a dose variation of better than 0.5% on the plane through the isocentre with compensation on both beams. Compensation for the lateral beam only is calculated using the optimisation technique in order to minimise the scatter dose to the contralateral breast. The optimisation algorithm minimises the dose variance over the target and sets upper dose limits for the lung and the remainder of the irradiated volume. RESULTS: For the group of patients the average dose heterogeneity in 3D using wedges is 12% (range 8-17%), which reduces to 8% (5-16%) using compensation on a plane and to 5% (4-7%) using the optimisation technique. CONCLUSIONS: Inverse planning is normally used for complex radiotherapy techniques but when applied to tangential breast irradiation, can reduce the dose heterogeneity through the breast as a whole to as little as 4%, with potential benefits in local control and cosmesis.

Algorithms↗
PubMed1999

The rationale for radical resection.

Radical esophagectomy results in survival rates exceeding those obtained by standard techniques and comparable with or possibly better than survival rates following combined modality therapy. The benefits of radical resection include improved surgical staging, superior local control, and a higher probability of achieving an R0 resection.

Cardia↗
PubMed1989

Clinical response and survival according to estrogen receptor levels after bilateral ovariectomy in advanced breast cancer.

Estrogen receptor levels were determined at the time of ovariectomy in 71 premenopausal women with advanced breast cancer. Three groups of estrogen receptor concentration were established: less than 10 fmol/mg cytosol protein (group 1), between 10 and 25 fmol/mg cytosol protein (group 2), and more than 25 fmol/mg cytosol protein (group 3). The frequency of clinical response to ovariectomy was low in group 1 (17.4%), high in group 3 (79.4%), and intermediate in group 2 (35.7%). Median survival was poor in group 1 (18.5 months) and better in groups 2 (33.0 months) and 3 (32.5 months). These results were independent of disease stage and neoplastic localization.

Adult↗
PubMed1981

Combined treatment of Lewis lung carcinoma by tumor excision and levan.

A combined treatment modality including surgical excision and daily injections of high molecular levan seemed to be effective against Lewis lung carcinoma in C57BL mice. The inhibitory effect of levan on tumor growth in mice treated by resection of the primary tumor was demonstrated as follows: (1) recurrence of primary tumors was less in levan-treated mice compared to untreated animals; (2) metastases were less numerous in the levan-treated animals; (3) levan treatment partly prevented loss in body weight, and (4) it increased the survival rate. Recurrence of primary tumors appeared to be more efficiently inhibited by local levan treatment, while systemic (i.p.) administration was more effective than local treatment in preventing metastases. The mechanism of inhibition of tumor growth was related to accumulation of macrophages around the metastases.

Animals↗
PubMed1995

Adjuvant intraoperative photodynamic therapy in experimental colorectal cancer.

A reliable animal model for quantitative assessment of local recurrence of colorectal cancer was developed using colo26 tumour in BALB/c mice. The effect of adjuvant intraoperative photodynamic therapy to potentially curative surgery on local recurrence was examined in four study and four control groups. Study groups received 15 mg kg-1 Photofrin (a photosensitizing drug) 24 h before surgery. After 'curative' tumour excision, the tumour beds were illuminated with either 630 nm or 510 nm laser light each at 40 and 70 J/cm-2. Controls received surgery only, surgery and Photofrin only or surgery and either 630 nm or 510 nm light. The local recurrence rates at 70 days were 17-33 per cent in the study groups compared with 83-100 per cent in the control groups (P < 0.001; log rank test). Photodynamic therapy is capable of reducing local recurrence following potentially curative excision of tumour in this model.

Animals↗
PubMed2005

[Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery].

BACKGROUND: The association between submucosal infiltration and tumor recurrence was analyzed by long-term follow-up of patients with pT1 "low risk" rectal carcinoma. PATIENTS AND METHODS: Forty patients with pT1 rectal cancer of the upper and middle rectum were treated by transanal endoscopic microsurgery. All carcinomas fulfilled the low-risk criteria, and were completely resected. No further treatment was carried out. Follow-up data were available for all 40 patients, with a median follow-up of 5.4 years. RESULTS: Two patients (5.0%) developed local tumor recurrence after 14 and 18 months, respectively, and had curative rectal resection after neoadjuvant radiochemotherapy. In the histology of the initial specimens, both patients had deep submucosal infiltration (sm3). Another patient, primarily sm2 without local recurrence, developed a metachronous singular liver metastasis which was curatively resected. The risk of developing a recurrent tumor was significant for sm3 carcinomas (sm1+sm2 vs sm3, P=0.046). CONCLUSION: Transanal endoscopic microsurgery is an excellent method of treating low-risk pT1 carcinomas of the rectum. Deep submucosal infiltration (sm3) seems to be an additional high-risk factor for developing local recurrence.

Adult↗
PubMed1998

[Indications and follow-up of total pelvic exenteration].

From 1988 to 1996 we performed 18 total pelvic exenterations in patients with an average age of 59.8 years who could be followed up for a mean 29.8 months. In 10 cases a recurrent tumor of the pelvic viscera and 7 times a primary carcinoma of the rectum, bladder or prostate were treated. In 1 patient a radiogenic fistula led to this operation. Intestinal continuity could be reconstructed in 7 cases. Following cystectomy, urinary diversion was accomplished in half of the cases by an ileal conduit. Due to septic multiorgan failure 2 patients died postoperatively (hospital mortality rate 11%). In 82% a complete resection (R0) was possible. Subsequently 5 patients (29%) developed tumor recurrence. Distant metastases were observed in 3 patients, 8-9 months after surgery. So far 10 further patients have died. Their mean survival time was 28.9 months (range 5-99 months). The remaining 6 patients are still alive between 22 and 36 months postoperatively. Despite the extent of this kind of major surgery, which also requires multidisciplinary cooperation, and the psychosocial problems resulting from two permanent stomas, total pelvic exenteration should be regarded as an adequate alternative in the treatment plan in selected patients with locally advanced or recurrent pelvic disease.

Adult↗
PubMed2005

Extremity soft tissue sarcoma: controversial management issues.

Unlike common malignancies, such as breast and colorectal carcinoma, where treatment modalities can be investigated with large prospective randomized trials, such an endeavor has been hampered with soft tissue sarcomas (STS) due to its rarity. In absence of such randomized clinical trials, controversy exists with regards to numerous clinically relevant questions and clinicians are left with single institutional experiences gathered either in a retrospective or prospective fashion. Some of these frequently encountered issues in the management of STS include (1) whether poorly executed biopsies affect outcome? (2) Do all unplanned excisions require re-excisions? (3) Is MRI a superior imaging modality? (4) Whether radiation should be provided pre- or post-operatively? (5) Does extent of surgical margin influence local control? (6) Is adjuvant radiation therapy necessary for stage IIB STS? (7) Does adjuvant chemotherapy influence local control? (8) Does local recurrence influence survival? We will address these topics in this review.

Antineoplastic Agents↗
PubMed1957

End results in parotid tumors.

Management of parotid tumors can be based on a clinical classification of these lesions as being either "encapsulated" or infiltrating. The Warthin tumor (papillary cystadenolymphomatosum) is a benign encapsulated tumor, often occurring multicentrically or bilaterally especially in the lower pole area of the parotid. It is characterized clinically by its softness and fluctuation in size and a high incidence in elderly men. The so-called "capsule" of well demarcated mixed and mucoepidermoid tumors is represented by a condensation of host fibrous stroma, in the interstices of which tumor cells may be present. The "encapsulated" tumors should be excised with a "shell" of uninvolved parotid tissue. To do this safely, the facial nerve should first be isolated. Total parotidectomy is necessary only if the size of the tumor, the multiplicity of recurrences, or the infiltrating nature of the tumor are such that complete eradication of the primary site must be done. Radical neck dissection is never performed electively except in the small group of nonencapsulated infiltrating primary lesions. In a series of cases of previously untreated parotid tumors treated by the method outlined, the local parotid recurrence rate was less than 1 per cent.

Adenolymphoma↗