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PubMed2001

Stratifying risk factors for follow-up: a comparison of recurrent and nonrecurrent colorectal cancer.

INTRODUCTION: The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on finding reliable prognostic criteria for recurrence. However, such criteria are not universally accepted, and follow-up is often standardized for all patients without regard for each individual's level of risk of recurrence. Such a system of follow-up is not cost-effective. METHODS: A comparison of operative findings, pathologic features, and follow-up data of 1,731 cases of nonrecurrent colorectal cancer (821 colon, 910 rectum) with 357 cases of recurrent colorectal cancer (164 colon, 193 rectum) following potentially curative surgery was made, and results were analyzed to ascertain criteria for stratifying follow-up according to risk factors. RESULTS: Single-factor analysis showed that Dukes staging and tumor invasion were significantly associated with recurrence in both rectal and colon carcinoma. Tumor fixation and grading were additional significant factors in rectal cancer. Recurrence rates, time to recurrence, site of recurrence (locoregional vs. distant), and pattern of metastatic spread were not significantly affected by original tumor site. Recurrence was not significantly affected by patient age and gender. Individual surgeon performance in this series had also no significant effects on tumor recurrence. With multivariate analysis only, Dukes staging and tumor invasion into adjacent tissues were found to be independent adverse prognostic factors for recurrence. CONCLUSIONS: Dukes staging and tumor penetration into adjacent tissues are the only significant adverse prognostic factors for tumor recurrence of colonic and rectal carcinoma. Tumor grade and tumor fixation are additional adverse prognostic factors in rectal cancer. Guidelines for follow-up may be based on these factors and follow-up thus stratified according to risk of developing recurrence.

Adult↗
PubMed2001

Palpable breast cancers are inherently different from nonpalpable breast cancers.

BACKGROUND: We examined the clinicopathologic profile of T1 cancers to determine whether palpable cancers are different from nonpalpable cancers. METHODS: A prospective database was reviewed. Palpable T1 cancers were compared with nonpalpable T1 cancers. Initial significance was determined by chi2 analysis. Factors found to be significant were then reanalyzed. controlling for tumor size by logistic or linear regression, as appropriate. RESULTS: Of 1263 T1 cancers treated between 1981 and 2000, 857 (68%) were palpable and 401 (32%) were nonpalpable. Palpability correlated with pathologic tumor size, mitotic grade, nuclear grade, high S-phase, lymphovascular invasion, nodal positivity, and lack of extensive intraductal component, multifocality, and multicentricity. There was no significant difference in estrogen receptor, progesterone receptor or Her-2/neu status, ploidy, or DNA index. Breast cancer-specific survival was worse for patients with palpable cancers. CONCLUSIONS: Palpable cancers are inherently different from nonpalpable cancers, with a less diffuse growth pattern, higher metastatic potential, higher proliferative activity, more nuclear abnormalities, and a worse prognosis.

Adult↗
PubMed2005

Bone marrow metastases from glioblastoma multiforme--A case report and review of the literature.

Clinically detected extra-cranial metastases from glioblastoma multiforme (GBM) are quite rare, with an incidence of <2% reported in the published literature. Among the various reported sites of systemic metastases from GBM, there are few cases of clinically symptomatic bone marrow metastasis. The case of a patient developing systemic dissemination of a GBM is described. A 60-year-old man with GBM who developed back pain, thrombocytopenia and subsequently neurological deficits was found to have extensive bony and bone marrow metastases. Previously reported cases of extra-cranial systemic spread of GBM and attempts made in the literature to explain the possible routes of extra-neural dissemination are reviewed.

Bone Marrow Neoplasms↗
PubMed1990

Hysterectomy with extended surgical staging and radiotherapy versus hysterectomy alone and radiotherapy in stage I endometrial cancer: a comparison of complication rates.

Extended surgical staging (ESS) has been added to total hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) in patients with clinical Stage I endometrial cancer in order to better define patterns of metastatic spread and the response to treatment. Adjuvant radiotherapy has a demonstrated efficacy in decreasing central recurrence in Stage I disease. The combined use of radical surgery and pelvic radiotherapy for cervical cancer patients results in an increased incidence of complications. This study compares major complication rates in Stage I endometrial cancer patients who underwent either TAHBSO with ESS or TAHBSO alone followed by adjuvant external beam radiotherapy (RT). Records of 52 patients with clinical stage I endometrial cancer were reviewed. Thirty-two patients underwent TAHBSO plus ESS and 20 patients had TAHBSO alone. All patients received postoperative, whole pelvis external radiotherapy. Four patients suffered complications potentially related to treatment which required rehospitalization, and all 4 were in the group which had undergone ESS. A comparison of complication rates between the ESS + RT group (4/37 or 10.8%) and TAHBSO + RT group (0/20) suggested a trend toward significance (P less than 0.10). Treatment protocols using extended surgical staging prior to adjuvant radiotherapy in Stage I endometrial cancer should examine complications potentially related to this combination, to further define treatment risks and benefits.

Adult↗
PubMed1990

Ovarian cancer: radiation sensitivity in vitro.

The radiosensitivity of four human ovarian cancer cell lines was investigated in vitro by a clonogenic assay and analyzed using the linear-quadratic model. Two cell lines were found to be highly radiosensitive (mean inactivation dose (D) 0.82-0.92 Gy; surviving fraction 2 Gy (SF2) less than or equal to 0.13). Two other cell lines were less sensitive to radiation (D 1.31-1.94 Gy; SF2 0.22-0.38). Although the use of external radiotherapy in ovarian cancer has been limited due to the pattern of metastatic spread of this cancer, the present data support the view that ovarian carcinomas are radiosensitive tumors. Investigations on the effects of new approaches, such as delivering radiation more specifically to intraperitoneal ovarian cancer cells, are warranted.

Cell Count↗
PubMed1982

DNA content distribution of in vivo and in vitro lines of Lewis lung carcinoma.

The kinetic features of Lewis lung carcinoma (3LL) and of two in vitro and two in vivo derivative lines were studied by flow cytometry. The in vitro lines C108 and BC215 show the same tetraploid DNA content and a very similar cell cycle structure, characterized by a prevalent S fraction. Also, the in vivo lines, the original 3LL and M1087, show a tetraploid DNA content, while the BM21548 is characterized by a hyperdiploid DNA mode and a broader distribution of DNA values. No difference in the modal DNA value is found between each primary tumor and the corresponding lung metastases for all the in vivo lines. In addition, an increase in the G1 component corresponding to a decrease in the S fraction is observed during the tumor growth. These kinetic features were related to some malignant properties of 3LL lines, such as growth pattern and metastatic potential. Our findings indicate that a direct correlation is not always possible to establish.

Animals↗
PubMed1983

RTOG Phase I study on fast neutron teletherapy for squamous cell carcinoma of the esophagus.

From August, 1977, through January, 1981, the Radiation Therapy Oncology Group sponsored a Phase I study (RTOG 77-09) on the use of fast neutrons for treating inoperable squamous cell carcinomas of the esophagus. A total of 39 evaluable patients were treated with curative intent using either fast neutrons alone or in combination with low LET irradiation as part of a mixed beam fractionation scheme. Actuarial survival curves are presented for both the "neutrons alone" and the "mixed beam" treatment groups. There was no significant survival difference between these groups of patients. The projected survival at two years is less than 10%, which is comparable with megavoltage photon results for an unselected series of patients. The size of the primary lesion and the initial Karnofsky performance status were found to be the most important prognostic indications for prolonged survival. Sixteen of 39 patients were felt to have achieved local clearance of their tumor at some time during their follow-up with the median time until a local recurrence being 17 months. Treatment related complications and patterns of metastatic spread are discussed. In general, it appeared that the response of large tumors to neutron irradiation resulted in necrosis and fistula formation. In many cases this was accompanied by persistent/recurrent tumor within the high dose radiation volume.

Aged↗
PubMed2004

Microvascular loops and networks in uveal melanoma.

Microvascular patterns--three-dimensional architectural arrangements of microvessels and extravascular matrix in uveal melanoma--were discovered when investigators were looking for histopathological features of sufficient size to be imaged clinically. Evidence that these patterns may be formed by tumour cells and that they may be able to conduct plasma and blood as well as discovery of similar elements in other cancers make them of general importance. Of nine different patterns described, closed microvascular loops and networks have been studied most extensively. When cell type, microvascular density and nucleolar size are controlled for, these two patterns independently predict time to metastasis. In addition to visualization in tumour specimens stained with periodic acid-Schiff reagent, they can often be visualized clinically on confocal indocyanine green angiography. The presence of networks is clinically associated with probability of growth of small uveal melanocytic tumours and with the rate of regression of uveal melanoma after brachytherapy. Networks are also associated with development of exudative retinal detachment from uveal melanoma. Histopathological studies show that loops and networks are less common in tumours enucleated after irradiation and that they are frequently repeated in metastases of uveal melanoma. Avenues for immediate future research include detailed elucidation of the histogenesis of microvascular patterns and determination of these patterns in metastatic melanoma to identify new histopathological characteristics for prognostication when clinical metastases have developed.

Humans↗
PubMed1988

Retroperitoneal lymphadenectomy for testis tumor with nerve sparing for ejaculation.

The principal morbidity of retroperitoneal lymphadenectomy is the potential loss of ejaculation and, therefore, fertility owing to damage of the retroperitoneal sympathetic nerves that form the superior hypogastric plexus. We describe the results of our retroperitoneal lymphadenectomy when individual nerves from the sympathetic ganglia are identified and preserved while still performing a thorough bilateral retroperitoneal lymphadenectomy. The nerve-sparing procedure was technically feasible in 20 of 30 consecutive patients and it was only impractical with extensive gross disease. Of the 20 patients 18 (90 per cent) ejaculate, including 8 with bulky (5 cm. or more) residual retroperitoneal disease who underwent a successful nerve-sparing operation. All 12 patients (100 per cent) with nonbulky disease ejaculate. With short followup, no retroperitoneal recurrences have been detected. This technique is an alternative to limited dissection designed to spare nerves using boundaries based on the patterns of metastatic involvement.

Ejaculation↗
PubMed1980

Breast carcinoma: treatment failures in "early" and "late" disease.

Review of 86 autopsied cases of disseminated breast carcinoma showed that the scatter in survival time and pattern of metastatic distribution was similar in those with and without node involvement at operation. There were tumour cells in the efferent vessels in 86% of cases with tumour-bearing nodes, this factor being thus associated with a "late" carcinoma, one in which latent metastatic spread was present at the time of operation. While one cannot distinguish between an "early" tumour confined to the breast, and a potential treatment failure in which tumour emboli may have passed the nodes without colonizing them, the present findings indicate that such a distinction may be real.

Adult↗
PubMed1998

Malignant rhabdoid tumor of the duodenum.

A polypoid malignant rhabdoid tumor of the duodenum is presented. The pattern of metastatic spread in this 58-year-old man included multiple duodenal and small intestinal transmural tumor implants and a large peribronchial lymph node causing superior vena cava syndrome. Microscopically, the tumor was composed of a diffuse population of rhabdoid cells characterized by homogeneous globular cytoplasmic inclusions that tended to indent or displace eccentric, vesicular nuclei with nucleoli. No glandular features were noted. Immunohistochemical and ultrastructural evaluation revealed that these inclusions contained vimentin, an intermediate filament of the mesenchymal cytoskeleton. Phenotypic features of a rhabdoid tumor have been reported in 10 poorly differentiated malignancies of the gastrointestinal tract. This is the first case report of a malignant rhabdoid tumor of the small intestine. Regardless of the site of the lesion, tumors showing these features are generally associated with a poor prognosis.

Duodenal Neoplasms↗
PubMed2000

Variable expression of cathepsin B and D correlates with highly invasive and metastatic phenotype of oral cancer.

The expression levels of cathepsins B, D, and L in oral cancer surgical specimens were determined using immunocytochemical analysis. Cathepsins B and D are frequently overexpressed in squamous cell carcinomas, whereas their overexpression was less frequent in verrucous carcinoma and basaloid squamous cell carcinomas. Elevated level of cathepsin B in oral carcinomas was significantly associated with advanced tumor stage (P < .05) and poor histologic malignancy grade (P < .001). Increased expression of cathepsin D correlated significantly with the presence of metastasis (P < .05), poor histologic malignancy grade (P < .001), and high proliferation rate (P < .05). Cathepsin L was less frequently overexpressed in oral cancers than cathepsin B and D. These findings indicate that there is a strong cause/effect relationship between the expression levels of cathepsin B and D in oral cancers and their local invasive and metastatic growth patterns. Thus, cathepsins B and D are useful prognostic markers as well as promising gene therapy targets for oral cancer.

Adult↗
PubMed1999

Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas.

The histological frequency and distribution of cervical lymph node metastases was studied in 326 neck dissections from 253 patients with an intraoral/oropharyngeal squamous cell carcinoma. Metastasis was evident in 118 patients (47%) and 18 had bilateral metastasis. For primary sites other than the tongue, metastasis developed initially in a node(s) in the first drainage group (level I or II) with progressive involvement of neighbouring nodes ('overflow'). Simultaneous bilateral metastases were seen in some tumours of the floor of mouth, tongue and oropharynx which involved the midline. An erratic distribution of metastases suggestive of 'fast-tracking' (skip lesions and peppering) was only seen in tongue tumours. The pattern of metastatic spread indicates that level IV nodes must be included in staging and therapeutic neck dissections in tongue cancer. Metastasis to 'accessory' lymph nodes (lingual, buccal) occurs infrequently but may explain some 'local' recurrences.

Adult↗
PubMed1991

Dormant metastases in medullary thyroid carcinoma. A case report.

Report on a patient in whom an extensively metastasizing medullary carcinoma of the thyroid was diagnosed at the age of 32 years. Noteworthy in her case history were watery diarrheas that had persisted for two years, suggesting that the medullary thyroid carcinoma had already existed for some time. Besides locoregional lymph node metastases, small foci of diffuse pulmonary metastases with lymphangitis carcinomatosa as well as osteoblastic skeletal metastases were present and intramammary metastases were detected later. The patient died from bilateral pleuropneumonia with empyema formation at the age of 47 years after an observation period of 15 years. During that period, no major changes in the pattern of metastatic spread were observed and one may therefore speak of "dormant" metastases in this case, although some manifestations showed increases and decreases in size.

Adult↗
PubMed2001

[Lymph node metastasis in head-neck tumors].

BACKGROUND: One of the most important criteria of malignancy of head and neck cancer are the cervical lymph metastases. Being significant for the therapeutical plan is how tumor depending parameters like T-stage, degree of differentiation and tumor localisation will influence the N-stage and therefore the extension of neck dissection. METHOD: To evaluate the pattern of formations of metastases and the success of therapy a retrospective study was performed on 405 patients with carcinoma of the oral cavity (n = 47), the oropharynx (n = 117), the hypopharynx (n = 47) and the larynx (n = 193). RESULTS: By the time of surgery carcinoma of the hypopharynx were most frequently accompanied by cervical metastases (80%), followed by carcinoma of the oropharynx (70%), the oral cavity (52%) and the larynx (26%). Occurrence and extension of regional lymph node metastases correlated well with T-stages and degree of differentiation. After surgical therapy locoregional recurrence could be observed in 5.2% of the patients. Five-year-survival rate was reduced to 50% on patients with positive lymph nodes. The different tumour sites showed preferred patterns of metastatic spread, without complete avoidance of certain levels. CONCLUSION: For the decision on indication and extent of neck dissection the preoperative diagnostic (ultrasound, CT-scan, MRI), localisation of tumour, T-stage, degree of differentiation and the knowledge of typical metastatic spread must be considered.

Carcinoma, Squamous Cell↗
PubMed1981

Identification of T-lymphocytes and T-subsets in human tonsil using monoclonal antibodies and the immunoperoxidase technic.

A study was performed using monoclonal antibodies and the immunoperoxidase technic to identify T-cells and T-subsets in human tonsil sections. The in situ topographic identification of T-cells, helper cells, and suppressor cells was achieved. This model may therefore be applied to other normal lymphoid tissues. Its potential pathologic importance lies in the fact that certain disorders may be associated with depletion of lymphocyte subsets from their normal areas of "homing," and that lymphoma cells may mirror their putative normal counterparts in their selective metastatic migration pattern. The improved knowledge of normal lymphocyte subset microenvironment afforded by this technic may therefore be of value in applied pathology.

Adolescent↗
PubMed1988

Is there a place for chemotherapy in advanced prostatic cancer?

The cure of adult solid tumors with chemotherapy remains illusive. However, useful palliation and survival prolongation are possible in a number of cancers. Chemotherapy can have major side effects, and a balance must be struck between the likely benefits and expected toxic effects and inconveniences of the therapy to the patient. The biology of prostate cancer is extremely variable, ranging from a condition causing little or no inconvenience, to a progressive, debilitating, rapidly fatal illness. For this latter group of patients, particularly those resistant or unresponsive to hormone therapy, chemotherapy is a therapeutic modality with potential for halting or reversing the disease process. Considerable effort has been expended in the last 15 years searching for useful drugs. The patterns of metastatic disease in prostate cancer make the assessment of response exceedingly difficult, and the results of different studies, showing widely divergent results, difficult to interpret. When strictly objective criteria are employed, very few drugs show worthwhile activity, with only mitomycin-C, doxorubicin, and cis-platinum exhibiting 20% plus response rates. Further effort is needed to identify useful drugs, but consideration must also be given to the effect of therapy on the patient's quality, as well as duration, of survival.

Adult↗