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PubMed1992

Etiology and prognosis of local recurrence in malignant melanoma of the skin.

All patients with stage I and stage II malignant melanoma of the skin were analyzed for stage; time of local, regional, or systemic recurrence, or two or more of these events; presence or absence of ulceration of the primary tumor; thickness of the primary tumor; level of invasion according to Clark; and margins of resection. Local recurrence had a significant negative impact on the long-term survival of patients. Our data revealed that local recurrence had the same poor prognostic effect as regional or systemic recurrence, or both. Factors significant in predicting local recurrence included the primary tumor characteristics of ulceration of the primary tumor and thickness of the primary tumor. Margins of resection and level of invasion were not noted significant in predicting local recurrence.

Florida↗
PubMed1991

A review of the role of established tumour markers.

Increasing numbers of commercial assays for the established tumour markers are available which are capable of excellent analytical performance. Whilst all these assays are useful as research tools, their clinical value is more limited and should be appreciated before any decision is taken to offer a tumour marker assay service. 1. Calcitonin (medullary carcinoma of thyroid), alphafetoprotein (hepatoma) and human chorionic gonadotrophin (choriocarcinoma) are the only tumour markers that can be used for screening for malignancy in high risk populations. 2. Hormones, paraproteins, alphafetoprotein, human chorionic gonadotrophin and prostate specific antigen are valuable in establishing the diagnosis of certain tumour types. 3. Alphafetoprotein and human chorionic gonadotrophin concentrations at the time of diagnosis are of value in predicting prognosis in specific tumour types. 4. Although their sensitivity for a particular tumour type may be poor, most tumour markers can be used for monitoring the therapy and follow-up of selected marker positive patients. Optimal clinical results of the management of patients with malignancy are usually obtained by specialist centres, and laboratory tumour marker services should be established so that they are appropriate to local oncology specialities.

Biomarkers, Tumor↗
PubMed1975

Experimental surgery on the Cloudman S91 melanoma with the carbon-dioxide laser.

The continuous wave CO2 laser lacks a number of draw-backs of the pulsed Ruby laser, and seems attractive for tumor surgery. We compared the CO2 laser with conventional surgery in experiments on mice bearing the Cloudman S91 melanoma. We had the same rate of local recurrence and lung metastasis in both techniques.

Animals↗
PubMed1990

[Adjuvant radiotherapy of rectal cancer].

Evaluation and refinement of surgical techniques in rectal carcinoma have reduced the rate of local recurrences. Nevertheless recurrence it remains high at more than 20% in patients with extensive infiltration of perirectal tissues and cures are an exception. Overview of many years of experience with adjuvant radiotherapy shows that local recurrence rate can be reduced and survival the rate improved.

Combined Modality Therapy↗
PubMed1991

Intraoperative gamma detection probe with presurgical antibody imaging in colon cancer.

In this study, presurgical gamma camera imaging and an intraoperative gamma detection probe were used in 12 consecutive patients 6 to 22 days after infusion with indium 111-labeled anticarcinoembryonic antigen monoclonal antibody (111In-MoAb). In three of 11 patients who underwent laparotomy, clinical management was affected by the probe findings: localization of occult retroperitoneal disease, identification of an occult cecal lesion, and localization of residual disease at a site of local recurrence. Of all intra-abdominal lesions seen using any method, the probe identified 18 (86%) of 21, compared with 14 (67%) of 21 with the 111In-MoAb scan, 10 (48%) of 21 by computed tomographic scan, and 16 (76%) of 21 after surgical exploration. Uptake of 111In-MoAb in the portal (n = 3) and mediastinal (n = 3) lymph nodes was not associated with histologic findings of malignant neoplasms. For all pathologically confirmed extrahepatic and nonportal sites of cancer, the probe localized nine of nine, compared with five of nine by 111In-MoAb scan, two of nine by computed tomographic scan, and six of nine by surgical exploration. Important clinical uses of the intraoperative probe included occult lesion identification, localization of areas with 111In uptake shown with MoAb scanning, and verification of complete resection of areas with 111In-MoAb uptake.

Abdominal Neoplasms↗
PubMed1992

DNA index as a significant indicator of lymph node metastasis and local recurrence of rectal cancer.

To confirm the prognostic significance of the DNA index (DI) in cases of rectal cancer, the nuclear DNA content of tumor cells was examined in 184 cases of rectal cancer treated with curative surgery, and the incidence of lymph node metastasis and recurrence of the cancer was analyzed. The incidence of lymph node metastasis was 43.9 percent in cases with aneuploidy (DI above 1.5), being statistically different from the 18.0 percent incidence in cases with diploidy (P < 0.001). Although the extent of lymph node metastasis was limited to adjacent lymph nodes in cases with diploidy, distant lymph node metastases were frequent in cases with aneuploidy, especially in those with a DI above 1.5. Furthermore, the incidence of recurrence of cancer, and especially of local recurrence, was significantly higher (P < 0.001) in cases with aneuploidy (DI above 1.5) than in cases with diploidy and aneuploidy (DI below 1.4). These findings indicate the significant value of the DNA index for the prediction of lymph node metastasis and local recurrence in patients with rectal cancer.

Aneuploidy↗
PubMed1991

The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast.

Most oncologic surgeons agree that removal of the nipple, the areola and any recent scar at the site of the biopsy is necessary during a mastectomy for treatment of carcinoma of the breast. There is less agreement about what should be done with the remaining uninvolved mammary skin. Its preservation facilitates the performance of immediate reconstruction of the breast and can lead to improved aesthetic results, but many oncologists fear that this practice could lead to an increased incidence of local tumor recurrence. To determine if that fear was justified, 87 patients who had undergone unilateral or bilateral mastectomy with immediate reconstruction for treatment of early carcinoma of the breast were studied. Preservation of uninvolved skin was used in all instances. All patients had a documented follow-up study of 12 months or more; the average follow-up time was 23.1 months. One peripheral local recurrence was observed. This 1.2 per cent rate of early local recurrence is lower than that reported from several series using modified radical mastectomy without skin preservation or immediate reconstruction, and suggests that skin preservation does not confer additional risks of local recurrence of carcinoma of the breast in properly selected patients.

Breast Neoplasms↗
PubMed1992

Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma.

Between 1977 and 1987, 519 patients underwent operation for rectal carcinoma. Sixty-three patients underwent intersphincteric resection with direct coloanal anastomosis (CAA), and 77 had an abdominoperineal resection (APR). Curative surgery was achieved in 57 and 65 patients, respectively. Both groups were comparable regarding age, stage of tumors, and localization of tumors. During the mean period of 6.7 years (range: 3 to 13.6 years), all patients were examined according to a predefined follow-up plan. From those patients with curative surgery, 11% presented with pelvic recurrence and 33% with distant metastases after coloanal anastomosis; the rates of recurrence and distant metastases after APR were 17% and 35%, respectively. The corrected 5-year survival rates were 62% following CAA and 53% following APR. Eighty-five percent of the patients with CAA reported good functional results regarding anal continence. Our study demonstrates that the intersphincteric resection with CAA is a valuable surgical technique for rectal carcinoma with the benefit of preservation of continence. It is suitable for neoplasms with high- and medium-grade differentiation (G1 to G2) and a localization that allows a minimum distal clearence of 3 cm.

Abdominal Muscles↗
PubMed1990

Blood transfusion and recurrence of colorectal cancer: the role of platelet derived growth factors.

Efforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion. However, the relationship between solid tumour development and the immune system is inconclusive. We have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon. Using a human fibroblast: [125I]deoxyuridine uptake mitogenesis assay, the relative amounts of growth factor in the plasma of stored blood were measured. There was a progressive increase in mitogenesis from day 0 (n = 6) to day 28 (n = 6; P less than 0.001, Mann-Whitney U test). The effect of growth factors on the development of liver and intraperitoneal metastases was studied in Hooded Lister rats. Following an intraportal injection of 10(5) MC28 tumour cells, the experimental group (n = 25) received 2 ml of syngeneic serum intravenously for 4 days. Likewise, colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 10(3) cells. The experimental groups (n = 20) received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally (n = 19). There was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group (P less than 0.01). Growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cancer.

Anastomosis, Surgical↗
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↗
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↗
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↗
PubMed1992

Local administration of monoclonal antibody-drug conjugate: a new strategy to reduce the local recurrence of colorectal cancer.

This report investigates the application of monoclonal antibody A7 and its drug conjugate in locally controlling colorectal cancer. The experimental protocol consisted of local retention, lymphatic delivery, normal organ distribution, systemic toxicity, and tumoricidal effects. When 125I-labeled monoclonal antibody (Mab) A7 was injected into the pelvis and the thigh of Balb/c mice, a high local retention unrelated to antigen-antibody interaction was observed at the injected site for 24 h after injection. An analysis of local retension properties related to antigen-antibody interaction, conducted by intratumorally or peritumorally injecting 125I-Mab A7 into the tumor-bearing athymic nude mice, revealed a significantly higher tumor localization of Mab A7 in comparison to i.v. injection. 125I-Mab A7 accumulated to a great extent in the ipsilateral regional lymph node but not in the contralateral regional lymph node. Normal organ accumulation of Mab A7 was lower in the locally injected group than in the i.v. injected group. Intratumoral injection of Mab A7-neocarzinostatin (A7-NCS) led to the complete remission of established tumor in 5 of 6 antigen-positive xenograft-bearing mice but exhibited a complete remission in only 1 of 6 antigen-negative xenograft-bearing mice. A single local injection of A7-NCS inhibited tumor development in 12 of 16 and 5 of 15 antigen-positive tumor-bearing mice and antigen-negative tumor-bearing mice, respectively, whereas neither a systemic injection of A7-NCS and NCS nor a local injection of NCS and saline had a notable inhibitory effect on tumor development. Systemic toxicity of NCS was markedly reduced when it was locally administered in the antibody-conjugated form. These findings indicate that local injection of immunoconjugate is a promising new field for controlling the local recurrence of colorectal cancer.

Animals↗
PubMed1990

The effect of preoperative endoscopy on recurrence and survival following surgery for colorectal carcinoma.

Numerous studies have elucidated the benefits of endoscopy before surgery for carcinoma of the colon and rectum. In patients with known colon cancer, the incidence of synchronous colon cancers is 1.5 to 7.6 per cent and synchronous colon polyps is 25 to 40 per cent. Standard barium contrast studies are inferior to endoscopic examination in detecting these synchronous lesions. Endoscopy has been shown to alter the planned surgical procedure in 11 to 13 per cent of patients with colorectal cancer. Nevertheless, some authors avoid preoperative endoscopy because of concern that neoplastic cells may be seeded throughout the colon during the examination. They fear that manipulation of the tumor may promote hematogenous or lymphatic spread. Our study seeks to demonstrate whether this concern is valid by comparing rates of local recurrence, distant metastases, and survival between patients who have undergone preoperative endoscopy with those who have not.

Adult↗
PubMed1992

[Local recurrence of breast cancer: prognostic factors, effect of adjuvant therapy].

UNLABELLED: Local recurrence after treatment of operable breast cancer occurred in about 20% of the patients before adjuvant therapy became common. The incidence of local recurrence is high during the first 2 years of follow-up, becomes lower afterwards, and is less than 1% after 10 years follow-up. Some primary tumor characteristics have been recognized as risk factors for the development of a local recurrence: size of the primary tumor, its histology and malignancy grade, number of involved axillary lymph nodes. The type and extent of primary tumor treatment, and additional adjuvant therapy are also factors influencing the frequency of local recurrence. Data from MD Anderson Hospital and from the Ludwig Study III are used to show the impact of adjuvant therapy upon local recurrence frequency. CONCLUSION: local recurrence after treatment of breast cancer is becoming less frequent, especially after introduction of adjuvant therapy. The question of additional systemic therapy after excision of local recurrences is still open, and is studied in a clinical trial of the Swiss Group of Clinical Cancer Research.

Aged↗
PubMed1992

[Treatment and treatment results of mouth floor cancers].

The records of 68 patients with cancer of the floor of the mouth were reviewed. 56 patients underwent surgical management, 51 of them got additionally postoperative radiation. The tumour-specific five years' survival for patients with operation was 46%, 57% of treatment failures developed from local recurrence of the tumour. In 52% of all cases there was a spread to the lymphatic system in the histological evaluation. There was high incidence of false negative clinical examinations of the neck. Conservative neck dissection was the procedure of choice for clinically positive lymph nodes and for the elective management of the neck. Only advanced tumours showed involvement of the mandibular bone. Therefore a conservative management of mandibular resection was preferred. Radical tumour extirpation and histological controlling with serial sectioned specimens are methods of avoiding local tumour recurrence.

Carcinoma, Squamous Cell↗
PubMed1992

[Study on local recurrence in patients undergoing curative surgical resection of lung cancer].

Clinical features of recurrence in patients of lung cancer undergoing curative surgical resection were examined with special reference to the local recurrence. Subjects were 308 patients, consisting of 160 adenocarcinomas, 121 squamous cell carcinomas, 15 large cell carcinomas, 12 small cell carcinomas. They underwent curative resection in our department between 1973 and 1987. Local recurrence developed in 54 patients (18%). There was no significant difference in the incidence of local recurrence among the four histological types of carcinoma. According to the pathological stage, the incidence was 9% in stage I, 15% in stage II, and 35% in stages IIIA+IIIB. The local recurrence was subdivided into the following patterns: 1) lymphatic metastases to the hilar, mediastinal, or supraclavicular sites, 2) recurrence at the surgical margin, 3) malignant pleuritis or pericarditis, 4) so-called "endobronchial metastasis". The incidence of recurrence according to the patterns was 15%, 2%, 2% and 1%, respectively. The incidence of recurrence due to lymphatic metastases was correlated significantly with the pN factor but not with the pT factor. Patients with central type lung cancer showed a significantly higher incidence of lymphatic recurrence than patients with the peripheral type. Patients having postoperative radiotherapy to prevent local recurrence showed a lower incidence of lymphatic recurrence than patients having no radiotherapy. In conclusion, lymphatic recurrence was the most frequent pattern in local recurrence after curative resection of lung cancer, and therefore improvements in the operative procedure of lymphatic dissection, as well as in postoperative adjuvant therapy including radiotherapy will be urgently required for the purpose of reducing local recurrence.

Adenocarcinoma↗