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PubMed2003

New trends in breast conservation therapy.

Breast conservation therapy for early-stage invasive breast cancer provides survival equivalent to mastectomy. Careful patient selection and surgical technique are necessary to minimize local recurrence. Extensive studies of breast conservation therapy over the past 15 years have identified risk factors for local recurrence, and have proven that certain cases previously thought to be ineligible for lumpectomy (such as occult breast cancer, locally advanced breast cancer, macromastia, and cancer in pregnant patients), can be safely managed with modified BCT approaches. Recent trends in breast cancer management, such as expanded applications of induction chemotherapy, use of magnetic resonance imaging and ultra sound, and touch-prep cytology for intraoperative margin evaluation, can improve success rates for BCT. New developments with brachytherapy may also improve BCT availability by shortening duration of treatment. Innovations with minimally invasive tumor ablation techniques are investigational at present, but may obviate the need for surgical resections in selected patients in the future. Local recurrences that develop after breast conservation therapy should be managed aggressively, as long-term survival can frequently be achieved.

Adolescent↗
PubMed1997

The use of gadolinium in the MR evaluation of soft tissue tumors.

MRI has emerged as the preferred modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of MR in detection, diagnosis and staging, the use of intravenous contrast in the evaluation of soft-tissue tumors and tumor-like masses remains controversial. The purpose of this review is to highlight these controversies, to put them in perspective, and to make recommendations for the use of gadolinium-enhanced imaging. The following specific areas will be addressed: (1) general considerations in the evaluation of soft tissue tumors, (2) added specificity in diagnosis, (3) response to chemotherapy, (4) evaluation for local recurrence after surgery and/or radiation therapy, and (5) selection of biopsy site.

Adolescent↗
PubMed2000

Stage 0 to stage III breast cancer in young women.

BACKGROUND: Breast cancer survival is improving because mammography is leading to diagnosis at earlier stages of the disease. Because young women with breast cancer rarely undergo mammography before diagnosis, outcomes for breast cancer in young women may not be improving. In addition to advanced stage, young age at diagnosis is associated with biologically more aggressive cancers with higher rates of local and distant recurrence. STUDY DESIGN: Risk factors, clinical presentations, pathologic findings, tumor characteristics, extent of disease, treatment, and outcomes for 101 women under age 36 treated for breast cancer between 1989 and 1997 were compared with 631 patients 36 years and older treated by us during the same interval. Stage IV patients were excluded. RESULTS: Patients younger than 36 years were more likely to present with a palpable mass (87% versus 55%, p < 0.001) and were less likely to undergo spot localization breast biopsy for mammographic findings (40% versus 6%, p < 0.001). Patients younger than 36 years had larger tumors (median 2.0 cm versus 1.5 cm, p < 0.001), more nodal involvement (50% versus 37%, p = 0.022), more nodes involved (median 1.0 versus 0, p = 0.010), and were more likely to be diagnosed with stage II or III cancer (60% versus 43%, overall p < 0.001). Young patients' cancers were more poorly differentiated (80% versus 44%, overall p < 0.001), estrogen receptor-negative (52% versus 31%, p < 0.001), aneuploid (70% versus 49%, p = 0.013), and had higher S-phase fractions (59% versus 29%, p = 0.001). Patients less than 36 years were treated more often with mastectomy (59% versus 22%, p < 0.001) and adjuvant chemotherapy (80% versus 54%, p < 0.001) and less often with tamoxifen (36% versus 58%, p = 0.001). Cumulative 5-year local and distant disease-free survival were significantly worse for patients younger than 36 years (p = 0.011 and p = 0.044, respectively). The higher rate of local recurrence in patients less than 36 years was from an excess number of local recurrences in patients treated with breast conservation. After consideration for nodal involvement, chemotherapy, and tamoxifen using the Cox proportional hazards model, no other variable, including age, was significantly related to local disease-free outcomes. After consideration for tumor size and nodal involvement, no other variable was significantly related to distant disease failure rates. CONCLUSIONS: Patients diagnosed with breast cancer before age 36 differ from older patients in numerous respects. They present more often with a palpable mass rather than a mammographic finding and their cancers are more advanced with features that are more aggressive. Despite aggressive treatment, most commonly with mastectomy and chemotherapy, local and distant failure rates are higher than for patients 36 and older. The higher rate of local recurrence in patients less than 36 years reflects an excess number of local recurrences in patients treated with breast conservation.

Adult↗
PubMed1982

Incidence of local recurrence after curative operations for cancer of the rectum.

Between January 1, 1969 and December 31, 1979 a total of 248 patients with infiltrative carcinoma of the middle third of the rectum were treated curatively either by sphincter saving anterior resection (176/248) or by abdomino-perineal excision (72/248). The observed incidence of local recurrence was 21% (52/248). Among the tumor specific factors which influence the development of local recurrence the type of growth (insular - circular, exophytic - ulcerous) and the presence of lymph node metastases at the time of the primary operation proved to be statistically significant. Among the surgical factors a sufficient distal margin of safety in anterior resection could be shown to be of major importance. In order to minimize the risk of local recurrence the distal margin of safety should be at least three cm determined in the fresh operative specimen without tension. The type of operation, be it abdomino-perineal excision or anterior resection, has no influence on the incidence of local recurrence as long as a sufficient distal margin of safety is achieved during anterior resection.

Abdomen↗
PubMed2002

Adjuvant therapy of colorectal cancer: the next step forward.

Adjuvant therapy for colorectal cancer includes chemotherapy, radiotherapy and immunotherapy. It is advocated in patients who are at significant risk of developing recurrence. We review recent advances in adjuvant treatment for colorectal cancer. Although colorectal cancer is often considered as a single entity, it is being increasingly recognised that colon and rectal cancers are distinct disease groups and separate therapeutic strategies should be considered for each. In colonic cancer, 5-fluorouracil is used, with or without other agents. Both preoperative radiotherapy and postoperative chemoradiotherapy have been used in rectal cancer. The development of oral chemotherapeutic agents has been a significant step in the management of colorectal cancer, while newer agents have been introduced with good results. Targeting the immune response and genetic manipulations are being developed as innovative management strategies. Although adjuvant therapy has improved outcome in colorectal cancer, stress should be laid on identifying patients who need adjuvant therapy, permitting individualisation of treatment strategy. Apart from including survival and local recurrence as outcome measures, new therapeutic approaches should be assessed in terms of quality of life of the patient.

Antineoplastic Agents↗
PubMedDate not supplied

[The impact of extracapsular spread and desmoplasia on local recurrence in patients with malignant tumors of the larynx and hypopharynx].

A study was made of the impact of the presence of extracapsular spread (ECS) and desmoplastic pattern (DP) in cervical lymph nodes on local recurrence in 119 patients with laryngeal and hypopharyngeal cancer. All patients underwent surgery between 1984 and 1992 for squamous-cell carcinoma and had histologically confirmed lymph node metastasis. The tumor recurred locally in 15.7% of patients without ECS and in 36.1% of patients with ECS (p < 0.03). The frequency of local recurrence did not differ significantly between patients without DP (20.0%) and patients with DP (29.0%) (p > 0.05). Therefore ECS in cervical lymph nodes of patients with laryngeal cancer was related with an increased rate of local recurrence, but DP did not modify the probability of local recurrence.

Adult↗
PubMed2001

[Regional chemotherapy--perfusion of the extremities].

Hyperthermic isolated limb perfusion with cytostatic drugs (HILP) is indicated in locoregional recurrences of malignant melanoma of the limbs. As a neoadjuvant treatment it is also used for non-curatively resectable soft tissue sarcoma or their recurrences on the extremities. Up to now, melphalan is still the standard drug in HILP for malignant melanoma. With melphalan, complete response can be achieved in 65-80% for clinically detectable in transit metastases (+/- regional lymph node metastases). The combination of tumor necrosis factor (TNF) alpha with melphalan has considerably improved response rates of HILP in sarcoma. In more than 80% of the patients the otherwise necessary amputation of the limb can be avoided. The combination of TNF with other drugs than melphalan could possibly further improve results of HILP in sarcoma patients. The high rate of local recurrences of malignant melanoma after HILP poses an unsolved problem yet.

Antineoplastic Agents↗
PubMed1992

[The pattern of recurrence of T3 rectum cancer].

Rectal carcinoma is one of the most common tumors of the GI-tract. At the time of initial treatment the majority of our patients had a stage T3 tumor. In order to contribute to the development of new guidelines for adjuvant therapies we analysed the patterns of recurrence in the patients operated with curative intention in our institution between 1981 and 1989. The pattern of recurrence shows that every fifth patient could benefit of a local measure to reduce local recurrence and that every second patient with positive nodal histopathology could benefit of a systemic adjuvant chemotherapy.

Adenocarcinoma↗
PubMed2006

[Incidence of local recurrence after breast preserving surgery].

Breast preserving surgery combined with adjuvant radiotherapy became more frequent in the last 20 years in the surgical treatment of early stage (Std. I-II) breast cancer in Hungary. Those who refuse this method usually allude to the frequent multifocality and the high recurrence rate of breast cancer. In the 1st Department of Surgery, Medical and Health Science Center, University of Debrecen, 825 patients underwent breast preserving surgery with a recurrence rate of 9.1% between January 1996 and December 2003. The time of appearance of recurrence varied between 5 and 102 months after surgery. There was no difference between the premenopausal and postmenopausal group. The 6.7% rate in pT1N0 tumors elevated to 16.7% in patients with pT2N1. According to histological grade the Grade 1 tumors had a recurrence rate of 2.3%, in Grade 2 we found 6.2% and in Grade 3 as high as 15.8%. Other unfavorable histo-morphological signs are the absence of estrogen receptors, the presence of extensive intraductal component and vessel invasion. Their opinion is that in case of local recurrence with favorable prognostic factors excision should be performed if acceptable cosmetic result can be achieved.

Adult↗
PubMed1988

Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of stage I breast cancer.

The results of a selective policy of conservative surgery without radiation over a 14-year period with a minimum 5 year follow-up indicates that routine postoperative radiotherapy can be safely omitted in certain cases. Eighty-one patients were studied, the overall survival at 5 years and 10 years was 88% and 73% respectively. The risk of local recurrence within the treated breast or axilla was 10% at 5 years and 11% within the total follow-up period. Most (91%) local recurrences were noted within 5 years. The rate of dying from breast cancer did not change over 10 years of follow up. The risk of recurrence was significantly higher in younger (less than 46 years) patients (P less than 0.05) and premenopausal patients (P less than 0.005) compared with older, post menopausal patients. The risk of dying from breast cancer was also significantly greater in the younger premenopausal women. At 10 years the rate of dying from breast cancer was unchanged from that seen soon after diagnosis. In postmenopausal patients with tumours less than 2 cm and uninvolved axillary nodes after pathological assessment, radiotherapy can be safely omitted. In these patients there is a low risk of local recurrence (10%), similar to that reported following segmental mastectomy and radiation.

Adult↗
PubMed1996

Squamous cell carcinoma of the anal margin treated with radiotherapy.

Squamous cell carcinoma of the anal margin is relatively rare. We present a series of patients treated with radiotherapy alone or combined with concomitant chemotherapy at our institution and review the pertinent literature. Ten patients with AJCC T2N0 and T3N0 squamous cell carcinoma of the anal margin were treated with radiotherapy alone or radiotherapy plus chemotherapy at the University of Florida between 1979 and 1993. All patients had a follow-up for at least 2 years, and no patient was lost to follow-up. All ten patients have remained continuously disease free after treatment. Three patients died of intercurrent disease at 29, 37 and 113 months after treatment. The remaining seven patients were alive and disease-free from 24 to 143 months after radiotherapy. No patient experienced a major complication and all retained a functional anal sphincter. Based on our experience and a review of the literature, superficial, well to moderately differentiated, T1 and T2 cancers may be successfully treated with radiotherapy alone or a local excision. More advanced lesions are best treated with combined radiotherapy and concomitant chemotherapy. Abdominoperineal resection should be reserved for those presenting with faecal incontinence and those with locally recurrent disease after previous radiotherapy.

Abdomen↗
PubMed1994

High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers.

PURPOSE: To assess the efficacy of high-dose preoperative radiation and full thickness local excision as an option for the management of selected distal rectal cancers. METHODS AND MATERIALS: Forty-eight patients with invasive distal rectal cancer have been treated with high-dose preoperative radiation (45-55 GY at 180 cGy/fx) followed 6 to 8 weeks later by full thickness local excision. Three groups of patients are included in this study. Group 1 (N = 15) Medically Compromised: patients with rectal cancers Stages T3 or > 3 cm in size and significant cardiorespiratory disease that precluded radical surgery. Group 2 (N = 18) Elective: patients suitable for local treatment by standard criteria (Stages < T2 and < 3 cm in size), and group 3 (N = 15) Staged: patients with Stages T3 or > 3 cm in size that postradiation were downstaged and met the criteria as in group 2. One patient in group 3 was found to be pathologically T3 following full thickness local excision and was converted to an abdominoperineal resection. Follow-up ranges from 6-96 months with a median of 40 months. RESULTS: The overall 5-year actuarial survival for the whole group is 83.5% and local recurrence is 10%. The 5-year survival is 74%, 92%, and 88% for Groups 1, 2, and 3 and 90%, 89%, and 50% for postradiation pathologic stages T0/T1, T2, and T3, respectively. Local recurrence rate by treatment groups are 20%, 11%, and 0% for groups 1, 2, and 3 and 11%, 0%, and 67% for postradiation Stages T0/T1, T2, and T3, respectively. Surgical complications, primarily wound healing, were observed in five patients (10%). Four patients required a subsequent colostomy (three for recurrence and one for a rectovaginal fistula). Sphincter function as measured by Parks criteria was good/excellent in 88% of patients. CONCLUSION: High-dose preoperative radiation and full thickness local excision appear to be a promising new option for the management of selected patients with invasive distal rectal cancers. Selected patients with Stage T3 cancers that as a result of preoperative radiation are downstaged and met the criteria for primary local therapy (T2 or less) appear to have an excellent survival with retained normal sphincter function following full thickness local excision.

Adenocarcinoma↗
PubMed1982

Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum.

Records of 230 patients who underwent abdominoperineal resection between 1963 and 1976 were reviewed. The median age of the patients was 62 years. The mortality rate was 1.7 per cent, and the morbidity rate was 61 per cent. One hundred eighty patients were followed for five to 13 years to identify patterns of recurrence. Ten-year survival for Dukes' A, B, and C lesions was 83 per cent, 57 per cent, and 31 per cent, respectively. Seventy-eight patients (43 per cent) had recurrent cancer; 10 per cent had local lesions, and 33 per cent had distant lesions. Dukes' B lesions had a greater latency for local recurrence than Dukes' C lesions. Dukes' A lesions with distant recurrence had a greater latency than Dukes' B or C lesions. Once recurrence was established, the survival rate was not significantly different, regardless of Dukes' stage or local or distant site. Radiation therapy for established local recurrence or chemotherapy for established distant recurrence did not seem to alter survival rates.

Adult↗
PubMed1996

Is local excision of pT1-ampullary carcinomas justified?

We propose that local excision of carcinomas of the ampulla of Vater is justifiable under the following conditions: when the tumour is limited to the ampulla of Vater as diagnosed by pre-operative endoluminal sonography (uT1) and UICC-staging (pT1); and when it is graded G1 or G2 and there is no lymphatic infiltration and the tumour is completely resected (R0). Under these conditions peri-operative morbidity and mortality were significantly reduced compared with more extensive surgery. There was no local recurrence of tumour in our study and long-term survival rates were comparable with Whipple's procedure. This implies that lymphatic spread is limited in localized disease and the feasibility of the proposed procedure may therefore be analogous to localized resections in other malignant tumours, e.g. carcinoma of the rectum.

Adult↗
PubMed1999

Local control after curative surgery for cancer of the extraperitoneal rectum. Twenty years of experience.

A retrospective study was carried out in 264 patients with low rectal cancer surgically treated with curative intent from January 1975 to December 1995 to analyze the influence of stapling devices on surgical and disease outcome. Patients were classified as follows: group 1 underwent surgery from 1975 to 1980, when staplers were not employed, and group 2 from 1981 to 1995, when stapling devices were routinely used. The use of stapling devices determined a corresponding increase in low anterior resection (LAR) and a decrease in postoperative mortality. A statistically significant difference in local recurrence rate between abdominoperineal resection (APR) patients and LAR sutured cases of group 1 was observed. In T3, N+ cases local recurrence rate was comparable in APR patients and LAR cases with stapled anastomosis. Improved local control occurred in stapled group 2 patients which was independent of the distal clearance. Although APR still plays an important role in treatment of lower rectal cancer, results indicated that a similar outcome after stapled LAR can also be expected in locally advanced carcinoma of the distal rectum, if accurate excision of perirectal tissue is carried out.

Aged↗
PubMed1986

Adrenocortical carcinoma.

From 1962 to 1985, 47 patients with carcinoma of the adrenal cortex were treated at Memorial Sloan-Kettering Cancer Institute. There were 21 men and 26 women. Seventy-two percent of the tumors were functional and 28% were nonfunctional. Despite the advent of ultrasonography and computerized tomography, these tumors were infrequently diagnosed until they infiltrated adjacent organs or metastasized to distant sites. Only 30% of patients had tumors confined to the adrenal gland; their mean duration of survival was 5.0 years. Seventy percent of the patients had invasion of the kidney, lymph nodes, liver, diaphragm, and/or pancreas at the initial operation; their mean duration of survival was 2.3 years. Eight patients had reoperation for abdominal recurrences; three of the patients with abdominal recurrence and one additional patient underwent thoracotomy to resect localized lung metastases. The mean duration of survival of these nine patients was 3.5 years, not significantly different from the mean overall survival of 3.1 years. The duration of survival of all patients was not significantly correlated with age, sex, adjuvant therapy, or production of hormones by the tumor. Only two patients were deemed unresectable. Wide en-bloc dissection of the primary tumor, resection of contiguous organs for local invasion, and excision of resectable metastases in the liver and lungs remain the basis of therapy.

Adrenal Cortex Neoplasms↗
PubMed1981

[Breast cancer treatment methods taking into account patient tumor and body characteristics].

On the basis of clinical evaluation of 1,007 case histories of breast cancer supplied from the Kazakh Republican Oncological Dispensary, Research Institute of Oncology and Radiation and Municipal Oncological Dispensary (Alma-Ata, 1960-1977), individually-tailored methods of therapy were developed. The procedures are based on such criteria as age, stage, localization, anatomical and histological characteristics of tumor.

Breast Neoplasms↗