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At least 613 records · Page 34Linked to original sources

PubMed2003

Surgical outcome of laparoscopic radical prostatectomy: summary of early multiinstitutional experience in Japan.

BACKGROUND: Because laparoscopic radical prostatectomy requires significant laparoscopic expertise, it needs to be evaluated critically before being accepted as a standard therapeutic option for localized prostate cancer. METHODS: A total of 148 men diagnosed as having clinically resectable prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early biochemical and oncological outcomes were investigated. RESULTS: Policies underlying the selection of laparoscopic radical prostatectomy did not appear to be consistent among the participating institutions. Pathologically organ-confined disease was found in 64.0% of the patients who had undergone neoadjuvant therapy and in 77.2% of those who had not. Positive surgical margins were found in 36.0% and 34.1%, respectively, of the specimens. The most common site was the apex, which accounted for 77.8% of positive margins in patients who had undergone neoadjuvant therapy and 50.0% in those who had not. Seven patients have experienced biochemical failure at a median follow-up of 9.0 months. No clinical progression has been reported. CONCLUSIONS: Continuing improvements in each step of laparoscopic radical prostatectomy, especially apical dissection, should be sought as we pursue the goal of still better oncological outcomes. A systematic approach and therapeutic guidelines should help to reduce the learning curve for competent performance of this procedure.

Aged↗

PubMedDate not supplied

Multimodality management of localized pancreatic cancer.

Despite improvements in surgical management, only a minority of patients enjoy long-term survival following pancreaticoduodenectomy for adenocarcinoma of the pancreas. Adjuvant therapy consisting of 5-fluorouracil and irradiation has improved median and 5-year survival rates; however, at least one third of eligible patients do not receive postoperative adjuvant therapy because of delayed recovery following pancreaticoduodenectomy. This has led to the development of treatment schedules incorporating the delivery of systemic therapy and/or chemoradiation prior to surgery. This article briefly outlines the history of adjuvant therapy for adenocarcinoma of the pancreas and reviews the available literature on neoadjuvant therapy for localized pancreatic cancer including investigational therapies under clinical trial evaluation.

Adenocarcinoma↗

PubMed2002

Clinical features and outcome of initially unresected nonmetastatic pediatric nonrhabdomyosarcoma soft tissue sarcoma.

PURPOSE: To describe the clinical features, response to therapy, and outcome of pediatric patients with initially unresected nonmetastatic nonrhabdomyosarcoma soft tissue sarcoma (NRSTS). PATIENTS AND METHODS: We retrospectively reviewed the presenting clinical features and tumor characteristics of all 40 pediatric patients with initially unresected nonmetastatic NRSTS who were seen at our institution between March 1962 and December 1996. A subset of 27 patients for whom complete treatment information was available was analyzed to determine whether response to therapy was associated with local disease control and event-free and overall survival. RESULTS: More than 70% of the 40 patients had tumors with high-risk features (tumor size > 5 cm, high grade, invasiveness). For the 27 patients included in the outcome analysis, 5-year event-free survival and survival estimates were 33% +/- 9% and 56% +/- 10%, respectively. Ten (37%) of these patients had a complete or partial response to neoadjuvant chemotherapy and/or radiotherapy, and only two of the 10 had residual tumor after surgery. Combined chemotherapy and radiotherapy seemed more effective than either modality alone in inducing a response, but the response to neoadjuvant therapy did not predict outcome. Most treatment failures were local, and postrelapse survival was poor (19% +/- 10%). CONCLUSION: Initially unresected NRSTS constitutes a unique subgroup of pediatric sarcomas that commonly present with high-risk features and respond poorly to neoadjuvant therapy. Only about one third of patients treated with multimodal therapy remain disease-free, and local control is the major limiting factor in achieving cure. More effective risk-directed treatments are needed for this unique subgroup of patients.

Adolescent↗

PubMed2003

Pediatric extraadrenal paraganglioma.

BACKGROUND: Pediatric paraganglioma is rare and extraadrenal paraganglioma has not been characterized in children. METHODS: The authors reviewed the medical records and pathology samples of children with extraadrenal paraganglioma treated at our institution between December 1978 and September 2000. Clinical presentation, treatment, and outcome were evaluated. RESULTS: Eight patients (median age, 11.4 years) were identified, 4 were boys and none had a family history of paraganglioma or associated syndromes. Primary tumors arose in the retroperitoneum (n = 3), carotid body (n = 2), jugulotympanic ganglion (n = 1), cervical-paraspinal region (n = 1), and lung (n = 1). Extraadrenal paraganglioma had not been suspected at presentation in any patient. Of 5 patients who underwent gross total resection at the time of diagnosis, 4 remain disease free, 1 had microscopic residual tumor and died of disease. Three patients had initially unresectable disease, 2 are disease free after neoadjuvant therapy and delayed surgery, and 1 has persistent disease after tumor embolization and radiotherapy. CONCLUSIONS: Pediatric extraadrenal paraganglioma occurs most commonly in the retroperitoneum and head and neck, and the diagnosis usually is not suspected at the time of presentation. Surgery is the mainstay of treatment, and outcome is good after gross total resection. Neoadjuvant therapy can facilitate complete resection of initially unresectable tumors.

Adolescent↗

PubMed2002

Recurrence-free survival and prognostic factors in resected pN2 non-small cell lung cancer.

OBJECTIVE: We sought to evaluate recurrence pattern and prognostic factors of recurrence-free survival in surgically resected N2 non-small cell lung cancer. METHODS: Between September 1994 and December 1999, 564 patients underwent operation for non-small cell lung cancer at our institute. Of these 564 patients, 101 patients were found to have pathologic N2 disease. Systematic mediastinal lymph node dissection was performed in all these patients. Recurrence was determined and nineteen clinicopathologic prognostic factors were evaluated in relation to recurrence-free survival. RESULTS: Complete resection rate was 83.2% and overall 5-year survival was 23.3%. Locoregional and distant metastasis were detected in 50 of 101 patients (49.5%) during follow-up. Five-year recurrence-free survival was 19.6%. Among 19 clinicopathologic prognostic factors, incomplete resection and non-downstaging after neoadjuvant therapy were unfavorable prognostic factors in univariate analyses. Clinical N2 status, multiple N2 nodes, and cell type of adenocarcinoma showed poor prognosis but were not statistically significant. Postoperative chemotherapy showed good prognosis but was not statistically significant. Multivariate analysis showed that significant favorable prognostic factors were complete resection and adjuvant chemotherapy. CONCLUSIONS: Complete resection and responsiveness to neoadjuvant therapy were the most important favorable prognostic factors in recurrence-free survival. Postoperative chemotherapy was also a favorable prognostic factor but not statistically significant in recurrence-free survival in pN2 non-small cell lung cancer.

Adult↗

PubMed2004

[A case of gastric GIST treated preoperatively by imatinib mesylate].

Gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the human gastrointestinal tract, is thought to originate from the interstitial cells of Cajal. The mutation of c-kit, cording KIT, is essential in the development of GIST. Imatinib mesylate (IM), an agent for chronic myeloid leukemia, was reported to inhibit tyrosine kinase activity of KIT and to be highly effective for GIST. We report, here, a case of huge gastric GIST who underwent neoadjuvant therapy followed by surgical resection. The patient was a 62-year-old man with GIST in cardia (KIT+, CD34+, mitotic rate 5/50 HPF), whose chief complaint was general fatigue. Because the huge tumor, 7.5 cm in size, directly invaded the pancreas, total gastrectomy with distal pancreatosplenectomy was necessary for curative resection. IM was administered (400 mg/body/day) as a neoadjuvant treatment for down-staging of the tumor. Leucopenia (grade 2) and diarrhea (grade 1) were observed as the adverse effects of IM. Partial response was obtained. He underwent proximal gastrectomy without pancreatosplenectomy since CT no longer showed direct invasion to the pancreas. Histological examination of the resected specimen revealed the extensive degeneration of the tumor, in which tumor cells containing condensed nuclei had decreased remarkably. Interestingly, mitotic rate decreased to 0/50 HPF in the effective area of the resected specimen, indicating that recurrent risk might be decreased. A part of the viable tumor cells, however, had the same feature to that in the biopsied specimen before treatment. The results suggest that the heterogeneity of GIST induces different sensitivity to IM. The postoperative course was uneventful and no sign of recurrence was observed 3 months after surgery. Neoadjuvant therapy with IM may become a useful strategy for GIST, as it reduces the tumor size and decreases the recurrence rate.

Antigens, CD34↗

PubMed1993

Neoadjuvant hormonal deprivation before radical prostatectomy.

Our experience with 40 patients receiving complete androgen blockade with luteinizing hormone-releasing hormone agonist and flutamide, prior to radical surgery, has shown a definitive decrease in prostate volume of 40-50%. This significant reduction in volume, induced by the neoadjuvant therapy, seems to facilitate the dissection of the prostate from closely vulnerable structures, with a reduction in blood loss (average 400 ml) and in time of surgery (average 135 min). Clinical downstaging was observed in one third of the patients, but the final pathological staging clearly showed that it is difficult to confirm this issue. Downgrading was not observed, but this is difficult to assess since the biopsies are not representative of the entire heterogeneous tumor. Prostate-specific antigen (PSA) dropped to undetectable levels in 59% of the patients 3 months after hormone suppression. Among these, 80% had pT2 and only 13% had pT3 tumors while there was 1 pT0 patient. Patients who still had a PSA of > 4 ng/ml after neoadjuvant therapy all had stage PT3-PT4 disease. Histological changes were observed in both the non-neoplastic tissue and the prostatic carcinoma, with effects being more marked in the latter. PSA, after 3 months of neoadjuvant hormone treatment, might have a useful predictive value in patient selection for radical surgery, since 86% of patients with undetectable PSA had tumors confined to the gland (pT2-B2). Large, prospective, randomized studies, comparing radical prostatectomy against radical prostatectomy with neoadjuvant complete androgen deprivation in locally advanced (T2-T3N0M0) prostatic carcinoma, are needed to assess the true influence of the combined approach on local control, time to progression and overall survival.

Aged↗

PubMed2006

Gigantic recurrent abdominal desmoid tumour: a case report.

Deeply seated fibromatosis or desmoid tumour (DT) is a rare entity characterized by benign proliferation of fibroblasts. Although non-malignant, this tumour can be life-threatening due to its invasive property and high recurrence rate. We report a unique case of a huge recurrent abdominal DT (36 cm in diameter, 25 kg in weight) that caused pressure necrosis and sloughing of the overlying anterior abdominal wall, and produced a large fungating mass protruding outside the abdomen. Although preoperative neoadjuvant therapies were all ineffective, radical surgical removal of the tumour was successful. The procedure was followed by an excellent clinical recovery and the patient is still alive with no evidence of recurrent disease after a 6-year follow-up. We recommend surgical removal of DT regardless of its size and in particular in cases where there is no or inadequate response to neoadjuvant therapy.

Adult↗

PubMed2000

Esophageal cancer.

Papers published in the English literature on esophageal cancer in 1999 were retrieved by a MEDLINE search. Selective publications were reviewed in light of current knowledge. Many studies were performed to refine staging methods of esophageal cancer, especially in the use of endoscopic ultrasound. Although better designs have overcome the problem of nontraversable tumors, its use in staging after neoadjuvant therapies remains suboptimal. Important studies on various surgical techniques were reported, including randomized trials on different routes of reconstruction after esophageal extirpation, and the updated results of transhiatal resections. In contrast to the minimalist approach of transhiatal resection, investigators from both East and West have also described the pathologic basis of lymphatic spread of esophageal cancer and its implications, favoring more radical lymphadenectomy. Another avenue that was explored is the use of neoadjuvant therapies to improve outcome. Different regimens were studied, and many papers focused on the molecular prediction of favorable response to such therapies. Overenthusiastic adoption of multimodality treatments is cautioned, however, in that they have not been validated. Further work is much needed in this area of research.

Journal Article↗

PubMed2006

[Trend in the management of pancreatic adenocarcinoma--Japan vs. US and Europe].

Pancreatic adenocarcinoma remains to have poor prognosis. Most of all patients have locally advanced disease with or without distant disease when diagnosed. Current rationale for the treatment of pancreatic adenocarcinoma in the US and European countries consists of the following formula: (1) accurate staging by improved imaging. (2) a balanced-resection which means not too extensive not too limited. (3) centralized treatment in high-volume center with minimal surgical mortality. (4) surgery alone is not enough for cure and need more radical adjuvant or neoadjuvant therapy. On the other hands, Japanese surgeons had challenged to improve outcome by radical resections but did not show their advantages in terms of survival benefit as shown in recent randomized controlled trials. Now we should look back to surgical role and think 'who can benefit by surgical resection'. The efficacy of "Japanese" radical resection including vascular resection or pancreatic nerve plexus resection should be evaluated, although the devise of novel diagnostic modalities and more effective adjuvant or neoadjuvant therapy are crucial to improve prognosis of this disease.

Adenocarcinoma↗

PubMed1986

Combined preoperative neoadjuvant radiotherapy and chemotherapy for anal and rectal cancer.

Neoadjuvant therapy combining 5-fluorouracil, mitomycin C, and moderate-dose radiotherapy was given preoperatively to 29 patients with adenocarcinoma of the rectum, 3 patients with squamous cell cancer, and 1 patient with basaloid carcinoma of the anus. Significant downstaging, and even eradication, of these lesions was realized in a high percentage of cases. Population-based data for the period of 1979 to 1984 which encompasses the time of our study indicate the survival of those treated by the neoadjuvant therapy was superior to that of patients treated by surgery alone or by surgery followed by radiotherapy. In general, patients with the poorest clinical presentation had been referred for this therapy.

Adenocarcinoma↗

PubMed2000

Differences between urologists in the United States and Canada in the approach to prostate cancer.

PURPOSE: We examine differences in screening, detection, staging and treatment of prostate cancer between urologists in the United States and Canada. MATERIALS AND METHODS: An anonymous questionnaire was developed and mailed to 700 randomly selected American and 350 Canadian urologists. The 7 domains of prostate cancer management comprised screening/case identification, radical prostatectomy indications, staging evaluations, neoadjuvant therapy, nerve sparing techniques, postoperative management and treatment of biochemical recurrence. The Dillman method of questionnaire administration was used. All data were stratified by country and analyzed using the generalized chi-square test. RESULTS: Surveys were adequately completed by 45% and 79% of American and Canadian urologists, respectively. Practice experience and clinical volumes were not significantly different between the 2 cohorts. Overall, there were few differences in prostate cancer screening, staging, postoperative management, biochemical failure and use of neoadjuvant therapy. However, practicing American urologists tended to pursue more aggressive case finding practices, such as a higher age cutoff for prostate specific antigen testing (p = 0.0001) and more frequent use of transition zone biopsies (p = 0.0001). American urologists also displayed a tendency toward more liberal indication for extirpative surgery. They were more likely to perform radical prostatectomy in men older than 70 years, those with higher prostate specific antigen and those with node positive disease. Among both national cohorts there was considerable variation in management patterns for all domains of prostate cancer. Variation was most common among treatment of patients with adverse pathological conditions (positive margins, seminal vesicle involvement) and postoperative biochemical failure. Even when credible evidence exists (biopsy technique, preoperative staging) significant proportions of urologists in both countries continued to practice contrary to existing data. CONCLUSIONS: American and Canadian practice patterns for prostate cancer differ significantly only in the domains of case identification and surgical indications. In addition, considerable intra-national variation in practice patterns exists. These data highlight the necessity to support randomized clinical trials in prostate cancer.

Canada↗

PubMed1995

[Preliminary results of the induction treatment in cases of NSCLC (stage III A and B)].

Up to 1994, we surgically treated for lung cancer, 1222 patients, selected from a total of 3157 observed cases. N.S.C.L.C. were 2891 and 899 of these were resected. Some neoadjuvant therapy has been applied in recent years to 170 patients: 83 of these were treated with CT (cisplatin, epirubicin and VP-16, in two cycles with a three week interval) and 41 had RT (30 Gy in daily fractions of 2); 16 patients had the two treatments in sequence. Radiation was mainly used for T problems, chemotherapy for management of N2; the sequence has so far been applied in selected cases. There have been 73 thoracotomies after a successful neoadjuvant, that is in more than 52% of the re-evaluated patients. Resection was possible in 32 of the RT-prepared patients, in 21 of the CT-prepared and in 8 who completed the double treatment: that means a resection was possible in 47% of cases. Because of the recent introduction of neoadjuvant therapy, late survival cannot be evaluated at present.

Carcinoma, Bronchogenic↗

PubMed1989

Neoadjuvant treatment in conservative surgery of peripheral sarcomas.

Twenty-five patients with soft-tissue and bony sarcomas of the head and neck and limbs were treated by local neoadjuvant therapy. It consisted of 90 mg of Adriamycin infused intra-arterially over 3 days into a vessel feeding the involved area and 30 Gy of radiotherapy given over 10 days; this was followed by a complete resection of the sarcoma 4 to 6 weeks later. All the tumors were associated with a high risk of local recurrence; eight were locally recurrent and the remainder were stage II to stage IV tumours. Serious local complications were seen in 4% of the patients. This rate compares well with other higher dose neoadjuvant regimens (35 Gy over 10 days), which are associated with a 35% local complication rate. Follow-up at a mean of 30 months demonstrated no local recurrence. All limbs were spared. Long-term morbidity was negligible. No effect on systemic control is suggested; only 63% of the patients were free of systemic disease. This report substantiates other similar experiences supporting neoadjuvant therapy followed by resection as the treatment of choice for local control of sarcomas.

Bone Neoplasms↗

PubMed2007

[MSCT for staging and response evaluation of esophageal cancer].

Squamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.

Esophageal Neoplasms↗

PubMed2004

A pilot study of neoadjuvant chemotherapy with mitomycin C, etoposide, cisplatin, and epirubicin for adenocarcinoma of the cervix.

BACKGROUND: To evaluate the efficacy and toxicity of the combination of mitomycin C, etoposide, cisplatin, and epirubicin (MEPA) as neoadjuvant therapy for patients with cervical adenocarcinoma. METHODS: Fourteen patients with cervical adenocarcinoma received neoadjuvant MEPA therapy followed by radical hysterectomy. The International Federation of Gynecology and Obstetrics stage was: IB1 in 2 patients, IB2 in 5, and IIB in 7. The MEPA regimen consisted of mitomycin C (15 mg/m2) on day 1, etoposide (70 mg/m2) on days 1 to 3, cisplatin (15 mg/m2) on days 1 to 5, and epirubicin (30 mg/m2) on day 1, with this course being repeated every 4 weeks. After two or three courses of chemotherapy, all patients underwent radical hysterectomy. Postoperative radiotherapy was given to 6 patients who showed risk factors at surgery. RESULTS: Of the 14 patients, 7 had complete remission (CR) clinically, 6 had partial remission, and only 1 showed no change. Examination of surgical material revealed no residual disease in 6 patients, and microscopic residual disease (<5 mm) in 2 patients. The patients who had no residual disease or microscopic disease in their hysterectomy specimens showed a significantly longer survival than those with macroscopic residual disease (P = 0.012). The dose-limiting toxicity was myelosuppression. Of the 33 treatment cycles administered, leukopenia of grade 3 or more occurred in 70%,and thrombocytopenia of grade 3 or more occurred in 79%. There were no therapy-related deaths. CONCLUSION: Although severe myelosuppression was also observed, there was a satisfactory response rate to MEPA therapy, which showed a good pathological CR rate.

Adenocarcinoma↗

PubMed1999

Quantitative changes in cytological molecular markers during primary medical treatment of breast cancer: a pilot study.

AIM: To quantify the changes in biological molecular markers during primary medical treatment in patients with operable breast cancer and to assess their possible relationship with response to treatment. METHODS: The treatment group consisted of 31 patients with operable breast carcinomas, median age 57 years (range 41-67), treated with four 3-weekly cycles of chemotherapy with Mitoxantrone, methotrexate (+/- mitomycin C), and tamoxifen before surgery. Fine needle aspiration (FNA) was used to obtain samples from patients prior to and at 10 or 21 days post-treatment. The following molecular markers were assessed: estrogen receptor (ER), progesterone receptor (PgR), p53, Bcl-2, and Ki67 measured by immunocytochemistry, and ploidy and S-phase fraction (SPF) by flow cytometry. To evaluate the reproducibility of the technique, repeat FNA was performed in a separate non-treatment control group of 20 patients and the same molecular markers assessed, two weeks after the first sample with no intervening treatment. RESULTS: The non-treatment control group showed a high reproducibility for the measurement of molecular markers from repeat FNA. In the treatment group there was a non-significant reduction in SPF and a significant reduction (p = 0.005) in Ki67. Patients who responded to neoadjuvant therapy were more likely to have a reduction in these two markers than those who failed to respond. Similarly, a reduction in ER scores was observed between the first and second samples (p = 0.04). For PgR, the change between the first and second samples was not significant although there was a significant difference between responders and non-responders (p = 0.03). All nine patients with an increase in PgR were responders. No significant changes in p53 or Bcl-2 were observed during treatment. CONCLUSION: Molecular markers can be adequately measured from FNA samples prior to and during neoadjuvant therapy. Changes in cellular proliferation and hormone receptors have been shown that may be related to tumour response. These relationships should be assessed in a larger cohort of patients.

Adult↗

PubMed2000

Clinical use of the self-expanding metallic stent in the management of colorectal cancer.

PURPOSE: This report describes our experience with the use of self-expanding metallic stents (SEMS) in the management of obstructing colorectal cancer. METHODS: A retrospective chart review of all patients undergoing placement of SEMS between May 1997 and January 2000 was performed. RESULTS: Insertion of SEMS was attempted in 12 patients. Successful stent placement was achieved in 10 of the 12 patients. The locations of lesions were hepatic flexure (2), splenic flexure (1), left colon (1), sigmoid colon (4) and rectum (4). The intended uses of SEMS were for palliation in 3 patients and as a bridge to elective surgery in 9. In the latter group, SEMS placement allowed for preoperative bowel preparation in 4 patients and administration of neoadjuvant therapy prior to elective surgery in 2 patients. One patient died prior to definitive surgery. Stent placement was unsuccessful in 2 patients. Three SEMS-related complications occurred; 1 stent migrated and 1 stent obstructed secondary to tumor ingrowth. One patient died 13 days after stent placement and colonic decompression. CONCLUSION: SEMS represent a useful tool in the management of obstructing colorectal neoplasms. As a bridge to surgery, SEMS provide time for a complete preoperative evaluation and a mechanical bowel preparation and may obviate the need for fecal diversion or on-table lavage. It may also allow for time to administer neoadjuvant therapy when indicated. As a palliative measure, SEMS can eliminate the need for an operation.

Adult↗