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PubMed1999

Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks.

BACKGROUND: Patent foramen ovale (PFO) is found in up to 50% of patients less than 55 years of age who have had a stroke. Therapeutic options include no therapy, antiplatelet therapy, warfarin and surgical closure of the PFO. OBJECTIVES: To determine the relative and attributable risks of PFO for recurrent cerebral ischemic events in young patients with stroke or transient ischemic attacks. The predictors of recurrent cerebral ischemic events and the effects of different therapies on recurrence rates were sought. DESIGN: Follow-up of a retrospective cohort of patients with cryptogenic stroke or transient ischemic attacks identified from an echocardiography database. SETTING: University-based regional neurology referral centre. PATIENTS: Consecutive group of 90 patients less than 60 years of age who underwent transesophageal echocardiography following a cryptogenic transient ischemic attack (TIA) or stroke (cerebrovascular accident [CVA]) between 1991 and 1997. INTERVENTIONS: Structured telephone interviews and chart reviews. RESULTS: Fifty-two patients had a PFO, and 38 patients did not have a PFO. During a mean follow-up of 46 months, 19 recurrent cerebral ischemic events (12 TIA and seven CVA) occurred in 14 patients with PFO, and eight recurrent events (three TIA and five CVA) occurred in six patients without PFO. The recurrence rates were 12% and 5%/patient/year in the PFO and control groups, respectively, for a crude recurrence rate ratio of 2.39 (95% CI 1.01 to 6.32, P < 0.03). The attributable risk of PFO in recurrent neurological events was 7%/patient/year. In a Cox regression model, predictors of recurrent neurological events were presence of PFO (hazard ratio 5.27, 95% CI 1.58 to 17.6, P < 0.007), history of migraine (hazard ratio 4.54, 95% CI 1.11 to 18.52, P < 0.035), hypertension requiring therapy (hazard ratio 3.5, 95% CI 1.33 to 9.01, P < 0.01), and antiplatelet or no therapy instead of warfarin therapy (hazard ratio 2.88, 95% CI 1.11 to 8.7, P < 0.04). Fourteen patients underwent surgical closure of PFO; there were no neurological recurrences during a mean follow-up of 43 months (crude incidence rate difference 12%/patient/year, 95% CI 6.6 to 17.9, P < 0.02). CONCLUSIONS: Patients with PFO had a significantly higher rate of recurrent cerebral ischemic events than those without PFO. Surgical PFO closure prevented any recurrences during a mean follow-up of 43 months. Warfarin was better than antiplatelet therapy or no therapy in preventing recurrences.

Adolescent↗

PubMedDate not supplied

Pattern of recurrence after esophageal resection for cancer.

BACKGROUND/AIMS: Surgery is still the main treatment option for esophageal cancer; however, long-term survival has remained poor, even when a curative operation is performed. The present study was undertaken to analyze the pattern and time of recurrence after a curative esophagectomy. METHODOLOGY: We studied 53 patients who underwent curative esophageal resection for cancer between 1985 and 1994. We examined number and pattern of recurrences, time after surgery, and any factor with contribution to carcinoma recurrence. RESULTS: During the follow-up period, 34 patients had tumor recurrence. The disease-free interval was 12.7 months (SD = 9.8). Twenty patients (58.9%) developed extrathoracic tumor recurrence and 23 patients (67.6%) intrathoracic. In 3 cases an esophageal stump recurrence was presented. Thirteen patients were considered for palliative treatment after recurrence. The 5-year survival rate was 13%, with median survival time between recurrence and death, 4.1 months. The recurrence of disease was always before 40 months after surgery. Any significant difference related with recurrence was observed between the analyzed factors. CONCLUSIONS: The majority of recurrences are developed before 2 years. Neoplastic recurrence is most common at the mediastinum. Palliative treatments after recurrence do not modify the progression of tumor.

Adult↗

PubMed2000

Vulvar squamous cell carcinoma. Prognostic factors for local recurrence after primary en bloc radical vulvectomy and bilateral groin dissection.

OBJECTIVE: To evaluate clinical prognostic factors for local recurrence of vulvar squamous cell carcinoma after primary surgical treatment. STUDY DESIGN: Of 104 patients treated for squamous cell carcinoma of the vulva in an 11-year period (1987-1997) at the Portuguese Cancer Institute, we selected for study 56 patients who meet the following criteria: (1) International Federation of Gynecology and Obstetrics (FIGO) stage Ib-IVa, (2) primary treatment of en bloc radical vulvectomy and bilateral groin dissection, and (3) follow-up reports. Files were retrieved for retrospective analysis. Fifteen patients (26.8%) had local recurrence at the fifth year. At the 24th month, 11 patients had local recurrence, and 31 were in follow-up, without recurrence. We evaluated age at initial diagnosis, date of surgical treatment, tumor size, results of tumor macroscopy, histologic differentiation, groin lymph node status, FIGO stage, resection limits, adjuvant radiotherapy, duration of stay, associated vulvar skin disease, date of detection of recurrence, site/sites of recurrence and follow-up status at the 24th month after surgical treatment between the 11 patients with local recurrence and 31 in follow-up without recurrence. RESULTS: The 11 patients with local recurrence had a significant initial FIGO stage, IVa (P = .049) and a significant association with the number of groin lymph nodes containing metastasis in comparison to the 31 patients without local recurrence. No other statistically compared data were significant. CONCLUSION: These results suggest that vulvar squamous cell carcinoma local recurrence after a primary surgical procedure is related to poor tumor prognostic factors (number of groin nodes containing tumor metastasis and FIGO stage IVa). On multivariate analysis, the presence of metastasis in two or more groin nodes was a powerful factor related to local recurrence. Postoperative radiotherapy to the vulva for such patients with a high risk of local recurrence is advisable.

Adult↗

PubMed2002

Outcome of surgical treatment of isolated local recurrence after radical nephrectomy for renal cell carcinoma.

PURPOSE: Isolated local recurrences after radical nephrectomy for renal cell carcinoma occur in 2% to 3% of cases. Today local recurrences can be detected at an early stage due to modern imaging techniques. It remains controversial whether an aggressive surgical approach to this problem can prolong survival. MATERIALS AND METHODS: We retrospectively analyzed 16 patients who were treated surgically at our institution for suspected isolated local renal cell carcinoma recurrence during the last 10 years. All patients had undergone extensive staging and had no evidence of distant metastases with the local recurrence. Surgical exploration confirmed carcinoma recurrence in 13 of the 16 cases and all 13 patients underwent complete resection of the local recurrence. Three patients were found to have had false-positive computerized tomography findings on surgical exploration. RESULTS: Mean time to recurrence was 45.5 months (range 7 to 224). Only 2 patients were symptomatic, while in 11 disease had been detected at routine followup. Mean size of the recurrent tumor was 5.92 cm. (range 2 to 10). All patients survived surgery without major complications. Of the patients 7 died of metastatic disease after a mean survival of 23.1 months (range 4 to 68) following recurrence removal and 6 are alive with a mean survival of 53.0 months (range 18 to 101) (p = 0.09). Time to recurrence after nephrectomy was significantly longer (p <0.05) and size of recurrence significantly smaller (p <0.04) in the patients still alive. In 1 surviving patient evidence of metastatic disease developed 9 months after surgery for recurrence. CONCLUSIONS: Careful followup after radical nephrectomy for renal cell carcinoma allows the diagnosis of small local recurrences before they become symptomatic in the majority of cases. Although most of these patients will eventually have and die of metastatic disease, an aggressive surgical approach is justified and can result in prolonged survival.

Aged↗

PubMed2002

Factors predictive of recurrence of retinal tumors, vitreous seeds, and subretinal seeds following chemoreduction for retinoblastoma.

OBJECTIVE: To identify the clinical features of eyes with retinoblastomas that predict the recurrence of retinal tumors, vitreous seeds, and subretinal seeds following treatment with chemoreduction. DESIGN: Prospective nonrandomized single-center clinical trial. SETTING: Ocular oncology service at Wills Eye Hospital of Thomas Jefferson University (Philadelphia, Pa) in conjunction with the division of oncology at Children's Hospital of Philadelphia. PARTICIPANTS: There were 158 eyes with 364 tumors in 103 consecutive patients with retinoblastoma managed with chemoreduction between June 1994 and August 1999. INTERVENTION: All patients received treatment for retinoblastoma with 6 cycles of chemoreduction using vincristine, etoposide, and carboplatin combined with focal treatment (cryotherapy, thermotherapy, or plaque radiotherapy) for each retinal tumor. MAIN OUTCOME MEASURES: The 3 main outcome measures included recurrence of retinal tumors, recurrence of vitreous seeds, and recurrence of subretinal seeds. The clinical features at the initial examination were analyzed for their association with the main outcome measures using a series of Cox proportional hazards regressions. RESULTS: All retinal tumors, vitreous seeds, and subretinal seeds showed an initial favorable response of regression during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurrence per eye was found in 37% of eyes at 1 year, 51% at 3 years, and no further increase at 5 years. By multivariate analysis, the only factor predictive of retinal tumor recurrence was the presence of tumor-associated subretinal seeds at the initial examination. Of the 54 eyes that had vitreous seeds at the initial examination, vitreous seed recurrence was found in 26% of eyes at 1 year, 46% at 3 years, and 50% at 5 years. By univariate analysis, the only factor predictive of vitreous seed recurrence was the presence of tumor-associated subretinal seeds at the initial examination. Of the 71 eyes that had subretinal seeds at the initial examination, subretinal seed recurrence was detected in 53% of eyes at 1 year, 62% at 3 years, and no further increase at 5 years. By multivariate analysis, factors predictive of subretinal seed recurrence included a tumor base greater than 15 mm and a patient age of 12 months or younger at diagnosis. There were no patients who developed retinoblastoma metastasis, pinealoblastoma, or second malignant neoplasms. CONCLUSIONS: Chemoreduction combined with focal therapy is effective for selected eyes with retinoblastomas. Eyes with subretinal seeds at initial examination are at particular risk for recurrence of retinal tumor and vitreous seeds. Younger patients with large tumors are at risk for recurrence of subretinal seeds. Retinal tumor and subretinal seed recurrence seems to manifest within 3 years of follow-up. Close follow-up of all patients treated with chemoreduction is warranted.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Predictors of postoperative diffuse intrahepatic recurrence of hepatocellular carcinoma.

BACKGROUND/AIMS: Diffuse intrahepatic recurrence of hepatocellular carcinoma in the liver remnant carries an extremely poor prognosis compared with other recurrence patterns. We studied the predictors of this type of recurrence. METHODOLOGY: We determined the risk factors for recurrence and predictors of long-term post-recurrence survival using the Cox's proportional hazard model. We divided 106 patients with recurrent intrahepatic hepatocellular carcinoma into 3 groups based on the number of nodules, and compared clinicopathologic features to determine which risk factors were associated with the diffuse intrahepatic recurrence pattern. RESULTS: An elevated alpha-fetoprotein concentration, invasive nodular- or massive-type hepatocellular carcinoma, intrahepatic metastasis, the presence of macroscopic ductal invasion, and the lack of a capsule predict diffuse intrahepatic pattern of recurrence. Patients who have three or more of these five factors, are poor candidates for hepatic resection because the likelihood of diffuse intrahepatic recurrence is great, and post-recurrence survival is worse than that with solitary or multiple intrahepatic recurrence. CONCLUSIONS: It is possible to reduce the risks of cancer recurrence at the time of primary resection. It is important to predict the pattern of early diffuse intrahepatic recurrence. In candidates with a poor prognosis, adjuvant therapy or transplantation should be considered.

Adult↗

PubMed2004

[Rescue operations of the recurrent nasal and paranasal sinus neoplasms].

OBJECTIVE: To investigate the symptoms, factors relating to recurrences, the styles of the rescue operation and the reconstructive methods of the surgical defects in patients with recurrent nasal and paranasal sinus neoplasms. METHODS: Excluding the primary neoplasm, only patients with recurrent tumors and suitable for rescue operations entered the group. Kaplan-Meier method was used to estimate the survival probability. RESULTS: Twenty-five patients receiving rescue operations from 1993 to 2002 who met the above inclusion criteria were reviewed. The age ranged from 13 - 66 years. All the patients had once surgery or radiation therapy at least. The time between the last treatments and the recurrences ranged from 2 weeks to 46 months. 80 per cent of the recurrences were within the first 2 years after the last therapy. The recurrent symptoms included headache (10 patients), eminences in or around the operation fields (9 patients), diminution of vision (7 patients), and so on. The patients were followed 1 to 65 months. There were no patients died during the rescue operations. Five patients were alive without recurrences and 3 alive with local or regional recurrences. Thirteen died of local recurrences and 1 died of metastasis to lung. The one-year, 2-year and 3-year survival rate were 62.5%, 43.7% and 29.1%, respectively. The median survival time was 18 months. Complications included cerebrospinal rhinorrhea (3 patients), central diabetes insipidus (1 patient) and necrosis of part of the flap (1 patient). CONCLUSIONS: Most of the local recurrences occur within 2 years after the last therapies. The recurrent symptoms are commonly headache and eminences in or around the operation fields. The recurrences are closely related to pathological types and differential degrees of the neoplasms. The reasonable and timely combined treatment may help to decrease the frequencies of the recurrences. The rescue operations with effective methods can improved the patients' life qualities and lengthen their life spans. The main complications are cerebrospinal rhinorrhea most of which can be cured by conservative treatment.

Adolescent↗

PubMed2005

IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage.

Most patients with IgA and/or IgG subclass deficiency are asymptomatic but some may suffer from frequent mainly respiratory infections. The aim of our study was to determine the frequency of IgA and/or IgG subclass deficiencies and the rate of chronic pulmonary damage secondary to recurrent pulmonary infections in these children. Serum IgA and IgG subclass levels were measured in 225 children aged 6 months to 6 years with recurrent sinopulmonary infections (44 with recurrent upper respiratory tract infections, 100 with recurrent pulmonary infections and 81 with recurrent bronchiolitis). In order to determine chronic pulmonary damage due to recurrent infections in patients with recurrent pulmonary infections CT scans of thorax were also obtained. The overall frequency of antibody defects was found to be 19.1%. IgA deficiency was observed in 9.3%, IgG subclass deficiency in 8.4% and IgA + IgG subclass deficiency in 1.4%. The prevalance of IgA and/or IgG subclass deficiency was 25% in patients with recurrent upper respiratory tract infections, 22% in patients with recurrent pulmonary infections and 12.3% in patients with recurrent bronchiolitis (p>0.05). Chronic pulmonary damage in lungs was determined radiologically in 17 of 100 cases with recurrent pulmonary infection. In IgG subclass deficiencies sequel changes, although not statistically significant, were observed five times more frequently than that of IgA deficiencies. CT scans revealed pulmonary sequels in 5 of the 22 (22.7%) patients with recurrent pulmonary infections and immunodeficiency (bronchiectasis in 2 patients with IgG3 deficiency, fibrotic changes in one with IgA deficiency and in one with IgG3 deficiency, bronchiolitis obliterans in one with IgG2 + IgG3 deficiency). On the other hand, pulmonary sequels were observed in 12 patients (15.4%) with normal immunoglobulin levels. Eight of them were bronchiolitis obliterans, 2 of them were atelectasia and 1 of them was bronchiectasia. We therefore suggest that determination of antibody levels and evaluation of pulmonary alterations is crucial in patients with recurrent sinopulmonary infections since the deficiency of antibodies is associated with a greater pulmonary damage.

Bronchiolitis↗

PubMed2006

[The long-term prognosis of locally recurrent breast cancer after breast conserving treatment].

OBJECTIVE: To study the long-term prognosis of patients with locally recurrent breast cancer following breast-conserving treatment. DESIGN: Descriptive. METHOD: Data were collected on 266 patients in 11 Dutch centres; in these patients, an isolated local recurrence of an infiltrating mammary carcinoma for which they had received breast-conserving treatment was diagnosed before January 1st, 1994. The median age was 45 years (range 16-81) at the time of treatment of the primary tumour and 49 years (range 17-82) at the time of diagnosis of the local recurrence. The patients were followed through December 2002. The median follow-up after local recurrence of those patients who were still alive was 11.2 years. RESULTS: Of the 226 patients with an infiltrating local recurrence, 148 (65%) had died and 145 (64%) had developed distant metastases. Of the metastases, 61% appeared within 2.5 years and 87% within 5 years after treatment of the local recurrence. 10 years after treatment of the local recurrence, the overall survival rate was 39% (95% CI: 32-46) and the distant metastasis-free survival rate was 36% (95% CI: 29-42). The prognosis of patients with a local recurrence occurring at a different site in the breast was the same as that of patients with a local recurrence < or = 1 cm in diameter occurring at or near the original tumour site. Both of these groups had a better prognosis than patients with a recurrence larger than 1 cm at the site of the original tumour or patients with a diffuse recurrence. CONCLUSION: Almost two-thirds of the patients with an invasive local recurrence following breast-conserving surgery for invasive breast cancer developed distant metastases. Both the exact location in the breast and the size of the local recurrence appeared to be predictors of the risk of subsequent metastatic disease.

Adolescent↗

PubMed2006

Experience of 100 surgical cases of encapsulating peritoneal sclerosis: investigation of recurrent cases after surgery.

Since 1993, we have performed enterolysis for encapsulating peritoneal sclerosis (EPS) in 86 patients. Five patients died after surgery, but the remaining 81 patients achieved symptomatic improvement. However, some of the surviving patients developed symptoms of intestinal obstruction after several months, and EPS recurrence remains our greatest challenge. In the present study, we identified factors related to recurrence by clinically comparing 47 recurrent and nonrecurrent patients that we were able to follow for more than 2 years after surgery. In the 47 patients we followed, 11 (23.4%) experienced recurrence, and 10 of those patients underwent a second surgery. Four patients needed a third surgery. The mean time to recurrence was 15.2 months, and all patients with recurrence, except one, experienced their recurrence within 20 months. We observed no differences between the recurrent and nonrecurrent patients in follow-up period, age, history of peritoneal dialysis, use or nonuse of steroids after surgery, thickness of the submesothelial compact zone, or inflammatory cell infiltration. However, the number of microvessels was significantly higher in the recurrent patients. Our surgical experience with EPS shows recurrence in approximately 23% of patients. The results of the present study suggest that peritoneal microvascular hyperplasia is a factor involved in recurrence, and that patients with recurrence may have an irreversible pathologic condition and may experience repeated recurrences.

Adolescent↗

PubMed1992

Patterns of recurrence after curative resection of carcinoma of the colon and rectum.

Data on 818 patients who had undergone curative resection for Dukes' B2 or Dukes' C carcinoma of the colon and rectum were analyzed to determine the timing and patterns of recurrence based on such tumor characteristics as location, Dukes' stage, grade, ploidy and the presence of obstruction, perforation or adherence to adjacent organs or tissues. Three hundred and fifty-three patients (43 per cent) had recurrent disease. There was recurrence in 52 per cent of patients with carcinoma of the rectum and in 40 per cent of patients with carcinoma of the colon. The median time to recurrence for all patients was 16.7 months, with a range from 1 month to 7.5 years. Dukes' C lesions and the presence of adhesion or invasion, or both, or perforation were associated with significantly earlier recurrence. Among patients with recurrence, the most frequent sites were hepatic in 33 per cent, pulmonary in 22 per cent, local or regional, or both, in 21 per cent, intra-abdominal in 18 per cent, retroperitoneal in 10 per cent and peripheral lymph nodes in 4 per cent. Rectal primary sites, when compared with colonic, had proportionally more local or regional, or both, recurrences (p = 0.00003) and fewer involving retroperitoneal nodes (p = 0.022). Both primaries of the rectum and colon at stage C, when compared with stage B, had fewer local or regional recurrences, or both (p = 0.01), but a greater tendency to involve retroperitoneal or peripheral nodes. Primaries of the colon with adhesion to, or invasion of, adjacent organs had a lesser tendency to pulmonary metastasis (p = 0.036). Whereas the grade of anaplasia and ploidy had a strong influence on the rate of recurrence, they did not influence timing or patterns of recurrence. Patterns of recurrence based on the characteristics of the tumor may facilitate selection of the most appropriate adjuvant procedures, particularly those directed toward local or regional recurrence, or both, and also may guide efforts at early recognition of recurrence.

Adenocarcinoma↗

PubMed1988

[Distribution of recurrent lesions after radical resection of cancer of the thoracic esophagus].

In 150 patients who got cancer recurrence after curative resection for cancer of the thoracic esophagus, the sites where recurrent lesions were clinically detected for the first time were examined. The distribution of recurrent lesions in patients who did not undergo neck dissection at the operation (group A) differed from the distribution in those who underwent neck dissection (group B). Cervical and/or upper mediastinal recurrence occurred in 49% of cases in group A and in 11% of group B. On the contrary, middle or lower mediastinal recurrence was more often in group B. The distribution of recurrent lesions varied depending on the state of lymph node metastasis detected at surgery. Cervical and upper mediastinal recurrence was much more frequent than hematogenic recurrence in cases without lymph node involvement in group A, while hematogenic recurrence was more frequent in cases with both mediastinal and abdominal lymph node metastasis. In the upper mediastinum, recurrence along the recurrent laryngeal nerves was most frequent and it was supposed to have developed from residual lymphatic metastases. In the middle and lower mediastinum, recurrent lesions were located around the left main bronchus and descending aorta, and cancer infiltration of the neighboring organs was frequent. Recurrence at the abdominal paraaortic nodes was observed mainly in cases with perigastric lymph node involvement.

Esophageal Neoplasms↗

PubMed1985

Recurrence of intrathoracic esophageal cancer.

We have investigated the site of recurrence after resection of esophageal cancer in a total of 147 cases, which were examined and classified according to the site as follows: lymph nodes, organs, local sites, remnant of the esophagus, and peritoneum. The highest incidence of recurrence was 40% in both lymph nodes and organs. Recurrence was found frequently in the cervical and upper mediastinal lymph nodes. Careful examination should be made in the abdominal paraaortic lymph nodes. As for recurrence in organs, high rates were observed in lung, liver and bone; 70% of the recurrences in these organs were combined with simultaneous metastasis in other organs. In our examination of autopsied cases with local recurrence, the cancer was revealed as a tumor mass covering extensively each side of the posterior mediastinum. At the same time pleural dissemination was frequently observed. In the cases involving recurrence in the remnant esophagus, the disease-free interval was about 18 months--longer than the interval before recurrence in any other site. Peritoneal recurrence appeared in the patients with middle thoracic esophageal cancer. The prognosis following recurrence was extremely bad, with only a few exceptions: the survival period after recurrence was 8 months if it was in the lymph nodes, and an average of 4 months for other types of recurrence. The survival period was only 2 months after peritoneal recurrence.

Adult↗

PubMed1995

[A comparison between flecainide and sotalol in the prevention of recurrences of paroxysmal atrial fibrillation].

OBJECTIVES: Aim of the present study was to assess the efficacy and safety of flecainide (F) and sotalol (S) for the prevention of recurrences of paroxysmal atrial fibrillation (PAF). METHODS: Sixty-six patients with PAF (> or = 3 episodes of atrial fibrillation in the last year) in sinus rhythm, were randomized to pharmacological oral treatment with F (20 patients-Group A), with S (20 patients-Group B) and placebo (P) (26 patients-Group C). During the follow-up (one year duration) were evaluated on I, III, VI and XII months the number and tolerance of the atrial fibrillation recurrences, cardiac and/or noncardiac side effects. The patients with more than two recurrences in the same follow-up interval withdrew from the study. In each patient 14 clinical and laboratory variables were evaluated. RESULTS: After 12 months were arrhythmia-free respectively 70% of Group A patients, 60% of Group B patients, 27% of Group C patients. Univariate analysis showed that treatment with F was related to decrease of atrial fibrillation recurrences (one recurrence 67%, two recurrences 81%, three recurrences 81%), treatment with S was related to decrease of recurrences (two recurrences 59%); the variable most significantly related to the risk of arrhythmia recurrence is the higher value of basal cardiac rate (one recurrence t = 2.15, two t = 2.22, three t = 2.96, four t = 2.06). There was not statistically significant difference in maintenance of sinus rhythm at the end of the follow-up between the groups of patients on F and S (p = 0.163); treatment efficacy was significantly higher than P (p = 0.002). Multivariate analysis showed that treatment with F and S decreases the risk of arrhythmia recurrence respectively of 85% and 76% versus placebo at the end of the follow-up. The incidence of cardiac and/or noncardiac side effects was not clinically significant. CONCLUSION: F and S are both effective and safe for prevention of PAF, with 70% and 60% respectively of patients arrhythmia-free after 12 months of treatment. Side effects were common, but clinically significant adverse events were uncommon. A higher value of basal cardiac rate was predictive of atrial fibrillation recurrences in the patients during treatment.

Adult↗

PubMed1995

[Locoregional recurrences of breast cancer].

AIM OF THE STUDY: To determine the characteristics of 51 cases of isolated local regional breast cancer recurrence. METHODS: Retrospective study from 1980 to 1992, survival calculated according to Kaplan-Meier and log-rank test. RESULTS: Twenty-five patients had had a conservative treatment of her primary tumour, 26 had been treated by modified radical mastectomy. Local regional recurrence rate was 9%: 44% of recurrences after lumpectomy and 43% of recurrences after mastectomy occurred within 2 years after the initial treatment. Site of local regional recurrence was chest wall only (16 cases), breast only (15 cases) or axillary or supraclavicular node with or without chest wall or breast involvement (20 cases). The actuarial 5-year survival rate after recurrence is 54%. It depends on the time to recurrence (40% if time to recurrence was less than 2 years, 68% if more than 2 years, p < 0.10), on initial node involvement (36% for N+, 71% for N-, p < 0.15) and on the site of recurrence (chest wall: 43%; breast: 48%; regional node: 12%, p < 0.10). CONCLUSION: Like in the literature, severe recurrences are early recurrences, lymph node recurrences and recurrences following a primary tumour with involved axillary nodes.

Actuarial Analysis↗

PubMed1995

[Recurrent aphthous stomatitis: current etiopathogenetic and therapeutic concepts].

The authors review the literature on aetiopathogenesis and therapeutic management of recurrent aphthous stomatitis. The data regarding the role of genetic, nutritional and microbiological factors in the genesis of recurrent aphthous stomatitis has been particularly examined. Despite significant associations with some antigens HLA have been reported in Southern Europe, there is no clear genetic predisposition in recurrent aphthous stomatitis. Several studies have analyzed the importance of iron, folic acid and vitamin B12 deficiencies, gluten intolerance and sensitivity to certain foods in the triggering of recurrent aphthous stomatitis however the results have been controversial. Recently, it has been suggested that recurrent aphthous stomatitis could be caused by reactivation of varicella-zoster virus and/or cytomegalovirus but these viruses may be reactivated by the immunodysregulation known to underlie recurrent aphthous stomatitis. Moreover, antiviral drugs appear to have only an equivocal effect on recurrent aphthous stomatitis. Recurrent aphthous stomatitis is probably determined by immunological mechanisms although there actually no unifying hypothesis which attempt to integrate the results of the many immunologic studies on recurrent aphotous stomatitis. Moreover, the target antigen and the cause of recurrences of recurrent aphthous stomatitis are still unknown. As far as the management of this disease it is important to recognize recurrent aphthous stomatitis secondary to systemic diseases like Behcet's syndrome, gluten enteropathy and haematinics deficiencies. Subsequently, the symptoms can be reduced with several drugs (mainly topical corticosteroids) but there are no effective therapies preventing recurrences.

Adjuvants, Immunologic↗

PubMed1997

Outcomes of patients with local recurrence of cutaneous malignant melanoma: a population-based study.

BACKGROUND: The definition of local recurrence of cutaneous malignant melanoma varies. The outcomes of patients with a local recurrence reported in the literature also vary, but the appearance of a local recurrence has generally been considered a negative prognostic sign. Few studies have been population-based thus far. METHODS: During the period 1976-1997, 3706 patients with cutaneous malignant melanoma (including 575 patients with melanoma in situ) were registered in a population-based regional cancer registry. Local recurrence was defined as a recurrence within the scar or transplant with no signs of regional or distant spread of the disease. Prognostic factors were investigated using univariate and multivariate analytic techniques. The prognostic importance of a local recurrence in terms of survival was analyzed using the Cox proportional hazards regression model, with local recurrence as a time-dependent covariate. RESULTS: Local recurrence as a first event was rare (occurring in 48 of 3706 patients, or 1.3%). Twenty-eight percent (11 of 39) of the patients with local recurrence of invasive primary melanoma developed distant metastases and subsequently died. Only ulceration had prognostic significance in univariate analysis. A Cox analysis, with melanoma death as the endpoint and local recurrence as a time-dependent covariate, demonstrated a relative risk of 1.3 associated with local recurrence; however, this was not statistically significant (confidence interval, 0.7-2.3). CONCLUSIONS: In this population-based study, local recurrence was a rare event. The outcomes after diagnosis were relatively favorable. The results did not indicate a major detrimental effect on survival from the local recurrence per se.

Adolescent↗

PubMed1998

[Treatment of hepatic recurrence after resection of hepatocellular carcinomas].

Between October 1990 and December 1995, 86 patients underwent hepatic resection for hepatocellular carcinoma (HCC). All resections were carried out with the aim of achieving complete cure. Fifty one (60%) of these patients subsequently developed recurrent HCC. Only twenty patients could be treated in our hospital. There were 18 men and 2 women, with a mean age of 61 years at the time of recurrence. Six patients had a normal liver. Fourteen patients had associated liver cirrhosis. using Pugh's classification, 7 patients were Pugh A, 6 Pugh B and 1 Pugh C. The initial hepatic resection had consisted of major hepatectomy in 9 cases and segmentectomy in the remaining 11 patients. The mean time to recurrence was 17 months. There were 3 recurrences on the resection margin and 17 recurrences away from the hepatic stump. The therapeutic choice after hepatic recurrence was based on the number of tumors, hepatic function and the size of the liver remnant. Six patients were treated by tamoxifen due to poor hepatic function; median survival after recurrence was 6 months. Four patients with a single recurrent tumor on an atrophied liver remnant were treated by percutaneous ethanol injection with a median survival after recurrence of 15 months. Five patients with multiple diffuse lesions and good hepatic function were treated by transarterial chemoembolisation with a median survival after recurrence of 30 months. Five patients with a solitary tumor and good hepatic function underwent a second hepatic resection with a median survival after recurrence of 35 months. The overall median survival after diagnosis of recurrence was 20 months. These results suggest that an active treatment should be carried out in cases of recurrence of HCC. A second resection, if technically possible, offers the best chance of survival.

Adult↗