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At least 667 records · Page 37Linked to original sources
PubMed1991

An evaluation of the clinical usefulness of CEA in colorectal cancer.

Carcinoembryonic antigen is the most common tumor marker in use today. Plasma CEA has no role as a screening tool for large patient populations but does correlate with tumor stage, prognosis, and extent of surgical resection for individual patients. Serial monitoring of plasma CEA levels can detect tumor recurrence prior to clinical or radiologic evidence of disease. An elevated or progressively rising post-operative CEA level is a definite indication for surgical reexploration, with the intent to surgically resect locally recurrent or metastatic disease. Finally, anti-CEA antibodies may be used in the future to improve preoperative staging and to treat colorectal carcinoma.

Carcinoembryonic Antigen↗
PubMed1990

[Results of the treatment of laryngeal cancer by a conventional method].

The authors described the results of 3-, 5-, and 10-years survival rate after conventional radiotherapy in laryngeal cancer patients in connection to localization and clinical development (International classification). The 3 years survival rate was found in 61% of patients, 5 years in 51.6% and 10 years in 38%. The best results were found in I and II stage of clinical development, and in glottic localization. In case of recurrencies after radiotherapy the surgery was applied. These procedures elongated the survival rate of 6-10%.

Epiglottis↗
PubMed1989

[Local recurrence and metastasis of thin malignant melanomas (less than or equal to 1mm)].

A total of 704 patients with malignant melanoma (MM) were documented in our clinical registry at the Department of Dermatology in Berlin from 1969 to 1987. At the time of first diagnosis 631 patients in this group were found to have clinical stage I disease, and complete histological reports were available for 516 of these cases. Of the 516 patients, 191 had thin MM (less than or equal to 1 mm) and in 10% of this group local recurrences or distant metastasis were seen. Nevertheless, recurrences were delayed in patients with thin MM compared with those with thicker MM (greater than 1 mm) (mean: thin MM 37 months, thicker MM 17 months), and patients with thin MM died of distant metastasis after longer time periods (mean: thin MM 67 months, thicker MM 33 months). The thinnest tumours followed by distant metastasis and death measured 0.40 mm and 0.45 mm in male and 0.63 mm and 0.72 mm in female patients. For thin MM, wide surgical total excision with safety margins (3-5 cm) was performed in 151/191 patients. No local recurrences were observed in this group, but primary lymphogenous and/or haematogenous metastasis was recorded in 12 patients (= 8%). Narrow surgical excision (less than or equal to 1.5 cm safety margin) was performed in 37/191 patients with thin MM; 6 patients (= 16%) in this group developed local recurrences, and in 2 of those lymphogenous or haematogenous metastasis occurred later. Another patient in this group showed primary haematogenous metastasis. Of 6 patients with local recurrences, 1 died of MM 13 years after the first diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1989

The role of combined composite resection and irradiation in the management of carcinoma of the oral cavity and oropharynx.

Squamous cell carcinoma of the oral cavity and oropharynx can invade the mandible requiring an "en bloc" or composite resection. With this procedure alone, reported local control rates for advanced stage tumors have been suboptimal suggesting the need for adjuvant therapy. The treatment records of 35 patients were reviewed who were treated with composite resection alone, composite resection plus radiotherapy, or composite resection as a salvage procedure for a primary treatment failure. Combined irradiation and composite resection resulted in a higher local control than patients receiving composite resection alone (72% vs. 43%). There was no difference in complication rates between these two treatment groups. Composite resection as a salvage procedure resulted in local control in 38% of patients through this was associated with a 64% rate of complications. This data and a review of the literature suggest that tumors of the oral cavity and oropharynx with extension to the mandible requiring composite resection probably represent a category of tumors with a high risk of local recurrence and may benefit from adjuvant irradiation.

Aged↗
PubMed1999

Ipsilateral breast tumor recurrence following breast-conserving surgery for early-stage invasive cancer.

Ipsilateral breast tumor recurrence (IBTR) following conservative surgery and radiation for early stage invasive cancer occurs in approximately 15% of all patients at 10 years and is diminished with surgical excisions which achieve negative margins. Treatment strategies of breast-conserving surgery with or without radiation that result in IBTR rates of 30 40% will impact negatively on survival and the magnitude of this effect will be influenced by the predominant pattern of local failure as well as initial and subsequent distant metastases. Optimal local control in early-stage invasive breast cancer is important to minimize the risk of a salvage mastectomy and maximize the potential for long-term survival.

Breast Neoplasms↗
PubMed2001

The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer.

OBJECTIVE: The use of extraperitoneal surgical staging prior to treatment in patients with bulky or locally advanced cervical cancer allows the detection and treatment of disease beyond the standard pelvic radiation fields. This study was conducted to evaluate the impact of extraperitoneal surgical staging in the treatment and outcome of patients with locally advanced cervical cancer. METHODS: 51 patients with locally advanced cervical cancer treated between 1985 and 1998 were retrospectively reviewed. Information on morbidity, usefulness, and results of surgery and patterns of disease recurrence were obtained. Survival distributions were calculated by the Kaplan-Meier product limit method and compared with the log-rank test. RESULTS: All 51 women were surgically staged by an extra-peritoneal approach. Preoperative CT scans (n=27) when compared with surgical findings showed sensitivity for pelvic and para-aortic lymph node metastasis of 39%, specificity of 88%, positive predictive value of 39% and negative predictive value of 88%. Lymph node metastases were found in 30/51 patients (59%). There were no significant treatment delays or surgical morbidity as a result of extra-peritoneal surgical staging. In 21 patients (41%), the highest level of involved nodes was in the pelvis and they were treated with pelvic radiation. The para-aortic nodes were involved in nine patients (18%) and were treated with extended field radiation. All patients also received concurrent radiosensitization with chemotherapy. The estimated survival for the entire group was 60% at 5 years. For node negative patients, estimated 5-year survival was 67% while it was 54% for all node positive patients (p=0.17). Analysis according to anatomic site of involved nodes showed that the estimated 2-year and 5-year survival for those with pelvic nodal involvement was 81% and 64%, respectively. However, in the group of nine patients with para-aortic nodal disease, the estimated 2-year survival was 44%. Five (56%) were dead of disease with a median time to death of 16.0 months and four patients (44%) were alive with a median duration of follow up of 16.1 months. There was a statistically significant difference in survival for the group of patients with positive pelvic nodes only compared to the group with positive para-aortic nodes (p=0.03). The estimated 5-year survival by FIGO stage was 80%, 70% and 51% for stages Ib, II, III, disease, respectively. Factors that did not significantly affect survival included age, histology and type of chemotherapy. CONCLUSIONS: Pre-therapy extra-peritoneal surgical staging resulted in treatment modification in 18% of patients with locally advanced cervical cancer. The morbidity from surgery and subsequent radiation therapy was acceptable. The procedure is recommended to allow for individualization of treatment in patients with local-regional cervical cancer.

Adult↗
PubMed1999

Squamous cell carcinoma of the buccal mucosa.

The purpose of this study was to establish treatment criteria for patients with early-stage squamous cell carcinoma of the buccal mucosa. Thirty-one patients were analyzed in a retrospective fashion. Distribution of patients according to tumor stage was relatively even. Within 5 years recurrent disease developed in nearly 80% of evaluable patients. There was a 100% overall incidence of local disease recurrence for patients with stage I and II tumors treated with wide local excision alone and followed up for more than 2 years. On the basis of these data, we conclude that wide local excision for early-stage buccal carcinoma is associated with a high local failure rate. Possible causes for failure and alternative treatment approaches are discussed.

Adult↗
PubMed2003

The effect of waiting time on local control and survival in head and neck carcinoma patients treated with radiotherapy.

PURPOSE: To determine the influence of waiting time for radiotherapy on local control and survival in a cohort of patients with head and neck carcinoma of different locations and stages treated with radiotherapy. MATERIAL AND METHODS: Retrospective study of 797 patients with squamous cell carcinoma located in the oral cavity, pharynx or larynx, treated with radiotherapy, and with a minimum follow-up of 3 years. Local recurrence and survival were analyzed in function of the waiting time, defined as the interval between date of histologic diagnosis and date of radiotherapy. A univariate and multivariate analysis was carried out. RESULTS: Median waiting time to radiotherapy was 44 days (25 and 75% quartiles: 33 and 60 days). There were significant differences in the waiting time period in relation to the primary location and the local extension of the tumor. Both univariate and multivariate analysis showed that waiting time had no significant impact either on local control or survival. CONCLUSION: Within the range of the waiting time observed in our study, delay in the initiation of radiotherapy did not affect local control or survival in patients with head and neck carcinoma.

Aged↗
PubMedDate not supplied

Evaluation of local recurrence and second malignancy in patients with T1 and T2 squamous cell carcinoma of the larynx.

PURPOSE: Evaluate outcome in patients with T1 and T2 laryngeal cancer treated with radiation therapy. PATIENTS AND METHODS: Retrospective review of 190 patients with SCC of the larynx, stage T1(63%) orT2 (37%), treated with primary radiation therapy from 1/75 through 12/93. Median age was 61 years and median follow-up was 16.6 years. Median field size was 6.0 cm x 6.0 cm with a median fraction size of 2 Gy delivered in 33 daily fractions over 48 days. Energy used was 2 MV (19%), 4 MV (46%), 6 MV (26%), or other (9%). Univariate Cox proportional hazards regression analysis was performed using the following variables: gender, age, T stage, anterior commissure involvement, treatment energy, treatment interruption, alcohol use, smoking history, and tobacco use during treatment. RESULTS: Overall actuarial 5-year survival was 76%, and 10-year survival was 56%. Actuarial local recurrence free survival (LRFS) at 5 years was 81%, and 10 years LRFS was 79%. Local relapse correlated with T stage (9% T1 versus 28% T2, P = 0.0009) and smoking history (14% for less than 100 pack-year versus 29% for greater than 100 pack-year, P = 0.02). Gender, age, anterior commissure involvement, treatment energy, treatment interruption, alcohol history, alcohol use during treatment, and tobacco use during treatment had no influence on outcomes. Actuarial second malignancies rate at 5 years was 18%. CONCLUSION: Heavy tobacco use and T stage appears to correlate with an increase in local relapse rates. Gender, age, anteriorcommissure involvement, treatment energy, treatment interruption, and alcohol use did not significantly correlate with local relapse rates. The risk of second malignancies is comparable to that of local relapse.

Adult↗
PubMed2003

Solitary fibrous tumors in the central nervous system. A clinicopathologic review of 18 cases and comparison to meningeal hemangiopericytomas.

CONTEXT: Solitary fibrous tumors (SFTs) of the central nervous system are rare neoplasms that usually present as dura-based masses and clinically resemble meningiomas. Histologically, they can be similar to fibrous meningioma or hemangiopericytoma (HPC). In particular, densely cellular regions seen in some SFTs can be indistinguishable from HPC. Little is known about the biological behavior of SFTs, although most seem amenable to total resection. OBJECTIVES: To define the clinicopathologic spectrum of SFTs in the central nervous system and to outline their differences from HPC and meningioma. DESIGN: We present the clinicopathologic features of 18 patients with SFT and compare them with those of an age- and sex-matched cohort of HPCs. RESULTS: Eleven SFTs were supratentorial, 3 were infratentorial, and 4 were intraspinal. Four of the 18 tumors were intra-axial (2 in the lateral ventricles and 2 within the spinal cord). Histologically, SFTs were similar to their soft tissue counterparts. Six tumors (6/18) had densely cellular regions, and 1 tumor showed frankly anaplastic features. All but 3 patients underwent gross total resection, and there were no metastases or tumor-related mortalities during the median follow-up of 40 months. In contrast, there were 15 local recurrences (83%), 5 extracranial metastases (27%), and 4 tumor-related deaths (22%) in the HPC cohort. CONCLUSIONS: Our study presents the clinicopathologic features of SFT as a distinct entity from both meningioma and HPC. We also present unusual examples of anaplastic, intraventricular, and intramedullary spinal SFTs that expand the clinicopathologic spectrum of these uncommon and sometimes diagnostically difficult neoplasms.

Adolescent↗
PubMed1989

Microvascular invasion and survival in cancer of the oral cavity and oropharynx.

Although the presence of squamous cell carcinoma within the peritumoral vascular spaces of primary lesions of the oral cavity and oropharynx has been statistically linked to regional lymph node metastases, the association of this finding with disease control and survival has not been well demonstrated. To evaluate this relationship, we have reviewed the clinical and histopathologic features of 65 consecutive cases of previously untreated T2 or greater squamous cell carcinoma of these sites managed by simultaneous surgical treatment of the primary lesion and regional lymph nodes. Of all the histopathologic features of the primary lesion studied, vascular invasion had the greatest impact on survival, as confirmed by both univariate and multivariate analysis. In addition, vascular invasion correlated statistically with local recurrence, neck recurrence, and distant metastasis.

Adult↗
PubMed1983

Radiation therapy of colorectal cancer.

Radiation therapy has been used with increasing frequency in patients with carcinoma of the rectum and rectosigmoid. After surgical resection alone, local failure rates of 20 to 60% are noted, with the rate increasing with degree of penetration of tumor through the bowel wall and with presence of lymph node involvement. Preoperative or postoperative radiation therapy has been shown to decrease the local failure rate significantly, and may improve survival rates. In patients who present with locally unresectable disease, preoperative irradiation has been shown to convert a large percentage of these tumors to resectable lesions, with eventual cure in perhaps 30% of patients. Newer techniques such as intraoperative electron beam radiation therapy, may be effective in decreasing the high local failure rate in these patients, by allowing the radiation therapist to increase safely the dose to the tumor volume. Even without surgical resection, external radiation therapy alone can cure approximately 10% of these patients. For small, superficial, well-differentiated tumors within 10 cm of the anal verge, endocavitary radiation therapy is an effective method of locally controlling these tumors, while avoiding general anesthesia and avoiding colostomy.

Colonic Neoplasms↗
PubMed1998

Recurrent cardiac myxoma: seeding or multifocal disease?

We describe a patient with left atrial myxoma followed by a second lesion in the left ventricle. Previous reports of "recurrent" myxoma were studied, with the following conclusions: There is little evidence for the process of myxoma seeding, local recurrence can occur through inadequate resection or malignant change, and many alleged recurrences are at a different site and multifocal disease occurs frequently in the familial setting.

Female↗
PubMed1997

Surgical enucleation for renal cell carcinoma (RCC). Prognostic significance of tumour stage, grade and DNA ploidy.

This study reviews a total of 26 renal cell carcinoma (RCC) who underwent enucleation of the tumour with functionally and anatomically normal controlateral kidney and no evidence of systemic renal disease. At follow-up, after a mean of 62 months the disease specific survival rate for this series was 88.5%. Survival rates according to the pathologic stage, grading, tumour diameter and ploidy are reported. Local recurrences were documented in 4 of the 26 RCC. All 4 RCC were more than 5 cm in diameter and recurred in the remaining parenchyma. After local recurrence, three tumours with aneuploid DNA content underwent radical nephrectomy, whereas 1 with diploid DNA content was submitted to a new enucleation of the recurrence. To date the diploid case is still alive 3 years after the original resection of the primary tumour whereas the other 3 patients died for metastatic disease. In our experience the ideal candidate for renal sparing surgery in the presence of a normal opposite kidney is an asymptomatic patient that incidentally is brought to our attention with a small size (less than 5 cm in diameter), low stage (T1-T2) tumour, well surrounded by a pseudocapsule. DNA content is a valuable prognostic factor in patients submitted to conservative surgery. Diploid tumours have been seen to have a better prognosis and in case of local recurrence they may be reconsidered for a new enucleation of the recurrence.

Adult↗
PubMed1985

Interstitial radiation: short-term palliation or curative therapy?

The management of clinically localized prostatic cancer by interstitial implantation of 125I seeds has been under exploration at Memorial Sloan-Kettering Cancer Center for thirteen years. This investigation was prompted by clinical evidence of the radioresponsiveness of some prostatic cancers, the limited applicability of surgical excision, and the possibility that interstitial therapy would have less of an adverse effect on the quality of life than would alternative treatments. Cumulative experience indicates that the technique is associated with low morbidity and mortality and high functional preservation rates; local control rates (routine biopsies were not done), within the constraints of still-limited follow-up intervals, are in the 80 per cent to 90 per cent range; and actuarial survival rates at nine years (including patients who received endocrine therapy for metastatic or intractable local disease) are approximately 90 per cent for T1, 60 per cent for T2, and 45 per cent for T3 lesions. Approximate actuarial nine-year survival rates are 80 per cent for all patients with negative nodes and 50 per cent for all patients with positive nodes. Taking into account limitations of the data and the hazards of comparing this therapy with other uncontrolled treatments, 125I appears to be a therapeutic option for the control of clinically localized prostatic cancer.

Actuarial Analysis↗
PubMed1998

Predictive value of p53 and pRb immunostaining in locally advanced bladder cancer treated with cystectomy.

PURPOSE: We elucidate the association between altered immunostaining for retinoblastoma gene protein (pRb) and p53 nuclear proteins, and cancer specific death in patients treated with cystectomy for locally advanced bladder cancer. MATERIALS AND METHODS: The hospital records of 173 patients treated with cystectomy for advanced urothelial bladder cancer between 1967 and 1992 were retrospectively reviewed. Representative biopsies obtained before treatment were sectioned and stained using the standard immunohistochemical technique with antibody DO-7 (p53) and antibody PMG3-245 (pRb). A tumor was considered to have an altered p53 expression if 20% or more of tumor cells exhibited nuclear staining. Similarly, if no tumor cell had nuclear immunostaining the tumor was considered to have an altered pRb expression. RESULTS: An altered expression was observed for p53 in 98 tumors (57%) and for pRb in 60 (35%). In a proportional hazards analysis no association was found between an altered expression of pRb or p53 and cancer specific death. This finding was also true in another analysis when the results of immunostaining for pRb and p53 were combined. CONCLUSIONS: An altered expression for pRb and/or p53 was not correlated to cancer specific death. Thus, these parameters could not be used as predictors of treatment outcome after cystectomy for locally advanced bladder cancer.

Adult↗