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PubMed1981

Carcinoma of the uterine cervix: review of experience at University of Kansas Medical Center.

A total of 211 patients with a diagnosis of carcinoma of uterine cervix, managed by radiotherapy at the University of Kansas Medical Center between 1969-1975 was reviewed. There were 90 patients in Stage I, 65 in Stage II, 43 in Stage III, and 13 with Stage IV disease. Squamous cell carcinoma was found to be the most common histologic type. Twenty-three patients had shown uterine extension of the disease; of these, eight had adenocarcinoma. The majority of the patients received external whole-pelvic telecobalt therapy followed by a variety of intracavitary radium applications. The combined dose to point A ranged from 5000-13,000 rad. There were 166 patients followed for five or more years. Overall five-year survival was 74% (124/166). Survival by stage: IA--92% (12/13); IB--88% (55/62); IIA2--74% (23/31); IIB--58% (14/24); IIIA&B--64% (18/28); and IV--25% (2/8). The overall three-year survival was 73% (155/211). Thirty-three patients (33/211 = 16%) developed local recurrence, and five of these patients were salvaged by surgery. Surgery for complications was required in nine patients. Rectovaginal and vesicovaginal fistulae occurred in three patients (1.5%). Local recurrence and complications vs. dose and system used were analyzed.

Adenocarcinoma↗

PubMed1991

Importance of the omentum in the development of intra-abdominal metastases.

Areas of trauma are preferred sites for metastatic tumour growth. In extensive intra-abdominal tumour recurrence the omentum is invariably involved. The importance of the omentum in the development of tumours at sites of intra-abdominal trauma has been investigated. Colonic anastomoses were performed in Hooded-Lister rats with and without omentectomy. Animals received intraluminal or intraperitoneal injections of a syngeneic tumour. With intraluminal injection, tumour occurred at the anastomosis and in the omentum in 38 and 43 per cent of animals respectively but following omentectomy the values were 14 and 9 per cent (omental remnant). With intraperitoneal administration tumour occurred in 53 per cent at the anastomosis and in 79 per cent in the omentum compared with 16 and 29 per cent (in omental remnant) following omentectomy. In this model a reduced ability of an anastomosis to support 'seeded' tumour following removal of the omentum is demonstrated and the development of local recurrence from spilled tumour cells during operation may be enhanced by, or be dependent on, the proximity of the omentum.

Anastomosis, Surgical↗

PubMed2004

Prognosis after reoperation for local recurrence of papillary thyroid carcinoma.

PURPOSE: To investigate the factors associated with a favorable prognosis after reoperation for local recurrent papillary thyroid carcinoma (PTC), we reviewed 45 patients who underwent surgery for first local recurrence of PTC. METHODS: We divided the patients into two groups. Group A (n = 28) had no second recurrence, and group B (n = 17) had second local recurrence after surgery for recurrence. RESULTS: The mean follow-up period after reoperation was 56.9 months. The mean age at the time of reoperation in group A was significantly lower than that in group B, at 48.1 years versus 62.3 years, respectively (P = 0.0007). The mean age at the time of the initial operation in group A was also significantly lower than that in group B, at 40.1 years versus 55.1 years, respectively (P = 0.0006). Patients with recurrent tumors only outside the area dissected at the initial operation (n = 27) had a better outcome than those with recurrence within the dissected area (n = 18; P = 0.0127). Patients who underwent systematic partial or modified neck dissection (n = 36) had a better outcome than those who underwent only simple local resection (n = 9; P = 0.0169). CONCLUSION: For local recurrent PTC, systematic neck dissection is recommended over local resection of recurrent tumors.

Adult↗

PubMed1994

Rapid dedifferentiating meningioma with repeated multifocal recurrences and pulmonary metastases.

A 62-year-old woman presented with a convexity meningioma which, after primary surgery, was histopathologically graded as grade II. There followed three more operations due to repeated rapid local recurrences. After each of these three operations histology revealed dedifferentiated grade III tumors. At third recurrence moreover, other multiple tumor masses in the vicinity of the primary tumor site and in the lung were found. These had the same histological appearance as the local recurrences. The patient died 30 months after primary surgery from respiratory failure due to the multiple lung metastases.

Brain↗

PubMed1989

[Paranasal sinus tumors with orbital involvement].

Paranasal sinus tumors frequently extend into the bony orbital contents. In the past, their treatment often resulted in severe visual defects or consisted in enucleation. In an effort to determine whether an effective but more conservative form of therapy, is possible, 40 patients with such lesions were treated over the past 11 years by microsurgical resection followed by radiotherapy and/or chemotherapy. The present paper describes the authors' surgical technique, i.e. the transfrontal extradural approach and the midface-degloving-technique. In addition, the following parameters are evaluated specifically: 1) the effects of conservative resection on overall survival rate, 2) frequency of local disease recurrence and 3) changes in orbital function as a result of the combined therapy.

Aged↗

PubMed2000

Local breast cancer recurrence caused by mammographically guided punctures.

PURPOSE: To evaluate the risk of needle track seeding or tumor cell implantation as the cause of locally recurrent breast cancer after breast conserving surgery. MATERIAL AND METHODS: We reviewed recurrences from a consecutive series of 303 clinically nonpalpable breast cancers treated with breast conserving surgery after pre-operative localization. The median mammographic follow-up was 5.4 years. The suspicion of seeding or implantation was based on the location of the recurrent lesion in comparison with the needle path in two orthogonal mammographic projections. Pre-operative percutaneous biopsies had been done in 71% (214/303) of the cases. Postoperative radiotherapy was administered to 82% (194/238) of the invasive cancers and to 28% (18/65) of the ductal cancers in situ (DCIS). RESULTS: Locally recurrent cancer occurred in 11% (33/303) of the cases. Radiotherapy demonstrated a protective effect from relapse among invasive cancers but not for DCIS. Seeding or implantation was suspected in 3 recurrent invasive cancers which had not been subject to radiotherapy. The histopathological diagnosis of the primary cancer and the recurrent cancer were the same in these cases: adenoid cystic, mucinous and tubuloductal cancer. CONCLUSION: Seeding or implantation was suspected as the cause of local recurrence in 7% (3/44) of the invasive cancers which did not receive radiotherapy.

Adenocarcinoma↗

PubMedDate not supplied

Breast conservation surgery achieving>or=2 mm tumor-free margins results in decreased local-regional recurrence rates.

Whether cosmetically acceptable tumor-free (>/=2 mm) surgical margins reduce the local-regional recurrence risk for patients treated with fractionated radiation therapy, chemotherapy, and hormonal therapy is unknown. The benefit of a minimum cosmetically acceptable tumor-free margin remains speculative because no contemporary studies have investigated the extent of invasive disease infiltration within the breast beyond the primary tumor. To address these clinical issues, we conducted a retrospective study of 341 women diagnosed with stage I or II invasive breast cancer to determine the rate of local in-breast, elsewhere in-breast, and ipsilateral regional lymph node recurrences of breast cancer after conservation surgery achieving either tumor-free (>or=2 mm) or close (>0 mm to <2 mm) surgical margins followed by whole breast radiation therapy over a 6-year period from January 1996 to December 2002. Women may have received adjuvant chemotherapy or hormonal therapy as clinically indicated. After a median follow-up of 56 months from the completion of breast conservation surgery, 14 of the 341 women (4.1%) developed breast cancer recurrences. Crude ipsilateral recurrence rates were 1.8% (4 of 222) for tumor-free (>or=2 mm) versus 8.4% (10 of 119) for close (>0 mm to <2 mm) surgical margins (p=0.007). The estimated 5-year cumulative local recurrence rate was significantly less for women with tumor-free margins (2.1%) as compared to close surgical margins (8.9%) (p=0.004). Multivariate analyses identified negative estrogen receptor expression (p=0.004), close surgical margins (p=0.012), and the presence of angiolymphatic invasion (p=0.040) as prognostic factors for local-regional recurrences. Microscopically the extent of invasive disease infiltration beyond the primary tumor was on average 1 mm, with all measured invasive disease less than 1 cm. Based on our findings, cosmetically acceptable tumor-free (>or=2 mm) surgical margins significantly reduce local in-breast and regional lymph node recurrences with fractionated radiation therapy, chemotherapy, and hormonal therapy.

Adult↗

PubMed2001

Renal cell carcinoma: evaluation of the 1997 TNM system and recommendations for follow-up after surgery.

OBJECTIVE: We evaluated the tumor recurrence pattern after radical or nephron-sparing surgery for localized renal cell carcinoma. Based on this pattern, we suggest a surveillance protocol after surgery. METHODS: The outcome of 200 consecutive patients with localized renal cell carcinoma (RCC) that were operated on between January 1982 and December 1997 was evaluated retrospectively. Radical nephrectomy was performed in 155 patients (77.5%), and nephron-sparing surgery in 45 patients (22.5%). The timing and site of disease recurrence were correlated with parameters of the primary tumor. RESULTS: One hundred and twenty-four patients (62%) had pathological stage T1, 26 (13%) had stage T2, and 50 (25%) had stage T3 (41 stage T3a, 8 stage T3b, and 1 stage T3c). The mean follow-up was 47 months (range 6--169 months). Four patients (3.2%) with stage T1, 6 patients (23%) with T2, and 13 patients (26%) with T3 developed recurrent disease. None of the patients with a stage T1 tumor, smaller than 4 cm, had tumor recurrence. There were no recurrences after nephron-sparing surgery compared to 23 recurrences (14.8%) among patients after radical nephrectomy (p = 0.01). Only 1 patient who underwent pulmonary lobectomy for asymptomatic metastases smaller than 2.5 cm, found by routine chest CT, attained long-term survival. CONCLUSIONS: The prognosis of patients after radical nephrectomy for renal cell carcinoma, smaller than 4 cm, is excellent and they do not need radiological follow-up. Patients with larger T1 tumors, 4--7 cm in diameter, or a higher stage should be followed with CT of the chest and abdomen done every 6 months for 5 years and then annually. Following partial nephrectomy of small renal tumors periodic renal ultrasonography should be done to rule out local recurrence in the operated kidney.

Adult↗

PubMed1995

Results of radiosurgery in the management of recurrent and residual medulloblastoma.

Between June 1989 and January 1994, 14 patients with recurrent (n = 11) or posttreatment residual (n = 3) medulloblastoma were enrolled in a program to evaluate the efficacy and toxicity of stereotactic radiosurgery (SR). Initial treatment consisted of subtotal surgical resection in 12 patients and complete surgical resection in 2. Thirteen patients received systemic chemotherapy, and all had craniospinal irradiation prior to SR. SR was used as a technique for boosting sites of posttreatment residual disease in 3 patients (3 tumors) and as salvage therapy in 11 patients (14 tumors) with radiographically well-defined, discrete recurrent tumors. Patients underwent SR 1-97 (median 20) months after completing craniospinal irradiation. The median minimum peripheral tumor dose was 12 Gy. The median tumor volume at the time of SR was 6.9 cm3. With a median follow-up period from diagnosis of 27 (range 8-39) months, all patients treated with SR as a boost to sites of residual disease are alive without evidence of disease. In contrast, 6 of 11 patients who underwent SR for treatment of recurrent disease have died of progressive medulloblastoma. The median survival from the time of SR for patients treated for recurrent disease was 10 (range 5-59+) months. The predominant site of failure after SR was distant within the central nervous system, with 6 patients (43%) failing outside the posterior fossa. No patient failed locally within the radiosurgical target volume. Two patients (14%) developed marginal recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

Survival in soft tissue sarcoma. Prognostic variables identified by multivariate analysis.

The prognostic influence of 15 separate factors on local recurrence and survival was analyzed in 144 patients with highly malignant (histologic Grades III and IV) soft tissue sarcoma of the locomotor system. The minimum follow-up time was 6 years, or until death. Three factors, marginal excision, tumor necrosis, and extracompartmental tumor location were identified as risk factors for local recurrence. Five factors, local recurrence, Grade IV, male sex, tumor necrosis, and increasing tumor size were associated with decreased life expectancy.

Adolescent↗

PubMed1986

Reconstruction using pedicled jejunal segments after resection for carcinoma of the cervical esophagus.

During the past 21 years, 45 (76.3 per cent) of 59 instances of cervical and hypopharyngeal carcinomas were treated by resection. The standard operative procedure for reconstruction after resection was interposition of pedicled jejunal segments between the cervical esophagus or the hypopharynx and the upper part of the thoracic esophagus with or without total laryngectomy, a procedure developed by one of the authors. The five year survival rate of 11 patients who underwent this operation which preserves the larynx was 33.3 per cent and that of 19 patients who underwent the operation with laryngectomy was 19.7 per cent. Therefore, the interposition of jejunal segments preserving the larynx is shown to be an appropriate operation for carcinoma localized in the cervical esophagus. In addition, reconstruction with free jejunal segments using microvascular operations in instances of recurrent malignant tumors of the thoracic esophagus in the cervical esophagus is introduced.

Adult↗

PubMed1987

Giant-cell tumor of bone.

Of 327 patients who had a giant-cell tumor of bone and were seen at the Istituto Rizzoli, 293 were treated at the Institute, and 280 of these were followed for two to forty-four years. The distribution according to sex and age of the patient and site of the tumor was similar to the distributions in major reports of large series. The tumor usually involved the metaphysis and the epiphysis, but was occasionally limited to the metaphysis, and in only 2 per cent of the patients was it adjacent to an open growth plate. The tumor on occasion invaded the articular space, also involving the ligaments and the synovial membrane. Extension to an adjacent bone through the joint occurred in 5 per cent of the tumors. Our radiographic grading, which is roughly comparable with the staging system of Enneking et al., was Grade I in 4 per cent, II in 74 per cent, and III in 22 per cent of 266 patients before treatment. A pathological fracture was apparent on the first radiograph in 9 per cent of the patients. In the 280 patients with adequate follow-up, 331 surgical procedures were performed. The rate of local recurrence was 27 per cent in the 151 intralesional procedures, 8 per cent in the 122 marginal excisions, and zero in the fifty-eight wide or radical procedures. These results did not correlate with the radiographic grade of the lesion. Of the fifty-one local recurrences that were seen after treatment at our institution, 90 per cent appeared in the first three years after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1998

Metachronous benign solitary fibrous tumours of the pleura (localized "mesotheliomas"): a case report.

Solitary fibrous tumours are uncommon pleural tumours that are not related to mesotheliomas. They are typically benign and pedunculated and may grow to massive sizes. Surgical resection is usually curative. Tumour recurrence and metachronous development of multiple tumours are unusual. In this report a patient was treated for 3 benign solitary fibrous tumours of the pleura over 23 years. The authors hypothesize that this represents multifocal tumorigenesis as opposed to local tumour recurrence. The importance of complete surgical excision and lifelong radiographic follow-up are stressed.

Aged↗

PubMed1999

[Prognostic significance of DNA analysis in neoplastic cells of patients with squamous cell lung neoplasms treated surgically].

The aim of our study was the assessment of the ploidia and its influence on the remission time and the survival of surgically treated patients with squamous cell lung cancer. The results were then related to the clinical staging, grading, size and localization of the tumor. The tissue samples (n = 60) of squamous cell lung carcinoma resected between 1995-1996 at the Department of Thoracic Surgery at University of Medical Sciences in Poznań were prepared using modified Hedley's method. The measurement was done in Cytoron Absolute flow cytometer. The abnormal DNA (aneuploid) was found in 40% of tumors. In two-year observation period more patients died with aneuploid tumors (54.6% deaths) than with diploid tumors (35.2% deaths). No significant correlation was found between the ploidy and frequency of metastasis to regional lymph nodes, tumor size, localization and grading. The estimation of the DNA content in the cancer cells seems to be a significant and valuable prognostic factor. The measurement of the DNA content can be useful in patients to estimate risk of recurrence after surgery.

Adult↗

PubMed2006

[Three-dimensional conformal radiotherapy for primary nasopharyngeal carcinoma and analysis of locoregional recurrence].

BACKGROUND & OBJECTIVE: The efficacy of routine two-dimensional radiotherapy for primary nasopharyngeal carcinoma (NPC) is dissatisfied, while three-dimensional conformal radiotherapy (3-D CRT) can optimize irradiation dose distribution. This study was to explore the efficacy of 3-D CRT on NPC, and investigate dosimetric factors of locoregional failure. METHODS: Records of 87 patients with primary NPC, treated with 3-D CRT between Feb. 2001 and Apr. 2004, were retrospectively reviewed. Dosimetric analysis was performed on the patients with locoregional relapse. RESULTS: Of the 87 patients, 5 (5.7%) had local failure, and 2 (2.3%) had regional failure. The overall 3-year locoregional control rate was 90.2%. The 3-year local control rates for stages T1, T2, T3, and T4 patients were 95.0%, 97.0%, 80.1%, and 100%, respectively. Five cases (71%) were marginal or outside failures of the irradiation fields. The occurrence rate of grade 3-4 late complications of the 62 patients progress-freely survived over 12 months was 9.7%. The 3-year overall survival rate and progress-freely survival rate were 88.2% and 80.3%, respectively. The 3-year survival rates were significantly higher in the patients at stages I, II, and III ('92 Fuzhou staging) than in the patients at stage IVa (100%, 100%, 84.7% vs. 47.5%, P<0.001). CONCLUSIONS: Increased locoregional control rate and reduced occurrence of grade 3-4 late complications of primary NPC could be achieved by 3-D CRT through careful delineation of target volumes and design of irradiation fields. Missing of target volumes is a reason of local relapse.

Adolescent↗

PubMed1990

Anorectal carcinoid tumors. Is aggressive surgery warranted?

The management of large carcinoid tumors of the anorectum is controversial. Most carcinoid tumors of the rectum and anus are early lesions, adequately treated by local excision. However, because of their relative rarity, the number of advanced cases seen at most institutions is small. Forty-three patients with anorectal carcinoid tumors were treated at our institution between 1960 and 1988 with complete follow-up. The median age of onset was 56 years. Eleven patients had no symptoms and the tumor was detected incidentally in eight additional patients with other diseases. Twenty tumors were larger than 2 cm in diameter and all patients had symptoms. Eight patients had another malignancy and three patients had ulcerative colitis. An association between ulcerative colitis and rectal carcinoid tumors is not widely appreciated. Eighteen tumors were treated by local excision, 16 by radical surgery, and nine underwent only biopsy. With complete resection of the primary lesion, local recurrence was never a problem. The median survival from diagnosis was 38 months in this series and 23 patients died of disease. After detection of metastases, the median survival time was 10 months. Tumors more advanced that T2 or larger than 2 cm in diameter were always fatal. All 13 patients with involved lymph nodes died of metastatic disease, with a median survival of 10 months, although one lived 9 years. Advanced rectal carcinoid tumors are aggressive malignancies. Adequate local excision controls regional disease but rectal carcinoid tumors are cured only when they are discovered before the T3 stage, measure less than 2 cm in diameter, and when lymph nodes are not involved. Consequently if a local excision permits complete resection, radical extirpative surgery will provide little benefit.

Adult↗

PubMed1987

Treatment options for patients with stage D1 (T0-3,N1-2,M0) adenocarcinoma of prostate.

Three hundred six patients with adenocarcinoma of the prostate underwent pelvic lymphadenectomy and had Stage D1 (T0-3,N1-2,M0) disease; 171 patients underwent radical retropubic prostatectomy with or without immediate adjuvant therapy (hormonal or radiation or both) or conservative (hormonal or radiation or both) treatment alone (n = 135). Follow-up was one-half to eighteen and one-half years (mean, 5 yrs). Immediate adjuvant orchiectomy significantly (P = 0.01) improved survival (87.4% at 10 years) and nonprogression rates for patients who underwent radical prostatectomy, but not for those who had lymphadenectomy. Overall patient survival was significantly better (P = 0.005) after prostatectomy than lymphadenectomy. Residual disease (n = 43) in patients who underwent prostatectomy and received adjuvant treatment (orchiectomy or radiation or both) did not affect disease outcome. Bilateral pelvic lymphadenectomy and radical prostatectomy with immediate adjuvant orchiectomy provided survival comparable to the expected survival; conservative treatment alone was associated with rapid disease progression and poor survival and significantly (P = 0.02) higher local morbidity.

Adenocarcinoma↗

PubMed1991

[Clinical study of prostate cancer--statistical analysis in the last 10 years].

Fifty one cases of prostate cancer were treated at Yamaguchi University Hospital during 10 years since 1975. Age distribution was between 43 and 90 years old with an average of 70.9 years. Chief complaints were difficulty on micturition (33%), complete urinary retention (19.6%), macroscopic hematuria (15.7%), and frequency (13.7%). Clinical stage was classified as 1 case (2%) with stage A, 7 cases (13.7%) with stage B, 20 cases (39.2%) with stage C and 23 cases (45.1%) with stage D cancer. Histological grade was classified as 9 cases (17.6%) with well differentiated type of adenocarcinoma, 15 cases (29.4%) with moderately differentiated type and 27 cases (52.9%) with poorly differentiated type. The 5-year actual survival rate was 75% for stage A&B, 50% for stage C and 60% for stage D. The 10-year actual survival rate was 20% for stage A&B, 17% for stage C and 20.5% for stage D. There were no statistically significant differences between stage, grade and survival rate. According to specific cause 18 cases (58%) were cancer deaths including 8 cases (15.7%) of refractory disease, and 4 cases (12.9%) of cardiovascular complication. Five of the eight refractory cases could survive over one year by multimodal treatment. Local irradiation to prostate was most effective to control symptoms against locally refractory prostate cancer.

Adenocarcinoma↗