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PubMed2006

Staging of laryngeal and hypopharyngeal cancer: value of imaging studies.

Imaging methods assist in the pre-treatment planning of laryngeal and hypopharyngeal neoplasms, by better defining the local extension of infiltrating tumours and by detecting subclinical neck adenopathies. Imaging has also an important role in excluding or detecting distant metastasis. Furthermore, there is evidence that several imaging-derived parameters can be used as predictors of locoregional control after radiotherapy, and this independently from the TN classification. Such prognostic information is helpful in determining the relative value of surgery and radiation therapy, in selecting patients who may benefit from adjuvant treatment, and in identifying patients at high risk for recurrence to be followed up more closely.

Carcinoma, Squamous Cell↗

PubMed1990

Utility of surgical margins in the radiotherapeutic management of soft tissue sarcomas.

Seventy-four adult patients with localized soft tissue sarcomas were treated with radiation therapy following surgery between 1965 and 1988. Fifty-three were treated after the first excision of their tumor with 6 (11.3%) local recurrences. Twenty-one received radiation after excision of recurrent disease with 11 (52.4%) local failures (P less than .0005). Metastatic disease occurred in 14 (26.4%) of the primary tumors and 8 (38.1%) with multiple previous excisions (P less than .48). Of those patients treated for primary sarcoma, there were no local failures with pathologically wide margins or if a single margin was microscopically positive. Local failure occurred in 4 of 26 (15.4%) if the tumor was merely enucleated and in 2 of 11 (18.2%) who had grossly positive surgical margins (P not significant). Local failure was also more common in truncal locations (33.3%) as compared with extremity locations (8.7%, P = .1359). Additional factors analyzed which adversely affected prognosis included tumor grade, stage, and inadequate radiation dose.

Adult↗

PubMed2001

The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy.

The aim of the study was to evaluate the importance of young age with regard to local control in a prospective cohort of 1085 women with pathological T1 tumours treated with breast conservative treatment (BCT). Patients were divided into two age groups: 40 years or younger, 7.8%, and older than 40 years, 92.2%. With a median follow-up of 71 months, the local recurrence rate was 10.6% in women < or =40 years, and 3.7% in older women. The local recurrence-free survival (LRFS) was significantly different for the two age groups, respectively 89%, < or =40 years, and 97.6%, >40 years (P=0.0046). A separate analysis showed a significantly decreased LRFS for young women with a positive family history, 75.4% versus 98.4% 5-year LRFS for older women. A worse LRFS for young women with a negative lymph node status was also observed, respectively 84% versus 98% 5-year LRFS (both P<0.001). In a multivariate analysis, taking into account the pre-treatment and treatment factors, age < or =40 years, was the only significant predictor of a decreased LRFS. Thus, young age is an important factor in relation to local control. In a subset analysis, this significant adverse effect of young age on outcome appears to be limited to the node-negative patients and those with a positive family history. To date, there is no evidence that young women with pT1 breast cancer, treated by mastectomy have an improved outcome when compared with those treated with conservative surgery and radiotherapy. Taking into account results from a subset analysis suggests that giving systemic therapy to a subgroup of women who are < or =40 years, node-negative and/or have a positive family history might give a better local control.

Adult↗

PubMed1997

[Adjuvant radiotherapy after radical prostatectomy. Apropos of a series of 73 patients in Lyons (France)].

PURPOSE: Descriptive analysis of adjuvant radiation therapy after radical prostatectomy. MATERIALS AND METHODS: From 1986 to 1993, 73 patients (median age, 64.5 years; Gleason score > or = 7 : 36 pts; T1:22; T2:40; T3:11) were included into the study. On the operative specimen, the cancer grades were pT2:5 (involvement of the apex), pT3:67, pT4:1, pN1-2:8. Radiation therapy was performed after a mean resting period of 112 days. The target volume was the prostatic area. The technique used was a four-field box with an 18 MV-X photon beam. The dose was 50 Gy/20 fractions/5 weeks. No hormonal treatment was administered, except for 5 patients for a short duration. RESULTS: The median follow up was 46 months. One anastomotic local failure was salvaged by trans-urethral resection, three distant metastatic failures. Out of 72 patients with a PSA < 3 ng/mL at the end of radiotherapy, 13 showed an isolated elevation. The 5-year overall survival rate was 93%. The event-free survival was 72% after 5 years. Pathological differentiation and Gleason score were significantly correlated with the survival. There was no complication related to radiotherapy. CONCLUSION: Elective adjuvant radiation therapy for pT3 prostate adenocarcinoma after radical prostatectomy provides a good local control with minimal morbidity.

Adenocarcinoma↗

PubMed2000

Surgical outcome after curative resection of rectal leiomyosarcoma.

PURPOSE: The aim of this study is to present the prognosis and possible associated prognostic factors after curative resection of rectal leiomyosarcoma. METHODS: From 1979 to 1996 our hospital saw 40 patients with rectal leiomyosarcoma, including 19 females, who did not have metastasis initially and received curative resection and regular postoperative follow-up. RESULTS: The mean age of the 40 patients was 58.7 years. Anal bleeding and perianal pain were the two most common symptoms at initial diagnosis. Twenty-nine patients received a radical surgical resection, such as abdominoperineal resection or low anterior resection; the other 11 patients received a wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade leiomyosarcoma, and 23 as low grade. Nineteen patients (48 percent) developed recurrence or metastasis postoperatively (median follow-up, 35 months). The overall and disease-free (1-year, 3-year, and 5-year) survival rates were 97, 90, and 75 percent and 90, 59, and 46 percent, respectively. In univariate analysis, younger group (<50 years, n = 9, P = 0.033) and high-grade leiomyosarcoma (P = 0.043) showed poorer prognosis in the disease-free survival curve. In the multivariate Cox model, gender, tumor size, tumor location, and operation type did not significantly affect disease-free survival, whereas histologic grade (P = 0.037) and age divided by a level of 50 years (P = 0.009) were shown to be independent factors. There was a strong trend toward higher local recurrence rate for the wide local excision group than for the radical resection group (55 vs. 24 percent, P = 0.067) despite the wide local excision group being composed of smaller tumors (5.1 vs. 7.5 cm, P = 0.069). There was no difference in the incidence of distant metastasis between the two groups with different operation types. The metastasis rates of the wide local excision and radical resection groups were 27 and 38 percent, respectively. CONCLUSION: A younger age (<50 years) and a high histologic grade of tumor were the two most significant poor prognostic factors for rectal leiomyosarcoma. Radical resection may be superior to wide local excision in the prevention of local recurrence but not distant metastasis.

Adult↗

PubMed2004

Significance of histopathological evaluation in primary therapy for breast cancer--recent trends in primary modality with pathological complete response (pCR) as endpoint.

In recent years, primary therapy has been used to improve the prognosis of patients with locally advanced breast cancer and to expand the indication for breast conserving treatment for patients with a relatively early stage of breast cancer. In addition, the therapeutic efficacy of primary therapy has been evaluated on the basis of pathological findings and pathological complete response (pCR)is considered to be a main target of primary therapy. The results of NSABP protocol B-18 and B-27, and the Aberdeen trials confirmed the prognostic significance of pCR in primary therapy and indicated the significance of minute pathological assessment. However, the criteria of pathological response is not yet universal, but the evaluation of the main invasive tumor, intraductal component and the regional lymph nodes, is thought to be necessary, shown by the "Histopathological Criteria for Assessment of Therapeutic Response in Breast Cancer" compiled by the Japanese Breast Cancer Society. Among these criteria, there exist methodological variations as to the evaluation of residual disease of intraductal carcinoma, thus some controversies exist. The presence of intraductal component might be negligible with regard to prognosis, but might be an important risk factor for local recurrence after breast conserving therapy. In the future, participation by the pathologist in the field of primary therapy for breast cancer will be a matter of course in most clinical studies.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

[Mucosectomy as sufficient therapy for early squamous cell].

Squamous cell carcinoma of the esophagus can be treated endoscopically under certain conditions. A carcinoma (T1a) limited to the mucosa with a low infiltration depth (m1-m2) and limited extent (< or =2 cm) can be removed by electrical snare with no risk of lymph node metastasis. Due to the increased risk of lymphatic spread, deeply infiltrating submucosal tumours (sm2-sm3) must be treated by surgical resection. Endoscopic resection (mucosectomy) is performed by electric snare and the cap method, additionally with APC coagulation or photodynamic therapy. Multifocal tumour growth and incomplete resection are both risk factors for local recurrence. If the strict conditions for endoscopic resection are fulfilled, the 5-year survival time of these patients with early cancer is no different from that of the population as a whole.

Algorithms↗

PubMed1998

[What should be done in positive margins after radical prostatectomy?].

In the last years radical retropubic prostatectomy has become the treatment of choice for locally confined prostate cancer (PCa). However, in the literature local recurrence is described in 4-23% of patients with clinical stage T1-2 prostate cancer and in 43% of patients with clinical stage T3 respectively. The problem is further aggravated that postoperatively raised PSA values are detected in 6-8% of patients with locally confined prostate cancer indicating either local residual tumor or systemic disease. Current datas show that wait-and-watch appears to be the best option for patients with locally confined prostate cancer and positive margins. In case of persistent or raising PSA-values following prostatectomy without detectable local recurrence or metastasis mere local therapy cannot be recommended. Primary radiotherapy should be considered in cases with confirmed clinical local recurrence without distant metastasis. Further prospective and randomized trials have to be initiated to identify the patients with positive margins who will benefit from adjuvant treatment.

Biomarkers, Tumor↗

PubMed1991

Improved survival after resection of pulmonary metastases from malignant melanoma.

The value of resecting pulmonary metastases from malignant melanoma was retrospectively examined. Between 1981 and 1989, 56 patients (35 men and 21 women with a mean age of 49 years) had 65 pulmonary resections for histologically proven metastatic melanoma after treatment of the primary tumor. In patients undergoing thoracotomy, 50% (28/56) had pulmonary metastases as the initial site of recurrence. Twenty-eight patients (50%) had local-regional recurrence before the development of lung metastases. Eight lobectomies, two segmentectomies, and 55 wedge excisions were done. Fifty-four patients (54/56, 96%) underwent complete resection, and there were no operative deaths. The postthoracotomy actuarial survival was 25% at 5 years (median interval, 18 months). Location of the primary tumor, histology, thickness, Clark level, local-regional lymph node metastases, or type of resection was not associated with improved survival. Patients without regional nodal metastases before thoracotomy had a median survival of 30 months compared with 16 months for all others (p = 0.04). Patients with lung as the site of first recurrence had a median survival of 30 months compared with 17 months for patients with initial local-regional recurrence (p = 0.038, log-rank test). Despite systemic spread, patients with isolated pulmonary metastases from melanoma may benefit from metastasectomy.

Female↗

PubMed2006

Penis conserving treatment for T1 and T2 penile carcinoma: clinical implications of a local recurrence.

PURPOSE: We evaluated our experience with primary tumor treatment for T1 and T2 penile squamous cell carcinoma and discussed the clinical implications of a local recurrence. MATERIALS AND METHODS: The primary tumor treatment and clinical course of 257 patients with T1 or T2 penile carcinoma were evaluated. Primary tumor treatment consisted of penis preservation in 157 and (partial) amputation in 100 patients. Median followup was 106 months (range 16 to 541). RESULTS: The 5-year local recurrence-free estimate after penis preservation was similar for T1 and T2 tumors (log rank test p = 0.1) and overall 63% (CI: 54%-72%) compared to 88% (CI: 81%-95%) for partial amputation (log rank test p = 0.0003). In case of a local recurrence after penis preserving treatment, local control could be achieved in 94% (51 of 54) of cases. Of patients with T1 tumors treated with penis preservation, regional recurrence developed in 33% (7 of 21) of patients with local recurrence compared to only 6% (3 of 47) of patients without local recurrences (Fisher's exact test p = 0.005). Of the patients with T2 tumors treated with penis preservation, regional recurrence developed in 27% (9 of 33) of patients with local recurrence compared to 27% (12 of 45) of patients without local recurrence (chi-square test p = 0.96). Of 10 patients with a local recurrence after partial amputation of the penis, 9 died of disease. CONCLUSIONS: The incidence of local recurrence increases with penis preservation but can be treated accurately in most cases. Local recurrences can signify lymphatic regional spread. A local recurrence after penile amputation carries a poor prognosis.

Adult↗

PubMed1979

Granular cell tumor of the tongue.

The granular cell tumor has been and still is a debatable lesion in several aspects. The etiology and pathogenesis are still unknown. Granular cell tumors may occur everywhere in the body, but the oral cavity is a favorite location. The majority of the oral lesions are found in the dorsum and the borders of the anterior two-thirds of the tongue. Seven patients with a granular cell tumor of the tongue are described. The clinical and microscopic findings have been discussed. In all cases an excisional biopsy had been aimed at. In spite of incomplete excision in six out of the seven cases, local recurrences were noticed in only one patient. In one patient "metastatic" occurrence of granular cell tumors was noticed.

Adult↗

PubMed2000

The significance of extracapsular extension of axillary lymph node metastases in early-stage breast cancer.

PURPOSE: To investigate if extracapsular extension (ECE) of axillary lymph node metastases predicts for a decreased rate of disease-free survival or an increased rate of regional recurrence of breast carcinoma. METHODS: The study population consisted of 368 patients with T1 or T2 breast cancer and pathologically-positive lymph nodes treated with breast-conserving therapy between 1968 and 1986. The median number of sampled lymph nodes was 10. Median follow-up time for the surviving patients was 139 months (range 70-244). Twenty percent of the patients were treated with supraclavicular RT, and 64% received both axillary and supraclavicular RT, with a median dose to the nodes of 45 Gy. The following factors were evaluated: presence of ECE, number of sampled lymph nodes (LN), number of involved LN, size of primary tumor, histologic grade of tumor, presence of lymphatic vessel invasion (LVI), presence of an extensive intraductal component (EIC), radiation dose, use of adjuvant chemotherapy, and age of patient. Recurrences were reported as the 5-year crude sites of first failure, and were divided into breast recurrences (LR), regional nodal failure (RNF, defined as isolated axillary, supraclavicular, or internal mammary recurrence), and distant metastases (DM). RESULTS: One hundred twenty-two patients (33%) had ECE and 246 patients did not. The median number of LN with ECE was 1 (range 1-10) and 20% of patients had ECE in > or =4 LN. Patients with ECE tended to be older (median age 51 vs. 47, p = 0.01), and had a higher number of involved LN (median 3 vs. 2, p = 0.005) than patients without ECE. Forty-three percent of patients with ECE had > or =4 involved LN compared to 15% of patients without ECE (p<0.0001). Models of ECE and the above factors revealed no significant correlation between ECE and either disease-free or overall survival. There was no statistically significant increase in local, regional nodal, or distant failures in patients with ECE as compared to patients without ECE. CONCLUSION: In this population of patients with nodal involvement, the presence of ECE correlates with the number of involved LN but does not appear to add predictive power to models of local, regional, or distant recurrence when the number of positive LN is included.

Axilla↗

PubMed2003

Secondary chondrosarcoma in osteochondroma: report of 107 patients.

Secondary chondrosarcomas are rare; recognition and diagnosis are difficult. Slow growth and late recurrence require long-term followup to understand the clinical course. In the current study, 107 patients had secondary chondrosarcoma arising in a solitary osteochondroma (61 patients) or multiple exostoses (46 patients). All histologic slides were reviewed without knowledge of the outcome, and radiologic studies were available for review in 71 cases. Patients with secondary chondrosarcoma were one to two decades younger than those with primary chondrosarcoma. Male preponderance and a predilection for flat bones were observed. The radiologic signs of sarcomatous degeneration included irregularity of the margin, inhomogeneous mineralization, and an associated soft tissue mass. The tumors generally were well-differentiated. Only 10 tumors were classified as Grade 2. Five-year and 10-year local recurrence rates were 15.9% and 17.5%, respectively, and 5- and 10-year mortality rates were 1.6% and 4.8% for patients having initial treatment at the authors' institution. Metastasis developed in five patients: in the lung in four patients and in the groin region in one patient. Most patients who died of tumor died of local recurrence. Wide excision had the lowest local recurrence rate. With successful surgical treatment, patients may have long-term disease-free survival.

Adolescent↗

PubMed2003

Dermatofibrosarcoma protuberans: reappraisal of wide local excision and impact of inadequate initial treatment.

BACKGROUND: The extent of local invasion in dermatofibrosarcoma protuberans (DFSP) is often clinically difficult to appreciate, and this leads to inadequate resections. We examined the effect of inadequate initial treatment and the efficacy of wide resection. METHODS: We performed a retrospective analysis of the records of 35 patients with DFSP treated at our institution (1985 and 2001). Data were analyzed with Wilcoxon's ranked sum test and Fisher's exact test. RESULTS: Of the 24 patients eligible for analysis, 11 had definitive wide resection after diagnostic excisions elsewhere (primary group), and 13 had recurrent tumors after previous surgical treatment elsewhere (recurrent group). Twenty-three patients were treated with wide resection only, and adjuvant radiation was administered to one patient who had a fibrosarcoma. At a median follow-up of 54 months, patients definitively treated at our institution had a 100% local recurrence-free survival. In comparison to the primary group, recurrent DFSPs were significantly larger and deeper and occurred in the head and neck region. Five cases had bone involvement, and of these, 80% occurred in the recurrent group. CONCLUSIONS: Inadequate initial treatment results in larger, deeper recurrent lesions, but these can be managed by appropriate wide excision. Wide resection of DFSP (whether recurrent or primary) with negative histological margins predicts a superior local recurrence-free survival.

Adolescent↗

PubMed1996

Wide perineal dissection and its effect on local recurrence following potentially curative abdominoperineal resection for rectal adenocarcinoma.

Ninety-three patients underwent a potentially curative abdominoperineal resection (APR) with a wide perineal dissection to the ischial tuberosities and excision of the entire mesorectum. There were 56 males and 37 females. The median follow-up was 67 months (range 7-240 months). The lymph node clearing technique was used and the median number of lymph nodes cleared was 35 (range 6-89). Eighteen of 93 patients (19%) developed a local recurrence, 12 of whom (13%) developed local recurrence only as the first site of recurrence. In 10 of 18 patients (56%) the distal rectum was the site of the primary rectal cancer. Of the 18 patients, 1 patient had stage I disease, 5 stage II, and 12 stage III. Five of the 18 patients (28%) who developed a local recurrence received adjuvant therapy. The median survival from the time of diagnosis of a local recurrence was 12 months. Histological grade (p=.001), patient age (p=.006), and presence of positive lymph nodes (p=.005) had a statistically significant adverse effect on survival. We believe the surgical technique of abdominoperineal resection with wide perineal resection to the ischial tuberosities and total excision of the mesorectum allowed us to achieve a low local recurrence rate (13%) in a high-risk group of patients. Clearly, the best form of prevention for local recurrence from rectal adenocarcinoma is radical surgical therapy of the primary tumor.

Adenocarcinoma↗

PubMedDate not supplied

Pathological changes of advanced lower-rectal cancer by preoperative radiotherapy.

BACKGROUND/AIMS: In the treatment of lower rectal cancer, we examined the pathological effects of preoperative radiotherapy on intramural spread of tumor and risk factors for local recurrence, including tumor deposit, budding growth of primary tumors, and micrometastasis to lymph nodes. METHODOLOGY: Ninety-four patients who underwent surgery for lower rectal cancer were selected. Forty-seven patients received preoperative radiotherapy, at a total dose of 50 Gy [Rad(+) group], whereas 47 did not [Rad(-) group]. Intramural spread was evaluated between the Rad(+) and Rad(-) groups. For analysis of tumor deposit, budding, and micrometastasis, 25 stage-matched patients were selected in both groups. RESULTS: Intramural spread was significantly less in the Rad(+) group, compared with the Rad(-) group. The Rad(+) group showed a significant decrease in tumor deposit, budding, and micrometastasis, compared with the Rad(-) group. In patients having overt lymph node metastases or not, the tumor deposit and budding were significantly higher in patients having overt metastases, compared with those not having them, in the Rad(-) group, whereas there was no significant difference in the Rad(+) group. CONCLUSIONS: Intramural spread and tumor deposit, budding, and micrometastasis were significantly decreased in the Rad(+) group, compared with the Rad(-) group. These results suggested effects of preoperative radiotherapy for sphincter preservation, as well as for decreasing the local recurrence rate.

Adult↗

PubMed1981

[Local recurrence of rectal carcinoma after abdomino-perineal resection (author's translation)].

From 1970 to 1974 165 patients suffering from rectal cancer underwent surgery at the Central Institute for Cancer Research of the Academy of Sciences of the GDR. In 112 patients abdomino-perineal excision of the rectum and rectosigmoid was performed for curative purposes. Subsequently local recurrences developed in 28 patients (25%). At the end of the 2nd postoperative year 82% of all patients had recurrences. In most cases only a palliative treatment of the recurrence could be established. From 9 patients with recurrences curatively treated only 3 survived for 5 years.--In a small subgroup of patients with postoperative irradiation a pelvic recurrence could be proved only once, whereas chemotherapy (mostly intraluminal) did not influence the rate of recurrences.--Obviously, early treatment of the primary tumour and local recurrence can be regarded as the only measure for improving the survival rate. It is too early for the evaluation of adjuvant therapy to be determined exactly.

Adenocarcinoma↗

PubMed1982

[Pelvic-peritoneal recurrences after amputation of the rectum for cancer. Report of 23 cases (author's transl)].

Of 79 patients surviving after amputation of the rectum for cancer, local and regional recurrences occurred in 23 cases, in 3 out of 4 of these during the 2-year period following operation. Only 3 patients survived. This illustrates the frequency and serious nature of these recurrent lesions. Based on their experience, the authors consider the risk of recurrence to be doubled if one of the following factors is present : patient under 60 years of age, cancer located in the lower rectum, tumour over 4 cm in diameter, stages B or C according to Dukes' classification, an anaplastic or colloid structure. Enzyme assay and computed tomography are unfortunately not determining factors for early diagnosis and effective therapy of pelvic-peritoneal recurrences. the authors suggest, therefore, though it was never employed in their own series, that pre-operative irradiation could be of value, in those patients that have a high risk of developing local or regional recurrences. The general use of this technique is not suggested because its known inconveniences.

Adenocarcinoma↗