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PubMed2004

Genetically altered fields as origin of locally recurrent head and neck cancer: a retrospective study.

PURPOSE: Surgeons treating patients with head and neck squamous cell carcinoma (HNSCC) rely heavily on histology to decide whether the resection margins are tumor free and subsequent adjuvant treatments can be omitted. However, despite the presence of tumor-free margins, 10-30% of HNSCC patients still develop a locally recurrent tumor. Evidence is available that recurrent cancer develops from either (a). outgrowth of a relatively small number of tumor cells that have not been detected by the pathologist or (b). a precursor lesion in which additional genetic alterations have led again to invasive cancer. EXPERIMENTAL DESIGN: In a retrospective study on 13 HNSCC cases, we analyzed the primary tumor, its surrounding histologically tumor-free resection margins, and local recurrences for loss of heterozygosity (22 microsatellite markers on 6 chromosomes) and TP53 mutations to determine the origin of the recurrent cancer. RESULTS: A precursor lesion was absent in 5 of 13 (39%) cases, and the genetic similarity of the primary and recurrent cancer was high, providing evidence that residual cancer cells were the origin of recurrence. For the remaining eight cases (61%) a genetically related precursor lesion (field) was detected, and for five of these cases, evidence was found that both the primary and recurrent carcinoma originated from this field. The remaining three cases were less conclusive. CONCLUSIONS: This study explains the pathobiology of locally recurrent HNSCC in patients with histologically tumor-free resection margins and indicates that the development of novel therapies to decrease the local recurrence rates in HNSCC should not only be focused on eradicating residual cancer cells but also on the precursor lesions that are left behind.

Adult↗

PubMed2002

[An experimental study on location and clinical application of recurrent laryngeal nerve in vagus nerve].

OBJECTIVE: To locate the recurrent laryngeal nerve fascicles in vagus and investigate the effect of latero-terminal neurorrhaphy to repair recurrent laryngeal nerve. METHOD: The method of dissection and acetylcholinesterase histochemical staining of neural fibers were used to locate the recurrent laryngeal nerve fascicles in vagus. Then 60 SD rats were divided into three groups. In experimental group right recurrent laryngeal nerve were incised and anastomosed to recurrent laryngeal nerve fascicles in vagus by means of latero-terminal neurorrhaphy. In control group right recurrent laryngeal were incised and sutured immediately by means of end-to-end nerve anastomosis. In normal group rats were not treated by any elements. One to three months later, 10 rats from each group were examined for vocal cord movement and nerve regeneration by using fibrolaryngscope and nerve electrormyography. RESULT: The recurrent laryngeal nerve fascicles is in the medial-front segment of the vagus and its diameter is about one-fourth as large as the vagus. One months after operation, This effect of latero-terminal neurorrhaphy had significant difference compared with the control group (P < 0.05). Three months after operation, This effect of latero-terminal neurorrhaphy had not significant difference compared with the control group (P > 0.05). CONCLUSION: The location of the recurrent laryngeal nerve fascicles in vagus provids important anatomical guideline for surgery. The latero-teminal neurorrhaphy has a similiar treatment effect compared with end-to-end nerve anastomosis. This microsurgical technique provides a new method for repairing recurrent laryngeal nerve.

Anastomosis, Surgical↗

PubMed1990

[Anterior approach to the cervical vertebrae and the location of the recurrent laryngeal nerve].

It is well known that the recurrent laryngeal nerve is often damaged during or following an anterior approach to the cervical vertebral column. Reports in the literature suggest that the right-sided approach gives rise to more complications of the recurrent nerve than the left-sided approach and that the right recurrent nerve is in a less protected position. There are also studies addressing the risks involved in the right-sided and the left-sided approach and suggesting the opposite conclusion. In our study, the position of the recurrent nerve was found to be variable and even to be different on the right and left sides in the same person. In 44.6% of cases (45 of 101) the recurrent nerve was found to be have an intermediate course (at the dorsal edge of the trachea or in the sulcus between trachea and esophagus) on both sides. The recurrent nerve was in an anterior position (lateral of the ventral two-thirds or the dorsal one-third of the trachea) in 50.5% (51 cases) on the left and in 49.5% (50 cases) on the right. A posterior position (lateral to the esophagus) of the recurrent nerve was found in 4.9% (5 cases) on the left and in 5.9% (6 cases) on the right. All combinations are possible. The position of the recurrent nerve cannot be inferred from its position on the opposite side. The right-sided or the left-sided approach cannot be preferred on the basis of the position of the recurrent nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗

PubMedDate not supplied

[Identification of the recurrent nerve in thyroid surgery. Technical note].

The authors report an experience of 1800 surgical operations for thyroid diseases executed, with identification of the recurrent laryngeal nerve in all cases, from 1988 to 1992, and analyse the various causes of recurrent laryngeal nerve injury. This complication of thyroid surgery is not completely avoidable, in spite of an extremely accurate surgical technique. In most instances of injury to one of the recurrent laryngeal nerves during thyroidectomy, the surgeon can confirm that the recurrent laryngeal nerve was not sectioned during the operation. This fact demonstrates that often the recurrent laryngeal nerve injury is due not to a section but to a stretching, a compression, an ischemia of the nerve. The recurrent laryngeal nerve injury may be due to a mistake in surgical technique: the ligation of the inferior pole vessels before identifying the recurrent laryngeal nerve; a mistake in hemostasis maneuvers; excessive aspiration near to the nerve; an excessive traction of the recurrent laryngeal nerve during the medial traction of the thyroid lobe with a stretching of the nerve; an excessive dissection of the nerve with ischemia. Other causes that make easier the recurrent laryngeal nerve injury are, anatomic variations of the nerve; extension of the surgical operation; histologic findings.

Humans↗

PubMed2005

Strategies to prevent recurrence of benign paroxysmal positional vertigo.

OBJECTIVE: To determine if a daily routine of Brandt-Daroff exercises increases the time to recurrence and reduces the rate of recurrence of benign paroxysmal positional vertigo (BPPV). DESIGN: Random sample of convenience and retrospective case review. SETTING: Tertiary referral center and outpatient clinic. PATIENTS: One hundred sixteen patients diagnosed with BPPV involving the posterior semicircular canal (BPPV-PC) who were successfully treated with the canalith repositioning procedure. INTERVENTIONS: Patients in the treatment group (n = 43) performed daily Brandt-Daroff exercises, while patients in the no-treatment group (n = 73) performed no exercises. MAIN OUTCOME MEASURES: Follow-up was as long as 2 years. Every 2 months patients were mailed a questionnaire. If BPPV had recurred, patients contacted the principal investigator within 24 hours. Within 1 to 2 weeks, patients were evaluated in the clinic with the Dix-Hallpike maneuver or, if unable to travel to the clinic, interviewed by telephone. RESULTS: Symptoms recurred in 50 (43%) of the 116 subjects, 34 (47%) of 73 in the no-treatment group and 16 (37%) of 43 in the treatment group. There was no significant difference in the frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .92). A history of recurrent BPPV-PC did not affect frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .72). CONCLUSION: Our results suggest that a daily routine of Brandt-Daroff exercises does not significantly affect the time to recurrence or the rate of recurrence of BPPV-PC.

Exercise↗

PubMed2000

Underlying causes of recurrent pneumonia in children.

OBJECTIVES: To determine the relative frequency of underlying factors for recurrent pneumonia and the proportion of patients in whom the underlying illness diagnosis was known prior to pneumonia recurrence. METHODS: Retrospective medical record review for a 10-year period from January 1987 through December 1997 at The Hospital for Sick Children in Toronto, Ontario, a tertiary care pediatric hospital. Recurrent pneumonia was defined as at least 2 pneumonia episodes in a 1-year period or at least 3 during a lifetime. RESULTS: Of 2952 children hospitalized with pneumonia, 238 (8%) met criteria for recurrent pneumonia. An underlying illness diagnosis was identified in 220 (92%). Of these, the underlying illness was diagnosed prior to pneumonia in 178 (81%), with the first episode in 25 (11%), and during recurrence in 17 (8%). Underlying illnesses included oropharyngeal incoordination with aspiration syndrome (114 cases [48%]), immune disorder (24 [10%]), congenital cardiac defects (22 [9%]), asthma (19 [8%]), pulmonary anomalies (18 [8%]), gastroesophageal reflux (13[5%]), and sickle cell anemia (10 [4%]). Clinical clues to diagnosis were recurrent infections at other locations and failure to thrive in the cases of an immune disorder, recurrences involving the same location in those with underlying pulmonary pathology, the association of respiratory symptoms with feeding in those with gastroesophageal reflux, or recurrent wheezing in asthmatic children. CONCLUSIONS: Recurrent pneumonia occurs in fewer than one tenth of all children hospitalized with pneumonia. Most of them have a known predisposing factor. The most common cause was oropharyngeal incoordination.

Adolescent↗

PubMed1996

Prospective study of recurrent radial head subluxation.

OBJECTIVES: To calculate a recurrence rate for radial head subluxation (RHS) and to identify risk factors for recurrence. DESIGN: Prospective cohort study. SETTING: Pediatric emergency department of an urban, tertiary care children's hospital. PATIENTS: Consecutive sample of 107 children younger than 6 years with definite (n = 94) or probable (n = 13) RHS enrolled during a 6-month period and followed up for at least 12 months. MAIN OUTCOME MEASURE: Recurrent episodes of RHS. RESULTS: Follow-up information was available on 86.9% (93/107) patients, with a mean +/- SD of 16.4 +/- 1.9 months (range, 12 to 20 months). Of these 93 patients, 22 (23.7%) had recurrent RHS. Among the patients who had their first episode of RHS during the study period (n = 76), those with recurrences were significantly younger than those without (21.7 +/- 9.9 months vs 29.2 +/- 13.5 months, respectively, P = .04, t test). Those 24 months or younger had a relative risk of 2.60 for one or more recurrences during the study period (95% confidence interval, 1.04 to 6.30) compared with those older than 24 months. No differences were observed in duration of follow-up, sex, elbow involved in the initial episode, or family history of RHS between those with and without recurrences. CONCLUSIONS: Recurrent RHS occurs in nearly one fourth of patients, and those 24 months or younger are at greatest risk. Sex, family history, and the elbow involved in the initial episode are not risk factors for recurrence.

Child, Preschool↗

PubMed1999

Are expandable metallic stents better than conventional methods for treating difficult intrahepatic biliary strictures with recurrent hepatolithiasis?

BACKGROUND: Conventional methods for treating patients with recurrent hepatolithiasis associated with complicated intrahepatic biliary strictures include balloon dilatation of the intrahepatic biliary strictures, lithotripsy, and the clearance of difficult stones as completely as possible, with the placement of an external-internal stent for at least 6 months. After these modalities are used, symptomatic refractory strictures remain. Recently we used internal Gianturco-Rosch metallic Z stents to treat patients who had refractory strictures. OBJECTIVE: To compare therapeutic results and complications of an internal expandable metallic Z stent with those of repeated external-internal stent placement. STUDY DESIGN: Case-control study. SETTING: A referral center. PATIENTS: From January 1992 to December 1996, 18 patients with recurrent hepatolithiasis and complicated intrahepatic biliary strictures underwent percutaneous dilatation of stricture and transhepatic percutaneous cholangioscopic lithotomy for recurrent stones. After their stones were completely cleared, their biliary strictures failed to dilate satisfactorily. The patients were randomly enrolled into 2 groups: group A (7 patients), who received an expandable metallic Z stent, and group B (11 patients), who had repeated placement of external-internal stents. INTERVENTIONS: Percutaneous stricture dilatation, electrohydraulic lithotripsy, balloon dilatation, percutaneous transhepatic cholangioscopic lithotomy, and biliary stenting by a Silastic external-internal catheter or a modified Gianturco-Rosch expandable metallic Z stent (for an internal stent). MAIN OUTCOME MEASURES: The number of procedures, days in hospital, procedure-related complications, incidents of stone recurrence and recurrence of cholangitis, readmissions to the hospital, treatment sessions required, and mortality rate. Patients' limitations in ordinary activities were also compared. RESULTS: The follow-up period ranged from 28 to 60 (40.7+/-12.7 [mean +/- SD]) months in group A and from 28 to 49 (36.0+/-7.2) months in group B. Fewer group A patients (3 [43%]) than group B patients (8 [73%]) tended to have recurrent cholangitis and to require readmission to the hospital, but this was not statistically significant (P = .33). When their cumulative probability of a first episode of cholangitis during follow-up was compared, however, it was significantly lower in patients treated with a metallic stent (P = .04). Compared with group B patients, group A patients had less frequent recurrence of stones (0% vs 64%; P = .01), fewer procedures for the clearance of biliary stones or sludge (1.7+/-2.2 vs 6.4+/-4.3; P = .03), and shorter hospital stays (8.0+/-11.5 days vs 17.0+/-12.0 days; P = .07). No patients in group A experienced limitation in ordinary activities, whereas 7 patients in group B did (P<.02). CONCLUSIONS: Compared with the repeated placement of external-internal stents, the use of a metallic internal stent effectively decreases stone recurrence, simplifies further procedures, and is more convenient. Its use is suggested as an alternative choice in the treatment of recurrent hepatolithiasis with refractory intrahepatic biliary strictures.

Adult↗

PubMed2000

DNA flow cytometry does not predict 5- or 10-year recurrence rates for T1-2 node-negative breast cancer.

BACKGROUND: A small proportion of T1 or T2 node-negative breast cancer tumors will recur in patients by 5 years, and more by 10 years. Results of recent studies have suggested improvement in overall survival with administration of adjuvant chemotherapy to all patients. More sensitive and specific methods are needed to identify patients at highest risk for recurrence who might benefit most from adjuvant therapy, saving others from unnecessary treatment. Some investigators have suggested DNA flow cytometry as a method to discriminate patients at greatest risk for recurrence. HYPOTHESIS: DNA flow cytometry has predictive value for breast cancer recurrence in node-negative patients. METHODS: The cancer registry of a medium-sized university-affiliated hospital was used to identify patients with T1-2 N0 M0 breast cancer treated with a uniform surgical approach and no adjuvant therapy who had completed at least 5 years of follow-up or had recurrence. Flow cytometric analysis was performed on paraffin-embedded specimens. RESULTS: Of 115 patients, 92 (80%) had disease-free survival without recurrence and 23 (20%) had recurrence. Comparison of diploid and nondiploid tumors for likelihood of recurrence revealed no association (P = .79). Furthermore, the DNA index and S-phase fraction were not significantly different between recurrent and nonrecurrent groups. CONCLUSIONS: The likelihood of recurrence of small node-negative breast cancers after mastectomy cannot be accurately predicted on the basis of DNA flow cytometric analysis. Traditional methods for determining risks-such as nuclear and histological grade, lymph node status, and tumor size-seem to be more useful. Sentinel lymph node biopsy techniques may increase the detection of micrometastases.

Breast Neoplasms↗

PubMed1992

Recurrence patterns and outcome in 1019 patients undergoing axillary or inguinal lymphadenectomy for melanoma.

Patterns of recurrence and outcome were determined in 403 patients with melanoma who underwent an axillary or inguinal lymphadenectomy. Recurrences developed at single sites in 291 (72%) patients, with a median survival of 11 months, and at multiple sites in 112 (28%) patients, with a median survival of 3 months. Among patients with single-site recurrence, those with nonvisceral recurrence (n = 190) had a median survival of 18.5 months compared with 6 months in those with visceral recurrence (n = 101). Recurrences were treated surgically in 240 (60%) patients, with a median survival of 15 months, and nonsurgically in 112 patients, with a median survival of 4 months. Median survival after complete resection of single-site recurrence was 19 months compared with 6 months after incomplete resection. Multivariate analysis revealed that outcome was improved by surgical treatment, single-site and nonvisceral recurrence, and primary site in an extremity. These observations support an approach of selective resection in the treatment of recurrences after lymphadenectomy.

Adolescent↗

PubMed1998

Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative Famciclovir Genital Herpes Research Group.

CONTEXT: Recurrent genital herpes simplex virus (HSV) may be treated episodically, but this may not be sufficient for patients with frequent recurrences. OBJECTIVE: To determine the efficacy and safety of famciclovir in the suppression of recurrent genital HSV infection. DESIGN: A randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Thirty university, hospital, or private outpatient referral centers in Canada and Europe. PATIENTS: A total of 455 patients (223 men, 232 women) aged 18 years or older with a history of 6 or more episodes of genital herpes during 12 of the most recent 24 months, in the absence of suppressive therapy, received study medication. INTERVENTION: Oral famciclovir, 125 mg or 250 mg 3 times daily or 250 mg twice daily, or placebo for 52 weeks. MAIN OUTCOME MEASURES: Time to the first recurrence of genital HSV infection; the proportion of patients remaining free of HSV recurrence at 6 months; frequency of adverse events. RESULTS: In an intent-to-treat analysis, famciclovir significantly delayed the time to the first recurrence of genital herpes at all dose regimens (hazard ratios, 2.9-3.3; P<.001); median time to recurrence for famciclovir recipients was 222 to 336 days compared with 47 days for placebo recipients. The proportion of patients remaining free of HSV recurrence was approximately 3 times higher in famciclovir recipients (79%-86%) than in placebo recipients (27%) at 6 months (relative risks, 2.9-3.1; P<.001); efficacy was maintained at 12 months. Famciclovir was well tolerated with an adverse experience profile comparable to placebo. CONCLUSIONS: Oral famciclovir (125 mg or 250 mg 3 times daily or 250 mg twice daily) is an effective, well-tolerated treatment for the suppression of genital HSV infection in patients with frequent recurrences.

2-Aminopurine↗

PubMed1999

Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years.

CONTEXT: Elderly patients with major depression are at high risk for recurrence, increased mortality, and chronic disability. OBJECTIVE: To determine the efficacy of maintenance nortriptyline hydrochloride and interpersonal psychotherapy (IPT) in preventing recurrence of major depressive episodes in patients older than 59 years. DESIGN: A 2 x 2 randomized, double-blind, placebo-controlled clinical trial, stratified by therapist. SETTING: University-based psychiatric research clinic. PATIENTS: Of a total of 187 patients with recurrent nonpsychotic unipolar major depression (average age, 67 years; one third aged > or =70 years) recruited through clinical referral and media announcements, 107 were fully recovered after open acute and treatment continuation with nortriptyline and IPT. These patients were randomly assigned to 1 of 4 maintenance therapy conditions. INTERVENTIONS: Monthly medication clinic with nortriptyline hydrochloride (80-120 ng/mL steady-state levels) (n = 24); medication clinic with placebo (n = 29); monthly maintenance IPT with placebo (n = 21); and monthly maintenance IPT with nortriptyline (n = 22). MAIN OUTCOME MEASURE: Recurrence of major depressive episode. RESULTS: The time to recurrence of a major depressive episode for all 3 active treatments was significantly better than for placebo. Recurrence rates over 3 years were as follows: nortriptyline and IPT, 20% (95% confidence interval [CI], 4%-36%); nortriptyline and medication clinic visits, 43 % (95% CI, 25%-61%); IPT and placebo, 64% (95% CI, 45%-83%); and placebo and medication clinic visits, 90% (95% CI, 79%-100%). Combined treatment with nortriptyline and IPT was superior to IPT and placebo and showed a trend to superior efficacy over nortriptyline monotherapy (Wald chi2 = 3.56; P = .06). Subjects aged 70 years and older had a higher and more rapid rate of recurrence than those aged 60 to 69 years. CONCLUSION: In geriatric patients with recurrent major depression, maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence. Combined treatment using both appears to be the optimal clinical strategy in preserving recovery.

Adrenergic Uptake Inhibitors↗

PubMed2006

Identification of patients at low risk for recurrent venous thromboembolism by measuring thrombin generation.

CONTEXT: Screening of patients with venous thromboembolism (VTE) for thrombophilic risk factors is common clinical practice. Because of the large number of risk factors, assessing the risk of recurrence in an individual patient is complex. A method covering multicausal thrombophilia is therefore required. OBJECTIVE: To investigate the relationship between recurrence of VTE and a simple global coagulation assay measuring thrombin generation. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 914 patients with first spontaneous VTE who were followed up for an average of 47 months after discontinuation of vitamin K antagonist therapy. The study was conducted at the Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria, between July 1992 and July 2005. Thrombin generation was measured by a commercially available assay system. Patients with a previous or secondary VTE; antithrombin, protein C, or protein S deficiencies; presence of lupus anticoagulant; cancer; or pregnancy were excluded. MAIN OUTCOME MEASURE: Objectively documented symptomatic recurrent VTE. RESULTS: Venous thromboembolism recurred in 100 patients (11%). Patients without recurrent VTE had lower thrombin generation than patients with recurrence (mean [SD], 349.2 [108.0] nM vs 419.5 [110.5] nM, respectively; P<.001). Compared with patients who had thrombin generation greater than 400 nM, the relative risk (RR) of recurrence was 0.42 (95% confidence interval [CI], 0.26-0.67; P<.001) in patients with values between 400 nM and 300 nM; for patients with lower values, the RR was 0.37 (95% CI, 0.21-0.66; P = .001). After 4 years, the probability of recurrence was 6.5% (95% CI, 4.0%-8.9%) among patients with thrombin generation less than 400 nM compared with 20.0% (95% CI, 14.9%-25.1%) among patients with higher values (P<.001). Patients with thrombin generation less than 400 nM, representing two thirds of patients, had a 60% lower RR of recurrence than those with greater values (RR, 0.40; 95% CI, 0.27-0.60; P<.001). CONCLUSION: Measurement of thrombin generation identifies patients at low risk for recurrent VTE.

Adult↗

PubMed1996

Clinical significance of simultaneous determinations of alpha-fetoprotein and des-gamma-carboxy prothrombin in monitoring recurrence in patients with hepatocellular carcinoma.

BACKGROUND: Measurements of serum alpha-fetoprotein (AFP) concentration and plasma concentration of des-gamma-carboxy prothrombin (DCP) have been widely used for the early diagnosis of hepatocellular carcinoma (HCC). The two markers generally run parallel to each other. However, in our study, they sometimes fluctuated independently in response to tumor regression or recurrence. METHODS: A longitudinal series of concentrations of serum AFP and plasma DCP were determined simultaneously for 245 patients with HCC from the time of diagnosis to tumor recurrence after treatment. RESULTS: Positive reactions for AFP were noted in 168 patients (69%) and for DCP in 126 patients (51%). One hundred and ten of 245 patients with HCC (45%) were positive for both AFP and DCP. In 35 patients (14%), these 2 tumor markers fluctuated independently in response to tumor regression and recurrence. These patients were categorized into four groups as follows: Group 1 had elevated AFP only at diagnosis; it then decreased after treatment, but DCP was elevated at the time of tumor recurrence without AFP elevation (3 patients); Group 2 had elevated DCP at diagnosis and elevated AFP at tumor recurrence (4 patients); Group 3 had elevated AFP and DCP at diagnosis, but only AFP (8 patients) or DCP (7 patients) was elevated at tumor recurrence; Group 4 had only elevated AFP (2 patients) or DCP (11 patients) at diagnosis, but both AFP and DCP were elevated at tumor recurrence. CONCLUSIONS: The results of this study indicate that simultaneous determinations of AFP and DCP are useful for monitoring recurrence in patients with HCC after treatment, and that the decrease to normal levels of a single marker does not always indicate the absence of tumor recurrence.

Adolescent↗

PubMed1997

Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection.

BACKGROUND: Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS: After PEI treatment of HCC, the patients were followed for a mean period of 33 +/- 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS: The cumulative 4-year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis > 6 years (P = 0.05) and AFP level before PEI of > 25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of > 13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS: Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program.

Adult↗

PubMed1985

Results of irradiation in the treatment of locoregional breast cancer recurrence.

A retrospective review is presented of 255 patients with chest wall and/or regional nodal recurrent breast cancer treated between January 1956 through December 1981 at the University of Texas M. D. Anderson Hospital; 61 patients had such massive or diffuse disease that only palliative irradiation was given, and 194 patients were treated with curative intent and form the basis of this report. All patients treated with radical irradiation received greater than or equal to 4500 rad, and 65% of the patients received boost therapy through reduced fields. Thirty-two percent of patients were treated only to a single recurrent site, 11% of two sites, and 57% to the chest wall and regional nodes. Failure to control recurrent disease within or on the border of the irradiated field occurred in 27% of patients. Of 62 patients treated to the local recurrence site, 27% had further recurrences in adjacent unirradiated sites. The patients with the greatest success for tumor control (78%) and survival at 5 years (48% disease-free) are those patients with histologically negative nodes at time of mastectomy and a single chest wall recurrence. Possible prognostic factors are discussed: initial clinical stage, age of the patient, axillary histology at the time of mastectomy, disease-free interval between mastectomy and recurrence, number and size of recurrences, and prior chest wall recurrence.

Female↗

PubMed1986

Patterns of recurrence in malignant mixed müllerian tumor of the uterus.

Of 120 patients treated definitively at University of Texas System Cancer Center, M. D. Anderson Hospital for malignant mixed müllerian tumor of the uterus, 67 had their tumors recur. These patients were analyzed for recurrence pattern and response of recurrence to treatment. The most frequent sites of recurrence were the lung and abdomen, accounting for 66% of all first-site recurrences and 80% of all first-site distant metastases. Locoregional recurrences were much less frequent, accounting for 18% of recurrences. There was no apparent change in recurrence pattern with the addition of adjuvant chemotherapy. The effect of adjuvant radiation could not be assessed, because 95% of patients treated surgically received adjunctive radiation. The survival after treatment of recurrence was shortest for patients with bone, brain, or liver metastases (median, 4 months). There were four long-term survivors (more than 36 months). Patients with resectable recurrences had the highest response rates. Response to chemotherapy alone was uniformly poor (6% response rate).

Female↗

PubMed1986

Local recurrences in patients with breast cancer at the North Carolina Memorial Hospital (1970-1982).

A study of predictive factors for locoregional recurrences after curative surgery for breast cancer was undertaken. Specifically, the authors wished to determine whether such recurrences correlated with either hormonal receptor status or a delay between the initial biopsy and the definitive surgery. A retrospective chart review was done on all women with breast cancer who had surgery for cure between 1970 and 1982. Factors analyzed included, among others, size of the tumor, clinical and pathologic status of the axilla, estrogen and progesterone receptors status, and delay between biopsy and definitive surgery. There were 404 patients studied. Pathologic axillary nodal status was the most important predictor of locoregional recurrence, with failures in 36 of 188 (19%) node-positive but only 9 of 216 (4%) node-negative patients (P = 0.0001). In node-positive patients, tumor size was a predictor of local recurrence, with failure in only 4 of 51 (8%) of tumors less than 2 cm, but in 14 of 44 (32%) of tumors greater than 6 cm (P = 0.004). Progesterone receptor (PR) status correlated with locoregional recurrence, but estrogen receptor status did not. In node-positive women, there were 4 of 14 PR-negative but 0 of 15 PR-positive local failures (P = 0.017); this result has not been previously reported. The presence of palpable axillary disease was also found to be a predictor of local recurrence. Finally, no increase in locoregional recurrence could be attributed to the delay between biopsy and definitive surgery. Two new predictors for locoregional recurrence in breast cancer, not previously emphasized, are PR and clinical axillary status. Should these findings be substantiated, patients at high risk for locoregional recurrence could then be more readily identified.

Actuarial Analysis↗