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PubMed1995

Gallbladder stone recurrence after medical treatment. Do gallstones recur true to type?

Medical treatments that dissolve or remove gallbladder stones but leave the gallbladder in situ have the disadvantage of gallstone recurrence. Little is known about the composition of recurrent stones or whether they recur true to type. In 21 patients with recurrent stones detected 5-74 months (mean +/- SEM, 26 +/- 4 months) after being rendered stone-free with dissolution therapy (N = 15) or percutaneous cholecystolithotomy (N = 6), we compared pretreatment and postrecurrence gallstone number, maximum gallstone attenuation scores measured by computed tomography (CT) and, in 13, the dissolvability of the recurrent stones with oral bile acids +/- extracorporeal shock-wave lithotripsy. Before treatment, five patients had solitary and 16 had multiple stones but on recurrence, the gallstones differed in number from the primary stones in 10 of the 21 patients. As a result of patient selection, before dissolution, the primary stones were all radiolucent with maximum CT scores of < 100 Hounsfield units (HU) (mean 45, range 10-84 HU). On recurrence, the stones were again CT-lucent in 13 of the 15 patients but were CT-dense in the remaining two (118 and 176 HU). Initially, all six patients treated by percutaneous cholecystolithotomy had radio-opaque stones, with a mean CT score of 459 (range 100-969) HU. However, on recurrence, only one had calcified stones (HU 140); the remaining five had CT-lucent stones (16-98 HU, P < 0.05). Of the 13 patients whose recurrent, plain x-ray-lucent and CT-lucent stones were treated with oral bile acids +/- lithotripsy, 12 (92%) showed evidence of gallstone dissolution. We conclude that gallbladder stones do not recur true to type in up to two thirds of patients. However, irrespective of original gallstone composition, recurrent stones are usually radio- and CT-lucent, presumed cholesterol-rich, and therefore potentially dissolvable with oral bile acids.

Bile Acids and Salts↗

PubMed2001

High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study.

INTRODUCTION: Serum carcinoembryonic antigen is used mainly for tumor follow-up to detect recurrence of colonic cancer. However, raised preoperative carcinoembryonic antigen levels may be helpful for the identification of understaged cases and of patients meriting more intensive preoperative and postoperative diagnostic workup. METHODS: From a prospectively collected database, the data on 261 patients who had curative colonic carcinoma with a minimal follow-up of five years and who had preoperative carcinoembryonic antigen levels assessed were retrieved and analyzed. Outcome parameters were local and/or distant recurrence and time to recurrence. These parameters were correlated with Dukes staging and preoperative carcinoembryonic antigen levels. RESULTS: The cumulative disease-free survival of patients with a preoperative carcinoembryonic antigen level within the normal range was significantly better than that of those whose carcinoembryonic antigen was 5 ng/ml or more (P = 0.001). No patient with carcinoembryonic antigen levels less than 1 ng/ml developed metastatic recurrence. Twenty-three percent of all patients with a raised carcinoembryonic antigen above 5 ng/ml compared with 2.1 percent of patients with carcinoembryonic antigen below 5 ng/ml developed a metastasis at two years. At five years, these figures were 37.2 percent and 7.5 percent, respectively. Dukes staging and carcinoembryonic antigen levels were found to be directly correlated (P < 0.001) when all patients were included. Carcinoembryonic antigen of more of 15 ng/ml was found to be a significant adverse prognostic indicator for disease-free survival irrespective of Dukes staging (P < 0.02). Raised carcinoembryonic antigen levels predicted distant metastatic recurrence (P < 0.001) but did not predict local recurrence (P = 0.72). CONCLUSIONS: High preoperative carcinoembryonic antigen levels above 15 ng/ml predicted an increased risk of metastatic recurrence in potentially curative colonic cancer and may indicate undetectable disseminated disease. Preoperative carcinoembryonic antigen levels predict understaging and the possibility of distant recurrence. Such patients may therefore be selected for adjuvant therapy where indicated. Therefore, carcinoembryonic antigen is complementary to conventional Dukes staging for the prediction of recurrence and survival.

Aged↗

PubMed2001

Local recurrence after curative resection of cancer of the rectum without total mesorectal excision.

PURPOSE: The aim of this article was to examine local recurrence after curative resection for carcinoma of the rectum in which the surgical technique of total mesorectal excision was not performed. METHODS: A single surgeon managed the patients and the data collected prospectively. Total excision of the distal mesorectum was not performed in the upper third or mid rectum. RESULTS: From 1969 to 1993 curative resections were performed in 549 patients, of which 17 died postoperatively, leaving 532 for analysis. Sphincter-saving resection was performed in 468 patients (88 percent) and abdominoperineal excision in 58 (10.9 percent). The pathology stages (Dukes) were A, 158 (29.7 percent); B, 184 (34.7 percent); and C, 190 (35.7 percent). Five hundred seventeen patients (97.2 percent) were followed up for a minimum of five years. The median period of follow-up was 82 months. Local recurrence confined to the pelvis occurred in 17 patients, and local recurrence associated with distant metastases occurred in 24 patients. The total five-year local recurrence rate was 7.6 percent. Local recurrence was increased in Stage C tumors (P = <0.0001). Diathermy dissection in the pelvis was associated with a decreased local recurrence rate (P = 0.023). The five-year survival rate in curative resections was 72.5 percent. CONCLUSIONS: It is essential that articles presenting local recurrence rates should include both local recurrence in isolation and that which occurs with distant metastases. Although total mesorectal excision for rectal cancer was not performed in this study, the local recurrence rate is not materially different from that in several articles where total mesorectal excision has been used. Whether the distal mesorectum needs to be pursued in mid-rectal cancer is not yet proven.

Adult↗

PubMed2000

Recurrent rectal prolapse: what is the next good option?

PURPOSE: The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse. METHODS: All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse. RESULTS: A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6 +/- 7.8 vs. rectal prolapse, 12.7 +/- 7.2; range, 0-20) or manometric or electromyography findings, and there were no significant differences in mortality (0 vs. 3.7 percent), mean hospital stay (5.4 +/- 2.5 vs. 6.9 +/- 2.8 days), anastomotic complications (anastomotic stricture (0 vs. 7.4 percent), anastomotic leak (3.7 vs. 3.7 percent) and wound infection (3.7 vs. 0 percent), postoperative incontinence score (2.8 +/- 4.8 vs. 1.5 +/- 2.7), or recurrence rate (14.8 vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6-68) and 22 (range, 5-55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent. CONCLUSION: The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.

Adult↗

PubMedDate not supplied

Effect of no touch isolation on survival and recurrence in curative resections for colorectal cancer.

BACKGROUND: Curative resections for colorectal cancer were studied to determine the effects of the application of bowel ligatures and the sequence of mesenteric ligation on survival and recurrence as part of the no touch isolation technique. METHODS: Records documenting the application of bowel ligatures in 2015 consecutive curative resections for colorectal cancer and the sequence of mesenteric vessel ligation in 1863 of these cases were reviewed. RESULTS: Bowel ligatures applied before tumor mobilization in curative resections for colorectal cancer consistently reduced cancer-related deaths and the incidence of distant, local, and suture line recurrences. Their impact on survival began to approach statistical significance in Dukes C colon cancers and in the overall group of colon cancers (P = .019). Early application of bowel ligatures decreased the incidence of subsequent liver metastases from 15.3% to 9.5% and systemic metastases from 18.0% to 13.0% (P <.0001). Local recurrence was reduced from 18.3% to 10.8% in Dukes B and from 28.6% to 19.3% in Dukes C cases (P = .002). The incidence of suture line recurrence was reduced from 6.8% to 0.9% in Dukes B and from 12.2% to 3.2% in Dukes C cases (P = .001). Ligating the mesenteric vessels before mobilizing the tumor did not significantly affect survival, but did increase the incidence of distant systemic metastases and of local and suture line recurrences. With early vessel ligation, systemic metastases developed in 24.5% of 813 curative resections, compared to 15.7% of 1050 cases in which vessel ligation followed tumor mobilization (P <.001). Early vessel ligation in Dukes C cancers was associated with an increase in local recurrence from 22.5% to 34.2% and in suture line recurrence from 6.9% to 18.8% (P = .0003). The correlation became greater as the stage of the cancer became more advanced. CONCLUSION: By controlling lymphatic and intraluminal dissemination of malignant cells as well as minimizing tumor manipulation, bowel ligatures help to reduce cancer-related deaths and the incidence of distant, local, and suture line recurrences. The sequence in which the mesenteric vessels were ligated did not affect survival, but did change the distribution of distant metastases and the incidence of local and suture line recurrences.

Colon↗

PubMed1999

The significance of p53 mutations as an indicator of the biological behavior of recurrent hepatocellular carcinomas.

The significance of p53 mutations in the primary lesion for recurrent hepatocellular carcinoma (HCC) was evaluated. Mutations of p53 were examined using nonradioisotopic (nonRI)-polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) in 98 resected HCCs. Of the 98 cases, 25 (26%) had a p53 mutation. In 83 patients who survived surgery, the presence of a p53 mutation was associated with a shortened overall survival (P < 0.001) and a shortened cancer-free survival (P < 0.05). In 43 patients who developed recurrence, there was no statistically significant correlation between the status of p53 in the primary lesion and the clinical features of recurrent HCCs examined, i.e., extrahepatic metastasis, the number of recurrent tumors, extent of recurrent tumors, and treatment for recurrent tumors. However, postrecurrence survival was significantly lower in patients in whom a p53 mutation had been detected in the primary lesion (P < 0.01). A multivariate analysis for prognostic value after recurrence revealed that the p53 mutation was a useful independent prognostic factor affecting survival after recurrence (P < 0.01). In conclusion, our findings suggest that HCCs with p53 mutations have a high malignant potential based on their poor prognosis. Therefore, a p53 mutation in the primary lesion is useful as an indicator of the biological behavior of recurrent HCCs.

Carcinoma, Hepatocellular↗

PubMed1992

Recurrence of superficial bladder tumours after transurethral resection.

From 1979 to January 1990, 48 patients with newly diagnosed superficial bladder tumours were treated by transurethral resection (TUR) at Toyama Medical and Pharmaceutical University Hospital. The relationship between tumour recurrence and the stage, grade, number, or size of the tumours was investigated. The 1-, 2-, 3-, 4- and 5-year non-recurrence rates were 72%, 63%, 47%, 40%, and 40%, respectively. Non-recurrence rate for pTa tumours was significantly higher than that for pT1 tumours (p < 0.05). There was no relationship between tumour grade and recurrence. The rate of recurrence of multiple tumours was higher than that of single ones. There was no difference in non-recurrence rate between tumours smaller than 1 cm and those of 1 cm or larger. Non-recurrence rate in the instillation therapy group was significantly higher than in the non-instillation group (p < 0.05). It was concluded that patients with multiple or high-stage tumours have the risk of a high rate of recurrence and that intravesical chemotherapy is effective in preventing local recurrence in some patients.

Administration, Intravesical↗

PubMed1987

Lung recurrence after curative surgery for colorectal cancer.

A total of 1578 patients were treated with potentially curative surgical resection for colon and rectal cancer by one surgeon from 1950 to 1982. Follow-up revealed that 117 (11.5 percent) of 1013 patients with rectal carcinoma eventually presented with clinical evidence of pulmonary recurrence, with or without evidence of spread elsewhere; the corresponding figures for the colon were 20 (3.5 percent) of 565 (P less than 0.001). An analysis of the times to recurrence revealed that half of the lung recurrences were clinically obvious within 32 months for rectal tumors and 34 months for colonic, compared to 22 and 21 months, respectively, for liver recurrences, excluding those with other distant metastases. The slower recurrence rate and the longer survival in patients with recurrences in the lung compared to the liver were statistically significant only for rectal primaries (P less than 0.02 and P = 0.001, respectively). Sixteen patients underwent surgery with curative intention for lung recurrences; four of these remain alive at two, six, 11, and 15 years, and one patient was free of recurrence when he died from other causes 15 months after surgery. The conditional probability survival rate for the 16 patients was 38 +/- 13 percent at five years after recurrence operation.

Colonic Neoplasms↗

PubMed1992

Complications associated with ulcer recurrence following gastric surgery for ulcer disease.

The present study is an attempt to assess the risks of the complications associated with recurrent ulcers in patients who have undergone gastric surgery and to determine whether these risks differ from those observed in patients receiving long term maintenance treatment with H2-receptor antagonists for ulcer disease. One hundred and thirty studies reported in the literature during the past three decades have been analysed to determine both the approximate rate of ulcer recurrence and the proportion of patients with recurrent ulcers who have presented with either haemorrhage or perforation following the various types of gastric surgery for ulcer disease. From these data, estimates of the risks of haemorrhage and of perforation during the years following gastric surgery have been calculated. Vagotomy and antrectomy is associated with a low risk of ulcer recurrence (less than 1%) and the risk of complications in later years is accordingly very small (less than 0.5%). Partial gastrectomy, although associated with low recurrence rates, has a higher risk of complications (1.3% for haemorrhage, 0.3% for perforation) because the proportion of recurrent ulcers that present with haemorrhage or perforation is high (33% and 8%, respectively). Truncal vagotomy plus drainage (TV + D) and highly selective vagotomy (HSV) are associated with recurrence rates of 9% and 12%, respectively, but ulcer recurrences following these operations are less frequently accompanied by complications then recurrences after gastric resection and, as a result, the risks of haemorrhage (1.7% for TV + D; 1.3% for HSV) are similar to the risks after gastric resection. During long term (five years or more) maintenance treatment with H2-receptor antagonists, the risks of haemorrhage and perforation are less than 2% and less than 0.5%, respectively. It appears, therefore, that the likelihood of developing haemorrhage or perforation following gastric surgery is of the same order as that during maintenance treatment with H2-receptor antagonists, at least during the first decade of follow-up.

Histamine H2 Antagonists↗

PubMed2003

The lymphoblastoid cell lines of recurrence condyloma acuminatum patients produce lower level of tumor necrosis factor stimulated with LPS.

To study the mechanism of Condyloma acuminatum (CA) recurrence, and the association of CA recurrence with the ability of the host derived lymphoblastoid cell lines (LCL) stimulated by LPS to produce tumor necrosis factor (TNF), EBV-transformed B LCL were used as TNF producing cells. The ability of LCL stimulated by LPS to produce TNF was measured by bioassay. The results showed that the LCL from CA patients (including recurrent and non-recurrent CA patients) produced similar level of TNF stimulated by LPS to that of normal controls (29.54% +/- 11.28% vs 34.31% +/- 11.46%, P = 0.1498). The LCL of CA recurrent patients produced significantly lower amount of TNF than that of non-recurrent CA patients (23.72% +/- 7.41% vs 37.33% +/- 11.10%, P = 0.0032). Compared with the normal controls, CA recurrent patients showed a decreased ability to produce TNF (23.72% +/- 7.41 vs 34.31% +/- 11.46, P = 0.0054), whereas CA non recurrent patients had the similar ability to the controls (37.33% +/- 11.10 vs 34.31% +/- 11.46, P = 0.4914). It was concluded that the onset of CA was not relevant to the individual's ability to produce TNF. But the recurrence of CA was associated with the ability to produce TNF. It was also indicated that the TNF involved cellular immunity might play an important role in the clearance of the residual HPV by the host after treatment.

Adolescent↗

PubMed2004

Methionine positron emission tomography for differentiation of recurrent brain tumor and radiation necrosis after stereotactic radiosurgery--in malignant glioma.

OBJECT: Following stereotactic radiosurgery (SRS), we examined how to differentiate radiation necrosis from recurrent malignant glioma using positron emission tomography (PET) with 11C-methionine (Met). METHODS: Met-PET scans were obtained from 11 adult cases of recurrent malignant glioma or radiation injury, suspected on the basis of magnetic resonance images (MRI). Patients had previously been treated with SRS after primary treatment. PET images were obtained as a static scan of 10 minutes performed 20 minutes after injection of Met. We defined two visual grades (e.g., positive or negative Met accumulation). On Met-PET scans, the portion of the tumor with the highest accumulation was selected as the region of interest (ROI), tumor-versus-normal ratio (TN) was defined as the ratio of average radioisotope counts per pixel in the tumor (T), divided by average counts per pixel in normal gray matter (N). The standardized uptake value (SUV) was calculated over the same tumor ROI. Met-PET scan accuracy was evaluated by correlating findings with subsequent histological analysis (8 cases) or, in cases without surgery or biopsy, by the subsequent clinical course and MR findings (3 cases). RESULTS: Histological examinations in 8 cases showed viable glioma cells with necrosis in 6 cases, and necrosis without viable tumor cells in 2 cases. Three other cases were considered to have radiation necrosis because they exhibited stable neurological symptoms with no sign of massive enlargement of the lesion on follow-up MR after 5 months. Mean TN was 1.31 in the radiation necrosis group (5 cases) and 1.87 in the tumor recurrence group (6 cases). Mean SUV was 1.81 in the necrosis group and 2.44 in the recurrence group. There were no statistically significant differences between the recurrence and necrosis groups in TN or SUV. Furthermore, we made a 2 x 2 factorial cross table (accumulation or no accumulation, recurrence or necrosis). From this result, the Met-PET sensitivity, specificity, and accuracy in detecting tumor recurrence were determined to be 100%, 60%, and 82% respectively. In a false positive-case, glial fibrillary acidic protein (GFAP) immunostaining showed a positive finding. CONCLUSION: There were no significant differences between recurrent malignant glioma and radiation necrosis following SRS in Met-PET. However, this study shows Met-PET has a sensitivity and accuracy for differentiating between recurrent glioma and necrosis, and presents important information for developing treatment strategies against post radiation reactions.

Adult↗

PubMed2001

Soft X-ray therapy of recurrent pterygium--an alternative to 90Sr eye applicators.

BACKGROUND: Analysis of effectiveness of perioperative 20 kV soft X-ray irradiation in recurrent pterygium as an alternative to postoperative 90Sr beta irradiation. PATIENTS AND METHODS: Between 1987 and 2000 a total of 65 patients with 81 pterygia were treated with 20 kV X-ray therapy in the course of surgical treatment of recurrent pterygium. Until 1995 simple excision (bare sclera technique) followed by postoperative irradiation (generally four fractions of 5 Gy) was applied, with radiation starting on mean 4 days following surgery (34 cases, mean follow-up 52 months). Since 1995 we have changed our policy to a perioperative regimen starting with a single dose of 7 Gy prior to microsurgical excision with conjunctival autograft and proceeding within 24 hours with 5 Gy single dose to the surgical bed and then every other day to a total dose of 27 Gy (47 cases, mean follow-up 31 months). Recurrence rate was calculated by Kaplan Meier method. A multivariate Cox regression analysis of prognostic factors for recurrence was performed. RESULTS: A total of 19 recurrences were observed, 15 in the historical postoperative group and four in the perioperative group. Actuarial 2- and 5-year recurrence rate is 9% in the "new treatment group" compared to 34% and 56% in the historical group (p = 0.001). Only one of the four recurrences among the pre- and postoperatively irradiated group required a new surgical procedure. In this case radiation had been terminated at 17 Gy. Actuarial rate of surgical reintervention was only 2% at 2 and 5 years compared to 28% and 36% in the historical group. In multivariate Cox regression analysis only the new treatment strategy was found to influence control rate significantly. Until now no case of severe side effects like scleral necrosis or thinning, symble-pharon, radiation-induced cataract or glaucoma were observed in both groups. CONCLUSION: The combination of pre- and postoperative 20 kV X-ray therapy and microsurgical excision combined with conjunctival autograft is a highly effective treatment to prevent recurrence in the high-risk group of recurrent pterygia and can be recommended as an alternative to postoperative 90Sr beta irradiation.

Actuarial Analysis↗

PubMed2003

Therapeutic outcome and prognostic factors in the radiotherapy of recurrences of cervical carcinoma following surgery.

PURPOSE: To evaluate the efficacy of radiotherapy in patients with recurrences of cervical carcinoma. PATIENTS AND METHODS: 26 patients who underwent radiation therapy for recurrences of cervical carcinoma following surgery between 1989 and 1999 were retrospectively analyzed. 17 patients had inoperable or macroscopic residual tumor. Nine patients had a complete/microscopically incomplete tumor resection. Depending on tumor burden and location of the recurrence, external beam radiotherapy or a combination with brachytherapy was delivered to a total dose of 50-65 Gy. RESULTS: The 5-year overall survival was 28%, relapse-free survival 24%, pelvic control 48%. Therapeutic outcome was related to the margins of resection, location of recurrence and technique of radiotherapy. In case of surgery without residual or microscopic tumor, the 5-year survival rate was 67%, with macroscopic tumor no patient was alive after 37 months (p = 0.05). 5-year overall survival was 42% for central recurrences, 10% for recurrences with pelvic wall infiltration. Recurrences confined to the vagina or paravaginal tissue had a higher 5-year overall probability as compared to all other patients (57% vs. 14%). All patients treated with combined radiotherapy were alive, whereas all patients treated only with external radiotherapy were dead after 32 months (p = 0.01). CONCLUSION: The probability of controlling recurrence mostly depends on a small tumor burden with the possibility of brachytherapy and/or complete surgery. Aggressive treatment modalities like radiochemotherapy and/or higher radiation doses are needed, especially for recurrences with infiltration of the pelvic wall and/or with macroscopic tumor.

Adenocarcinoma↗

PubMed1999

Recurrent pleomorphic adenoma of the head and neck.

We reviewed the clinical and imaging files of 15 patients with pathologically confirmed recurrent pleomorphic adenomas of the head and neck. The primary tumours were in the lacrimal gland (1 case), cheek (2), palate (5), parotid gland (4), and submandibular gland (3). Recurrence was generally late, with an average of 14.9 years between initial surgery and recurrence. Multiple recurrent tumours, measuring 5-50 mm were found in eight patients. In all palatal cases recurrence was large and solitary. Most recurrent pleomorphic adenomas were well delineated with smooth margins, like most primary tumours. Irregularity of the margins was seen in four patients. In four of the five tumours of the palate and in the orbital lesion, the recurrent tumours caused bone destruction, thus mimicking malignant lesions. Irregular-margined recurrences seem to be rather small and found among multiple recurrent nodules.

Adenoma, Pleomorphic↗

PubMed2004

Value of O-(2-[18F]fluoroethyl)- L-tyrosine PET for the diagnosis of recurrent glioma.

PURPOSE: The prognosis of patients with recurrent gliomas depends on reliable and early diagnosis of tumour recurrence after initial therapy. In this context, magnetic resonance imaging (MRI) and computed tomography (CT) often fail to differentiate between radiation- and tumour-induced contrast enhancement. Furthermore, absence of contrast enhancement, or even of 18F-fluorodeoxyglucose uptake in PET, does not exclude recurrence. The aim of this study was to establish the diagnostic value of O-(2-[18F]fluoroethyl)- L-tyrosine (FET) PET in recurrent gliomas. METHODS: Fifty-three patients with glioma (primary grading: 27=WHO grade IV, 16=grade III, 9=grade II, 1=grade I) and clinically suspected recurrence underwent FET PET scans 4-180 months after different treatment modalities. For semiquantitative evaluation, maximal SUV (SUVmax) and mean SUV within 80% and 70% isocontour thresholds (SUV80/SUV70) were evaluated and the respective ratios to the background (BG) were calculated. PET results were correlated with MRI/CT, clinical follow-up or biopsy findings. RESULTS: All patients presented with FET uptake, of varying intensity, in the area of the primary tumour after initial therapy. In the 42 patients with confirmed recurrence, there was additional distinct focal FET uptake with significantly higher values compared with those in the 11 patients without clinical signs of recurrence and showing only low and homogeneous FET uptake at the margins of the resection cavity. With respect to tumour grading, there was a slight but non-significant increase from WHO II (SUVmax/BG: 2.53+/-0.28) to WHO III (SUVmax/BG: 2.84+/-0.49) and WHO IV (SUVmax/BG: 3.55+/-1.07) recurrence. CONCLUSION: FET PET reliably distinguishes between post-therapeutic benign lesions and tumour recurrence after initial treatment of low- and high-grade gliomas.

Brain Neoplasms↗

PubMed1999

Evaluation of l-3-[123I]iodo-alpha-methyltyrosine SPET and [18F]fluorodeoxyglucose PET in the detection and grading of recurrences in patients pretreated for gliomas at follow-up: a comparative study with stereotactic biopsy.

Based on the results of stereotactic biopsy, we evaluated in a prospective fashion the efficiency of l-3-[123I]iodo-alpha-methyltyrosine-single-photon emission tomography (SPET) and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in the detection and grading of recurrences in patients previously treated for gliomas. The patient population comprised 30 individuals, nine with astrocytomas of grade II, ten with astrocytomas of grade IV, three with oligoastrocytomas of grade II, six with oligodendrogliomas of grade II and two with anaplastic oligodendrogliomas of grade III) suspected of recurrence and scheduled for further treatment. IMT SPET data were acquired using either by dual-or a triple-headed SPET camera, Multispect 2/3. FDG uptake was measured with an ECAT ART PET camera. Two independent observers classified PET and SPET images as positive or negative for tumour tissue. Uptake of FDG and IMT was evaluated visually and, in the case of IMT, also quantitatively by calculating the ratios between tracer accumulation in the lesion and the unaffected contralateral regions of reference using the region of interest (ROI) technique. The PET and SPET results were compared with the histopathological findings obtained either by stereotactic biopsy or in one case by open surgery. Glucose metabolism and amino acid uptake of recurrences of brain tumours as assessed by FDG-PET and IMT-SPET correlated highly with the histopathological findings. Based on the histopathological data, FDG-PET and IMT-SPET findings confirmed recurrence in all cases of high-grade gliomas (IV). A difference could be demonstrated in low-grade (II-III) tumour recurrences. True-positive IMT-SPET results were found in 86% of grade III and 75% of grade II recurrences, whereas FDG-PET yielded a sensitivity of 71% in tumours of grade III and 50% in those of grade II. With respect to the grade of malignancy of brain tumours at recurrence, IMT-SPET, in contrast to FDG-PET, does not permit adequate in vivo grading of non-mixed brain tumours of astrocytic or oligodendroglial origin. However, in this study FDG-PET did not permit discrimination between upgrading of low-grade oligoastrocytomas (II) into anaplastic oligodendrogliomas (III) and upgrading into glioblastomas (IV) The results of this study indicate that FDG-PET and IMT-SPET are equivalent to stereotactic biopsy in their ability to identify high-grade tumours at recurrence. IMT-SPET proved to be superior to FDG-PET in confirming low-grade recurrences. In the case of suspected progression of the grade of malignancy in ordinary gliomas, FDG-PET correlated significantly with the histopathological grading, whereas IMT-SPET did not. However, tumour grading by FDG-PET has a limitation in mixed brain tumours in that it is not possible to discriminate between progression of the oligo- versus the astrocytic tumour entity. In this case histopathological evaluation of the tumour grade remains necessary.

Adult↗

PubMed2004

Procedures of choice for resection of primary and recurrent liver metastases from colorectal cancer.

Although liver resection offers the only realistic chance of cure for patients with liver metastases from colorectal cancer, no consensus exists as to the procedure of choice for managing these tumors. Data from 193 patients who underwent hepatectomy for liver metastases from colorectal cancer and 26 of 193 patients who underwent repeat hepatectomy for recurrent metastases were collected. The suitability of resection was evaluated retrospectively based on known risk factors for recurrence and patterns of recurrence. On multivariate analysis, a positive surgical margin (SM+) was the only risk factor for recurrence after the initial resection (p < 0.01). SM+ (p < 0.01) and nonanatomic resection (p < 0.05) that was less than a sectionectomy (p < 0.05) were risk factors for recurrence after repeat hepatectomy. Multiple tumors (four or more) was the most common pattern of recurrence after initial hepatectomy, and recurrence close to the line of resection was most common after repeat hepatectomy. Based on tumor doubling times, recurrence after initial hepatectomy seemed to originate from the primary colorectal lesion, whereas recurrence after repeat hepatectomy was derived from a hepatic metastasis. Retrospective analysis suggests that hepatectomy with clear surgical margins is more important than anatomic resection for initial hepatectomy, and at least sectionectomy is necessary for repeat hepatectomy.

Colorectal Neoplasms↗

PubMed2004

Hepatitis C virus infection is a risk factor for tumor recurrence after resection of small hepatocellular carcinomas.

Hepatocellular carcinoma (HCC) is closely associated with chronic hepatitis B or C virus (HBV, HCV) infection. Tumor recurrence frequently occurs after surgical resection and may adversely affect the outcome. This study aimed to investigate the effect of viral hepatitis in association with HCC recurrence after resection. A total of 248 patients [HBV in 165, HCV in 44, dual HBV+HCV in 15, and non-B non-C (NBNC) in 24] who underwent curative resection for HCC were included. The cumulative recurrence rate was compared according to the etiology of the underlying hepatitis and was stratified by tumor size and other clinicopathologic parameters. Altogether, 116 patients (47%) had a tumor recurrence within 17 +/- 11 months after resection. No significant difference in recurrence was noted among the four groups of patients (HBV, HCV, HBV+HCV, NBNC) ( p = 0.248). Persistent hepatitis was more common in the HCV group ( p < 0.001) after resection. Among the 157 patients with a small (= 5 cm) tumor, the recurrence rate was significantly higher in the HCV group than in the HBV, HBV+HCV, and NBNC groups ( p = 0.036). Cox multivariate analysis showed that HCV infection [relative risk (RR) 4.4, 95% confidence interval (CI) 1.3-14.8, p = 0.018] and vascular invasion (RR 3.2, 95% CI 1.2-8.9, p = 0.044) were independent predictors of tumor recurrence. Stratified analysis in other parameters did not show significant differences in terms of tumor recurrence among the four virologic groups ( p > 0.1 for all parameters). In conclusion, patients with small HCCs and concurrent HCV infection are at a high risk of tumor recurrence after resection.

Adult↗