401
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Dubory A, Missenard G, Court C. Late local recurrence, at 19 and 17 years, of sacral chordoma treated by en bloc resection. Orthop Traumatol Surg Res 2016; 102:121-5. [PMID: 26796999 DOI: 10.1016/j.otsr.2015.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED Sacral chordoma (SC) is a malignant bone tumor with high risk of local recurrence (LR) even after en bloc resection, generally in the first 10 years after resection. We report two cases of late LR, at 17 and 19 years. Two male patients, aged 45 and 53 years, presented with large SC needing a combined approach for en bloc resection. Surgical margins were safe for the first patient and borderline for the second. The patients had yearly follow-up. The first patient developed LR on the posterior wall of the right acetabulum and the second developed LR in the right sciatic notch, at 17 and 19 years, respectively. These two cases of very late LR of SC advocate for yearly screening of patients even more than 20 years after resection. LEVEL OF EVIDENCE IV (case report).
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Affiliation(s)
- A Dubory
- Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de Médecine Paris-Sud, Université Paris-Sud Orsay, JE 2494, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France.
| | - G Missenard
- Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de Médecine Paris-Sud, Université Paris-Sud Orsay, JE 2494, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - C Court
- Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de Médecine Paris-Sud, Université Paris-Sud Orsay, JE 2494, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
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402
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Yıldız İ, Koca YS, Okur K, Barut İ. A tumoral mass ( local recurrence of renal cell carcinoma) causing massive intraabdominal bleeding after blunt abdominal trauma. Int J Surg Case Rep 2016; 20:57-9. [PMID: 26812671 PMCID: PMC4818291 DOI: 10.1016/j.ijscr.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 12/23/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Solid organ injury after abdominal trauma is a common condition, however, injury of the local recurrent tumoral masses following abdominal trauma is rare. The injuries and bleeding in recurrent tumors tend to be highly serious since they are more fragile. The bleedings caused by renal cell carcinomas and by the traumatic laceration of their recurrence commonly occur in the retroperitoneum. In this report, we present a 55-year-old female patient who underwent emergency surgery due to intraabdominal bleeding and bleeding was from the recurrence of a renal cell carcinomas. PRESENTATION OF CASE The 55-year-old female patient was admitted to the emergency service with intraabdominal bleeding. Physical examination revealed tenderness in the right lower quadrant, particularly in the traumatic area. Ultrasonography and computed tomography revealed diffuse intraabdominal fluid and a ruptured bleeding mass was excised. Pathological analysis indicated that the mass was isolated local recurrence of renal cell carcinoma. DISCUSSION Solid organ injury caused by blunt abdominal trauma may be accompanied by tumoral laceration; however, minor bleeding may occur in cases with blunt trauma, coexistence of blunt abdominal trauma with local recurrence and massive bleeding is extremely rare. Control of bleeding is more challenging in tumoral tissues compared to normal tissues. The bleeding intraabdominal area rather than the retroperitoneal area, and this condition was attributed to the peritoneal tear caused by the trauma. CONCLUSION Local recurrent tumoral masses may be the source of the intraabdominal massive bleeding after blunt trauma.
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Affiliation(s)
- İhsan Yıldız
- Suleyman Demirel University, Medical School, Department of General Surgery, Isparta, Turkey.
| | - Yavuz Savaş Koca
- Suleyman Demirel University, Medical School, Department of General Surgery, Isparta, Turkey
| | - Koray Okur
- Suleyman Demirel University, Medical School, Department of General Surgery, Isparta, Turkey
| | - İbrahim Barut
- Suleyman Demirel University, Medical School, Department of General Surgery, Isparta, Turkey
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403
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Takenaka R, Shibamoto Y, Miyakawa A, Hashizume C, Baba F. The Fate of Residual Tumor Masses That Persist After Stereotactic Body Radiotherapy for Solitary Lung Nodules: Will They Recur? Clin Lung Cancer 2015; 17:406-411. [PMID: 26781347 DOI: 10.1016/j.cllc.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND After stereotactic body radiotherapy (SBRT) to the lung, radiation pneumonitis and fibrotic changes often develop, and the tumor shadow usually becomes indistinguishable from the fibrotic shadow. Occasionally, however, a residual mass in patients with no or mild radiation pneumonitis will be observed on serial computed tomography (CT) scans. The purpose of the present study was to evaluate the fate of such residual masses and, if possible, to determine the types of tumor at increased risk of local recurrence. PATIENTS AND METHODS A total of 50 patients (underlying disease: primary lung cancer in 45, local recurrence in 2, and metastasis in 3) were selected because they had been followed up for > 2 years or until death and had observable CT changes and measurable tumor size for > 1 year, regardless of the influence of radiation pneumonitis. The patients' outcomes were compared according to various patient and tumor characteristics, including the presence and absence of emphysema, tumor size, and tumor shrinkage rate. The median follow-up period was 52 months. RESULTS Of the 50 patients, only 8 developed local recurrence. The local control rate was 81% at 3 years and 73% at 5 years. The local control rates were similar between patients with a high tumor shrinkage rate and those with a low rate. The patients with emphysema exhibited a lower local control rate. CONCLUSION The persistence of lung masses for > 1 year after SBRT is not necessarily indicative of an increased risk of local recurrence. A low tumor shrinkage rate also was not predictive of recurrence.
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Affiliation(s)
- Ran Takenaka
- Department of Radiology, Narita Memorial Hospital, Toyohashi, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, Nanbu Tokushukai General Hospital, Yaese, Okinawa, Japan
| | | | - Fumiya Baba
- Nagoya City West Medical Center, Nagoya, Japan
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404
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Dulamea AO, Ionescu V. Perineural spreading along the trigeminal nerve in a squamous cell carcinoma of the tongue. Acta Neurol Belg 2015; 115:699-701. [PMID: 25578636 DOI: 10.1007/s13760-015-0426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
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405
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Kostron A, Friess M, Crameri O, Inci I, Schneiter D, Hillinger S, Stahel R, Weder W, Opitz I. Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2015; 49:1516-23. [PMID: 26590183 DOI: 10.1093/ejcts/ezv398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment. METHODS Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. RESULTS The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median post-recurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P < 0.0005). The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio- or chemo-radiotherapy (P = 0.04). CONCLUSIONS Local recurrence of MPM remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS; however, these results need to be confirmed in a prospective manner.
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Affiliation(s)
- Arthur Kostron
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martina Friess
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ornella Crameri
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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406
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Ayala S, Perlaza P, Puig S, Prats E, Vidal-Sicart S. Usefulness of (18)F-FDG PET/CT in recurrent basal cell carcinoma: Report of a case. Rev Esp Med Nucl Imagen Mol 2015; 35:124-6. [PMID: 26522004 DOI: 10.1016/j.remn.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
We analyze the case of a patient with left periorbital infiltrating basal cell carcinoma treated with surgical excision in October 2010. Surgery included orbital exenteration and reconstruction using skin graft and radiotherapy. In May 2013 a MR imaging showed a mass in the left orbital fossa, suggesting a recurrence in the graft. A basal cell carcinoma recurrence with perineural invasion was confirmed in the biopsy. On (18)F-FDG PET/CT performed, a hypermetabolic activity was observed in the left periorbital area with extension to surrounding sinus and bones. The use of (18)F-FDG PET/CT in patients with advanced basal cell carcinoma has not been fully explored due to the rarity of this entity. This case demonstrates the usefulness of this technique to determine the extent of non-melanocytic recurrent skin tumors, and its value in the staging and treatment control, supporting the incorporation of (18)F-FDG PET/CT in the management of advanced basal cell carcinoma.
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Affiliation(s)
- S Ayala
- Servei de Medicina Nuclear (CDIC), Hospital Clínic Barcelona, Spain; Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - P Perlaza
- Servei de Medicina Nuclear (CDIC), Hospital Clínic Barcelona, Spain
| | - S Puig
- Unitat de Melanoma, Servei de Dermatologia (ICMiD), Hospital Clínic de Barcelona, Spain
| | - E Prats
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S Vidal-Sicart
- Servei de Medicina Nuclear (CDIC), Hospital Clínic Barcelona, Spain
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407
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Abstract
OBJECTIVE Review of the databases of carcinogenesis and the principles of local control of the primary tumor in order to decrease the risk of tumor progression and predict metastatic behavior. MATERIALS AND METHODS Review of the literature using Medline databases based on scientific relevance. Research was centered on the characteristics of solid tumor development, the basics of local control of the primary tumor, latest advance in genomics and the oncological principles applied on prostate cancer surgery. RESULTS The cornerstone in order to cure a local or locally advanced cancer is to eradicate the primary tumor. This should be done using effective methods that can assure local control, decrease the risk of progression and metastasis. The oncological surgery is the most important step in order to have this tumor control, beside radiotherapy and systemic therapy associated. In localized prostate cancer, surgery remains the gold standard between the multiple therapeutic modalities proposed. CONCLUSION The local control of solid malignant tumor is primordial in order to change the natural history of the disease and decrease its risk of progression. This is the goal of oncological surgery, and starting from these principles radical prostatectomy was favored.
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Affiliation(s)
- M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
| | - G Portier
- Service de chirurgie digestive, CHU Purpan, place Baylac, 31059 Toulouse cedex 9, France
| | - L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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408
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Wang L, Li YH, Cai Y, Zhan TC, Gu J. Intermediate Neoadjuvant Radiotherapy Combined With Total Mesorectal Excision for Locally Advanced Rectal Cancer: Outcomes After a Median Follow-Up of 5 Years. Clin Colorectal Cancer 2015; 15:152-7. [PMID: 26508595 DOI: 10.1016/j.clcc.2015.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND We previously reported the oncologic results for intermediate neoadjuvant radiotherapy (nRT) plus total mesorectal excision (TME) for locally advanced rectal cancer in a retrospective study. The objective of the present study was to further investigate the efficacy and long-term outcomes after this nRT regimen. PATIENTS AND METHODS From 2002 to 2011, 382 patients with resectable locally advanced rectal cancer were treated at the Peking University Cancer Hospital with 30 Gy of intermediate nRT in 10 fractions (biologic equivalent dose, 36 Gy) plus TME. Surgery, RT, and pathologic examination were standardized. The primary endpoints were local recurrence-free survival (LRFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS The median patient age at the initial treatment was 58 years (range, 22-85 years). The median patient follow-up time was 5.5 years. The estimated 5-year LRFS, CSS, and OS were 93.6%, 79.0%, and 73.6%, respectively. Of the 382 patients, 4 (1%), 4 (1%), 4 (1%), and 11 (2.9%) patients died of postoperative complications, secondary malignancies, cardiovascular and/or neurologic events, or other causes, respectively. Seven patients (1.8%) developed late-onset ileus and died after conservative treatment in peripheral hospitals. CONCLUSION The 10-fraction intermediate nRT regimen reported in the present study is efficient and safe. The long-term outcome is acceptable. This treatment schedule is useful as an alternative that provides efficiency, patient convenience, and low medical costs.
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Affiliation(s)
- Lin Wang
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Yong-Heng Li
- Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Yong Cai
- Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Tian-Cheng Zhan
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Jin Gu
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China.
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409
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Mizobuchi T, Yamamoto N, Nakajima M, Baba M, Miyoshi K, Nakayama H, Watanabe SI, Katoh R, Kohno T, Kamiyoshihara M, Nishio W, Kamada T, Fujisawa T, Yoshino I. Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer. Eur J Cardiothorac Surg 2015; 49:1503-9. [PMID: 26468271 DOI: 10.1093/ejcts/ezv348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/03/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT. METHODS From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed. RESULTS There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%. CONCLUSIONS The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
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Affiliation(s)
- Teruaki Mizobuchi
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Pneumothorax Research Center and Thoracic Surgery Division, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Naoyoshi Yamamoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Mio Nakajima
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Masayuki Baba
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Kentaro Miyoshi
- Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan
| | - Syun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Ryoichi Katoh
- Department of Pulmonology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Tadasu Kohno
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | | | - Wataru Nishio
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Takehiko Fujisawa
- Research Chiba Foundations for Health Promotion and Disease Prevention Center, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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410
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Shimo A, Tsugawa K, Tsuchiya S, Yoshie R, Tsuchiya K, Uejima T, Kojima Y, Shimo A, Hayami R, Nishikawa T, Yabuki Y, Kawamoto H, Sudo A, Fukuda M, Kanemaki Y, Maeda I. Oncologic outcomes and technical considerations of nipple-sparing mastectomies in breast cancer: experience of 425 cases from a single institution. Breast Cancer 2015; 23:851-860. [PMID: 26464007 DOI: 10.1007/s12282-015-0651-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is an advantageous treatment option, providing a complete cure and good cosmetic results. We tested whether NSM is a surgically and oncologically safe technique. METHODS We evaluated the oncological outcome of 425 breasts in 413 patients who underwent NSM between January 2000 and March 2013. We retrospectively reviewed patient data and analyzed all patient characteristics as potential risk factors of recurrence at the nipple-areola complex (NAC). To confirm the oncological safety of NSM, we compared outcomes of NSM and conventional total mastectomy. RESULTS The median follow-up time after surgery was 46.8 months (range 6-158 months). Nipple necrosis was observed in 6 cases (1.4 %). The cumulative local recurrence rate after NSM was 5.8 % (25/425 cases), similar to that of conventional total mastectomy in the same period (5.6 %, 49/878 cases). Furthermore, the cumulative local recurrence rate at the NAC was 2.3 % (10 cases). HER2-enriched tumors and young age (<40 years) were significant risk factors for recurrence at the NAC. In patients with recurrence, the site of recurrence was easily excised, and good cosmetic results were achieved in breast reconstruction cases. CONCLUSION NSM is safe with a low complication rate. No significant difference was observed in cumulative local recurrence rate, cumulative distant disease recurrence rate, and overall survival between patients who underwent NSM or conventional total mastectomy, confirming that NSM was surgically and oncologically safe.
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Affiliation(s)
- Ayaka Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Seiko Tsuchiya
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Reiko Yoshie
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Kyoko Tsuchiya
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Tomoko Uejima
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Yasuyuki Kojima
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Arata Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Ryosuke Hayami
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Toru Nishikawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Yukari Yabuki
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
| | - Hisanori Kawamoto
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan
- Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiko Sudo
- Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mamoru Fukuda
- Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshihide Kanemaki
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, Kanagawa, Japan
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411
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Alsubhi N, Middleton F, Abdel-Fatah TMA, Stephens P, Doherty R, Arora A, Moseley PM, Chan SYT, Aleskandarany MA, Green AR, Rakha EA, Ellis IO, Martin SG, Curtin NJ, Madhusudan S. Chk1 phosphorylated at serine345 is a predictor of early local recurrence and radio-resistance in breast cancer. Mol Oncol 2015; 10:213-23. [PMID: 26459098 DOI: 10.1016/j.molonc.2015.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 12/28/2022] Open
Abstract
Radiation-induced DNA damage activates the DNA damage response (DDR). DDR up-regulation may predict radio-resistance and increase the risk of early local recurrence despite radiotherapy in early stage breast cancers. In 1755 early stage breast cancers, DDR signalling [ATM, ATR, total Ckh1, Chk1 phosphorylated at serine(345) (pChk1), Chk2, p53], base excision repair [PARP1, POLβ, XRCC1, FEN1, SMUG1], non-homologous end joining (Ku70/Ku80, DNA-PKcs) and homologous recombination [RAD51, BRCA1, γH2AX, BLM, WRN, RECQL5, PTEN] protein expression was correlated to time to early local recurrence. Pre-clinically, radio-sensitization by inhibition of Chk1 activation by ATR inhibitor (VE-821) and inhibition of Chk1 (V158411) were investigated in MDA-MB-231 (p53 mutant) and MCF-7 (p53 wild-type) breast cancer cells. In the whole cohort, 208/1755 patients (11.9%) developed local recurrence of which 126 (61%) developed local recurrence within 5 years of initiation of primary therapy. Of the 20 markers tested, only pChk1 and p53 significantly associated with early local recurrence (p value = 0.015 and 0.010, respectively). When analysed together, high cytoplasmic pChk1-nuclear pChk1 (p = 0.039), high cytoplasmic pChk1-p53 (p = 0.004) and high nuclear pChk1-p53 (p = 0.029) co-expression remain significantly linked to early local recurrence. In multivariate analysis, cytoplasmic pChk1 level independently predicted early local recurrence (p = 0.025). In patients who received adjuvant local radiotherapy (n = 949), p53 (p = 0.014) and high cytoplasmic pChk1-p53 (p = 0.017) remain associated with early local recurrence. Pre-clinically, radio-sensitisation by VE-821 or V158411 was observed in both MCF-7 and MDA-MB-231 cells and was more pronounced in MCF-7 cells. We conclude that pChk1 is a predictive biomarker of radiotherapy resistance and early local recurrence.
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Affiliation(s)
- Nouf Alsubhi
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Fiona Middleton
- Northern Institute for Cancer Research, School of Clinical & Laboratory Sciences, Newcastle University, Medical School, Newcastle upon Tyne NE2 4HH, UK
| | | | - Peter Stephens
- Northern Institute for Cancer Research, School of Clinical & Laboratory Sciences, Newcastle University, Medical School, Newcastle upon Tyne NE2 4HH, UK
| | - Rachel Doherty
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Arvind Arora
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Paul M Moseley
- Department of Oncology, Nottingham University Hospitals, Nottingham NG51PB, UK
| | - Stephen Y T Chan
- Department of Oncology, Nottingham University Hospitals, Nottingham NG51PB, UK
| | | | - Andrew R Green
- Department of Pathology, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Emad A Rakha
- Department of Pathology, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Ian O Ellis
- Department of Pathology, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Stewart G Martin
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham NG51PB, UK
| | - Nicola J Curtin
- Northern Institute for Cancer Research, School of Clinical & Laboratory Sciences, Newcastle University, Medical School, Newcastle upon Tyne NE2 4HH, UK.
| | - Srinivasan Madhusudan
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham NG51PB, UK; Department of Oncology, Nottingham University Hospitals, Nottingham NG51PB, UK.
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Abstract
INTRODUCTION Breast conservation is a legacy of Umberto Veronesi who laid the groundwork for the preservation of the body image of women affected by breast cancer (BC) with the Milan I study in the late 70ies of the last millennium. Breast conservative surgery (BCS) has two aspects: oncological safety of tumour resection with free margins and aesthetic preservation of the breast. Determinants of local control used to be T-size, nodal status and receptor status until biologically driven concepts defined risk of recurrence on the basis of molecular portraits. We explored whether these concepts of intrinsic subtypes prove at a large scale in the context of BCS and which surgical techniques procure best oncological and aesthetic outcomes, avoiding re-excision and necessity of conversion to mastectomy. PATIENTS AND METHODS We analyzed 1035 BCS patients with primary unilateral breast cancer (2004-2009) with regards to the local recurrence as a function of tumour location, surgical technique, resection volume, T-size, nodal status, grading, histopathological and intrinsic subtype and margins. RESULTS Five surgical techniques were applied to 944 eligible patients at a median follow-up of 5.2 years with the following frequency: Glandular rotation mammoplasty (63.8%), tumour-adapted rotation mammoplasty (20.9%), dermoglandular rotation mammoplasty (6.7%), 4.4% (lateral thoracic wall advancement), 0.7% latissimus dorsi flap (0.7%) and others (13.5%). Tumour-free margins were achieved in 88.6% of all patients at first surgery. Recurrence was independent of the surgical technique used, resection volume, T-size (in a T1/T2-cohort), nodal status (in low N-stages: NO/N1) and histopathology (inv.-ductal vs. lobular), however non-invasive subtype (DCIS), high grading (G3 vs. G1), non-luminal Her2 positive BC and triple-negative breast cancer (TNBC) were significantly associated with local recurrence. CONCLUSIONS Five defined oncoplastic principles presented in our nomogramme (targeted breast surgery) allow the reconstruction of major segmental resection defects during breast-conserving therapy with high clinical applicability and result in favorable oncological and aesthetic outcome. Recurrence was not a function of traditional prognostic factors like T-size or nodal status (in a T1/T2, N0/N1 cohort), but of grading, intrinsic subtypes and non-invasive breast cancer components. Lobular histology, multi-centricity and DCIS were predictive for breast preservation failure and conversion to mastectomy.
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Affiliation(s)
- Mahdi Rezai
- European Breast Center - Dr. Rezai, Hans-Günther-Sohl-Str.6-10, D-40235 Düsseldorf, Germany.
| | - Stefan Kraemer
- University Medical Center Cologne, Kerpener Str. 34, D-50931 Cologne, Germany.
| | - Rainer Kimmig
- University Hospital of Essen, Women's Department, Hufelandstr.55, D-45147 Essen, Germany.
| | - Peter Kern
- University Hospital of Essen, Women's Department, Hufelandstr.55, D-45147 Essen, Germany.
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413
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Di Biagio D, Chiaravalloti A, Tavolozza M, Abbatiello P, Schillaci O. Detection of local recurrence of prostate cancer after radical prostatectomy: Is there a role for early ¹⁸F-FCH PET/CT? Ann Nucl Med 2015; 29:861-9. [PMID: 26261000 DOI: 10.1007/s12149-015-1015-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/03/2015] [Indexed: 01/12/2023]
Abstract
AIM To investigate the diagnostic performance of early acquisition compared to late imaging for the detection of local recurrence of prostate cancer by means of ¹⁸F-FCH PET/CT. MATERIALS AND METHODS 99 patients with radical prostatectomy (mean PSA 3.9 ± 5.03) were subjected to early dynamic PET/CT acquisition of the pelvis and a whole body PET/CT in the same exam session. None of the patients examined was subjected to radiotherapy for local or distant recurrence. All the subjects were taken off hormonal therapy. RESULTS 58 subjects did not show local recurrence in both early and late acquisition, 22 were positive in both modalities, 10 showed a positive early and a negative late acquisition while 9 showed a negative early and a positive late acquisition (Cohen's k = 0.558). When the results of imaging modalities were considered separately, sensitivity, specificity, positive predictive value and negative predictive value resulted: 78.9, 96.7, 93.8 and 88.1 % for early acquisition and 73.7, 95.1, 90.3 and 85.3 % for late acquisition, respectively. When the results of early and late acquisition were considered together, results were 97.4, 93.4, 90.2 and 98.3 %, respectively. CONCLUSIONS The combination of early acquisition with late acquisition lead to an increase of the diagnostic accuracy of ¹⁸F-FCH PET/CT for the diagnosis of local recurrence in prostate cancer.
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414
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Tunn PU, Werner M. [Osteosarcomatous dedifferentiated chondrosarcoma]. Orthopade 2015; 44:720-3. [PMID: 26205358 DOI: 10.1007/s00132-015-3143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A secondary peripheral chondrosarcoma (SPC) evolving from an osteochondroma is rare, but it has been described several times. The development of an osteosarcomatous dedifferentiated chondrosarcoma in a locally recurrent SPC is extremely rare. The following case report of a 46-year-old man demonstrates and discusses this phenomenon.
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415
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Kent C, Horton J, Blitzblau R, Koontz BF. Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review. Clin Breast Cancer 2015; 15:403-12. [PMID: 26198331 DOI: 10.1016/j.clbc.2015.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.
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416
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Tanaka S, Martling A, Lindholm J, Holm T, Palmer G. Remaining cancer cells within the fibrosis after neo-adjuvant treatment for locally advanced rectal cancer. Eur J Surg Oncol 2015; 41:1204-9. [PMID: 26108735 DOI: 10.1016/j.ejso.2015.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/06/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022] Open
Abstract
AIM To analyse the incidence and distribution of remaining cancer cells within the fibrosis induced by preoperative chemo-radiotherapy (CRT) for locally advanced rectal cancer. METHODS The histopathological specimens from 46 patients operated on with extensive surgery for locally advanced rectal cancer after CRT were examined. The extension of fibrosis in relation to the mesorectal fascia (MRF) and the distribution of cancer cells within the fibrosis was examined using routine haematoxylin-eosin staining. In addition, immunohistochemical staining with CK20 was done to examine if cancer cells were missed by routine pathological work up. RESULTS All specimens showed CRT induced fibrosis. Two specimens showed complete response without viable cancer cells (ypT0). The fibrosis was limited inside the MRF in three cases, adherent to or involved the MRF in ten cases and in 33 cases the fibrosis was obvious outside as well as inside the fascia. Twenty-one cases showed fibrosis on the surgical resection margin, and in 9 of these cancer cells were found on the surgical margin (R1, R2-resection). 37 patients had R0 resections and among those 24 showed fibrosis beyond the MFR and 13 had scattered cancer cells in the fibrosis along or outside the MRF. CONCLUSIONS The rate of remaining cancer cells within the fibrosis was high in patients with locally advanced rectal cancer treated with CRT. Frequently cancer cells were detected near the border of the fibrosis. A complete resection of the fibrosis is therefore recommended to achieve an R0 resection after neo-adjuvant treatment.
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Affiliation(s)
- S Tanaka
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Surgery, Matsuda Colo-Proctology Center, 753 Irino-cho, Hamamatsu, Shizuoka 4328061, Japan
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - J Lindholm
- Department of Pathology, Karolinska University Hospital and Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - T Holm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - G Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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417
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Abstract
OBJECTIVES To evaluate the relationship between a positive resection margin in partial nephrectomy (PN) and local recurrence. METHODS From January 2005 through December 2012, there were 473 PNs in 466 patients at the University of Chicago. A positive margin was defined as tumor extending to the inked specimen edge, either the parenchymal interface or the peripheral fibroadipose tissue. A local recurrence was defined as an ipsilateral tumor of identical histologic type. RESULTS Renal cell carcinoma (RCC) accounted for 406 tumors: 243 clear cell RCCs (CRCCs), 77 papillary RCCs (PRCCs), and 47 chromophobe RCCs (CHRCCs). Sixty-one RCCs had positive margins: 43 CRCCs, six PRCCs, nine CHRCCs, and three miscellaneous cell types. Of the 61 positive margins, four CRCCs (all originally multifocal) had a local recurrence, two of which occurred in the same patient. One translocation RCC also recurred. Six cases with negative resection margins had a recurrence. CONCLUSIONS A literature review of 3,803 cases, including our study, shows positive margins in 173, of which 13 recurred; however, 39 with negative margins also recurred. A positive margin in PN seldom correlates with a local recurrence. However, protection from recurrence is not ensured by a negative margin.
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Affiliation(s)
- Tatjana Antic
- Department of Pathology, University of Chicago Medicine, Chicago, IL
| | - Jerome B. Taxy
- Department of Pathology, University of Chicago Medicine, Chicago, IL
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Osako T, Nishimura R, Nishiyama Y, Okumura Y, Tashima R, Nakano M, Fujisue M, Toyozumi Y, Arima N. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast cancer. Int J Clin Oncol 2015; 20:1093-101. [PMID: 25855313 DOI: 10.1007/s10147-015-0827-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intraoperative frozen section analysis of the surgical margins during breast-conserving surgery (BCS) for breast cancer can reliably achieve clear surgical margins and prevent re-operations. The aim of this study was to assess intraoperative entire-circumferential frozen section analysis (IEFSA) of the lumpectomy margins during BCS. METHODS A total of 1029 patients who underwent BCS with IEFSA between June 2007 and July 2013 were available for assessment. The inner surfaces of the shaved lumpectomy margins were examined as frozen sections during BCS. The margins were defined as positive when the cancer cells were present within 5 mm from the edge of the outermost margins of the specimens. RESULTS Out of 1029 patients, 312 patients (30.3 %) had positive margins after the initial lumpectomy and underwent additional resections during BCS. Fourteen patients (1.4 %) underwent mastectomy following the results of additional resections during the first surgery. Of 1015 patients who completed BCS, 60 patients (5.9 %) were found to have positive margins in the final pathology. One patient (0.1 %) underwent re-operation after BCS while the residual diseases of the other 59 patients were judged to be minimal. Of the 312 patients who were judged to have positive margins after the initial lumpectomy with IEFSA, 53 patients (16.9 %) were found to have negative margins in the final pathology. At a median follow-up time of 54.1 months, one patient (0.1 %) had a recurrence of breast cancer in the preserved breast. CONCLUSION IEFSA is useful for preventing the need for re-operation and local recurrence after BCS.
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Affiliation(s)
- Tomofumi Osako
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan.
| | - Reiki Nishimura
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuyuki Nishiyama
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuhiro Okumura
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Rumiko Tashima
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Masahiro Nakano
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Mamiko Fujisue
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuo Toyozumi
- Department of Pathology, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Nobuyuki Arima
- Department of Pathology, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
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419
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Srivastava P, Kingsley PA, Srivastava H, Sachdeva J, Kaur P. Persistent Post-radiotherapy Pain and Locoregional Recurrence in Head and Neck Cancer-Is There a Hidden Link? Korean J Pain 2015; 28:116-21. [PMID: 25852833 PMCID: PMC4387456 DOI: 10.3344/kjp.2015.28.2.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To explore the relationship between persistent post-radiotherapy pain and locoregional recurrence in head and neck cancer patients. METHODS Five year retrospective data was reviewed of 86 patients of head and neck cancer treated with radiotherapy who continued to have pain at 6 weeks after completion of treatment. At follow-up after 3 months, these patients were stratified into: Group A (n = 39) constituted of patients whose pain subsided and Group B (n = 47) were patients who continued to have persistent pain. RESULTS At median follow-up time of 25 months (range: 8-47), one patient (2.6%) and 18 (38.3%) patients in group A and group B had locoregional recurrence respectively (P < 0.0001). Furthermore, group B patients had higher mean pain score levels as compared to group A (P = 0.03). Patients in whom pain subsided within 3 months had statistically much greater disease-free survival in comparison to those with persistent pain (P < 0.0001). CONCLUSIONS Pain in head and neck cancer is an important symptom and should be considered a poor prognostic factor. In the current study, the majority of the patients with persistent pain had recurrent disease as compared to those in whom pain subsided within 3 months of post-treatment. It is suggested that patients with persistent pain need more intense follow-up and should be investigated thoroughly to detect recurrence at an early stage to provide a better quality of life.
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Affiliation(s)
- Preety Srivastava
- Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Pamela Alice Kingsley
- Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Himanshu Srivastava
- Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Jaineet Sachdeva
- Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Paramdeep Kaur
- Department of Community Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
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420
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Gas J, Beauval JB, Chalret du Rieu M, Bou Nasr E, Philis A, Kirzin S, Thoulouzan M, Soulié M, Ghouti L. [Urinary complications of pelvic exenterations for rectal cancer with urinary invasion]. Prog Urol 2015; 25:348-54. [PMID: 25804429 DOI: 10.1016/j.purol.2015.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/30/2015] [Accepted: 02/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pelvic exenteration for rectal cancer is indicated in locally advanced rectal tumors or pelvic recurrence invading adjacent organs. The oncologic goal being a complete R0 resection. Our aim was to study the urinary complications resulting from pelvic exenterations with urinary reconstruction in order to obtain a complete local control of the disease. METHODS Between April 2004 and June 2013, 42 patients who underwent pelvic exenteration for primary or recurrent rectal adenocarcinoma with urinary tract reconstruction were included. The urinary reconstruction was performed based on preoperative imaging and intraoperative findings. We studied early (within 30 postoperative days) and late urinary morbidity, as well as postoperative carcinologic control. RESULTS Forty-two exenterations were performed for primary rectal cancer (n=15) or pelvic recurrence (n=27). R0 complete resection was achieved in 64% of patients. The resection was incomplete (R1) on the urinary tract in 9.5% of patients. The urinary reconstruction methods used were: 31 transileal ureterostomies after total exenteration (bricker procedure), 6 ureteral reimplantations on psoic bladder, 2 ureteroileoplasties, 2 partial cystectomies and one ureteral resection with simple ligation. The median follow-up was 20 months. The perioperative mortality was 2.3% (n=1) and postoperative overall morbidity was 64%. Early and late urinary morbidity was 23.8% and 21.4% respectively. Six patients developed major urinary complications (≥ Clavien IIIb). CONCLUSION Pelvic exenteration with urinary resection resulted in our experience, in a local disease control of 64% (including a 90.5% for the urinary tract) at the price of an acceptable early specific morbidity and a low mortality that seems to justify an aggressive surgical approach.
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Affiliation(s)
- J Gas
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France.
| | - J B Beauval
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France
| | - M Chalret du Rieu
- Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France
| | - E Bou Nasr
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France
| | - A Philis
- Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France
| | - S Kirzin
- Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France
| | - M Thoulouzan
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France
| | - M Soulié
- Département d'urologie, d'andrologie et de transplantation rénale, CHU Toulouse Rangueil, 1, avenue du Pr-Jean-Poulhes, 31000 Toulouse, France
| | - L Ghouti
- Département de chirurgie digestive et oncologique, CHU Toulouse Purpan, place du Docteur Baylac, 31059 Toulouse, France
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421
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Simorre M, Chaput B, Voglimacci Stephanopoli M, Garrido I, Soule-Tholy M, Leguevaque P, Vaysse C. [Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]. ACTA ACUST UNITED AC 2015; 43:309-18. [PMID: 25813431 DOI: 10.1016/j.gyobfe.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.
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Affiliation(s)
- M Simorre
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France.
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Voglimacci Stephanopoli
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Soule-Tholy
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - P Leguevaque
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - C Vaysse
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
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Westberg K, Palmer G, Johansson H, Holm T, Martling A. Time to local recurrence as a prognostic factor in patients with rectal cancer. Eur J Surg Oncol 2015; 41:659-66. [PMID: 25749391 DOI: 10.1016/j.ejso.2015.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Abstract
AIMS Survival after the local recurrence of rectal cancer is influenced by several factors. The aim of this study was to ascertain whether the time interval from primary surgery for rectal cancer to local recurrence diagnosis has any impact on survival. METHODS Population-based data was collected from the Swedish Colorectal Cancer Registry. 7410 patients were operated with radical abdominal surgery for rectal cancer during the period 1995-2002. Of these, 386 (5%) developed a local recurrence as a first event. The patients were divided into two groups: early local recurrence (ELR), diagnosed <12 months after primary surgery, and late local recurrence (LLR), diagnosed ≥12 months after primary surgery. Kaplan-Meier curves and hazard ratios were calculated for survival analyses. Survival was calculated from the date of the local recurrence diagnosis to death or end of follow-up. RESULTS Ninety-five patients had ELR and 291 patients LLR. Median time to local recurrence was 1.7 (0.1-7.9) years. Patients with a stage III primary tumour and non-irradiated patients were more common in the ELR compared with the LLR group. Factors that influenced survival were age at diagnosis of local recurrence (p < 0.001), stage of primary tumour (p = 0.027), and surgical resection of local recurrence (p < 0.001). Time to diagnosis of local recurrence had no influence on survival. CONCLUSIONS No difference in survival from date of diagnosis of local recurrence was seen between patients with ELR and patients with LLR. All patients with local recurrence should therefore be assessed for potential curative surgery, disregarding time to local recurrence.
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Affiliation(s)
- K Westberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Division of Surgery, Danderyd Hospital, S-182 88 Stockholm, Sweden.
| | - G Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institutet, K7, Z4:01, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - T Holm
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
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Thaker NG, Hoffman KE, Stauder MC, Shaitelman SF, Strom EA, Tereffe W, Smith BD, Perkins GH, Huo L, Munsell MF, Pusztai L, Buchholz TA, Woodward WA. The 21-gene recurrence score complements IBTR! Estimates in early-stage, hormone receptor-positive, HER2-normal, lymph node-negative breast cancer. Springerplus 2015; 4:36. [PMID: 25674496 PMCID: PMC4318826 DOI: 10.1186/s40064-015-0840-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/20/2015] [Indexed: 01/21/2023]
Abstract
Clinicians have traditionally used clinicopathological (CP) factors to determine locoregional recurrence (LR) risk of breast cancer and have generated the IBTR! nomogram to predict the risk of ipsilateral breast tumor recurrence (IBTR). The 21-gene recurrence score (RS) assay was recently correlated with LR in retrospective studies. The objective of this study was to examine the relationship between the RS and IBTR!. CP characteristics of 308 consecutive patients who underwent RS testing at our institution were examined. IBTR! was used to estimate the risk of 10-year IBTR. Descriptive statistics were used to compare the RS with the estimated IBTR!. Given a low event rate in this cohort, actual IBTR rates were not reported. Most patients had stage I/II (98%) and grade I/II (77%) disease. Median age was 54 years (range, 30–78). Median IBTR! without radiation therapy was 10% (mean, 12% [range, 4-43%]). RS was low (<18), intermediate (18–30), and high (>30) in 52% (n = 160), 40% (n = 123), and 8% (n = 25) patients. Overall, IBTR! did not correlate with RS (P = .77). We saw no correlation between RS and IBTR! in patients with less than (P = .32) or greater than (P = .48) a 10% risk of IBTR. Interestingly, Ki-67 expression correlated with both IBTR! (P = .019) and the RS (P = .002). Further study is warranted to determine if the RS can provide complementary biological information to CP factors in estimating the risk of LR. Prospective studies evaluating this association may potentially allow for individualized treatment decisions.
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Affiliation(s)
- Nikhil G Thaker
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Karen E Hoffman
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Michael C Stauder
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Eric A Strom
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Welela Tereffe
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Benjamin D Smith
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - George H Perkins
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lajos Pusztai
- Department of Medical Oncology, Yale Cancer Center, New Haven, CT USA
| | - Thomas A Buchholz
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Wendy A Woodward
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
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Abstract
Melanoma accounts for less than 2% of skin cancer cases but causes most skin cancer-related deaths. Surgery continues to be the cornerstone of treatment of melanoma and surgical principles are guided by data derived from clinical research. This article examines the evolution of surgical techniques for the diagnosis and treatment of primary and locally recurrent melanoma.
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Affiliation(s)
- Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
| | - Nandini Kulkarni
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Cary Hsu
- Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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425
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Jamshidi K, Jabalameli M, Hoseini MG, Bagherifard A. Stage IE Primary Bone Lymphoma:Limb Salvage for Local Recurrence. Arch Bone Jt Surg 2015; 3:39-44. [PMID: 25692168 PMCID: PMC4322124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/06/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Primary bone lymphoma or non-Hodgkin lymphoma of bone is a rare disease. There are only a few case series of stage IE of this condition in medical literature. The aim of this study is to determine the rate of survival for stage IE after combined modality treatment, the rate of local recurrence, and the results of limb salvage in cases of local recurrence. METHODS We collected data from 61 patients with histologically confirmed PBL treated at the Musculoskeletal Oncology Department of our hospital from 2000 to 2010. Retrospective evaluation included demographics, symptoms, tumor locations, outcomes of surgical treatment for local recurrence and survival rates. RESULTS All patients received Combined Modality Therapy. Overall,five year survival was 89% and five year disease free survival rate was 78%. Local recurrence occurred in 6 patients during follow up period, which was treated surgically by wide excision and reconstruction. The mean follow-up for the local recurrence group was 36(24-54) months and mortality rate in this group was 17%. CONCLUSIONS Combined Modality Therapy for stage IE primary bone lymphomaresults in good survival rate. In case of local recurrence, wide excision and reconstruction improves the outcomes.
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Affiliation(s)
- Khodamorad Jamshidi
- Khodamorad Jamshidi MD, Orthopedic Oncology Department, Shafa Yahyaean Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mahmoud Jabalameli
- Khodamorad Jamshidi MD, Orthopedic Oncology Department, Shafa Yahyaean Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Ghorban Hoseini
- Khodamorad Jamshidi MD, Orthopedic Oncology Department, Shafa Yahyaean Hospital, Iran University of Medical Science, Tehran, Iran
| | - Abolfazl Bagherifard
- Khodamorad Jamshidi MD, Orthopedic Oncology Department, Shafa Yahyaean Hospital, Iran University of Medical Science, Tehran, Iran
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426
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Halpenny D, Ridge CA, Hayes S, Zheng J, Moskowitz CS, Rimner A, Ginsberg MS. Computed tomographic features predictive of local recurrence in patients with early stage lung cancer treated with stereotactic body radiation therapy. Clin Imaging 2014; 39:254-8. [PMID: 25571791 DOI: 10.1016/j.clinimag.2014.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/13/2014] [Accepted: 12/06/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this study is to identify computed tomography (CT) features of local recurrence (LR) after stereotactic body radiation therapy (SBRT) for lung cancer. METHODS Two hundred eighteen patients underwent SBRT for lung cancer from January 1st, 2006 to March 1st, 2011. Signs of LR recorded: opacity with new bulging margin, opacification of air bronchograms, enlarging pleural effusion, new or enlarging mass, and increased lung density at the treatment site. RESULTS A new bulging margin at the treatment site was the only feature significantly associated with LR (P<.005). CONCLUSION Most CT features classically associated with LR following conventional radiation therapy are unreliable for predicting LR following SBRT.
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Affiliation(s)
- Darragh Halpenny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
| | - Carole A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sara Hayes
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Andreas Rimner
- Department of Thoracic Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York.
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427
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Uehara K, Ito Z, Yoshino Y, Arimoto A, Kato T, Nakamura H, Imagama S, Nishida Y, Nagino M. Aggressive surgical treatment with bony pelvic resection for locally recurrent rectal cancer. Eur J Surg Oncol 2014; 41:413-20. [PMID: 25477268 DOI: 10.1016/j.ejso.2014.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/13/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In the current era of total mesorectal excision, local relapse remains a main cause of recurrence. Although standard treatment for locally recurrent rectal cancer (LRRC) has not been established, R0 resection represents the only potentially curative treatment. However, extended surgery accompanying bony pelvic resection is technically demanding and is still challenging. METHODS Studied were 35 patients with LRRC who underwent combined resection of bony pelvis between August 2006 and October 2013. Safety and prognostic factors for survival were analyzed. Median follow-up was 33 months. RESULTS Sacrectomy was performed in 32 patients and 3 patients underwent combined resection of the pubis and ischium. The dominant operative procedure was total pelvic exenteration in 30 (86%) patients. R0 resection was achieved in 27 (77%) patients. No patients died. Pelvic sepsis was the most frequent complication (40%). Recurrence developed in 20 (57%), with the lung the most frequent site (10 patients). Three-year local relapse-free survival (LRFS) and disease-free survival (DFS) were 72.1% and 32.7%, respectively. On multivariate analysis, R1 resection was the only independent risk factor for local recurrence (p = 0.010), and concomitant liver metastasis and initial non sphincter-preserving surgery were independent predictors of worse DFS (p = 0.008 and p = 0.042, respectively). CONCLUSIONS Aggressive surgical treatment combined with bony resection for carefully selected patients with LRRC was safe with a high rate of R0 resection and favorable LRFS. However, DFS was not satisfactory even after R0 resection and the main cause was lung metastasis. Preventing distant recurrence might be a key to improve survival.
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Affiliation(s)
- K Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Z Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - A Arimoto
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Kato
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Nakamura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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428
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Pradhan A, Reddy KIA, Grimer RJ, Abudu A, Tillman RM, Carter SR, Jeys L. Osteosarcomas in the upper distal extremities: are their oncological outcomes similar to other sites? Eur J Surg Oncol 2014; 41:407-12. [PMID: 25442503 DOI: 10.1016/j.ejso.2014.11.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/02/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022] Open
Abstract
AIMS To investigate whether the oncological outcomes of patients with osteosarcomas in the upper distal extremity are similar to other sites and assess if limb-salvage surgery is safe in this location. METHODS The centre database was used to identify all patients with osteosarcomas in the lower humerus and distally between 1985 and 2012. Patient, tumor, treatment and outcome data was collected. RESULTS Twenty-six patients were included in this study. There were 9 males and 17 females with a mean age of 33 years (9-90). Seventeen osteosarcomas were located in the forearm bones (65%), six in the distal humerus (23%), and three (12%) in the hand. The three most common sub-diagnoses were parosteal 7/21 (33%), fibroblastic 4/21 (19%) and osteoblastic osteosarcomas 3/21 (14%). 2 patients (8%) had Paget's disease and 19 patients (73%) had high-grade tumors. Local excision was carried out in 12 patients (48%), 4 patients underwent endoprosthetic replacement (16%) and 9 underwent amputation (36%). The overall risk of local recurrence was 4% in our series. The five-year overall survival rate was 67%, with low tumor grade and parosteal type of osteosarcoma being positive predictors of survival. CONCLUSION This series has shown that patients with high-grade osteosarcomas of the upper distal extremities have a higher amputation risk than other limb sites but have favorable outcomes with limb-salvage surgery, comparable to other anatomical sites. Parosteal osteosarcomas in particular have a good prognosis.
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Affiliation(s)
- A Pradhan
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
| | - K I A Reddy
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - R J Grimer
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - A Abudu
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - R M Tillman
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - S R Carter
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - L Jeys
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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429
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Kim MG, Lee JH, Ha TK, Kwon SJ. The distance of proximal resection margin dose not significantly influence on the prognosis of gastric cancer patients after curative resection. Ann Surg Treat Res 2014; 87:223-31. [PMID: 25368847 PMCID: PMC4217255 DOI: 10.4174/astr.2014.87.5.223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 12/11/2022] Open
Abstract
Purpose It is well known that the curative resection with an adequate proximal margin length is the most effective treatment in gastric cancer. However, despite surgeon's effort to achieve a sufficient proximal margin length, it is often difficult to obtain a recommended proximal margin length in some cases. Therefore, this study was planned to investigate the impact of the length of proximal margin on prognosis of overall survival. Methods Between June 1992 and December 2010, 1,888 gastric cancer patients who underwent gastrectomy with curative intent were reviewed. According to tumor's location (total vs. subtotal gastrectomy), pathologic T staging, and differentiation, univariate and multivariate analyses were performed to evaluate the impact of the discrepancies of proximal margin length on overall survival. Also, the impact of the discrepancies of proximal margin length on local recurrence was assessed. Results The 5-year survival rate of positive proximal margin group was 5.9%. In negative proximal margin groups, multivariate analysis showed that the discrepancies of proximal margin length have no impact on overall survival. Kaplan-Meier analyses showed that there is no association between discrepancy of proximal margin length and local recurrence. Conclusion It takes effort to secure a negative proximal margin in the surgical treatment of gastric cancer because of the poor prognosis of positive proximal margin. In negative proximal margin patients, there's no need to achieve an additional proximal margin length for long-term survival benefit because there was no impact of proximal margin length on overall survival and local recurrence.
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Affiliation(s)
- Min Gyu Kim
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Joon Kwon
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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430
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Jimbo K, Kinoshita T, Asaga S, Hojo T. Oncological safety of breast-conserving surgery after primary systemic chemotherapy in cT3-4 breast cancer patients. Surg Today 2014; 45:1255-62. [PMID: 25326672 DOI: 10.1007/s00595-014-1052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/24/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to retrospectively assess the oncological safety of breast-conserving surgery (BCS) after primary systemic chemotherapy (PST) in terms of local recurrence (LR) in cT3-4 patients. METHODS The subjects were 146 cT1-2 patients who underwent BCS after PST, and 169 patients with cT3-4 primary breast cancer. Of the 169 patients with cT3-4 disease, 20 underwent surgery first, and 149 underwent surgery after PST (mastectomy: 101 patients; BCS: 48 patients). The LR-free survival (LRFS) was analyzed using a Kaplan-Meier analysis. We evaluated the predictors using Cox proportional hazards modeling for LR after PST. RESULTS There was no significant difference in 5-year LRFS between the cT1-2 and cT3-4 groups that underwent BCS after PST (98.6 vs. 92.5 %; P = 0.074). The 5-year LRFS was 94.7 % in the group that underwent initial surgery and 93.0 % in the PST group (P = 0.845) in the cT3-4 patients, while the 5-year LRFS rates were 93.2 % in the BCS subgroup and 92.5 % in the mastectomy subgroup (P = 0.958). In a multivariate analysis, the histological type, hormone negativity and a higher histological grade were independent predictors of LR after PST. CONCLUSIONS BCS after PST may be oncologically acceptable for cT3-4 breast cancers in terms of the LR compared with initial surgery or mastectomy after PST.
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Affiliation(s)
- Kenjiro Jimbo
- Breast Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Takayuki Kinoshita
- Breast Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sota Asaga
- Breast Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takashi Hojo
- Breast Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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431
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Dávila-Arias C, Ocón O, Fernández MF, Arrebola JP, Sánchez MJ, Aneiros J, Torné P, Olea N. [Disease-free survival related factors in breast cancer]. Med Clin (Barc) 2014; 143:293-9. [PMID: 24378147 DOI: 10.1016/j.medcli.2013.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/20/2013] [Accepted: 09/05/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the relationship between the clinical and pathological parameters of the primary tumor and disease-free survival (DFS) in a sample of hospital cases of invasive breast cancer. MATERIAL AND METHOD We performed a retrospective cohort study in 635 patients recruited at San Cecilio University Hospital in Granada (Spain) between 1994 and 2006. Information on the primary tumor and the outcomes of patients was collected by reviewing the medical records. Predictors of recurrence and/or metastasis and DFS (follow up of 3, 5 and 10 years) were analyzed by using Cox regression analysis. RESULTS Multivariate models adjusted for age, tumor size, lymph nodal status, histological grade and estrogen and progesterone receptor expression showed a higher risk of recurrence and/or metastasis and lower DFS (adjusted relative risk, 95% confidence intervals) with tumor size (3 yrs: 3.00, 1.79-5.03; 5 yrs: 2.56, 1.65-3.98; 10 yrs: 2.16, 1.44-3.24), lymph nodal status (3 yrs: 4.58, 2.42-8.65; 5 yrs: 3.84, 2.35-6.30; 10 yrs: 3.08, 2.05-4.61), lymphovascular invasion (5 yrs: 1.88, 1.16-3.04; 10 yrs: 2.19, 1.43-3.35), multifocal and/or multicenter tumors (3 yrs: 2.69, 1.46-4.96; 5 yrs: 1.90, 1.08-3.35) and p53 protein expression (3 yrs: 2.03, 1.00-4.09). DFS was positively associated with an increased expression of progesterone receptor (3 yr: 0.48, 0.26-0.89; 5 yrs: 0.58, 0.35-0.97; 10 yrs: 0.59, 0.38-0.90). CONCLUSIONS The biological characteristics of the primary tumor can be used to identify patients with distinctive prognoses and DFS, and could be helpful in making individual follow up strategies.
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432
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Abstract
We identified thirteen patients with desmoplastic fibroma of bone treated at our institute over a 30 year period. The patients had a mean age of 25.9 years; eight were female. The incidence of desmoplastic fibroma of bone in all patients with benign bone tumours in our population is 0.003%. Surgical treatment ranged from primary amputation to intra-lesional curettage. The incidence of local recurrence was 15.4%. All cases of local recurrence after curettage or marginal excision demonstrated soft-tissue extension of their tumours on initial presentation suggesting that extra-osseous extension requires more radical surgery to control the disease. This study presents the largest single centre series of desmoplastic fibroma of bone with a mean follow-up time of 8 years. We recommend wide surgical excision, particularly if the lesion can be resected without significant loss of function, as the treatment modality of choice with the lowest rate of recurrence. Patients undergoing intra-lesional or marginal resection need to be advised of the possibility of local recurrence and the need for long-term surveillance.
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433
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Sugarbaker PH. Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer. World J Gastroenterol 2014; 20:9286-91. [PMID: 25071322 PMCID: PMC4110559 DOI: 10.3748/wjg.v20.i28.9286] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 02/15/2014] [Accepted: 04/05/2014] [Indexed: 02/06/2023] Open
Abstract
The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.
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434
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Gouin F, Rochwerger AR, Di Marco A, Rosset P, Bonnevialle P, Fiorenza F, Anract P. Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone. Eur J Cancer 2014; 50:2425-31. [PMID: 25088085 DOI: 10.1016/j.ejca.2014.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Giant cell tumours (GCT) of bone are benign neoplasms associated with a high rate of local recurrence after extensive intra-lesional curettage. Recently, understanding of the biological molecular availability of strong anti-osteoclastic drugs has suggested their potential value in reducing local recurrences after curettage. Through a phase II clinical trial, we investigated the effect of a short treatment with zoledronic acid (ZOL) after intra-lesional curettage of GCT, as well as local recurrence and tolerance of the treatment. METHODS AND PATIENTS Twenty-four patients were enrolled in a multicentre, phase 2 study. The patients were treated with extensive intra-lesional curettage followed by five courses of ZOL (4 mg IV every 3 weeks). The clinical and biological tolerance of each patient was assessed. Patients were reviewed clinically and by X-ray every 6 months until the end of the study (36 months). RESULTS Eighteen out of 20 patients reported side-effects with ZOL, mainly grade 1 and 2 effects. The local recurrence rate was 15%; three patients had a recurrence, one at 4 months (huge GCT of the sacrum), one at 24 months (patient who discontinued the treatment after the first course of ZOL), and one after the observational period, at 58 months. Finally, local relapse-free survival was 82 ± 9% at 60 months. CONCLUSION Short adjuvant treatments with ZOL after extensive intra-lesional curettage of GCT were associated with a low rate of recurrence but did not prevent local recurrence in this study. No serious general adverse effects were observed. More studies are needed to evaluate the potential benefit of medical bisphosphonate injections combined with intra-lesional curettage in the treatment of GCTB.
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Affiliation(s)
- Francois Gouin
- Orthopaedics and Traumatology Department, University Hospital of Nantes CHU, Hôtel-Dieu, 44 093 Nantes Cedex, France; LPRO, Inserm U957, UFR Médecine, Université de Nantes, 1 Rue Gaston Veil, 44000 Nantes, France.
| | | | - Antonio Di Marco
- University Hospital de Hautepierre, Av. Molière, 67 000 Strasbourg, France.
| | - Philippe Rosset
- University Hospital Trousseau, Rue des Loches, 37 004 Tours, France.
| | - Paul Bonnevialle
- University Hospital of Purpan, Place du Dr. Baylac, 31 059 Toulouse, France.
| | - Fabrice Fiorenza
- University Hospital Dupuytren, Av. Martin Luther King, 87 042 Limoges, France.
| | - Philippe Anract
- University Hospital of Cochin-Port Royal, Av. Du Fb Saint Jacques, 75 014 Paris, France.
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435
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Abstract
Abdominoperineal excision (APE) is a necessary operation in many patients with low rectal cancer. Outcomes after this procedure, however, have been variable and often suboptimal. With a new concept of APE, three different types of procedures can be described, based on pelvic and pelvic floor anatomy: intersphincteric APE, extralevator APE (ELAPE), and ischioanal APE. Improved outcomes have been reported after ELAPE but the concept is still controversial and there are disagreements related to the extent of pelvic floor removal, positioning of the patient, and methods of pelvic floor reconstruction.
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Affiliation(s)
- Torbjörn Holm
- Section of Coloproctology, Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm 171 76, Sweden.
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436
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Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: A meta-analysis. World J Gastroenterol 2014; 20:8282-8287. [PMID: 25009404 PMCID: PMC4081704 DOI: 10.3748/wjg.v20.i25.8282] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/27/2014] [Accepted: 04/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.
METHODS: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications.
RESULTS: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group (OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups (OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR.
CONCLUSION: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications.
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437
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Ghouti L, Pereira P, Filleron T, Humeau M, Guimbaud R, Selves J, Carrere N. Pelvic exenterations for specific extraluminal recurrences in the era of total mesorectal excision: is there still a chance for cure?: a single-center review of patients with extraluminal pelvic recurrence for rectal cancer from March 2004 to November 2010. Am J Surg. 2015;209:352-362. [PMID: 25524284 DOI: 10.1016/j.amjsurg.2014.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 12/05/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The benefits in terms of curative resection and survival of pelvic exenterations for specific extraluminal pelvic recurrences from rectal cancer in the era of total mesorectal excision were assessed. METHODS We conducted a single-center review of patients with extraluminal pelvic recurrence from colorectal cancer between March 2004 and November 2010. Twenty-seven pelvic exenterations (13 posterior and 14 total) were performed. Independent predicative factors such as age, sex, local control on first surgery, pelvic sidewall excision, initial International Union Against Cancer (UICC) staging, sphincter-preserving resection at first surgery, tumor presentation on computed tomography and magnetic resonance imaging (pelvis sidewall involvement, number of fixation sites, ureteral involvement), local disease-free interval, previous symptoms, and postoperative treatment were analyzed. RESULTS No operative mortality was noted in this series. Overall morbidity rate was 74%; 22% of the patients developed severe complications. Complete surgical clearance (R0) was obtained in 63% of the patients. The rate of R0 resections was lower in total pelvic exenteration (57%) than in posterior pelvic exenteration (69%). Three years overall survival and disease-free survival were 76% and 59%, respectively. Curative resection (R0) was the only independent prognostic factor for overall survival (P = .0016) and disease-free survival (P < .0001). CONCLUSION Pelvic exenterations for extraluminal pelvic recurrences from rectal cancer afford a high R0 resection rate with acceptable morbidity.
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438
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Zhou C, Ren Y, Li J, Li X, He J, Liu P. Systematic review and meta-analysis of rectal washout on risk of local recurrence for cancer. J Surg Res 2014. [PMID: 24630520 DOI: 10.1016/j.jss.2014.01.030.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND It has been shown that intraluminal washout (WO) can prevent local recurrence (LR) of rectal cancer. This meta-analysis was to evaluate the association of rectal WO and the risk of LR after anterior resection in patients with rectal cancer. METHODS The relevant studies were identified by a search of the MEDLINE, Embase, Wiley Online Library, and Cochrane Oral Health Group Specialized Register with no restrictions on October 18, 2013, and these studies were included in a systematic review and meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in fixed effects model. RESULTS A total of nine studies were included in our study, yielding a total of 5519 patients, and pooled ORs for overall LR in corresponding subgroups were calculated. Rectal WO was associated with a lower risk for LR (240/4176, 5.75% versus 9.75%, 131/1343, OR = 0.53, 95% CI = 0.42-0.68, and P < 0.00001) in patients with anterior resection, having total mesorectal excisions (234/3942, 5.93% versus 9.34%, 97/1039, OR = 0.59, 95% CI = 0.46-0.75, and P < 0.00001), and after radical resection (RR; 122/2665, 4.99% versus 8.90%, 74/831, OR = 0.56, 95% CI = 0.41-0.78, and P = 0.0005), with an overall LR rate of 6.72% (371/5519). But, the stability of RRs is not high in the total mesorectal excisions or RR subgroup by sensitivity analysis. CONCLUSIONS The use of rectal WO decreases risks of LR in patients after anterior resection of cancer.
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Affiliation(s)
- Can Zhou
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yu Ren
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiao Li
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jianjun He
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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439
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Abstract
The molecular subtype of breast cancer is the major determinant of the type of systemic therapy, but less attention has been paid to the impact of subtype on local therapy outcomes. Presenting features of breast cancer vary with hormone receptor status, with triple negative cancers being significantly less likely than hormone receptor positive cancers to have nodal metastases, and HER2 overexpressing cancers being more likely to be multifocal or multicentric and to have an extensive intraductal component. The risk of local recurrence varies with subtype as well, with triple negative cancers having the highest risk of local recurrence after both breast-conserving therapy and mastectomy, indicating that bigger surgery does not overcome bad biology.
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Affiliation(s)
- Monica Morrow
- Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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440
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Lacerda L, Reddy JP, Liu D, Larson R, Li L, Masuda H, Brewer T, Debeb BG, Xu W, Hortobágyi GN, Buchholz TA, Ueno NT, Woodward WA. Simvastatin radiosensitizes differentiated and stem-like breast cancer cell lines and is associated with improved local control in inflammatory breast cancer patients treated with postmastectomy radiation. Stem Cells Transl Med 2014; 3:849-56. [PMID: 24833589 DOI: 10.5966/sctm.2013-0204] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Reported rates of local failure after adjuvant radiation for women with inflammatory breast cancer (IBC) and triple-negative non-IBC are higher than those of women with receptor-expressing non-IBC. These high rates of locoregional recurrence are potentially influenced by the contribution of radioresistant cancer stem cells to these cancers. Statins have been shown to target stem cells and improve disease-free survival among IBC patients. We examined simvastatin radiosensitization of multiple subtypes of breast cancer cell lines in vitro in monolayer and mammosphere-based clonogenic assays and examined the therapeutic benefit of statin use on local control after postmastectomy radiation (PMRT) among IBC patients. We found that simvastatin radiosensitizes mammosphere-initiating cells (MICs) of IBC cell lines (MDA-IBC3, SUM149, SUM190) and of the metaplastic, non-IBC triple-negative receptor cell line (SUM159). However, simvastatin radioprotects MICs of non-IBC cell lines MCF-7 and SKBR3. In a retrospective clinical study of 519 IBC patients treated with PMRT, 53 patients used a statin. On univariate analysis, actuarial 3-year local recurrence-free survival (LRFS) was higher among statin users, and on multivariate analysis, triple negative breast cancer, absence of lymphatic invasion, neoadjuvant pathological tumor response to preoperative chemotherapy, and statin use were independently associated with higher LRFS. In conclusion, patients with IBC and triple-negative non-IBC breast cancer have the highest rates of local failure, and there are no available known radiosensitizers. We report significant improvement in local control after PMRT among statin users with IBC and significant radiosensitization across triple-negative and IBC cell lines of multiple subtypes using simvastatin. These data suggest that simvastatin should be justified as a radiosensitizing agent by a prospective clinical trial.
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Affiliation(s)
- Lara Lacerda
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jay P Reddy
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard Larson
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Li Li
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Hiroko Masuda
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Takae Brewer
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bisrat G Debeb
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Xu
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel N Hortobágyi
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas A Buchholz
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and the Departments of Radiation Oncology, Biostatistics, and Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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441
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Pasko J, Schray M, Lee M, Johnson N. Experience with partial breast irradiation for treatment of breast cancer at a community-based cancer center. Am J Surg 2014; 207:682-5; discussion 685. [PMID: 24791627 DOI: 10.1016/j.amjsurg.2013.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients after lumpectomy have barriers to whole breast radiation. Accelerated partial breast irradiation (APBI) was introduced at our institution as an alternative. METHODS Retrospective review of patients who were treated with ABPI from March 2003 to December 2011 was conducted. Results of demographics, tumor pathology, infection, and recurrence were reviewed. RESULTS Two hundred ninety-four patients received 298 treatments of APBI. The mean follow-up was 58.5 months. Using the American Society for Radiation Oncology criteria, 101 patients were suitable, 142 cautionary, and 52 patients were unsuitable. The average age was 65 with a range of 37 to 93. In our study, true local recurrence occurred in only 1.0% (n = 3). Patients recurring in the same breast elsewhere was 2% (n = 6). CONCLUSIONS Outcomes after treatment with APBI were excellent, and breast recurrence was similar to whole breast irradiation. It may safely be offered to patients with less than suitable criteria or barriers to whole breast radiation.
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Affiliation(s)
- Jennifer Pasko
- Division of Surgical Oncology and Radiation Oncology, Legacy Good Samaritan Hospital, 1040 NW 22nd Avenue, Suite 560, Portland, OR 97210, USA
| | - Mark Schray
- Division of Surgical Oncology and Radiation Oncology, Legacy Good Samaritan Hospital, 1040 NW 22nd Avenue, Suite 560, Portland, OR 97210, USA
| | - Misa Lee
- Division of Surgical Oncology and Radiation Oncology, Legacy Good Samaritan Hospital, 1040 NW 22nd Avenue, Suite 560, Portland, OR 97210, USA
| | - Nathalie Johnson
- Division of Surgical Oncology and Radiation Oncology, Legacy Good Samaritan Hospital, 1040 NW 22nd Avenue, Suite 560, Portland, OR 97210, USA.
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442
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Scanlon P, Tian J, Zhong J, Silva I, Shapiro R, Pavlick A, Berman R, Osman I, Darvishian F. Enhanced immunohistochemical detection of neural infiltration in primary melanoma: is there a clinical value? Hum Pathol 2014; 45:1656-63. [PMID: 24890944 DOI: 10.1016/j.humpath.2014.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/17/2022]
Abstract
Neural infiltration in primary melanoma is a histopathologic feature that has been associated with desmoplastic histopathologic subtype and local recurrence in the literature. We tested the hypothesis that improved detection and characterization of neural infiltration into peritumoral or intratumoral location and perineural or intraneural involvement could have a prognostic relevance. We studied 128 primary melanoma cases prospectively accrued and followed at New York University using immunohistochemical detection with antihuman neurofilament protein and routine histology with hematoxylin and eosin. Neural infiltration, defined as the presence of tumor cells involving or immediately surrounding nerve foci, was identified and characterized using both detection methods. Neural infiltration rate of detection was enhanced by immunohistochemistry for neurofilament in matched-pair design (47% by immunohistochemistry versus 25% by routine histology). Immunohistochemical detection of neural infiltration was significantly associated with ulceration (P = .021), desmoplastic and acral lentiginous histologic subtype (P = .008), and head/neck/hands/feet tumor location (P = .037). Routinely detected neural infiltration was significantly associated with local recurrence (P = .010). Immunohistochemistry detected more intratumoral neural infiltration cases compared with routine histology (30% versus 3%, respectively). Peritumoral and intratumoral nerve location had no impact on clinical outcomes. Using a multivariate model controlling for stage, neither routinely detected neural infiltration nor enhanced immunohistochemical characterization of neural infiltration was significantly associated with disease-free or overall survival. Our data demonstrate that routinely detected neural infiltration is associated with local recurrence in all histologic subtypes but that improved detection and characterization of neural infiltration with immunohistochemistry in primary melanoma does not add to prognostic relevance.
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Affiliation(s)
- Patrick Scanlon
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Jaiying Tian
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Judy Zhong
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Ines Silva
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Richard Shapiro
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY
| | - Anna Pavlick
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Russell Berman
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY
| | - Iman Osman
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Farbod Darvishian
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Pathology, New York University School of Medicine, 10016, New York, NY.
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443
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Abstract
This article reviews the relevant data on breast magnetic resonance imaging (MRI) use in screening, the short-term surgical outcomes and long-term cancer outcomes associated with the use of MRI in breast cancer staging, the use of MRI in occult primary breast cancer, as well as MRI to assess eligibility for accelerated partial breast irradiation and to evaluate tumor response after neoadjuvant chemotherapy. MRI for screening is supported in specific high-risk populations, namely, women with BRCA1 or BRCA2 mutations, a family history suggesting a hereditary breast cancer syndrome, or a history of chest wall radiation.
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444
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Damodaran O, Robbins P, Knuckey N, Bynevelt M, Wong G, Lee G. Primary intracranial haemangiopericytoma: comparison of survival outcomes and metastatic potential in WHO grade II and III variants. J Clin Neurosci 2014; 21:1310-4. [PMID: 24726230 DOI: 10.1016/j.jocn.2013.11.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Abstract
Primary intracranial haemangiopericytomas (HPC) are rare, highly vascular tumours with a high propensity for local recurrence and distant metastasis. Optimal treatment includes maximal surgical resection followed by adjuvant radiotherapy. In 2007, new histopathological grading criteria were introduced to differentiate between high grade (World Health Organization [WHO] grade III) and low grade (WHO grade II) tumours. Given the rarity of this tumour, there is a paucity of information regarding the prognostic significance of histological grade. We conducted a retrospective review of our 20 year experience in treating 27 patients with HPC at our institution. Statistical analysis to compare overall survival, local recurrence rate and metastatic potential between the two grades were conducted using Kaplan-Meier analysis. The estimated median survival for grade II HPC was 216 months and for grade III tumours was 142 months. On multivariate analysis, grade II tumours were associated with better survival than grade III lesions (hazard ratio=0.16, 95% confidence interval 0.26-0.95; p=0.044). During the study period, 33% of grade III tumours developed local recurrence compared to 21% of grade II tumours. Metastases were found in 36% of grade II patients and 25% of grade III patients. There was no significant statistical difference in local recurrence rate and metastasis between the two grades. Higher histological grading in HPC is associated with worse overall survival. However based on our series higher histological grading is not associated with higher local recurrence or distant metastatic rates.
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Affiliation(s)
- Omprakash Damodaran
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; Department of Neurosurgery, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia.
| | - Peter Robbins
- Department of Pathology (PATHWEST), Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Neville Knuckey
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Surgery, University of Western Australia, WA, Australia
| | - Michael Bynevelt
- Neurological Intervention and Imaging Service (WA), Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - George Wong
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Gabriel Lee
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Surgery, University of Western Australia, WA, Australia
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445
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Lippa N, Sargos P, Italiano A, Kind M, Dallaudière B, Hauger O, Cornelis F. Standardization of selection criteria for percutaneous image-guided cryoablation of recurrent soft-tissue sarcomas. Diagn Interv Imaging 2014; 95:1071-7. [PMID: 24637209 DOI: 10.1016/j.diii.2014.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Percutaneous image-guided cryoablation has not been validated for local management of recurrence of soft tissue sarcoma (STS) of the trunk or limbs. This study aims to identify selection criteria for cryoablation in order to standardize indications of this treatment. PATIENTS AND METHODS Between 2000 and 2010, 46 patients (57 tumors) presenting local recurrences of STS of the trunk or limbs and treated following standards of care were selected from our institutional database. Eligibility for cryoablation was assessed by two radiologists according to predefined criteria: maximal diameter size of the tumor ≤10cm, distance to skin >5mm, distance to neurovascular structures 3mm at least, absence of articular involvement and planned cryoablation covering the entire lesion volume. Characteristics and outcomes were compared. RESULTS There was nearly perfect agreement for all criteria (k coefficient ranging from 0.83 to 0.98) between both readers. A subgroup of 13patients was identified as eligible for cryoablation. Locations to the trunk, pelvic girdle or shoulder were significantly more present in the cryoablation group (P=0.002). In this group, tumors were mainly located deeply (P=0.002) with great axes ≤5cm (P=0.044). High local tumor aggressiveness (P=0.016) and differentiated myxoid liposarcoma or myxofibrosarcoma (P=0.007) were more frequent in the eligible group. CONCLUSION Based on these criteria, two groups of patients with local relapse of STS can be identified. These results may improve the standardization of selection of patients who could be candidates for cryoablation.
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Affiliation(s)
- N Lippa
- Department of Radiology, Institute Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - P Sargos
- Department of Radiotherapy, Institute Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institute Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - M Kind
- Department of Radiology, Institute Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - B Dallaudière
- Department of Radiology, Pellegrin Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - O Hauger
- Department of Radiology, Pellegrin Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of Radiology, Pellegrin Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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446
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Hocevar M, Dragonja Z, Pilko G, Gazic B, Zgajnar J. Residual melanoma after an excisional biopsy is an independent prognostic factor for local recurrence and overall survival. Eur J Surg Oncol 2014; 40:1271-5. [PMID: 24656456 DOI: 10.1016/j.ejso.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/25/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED The aim of this study was to evaluate the effect of a residual melanoma after an excisional biopsy on prognosis of patients with cutaneous melanoma. PATIENTS AND METHODS Between 2000 and 2007 sentinel lymph node biopsy with wide reexcision of a primary melanoma site was successfully performed in 692 patients (315 male and 377 female; mean age 55.7 years) at the Institute of Oncology Ljubljana, Slovenia. Clinicopathological data of all patients were extracted from a prospective institutional melanoma database and the frequency of local recurrences and survival were compared between patients with residual melanoma and those without it. For a statistical analysis univariate and multivariate analyses were used. RESULTS Only 25 (3.6%) patients had a residual melanoma. There was no difference in mean tumor thickness (3.9 and 2.8 mm) and ulceration (40% and 34%) of the primary melanoma between patients with and without residual melanoma. However, a number of local recurrences (16% versus 2.7%) and a number of metastases in sentinel lymph nodes (44% versus 22%) were significantly higher and a 5-year survival was significantly lower (64% versus 87.5%) in patients with residual melanoma. Breslow thickness, ulceration, positive SLNB and residual melanoma were independent prognostic factors for overall survival. CONCLUSIONS Residual melanoma is very rare after an excisional biopsy of the primary melanoma. However, when present it indicates a higher probability of local recurrence and a worse overall survival.
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Affiliation(s)
- M Hocevar
- Institute of Oncology, Dept. of Surgical Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia.
| | - Z Dragonja
- Institute of Oncology, Dept. of Surgical Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - G Pilko
- Institute of Oncology, Dept. of Surgical Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - B Gazic
- Institute of Oncology, Dept. of Surgical Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - J Zgajnar
- Institute of Oncology, Dept. of Surgical Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
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447
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Abdel-Gawad W, Zaghloul A, Fakhr I, Sakr M, Shabana A, Lotayef M, Mansour O. Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer. J Egypt Natl Canc Inst 2014; 26:87-92. [PMID: 24841159 DOI: 10.1016/j.jnci.2014.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/26/2013] [Accepted: 02/03/2014] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Abdomino-perineal resection has been the standard treatment for rectal tumors located ≤5cm from the anal verge. Recently, intersphincteric resection became a valid option which preserves the bowel continuity with better functional outcome. AIM Is to evaluate the oncological and functional outcome alongside the associated surgical morbidity in patients with T1-3 rectal cancer, who underwent intersphincteric resection (ISR). PATIENTS & METHODS Between the years 2006 and 2011, 55 patients with invasive rectal adenocarcinoma, T1-3 lesions, located 2-5cm from the anal verge underwent ISR with total mesorectal excision. When inevitable, complete. ISR was performed, otherwise partial ISR was done. All T3 patients underwent total meso-rectal excision (TME) while some had lateral lymph node dissection (LND) with concomitant pelvic autonomic nerve preservation (PANP). RESULTS Among the 55 patients, 21 (38.1%) patients were T1-2 and 34 (61.9%) patients were T3. The tumor location range was 0-5cm from the anal verge (median 2.3cm). Partial or complete ISR was done for 35 (63.6%) and 20 (36.4%), respectively. Patients were followed for a median of 1.5 years (range 1-4.6 years). The 3 year local recurrence and distant metastasis free rates were 85.2% and 85.6%, respectively. All the 3 local recurrences occurred in T3 patients group, and had positive circumferential resection margins. Overall 3-year disease-free survival was 82.6%; while the overall 3-year survival was 88.7%. CONCLUSION Intersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.
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Affiliation(s)
- W Abdel-Gawad
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - A Zaghloul
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - I Fakhr
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
| | - M Sakr
- Surgical Pathology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - A Shabana
- Radio-Diagnosis Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - M Lotayef
- Radiation Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - O Mansour
- Medical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
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448
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Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag PM, Punt CJA, Ledermann J, Ruers TJM. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50:912-9. [PMID: 24411080 DOI: 10.1016/j.ejca.2013.12.008] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/07/2013] [Accepted: 12/10/2013] [Indexed: 01/03/2023]
Abstract
AIM The aim of this study is to describe local tumour control after radiofrequency ablation (RFA) and surgical resection (RES) of colorectal liver metastases (CLM) in two independent European Organisations for Research and Treatment of Cancer (EORTC) studies. BACKGROUND Only 10-20% of patients with newly diagnosed CLM are eligible for curative RES. RFA has found a place in daily practice for unresectable CLM. There are no prospective trials comparing RFA to RES for resectable CLM. METHODS The CLOCC trial randomised 119 patients with unresectable CLM between RFA (±RES)+adjuvant FOLFOX (±bevacizumab) versus FOLFOX (±bevacizumab) alone. The EPOC trial randomised 364 patients with resectable CLM between RES±perioperative FOLFOX. We describe the local control of resected patients with lesions ≤4 cm in the perioperative chemotherapy arm of the EPOC trial (N=81) and the RFA arm of the CLOCC trial (N=55). RESULTS Local recurrence (LR) rate for RES was 7.4% per patient and 5.5% per lesion. LR rate for RFA was 14.5% per patient and 6.0% per lesion. When lesion size was limited to 30 mm, LR rate for RFA lesions was 2.9% per lesion. Non-local hepatic recurrences were more often observed in RFA patients than in RES patients, 30.9% and 22.3% respectively. Patients receiving RFA had a more advanced disease. CONCLUSIONS LR rate after RFA for lesions with a limited size is low. The local control per lesion does not appear to differ greatly between RFA and surgical resection. This study supports the local control of RFA in patients with limited liver metastases. Future studies should evaluate in which patients RFA could be an equal alternative to liver resection.
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Affiliation(s)
- E Tanis
- EORTC Headquarters, Brussels, Belgium.
| | - B Nordlinger
- Department of Surgery, Centre Hospitalier Universitaire Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne-Billancourt, France
| | - M Mauer
- Department of Statistics, EORTC Headquarters, Brussels, Belgium
| | - H Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - F van Coevorden
- Department of Surgery, The Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - T Gruenberger
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - P M Schlag
- Department of Surgery, Robert-Roessle-Klinik, Humboldt-Universitat Berlin, Berlin, Germany
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Ledermann
- UCL and UCL Hospitals Comprehensive Biomedical Research Centre, University College London, London, United Kingdom
| | - T J M Ruers
- Department of Surgery, The Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
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449
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Dieterich M, Hartwig F, Stubert J, Klöcking S, Kundt G, Stengel B, Reimer T, Gerber B. Accompanying DCIS in breast cancer patients with invasive ductal carcinoma is predictive of improved local recurrence-free survival. Breast 2014; 23:346-51. [PMID: 24559611 DOI: 10.1016/j.breast.2014.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 10/28/2013] [Accepted: 01/19/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) often accompanies invasive ductal carcinoma (IDC). The presence of co-existing DCIS is postulated to present as a less aggressive phenotype than IDC alone. PATIENTS AND METHODS Patients diagnosed with hormone receptor-positive breast cancer receiving mastectomy were evaluated. Only patients without adjuvant radio- and chemotherapy were included to decrease treatment bias on local recurrence (LR). RESULTS Of 2239 breast cancer patients, 198 fulfilled the inclusion criteria. The overall LR rate was 11.6%. Tumor stage (p = 0.002), nodal status (pN2 vs. pN0, p = 0.023) and pure IDC compared with IDC-DCIS (p = 0.029) were multivariate independent factors for increased LR risk. Patients with IDC-DCIS were significantly younger (p < 0.001), had smaller tumors (p = 0.001), less lymph node involvement (p = 0.012). The LR rate was significantly increased in patients with pure IDC (p = 0.012). The time to distant metastases was decreased in patients with pure IDC compared with that observed in patients with IDC-DCIS (log rank = 0.030). CONCLUSION Invasive ductal carcinoma accompanied by DCIS is associated with lower LR. The prognostic value of co-existing DCIS in the adjuvant decision-making process may be considered a new independent prognostic marker. This finding needs further studies to evaluate its usefulness in premenopausal women.
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Affiliation(s)
- M Dieterich
- Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany.
| | - F Hartwig
- Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany
| | - J Stubert
- Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany
| | - S Klöcking
- Cancer Registry Rostock, Department of Radiotherapy, University of Rostock, Suedring 75, 18059 Rostock, Germany
| | - G Kundt
- Institute for Biostatistics and Informatics in Medicine, University of Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - B Stengel
- Institute for Pathology, Hospital Suedstadt, Suedring 81, 18059 Rostock, Germany
| | - T Reimer
- Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany
| | - B Gerber
- Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany
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450
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Inoue T, Fujii H, Koyama F, Nakagawa T, Uchimoto K, Nakamura S, Ueda T, Nishigori N, Kawasaki K, Obara S, Nakamoto T, Nakajima Y. Local recurrence after rectal endoscopic submucosal dissection: a case of tumor cell implantation. Clin J Gastroenterol 2014; 7:36-40. [PMID: 24523830 PMCID: PMC3915078 DOI: 10.1007/s12328-013-0445-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/08/2013] [Indexed: 12/12/2022]
Abstract
We report a case of local recurrence of cancer after rectal endoscopic submucosal dissection (ESD). A 52-year-old male underwent a curative resection with ESD for rectal intramucosal cancer. Seventy-four months after ESD, surveillance colonoscopy showed an elevated lesion on the ESD scar, suspicious of a recurrence. The patient subsequently underwent a low anterior resection (intersphincteric) with lymph node dissection. Pathology revealed a well-differentiated adenocarcinoma, similar to the ESD specimen. We suspected that the local recurrence was caused by implantation of tumor cells during the ESD, due to surgical manipulation performed with the tumor in an exposed setting for a long period of time.
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Affiliation(s)
- Takashi Inoue
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Hisao Fujii
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Tadashi Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Kazuaki Uchimoto
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Shinji Nakamura
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Takeshi Ueda
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Naoto Nishigori
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Keijiro Kawasaki
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Shinsaku Obara
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Takayuki Nakamoto
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
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