1
|
Cavalcante LG, Domingues RAR, Junior BDO, Fernandes MAR, Pessoa EC, Abbade LPF. Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study. An Bras Dermatol 2024; 99:57-65. [PMID: 37657957 DOI: 10.1016/j.abd.2023.01.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. OBJECTIVE To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. METHODS Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. RESULTS The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR=1.14 [95% CI 1.04-1.26]; p=0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR=4.27 [95% CI 1.11-16.42]; p=0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR=0.55 [95% CI 0.36-0.82]; p=0.004). STUDY LIMITATIONS The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. CONCLUSIONS There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.
Collapse
Affiliation(s)
- Loren Giagio Cavalcante
- Department of Nursing, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil; Sector of Radiotherapy, Hospital das Clínicas de Botucatu, Botucatu, SP, Brazil
| | | | | | - Marco Antônio Rodrigues Fernandes
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Eduardo Carvalho Pessoa
- Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Luciana Patrícia Fernandes Abbade
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| |
Collapse
|
2
|
Sharma J, Deo SVS, Kumar S, Bhoriwal S, Gupta N, Saikia J, Bhatnagar S, Mishra S, Bharti S, Thulkar S, Bakhshi S, Sharma DN. Malignant Chest Wall Tumors: Complex Defects and Their Management-A Review of 181 Cases. Ann Surg Oncol 2023:10.1245/s10434-023-14765-w. [PMID: 38153642 DOI: 10.1245/s10434-023-14765-w] [Citation(s) in RCA: 2] [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: 09/21/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Chest wall tumors are a heterogeneous group of tumors that are managed by surgeons from diverse specialties. Due to their rarity, there is no consensus on their diagnosis and management. MATERIALS This retrospective, descriptive analysis includes patients with malignant chest wall tumors undergoing chest wall resection. Tumors were classified as primary, secondary, and metastatic tumors. The analysis includes clinicopathological characteristics, resection-reconstruction profile, and relapse patterns. RESULTS A total of 181 patients underwent chest wall resection between 1999 and 2020. In primary tumors (69%), the majority were soft tissue tumors (59%). In secondary tumors, the majority were from the breast (45%) and lung (42%). Twenty-five percent of patients received neoadjuvant chemotherapy, and 98% of patients underwent R0 resection. Soft tissue, skeletal + soft tissue, and extended resections were performed in 45%, 70%, and 28% of patients, respectively. The majority of patients (60%) underwent rib resections, and a median of 3.5 ribs were resected. The mean defect size was 24 cm2. Soft tissue reconstruction was performed in 40% of patients, mostly with latissimus dorsi flaps. Rigid reconstruction was performed in 57% of patients, and 18% underwent mesh-bone cement sandwich technique reconstruction. Adjuvant radiotherapy and chemotherapy were given to 29% and 39% of patients, respectively. CONCLUSIONS This is one of the largest single-institutional experiences on malignant chest wall tumors. The results highlight varied tumor spectra and multimodality approaches for optimal functional and survival outcomes. In limited resource setting, surgery, including reconstructive expertise, is very crucial.
Collapse
Affiliation(s)
- Jyoti Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Gupta
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoutishman Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Bharti
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Yu JI. Role of Adjuvant Radiotherapy in Gastric Cancer. J Gastric Cancer 2023; 23:194-206. [PMID: 36750999 PMCID: PMC9911621 DOI: 10.5230/jgc.2023.23.e1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Although continuous improvement in the treatment outcome of localized gastric cancer has been achieved through early screening, diagnosis, and treatment and the active application of surgery and adjuvant chemotherapy, the necessity of adjuvant radiotherapy (RT) remains controversial. In this review, based on the results of two recently published randomized phase III studies (Adjuvant Chemoradiation Therapy In Stomach Cancer 2 and ChemoRadiotherapy after Induction chemoTherapy of Cancer in the Stomach) and a meta-analysis of six randomized trials including these two studies, the role of adjuvant RT in gastric cancer was evaluated and discussed, especially in patients who underwent curative gastrectomy with D2 lymphadenectomy. This article also reported the possible indications for adjuvant RT in the current clinical situation and in future research to enable patient-specific treatments according to the risk of recurrence.
Collapse
Affiliation(s)
- Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Riemenschnitter CE, Morand GB, Schouten CS, Rupp NJ, Balermpas P, Gander T, Broglie Däppen MA. Need for adjuvant radiotherapy in oral cancer: depth of invasion rather than tumor diameter. Eur Arch Otorhinolaryngol 2023; 280:339-46. [PMID: 35913631 DOI: 10.1007/s00405-022-07561-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The 8th edition of the TNM Cancer Staging Manual incorporates depth of invasion (DOI) into the pathologic tumor classification for oral squamous cell carcinoma (OSSC). While deep invading tumors with small tumor diameters (TD) have been categorized as early stage tumors in the 7th edition, they are now upstaged, potentially influencing the decision to initiate adjuvant radiotherapy (RT). METHODS OSCC patients surgically treated with curative intent between 2010 and 2019 were consecutively included. Tumors were staged based on TD only (according to the 7th edition TNM Cancer Staging Manual), then restaged based solely on DOI. RESULTS Of the 133 included patients, 58 patients (43.6%) had a different pT-stage when using DOI instead of TD for staging (upstaging in 23.3%). Overall survival (OS) was significantly worse in patients who were upstaged with DOI. In addition, stratification by adjuvant RT showed significant worse OS in upstaged patients without receiving adjuvant RT. CONCLUSIONS DOI seems to be an import indicator for adjuvant RT in OSCC-patients.
Collapse
|
5
|
Wiesweg M, Eberhardt WE, Schuler M, Plönes T. [Treatment of early and locally advanced stages of non-small cell lung cancer]. Inn Med (Heidelb) 2022; 63:717-723. [PMID: 35925268 DOI: 10.1007/s00108-022-01366-0] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
Treatment concepts for patients with localized and locally advanced non-small cell lung cancer (NSCLC) are based on local treatment, surgery and/or radiotherapy, with curative intent. An adjuvant systemic treatment is added after primary resection of an operable NSCLC primarily to reduce the systemic risk of relapse. Locally advanced stages with mediastinal lymph node involvement carry a substantial risk of local and distant recurrence and require multimodal treatment strategies in an interdisciplinary approach. Recently, immunotherapy with programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) checkpoint inhibitors is increasingly being integrated into adjuvant, neoadjuvant or perioperative treatment concepts.
Collapse
Affiliation(s)
- Marcel Wiesweg
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - Wilfried E Eberhardt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Martin Schuler
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
- Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Till Plönes
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Westdeutsches Tumorzentrum, Ruhrlandklinik - Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| |
Collapse
|
6
|
Mayer M, Nachtsheim L, Arolt C, Quaas A, Prinz J, Grosheva M, Klußmann JP, Wolber P. [Diagnostics and treatment of secondary malignancies of the parotid gland-An overview]. HNO 2022. [PMID: 35579673 DOI: 10.1007/s00106-022-01178-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Secondary malignancies of the parotid gland frequently have a cutaneous origin and the incidence in central Europe is increasing. OBJECTIVE The aim of this review article was to present the epidemiology, (differential) diagnostics and treatment of secondary malignancies of the parotid gland. MATERIAL AND METHODS A literature search of the current guidelines and evidence was carried out in the web-based databank PubMed. RESULTS The incidence of secondary malignancies of the parotid gland seems to be increasing in Europe, mainly due to a rising incidence of metastases of cutaneous squamous cell carcinomas. Except for malignant lymphomas, parotidectomy is the treatment of choice in the curative situation. In the absence of clear evidence, in the case of an intact facial nerve lateral or total parotidectomy with ipsilateral neck dissection seems to be indicated, depending on the entity of the secondary malignancy. CONCLUSION The differential diagnostics of squamous cell carcinoma (in) of the parotid gland can be complicated. When a squamous cell carcinoma of the parotid gland is diagnosed for the first time, a dermatological full body examination and a detailed medical history should be taken with respect to skin tumors of the head and neck region. In addition to surgical treatment of the parotid gland and neck, adjuvant radiotherapy is usually indicated.
Collapse
|
7
|
Duma MN, Kulms T, Knippen S, Teichmann T, Wittig A. Breast clinical target volume: HU-based glandular CTVs and ESTRO CTVs in modern and historical radiotherapy treatment planning. Strahlenther Onkol 2021. [PMID: 34477884 DOI: 10.1007/s00066-021-01839-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/09/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The current study aimed to compare contouring of glandular tissue only (gCTV) with the clinical target volume (CTV) as defined according to European Society for Radiotherapy and Oncology (ESTRO) guidelines (eCTV) and historically treated volumes (marked by wire and determined by palpation and anatomic landmarks) in breast cancer radiotherapy. METHODS A total of 56 consecutive breast cancer patients underwent treatment planning based solely on anatomic landmarks/wire markings ("wire based"). From these treatment plans, the 50% and 95% isodoses were transferred as structures and compared to the following CT-based volumes: eCTV; a Hounsfield unit (HU)-based automatic contouring of the gCTV; and standardized planning target volumes (PTVs) generated with 1‑cm safety margins (resulting in the ePTVs and gPTVs, respectively). RESULTS The 95% isodose volume of the wire-based plan was larger than the eCTV by 352.39 ± 176.06 cm3 but smaller than the ePTV by 157.58 ± 189.32 cm3. The 95% isodose was larger than the gCTV by 921.20 ± 419.78 cm3 and larger than the gPTV by 190.91 ± 233.49 cm3. Patients with larger breasts had significantly less glandular tissue than those with small breasts. There was a trend toward a lower percentage of glandular tissue in older patients. CONCLUSION Historical wire and anatomic landmarks-based treatment planning sufficiently covers the glandular tissue and the theoretical gPTV generated for the glandular tissue. Modern CT-based CTV and PTV definition according to ESTRO results in a larger treated volume than the historical wire-based techniques. HU-standardized glandular tissue contouring results in a significantly smaller CTV and might be an option for reducing the treatment volume and improving reproducibility of contouring between institutions.
Collapse
|
8
|
Bdeir M, Vassos N, Darwich A, Weis CA, Gravius S, Renker E. [Solitary locoregional metastasis of an undifferentiated pleomorphic sarcoma in the M. quadratus femoris]. Orthopade 2021; 50:489-492. [PMID: 33733296 PMCID: PMC8189966 DOI: 10.1007/s00132-021-04093-w] [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] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
Das undifferenzierte pleomorphe Sarkom („undifferentiated pleomorphic sarcoma“ [UPS]) gehört zur Gruppe der Weichteilsarkome und macht fast 10 % aller Weichteilsarkome aus. Der Fall eines 49-jährigen Patienten wird vorgestellt, bei dem die kompartmentorientierte Resektion eines primären UPS im linken Musculus gluteus maximus mit adjuvanter Radiotherapie (60 Gy) durchgeführt wurde. Im Rahmen der Tumornachsorge (3 Jahre später) wurde eine lokoregionäre Metastase an einer ungewöhnlichen Lokalisation im M. quadratus femoris festgestellt, welche mittels einer In-toto-Resektion mit intraoperativer Radiotherapie (10 Gy) behandelt wurde. Der intra- und postoperative Verlauf gestalten sich komplikationslos ohne neurologische Defizite. Im Rahmen der Nachtuntersuchung 6 Monate postoperativ war der Patient tumor- und beschwerdefrei.
Collapse
Affiliation(s)
- Mohamad Bdeir
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Nikolaos Vassos
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Ali Darwich
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Cleo-Aron Weis
- Pathologisches Institut, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Sascha Gravius
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Eva Renker
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| |
Collapse
|
9
|
Bastian T, D'Heygere V, Deuß E, Lax H, Wittig A, Sauerwein W, Arweiler-Harbeck D. [Results of surgical and radiotherapeutic treatment of adenoid cystic carcinoma of the salivary glands]. HNO 2020; 68:678-687. [PMID: 32821981 DOI: 10.1007/s00106-020-00913-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/11/2022]
Abstract
Surgical treatment in patients with rare adenoid cystic carcinoma (ACC) of the salivary glands is considered to be the state of the art. With respect to an additional radiotherapy there are different approaches regarding the type of radiotherapy and timing. In this study the overall survival and recurrence-free survival in 52 individuals with salivary gland ACC who were treated at the University Hospital in Essen and received irradiation with fast neutrons and photons (mixed beam technique) either A) immediately following surgical treatment or B) only after the appearance of local recurrence were compared. Group A (n = 28, first diagnosis, FD September 1991-September 2009) received adjuvant radiotherapy immediately postoperative, group B (n = 24, FD June 1979-November 2001) underwent primarily surgical tumor resection according to the treatment regimen at that time and were irradiated only on the appearance of a local recurrence. In comparison to group B, patients in group A showed a lower recurrence rate and a significantly longer local relapse-free survival. Group B, however, showed a significantly higher overall survival. The frequency of distant metastasis occurred equally in both groups but the onset of distant metastasis was significantly earlier in group A. In general, overall survival was negatively influenced by distant metastasis. The local recurrence rate was very high after primary surgical treatment only. The immediate adjuvant high-linear energy transfer (LET) radiotherapy reduced the local recurrence rates. Irradiation after the appearance of a recurrence had a positive influence on overall survival. Overall, definitive high-LET radiotherapy in the mixed beam technique enabled high local control rates both primarily postoperative and also locoregional recurrences.
Collapse
Affiliation(s)
- T Bastian
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - V D'Heygere
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - E Deuß
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - H Lax
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - A Wittig
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - W Sauerwein
- Klinik für Strahlentherapie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - D Arweiler-Harbeck
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| |
Collapse
|
10
|
Abstract
Primary malignant tumors of the trachea are very rare with the incidence of less than two per million people per year, and only ten percent of them are adenoid cystic carcinomas. Eighty percent of all tracheal tumors are malignant. Diagnosis is usually late because the symptoms mimic other conditions such as asthma. Clinical picture may sometimes be dramatic when airway is almost closed and emergency recanalization is necessary. Diagnosis is made by chest computed tomography scan or magnetic resonance imaging. Definitive treatment is surgical resection alone or followed by radiation therapy or radiation therapy alone. Radical resection is only accomplished in about half of all cases because of the submucosal tumor growth and limited length of tracheal resection. The role of adjuvant radiation therapy in negative resection margin cases is not clear but all patients with positive resection margin benefit from radiation therapy. We present a case of a 43-year-old patient with primary adenoid cystic carcinoma of distal trachea treated by emergency bronchoscopic recanalization and resection of the tracheal tumor with end-to-end anastomosis.
Collapse
Affiliation(s)
| | - Zoran Janevski
- Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vedran Cesarec
- Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Zoran Slobodnjak
- Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Dinko Stančić-Rokotov
- Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| |
Collapse
|
11
|
Ott S, Wiegel T, Laban S, Hoffmann TK, Petersen C, Tribius S. [Radiotherapeutic studies of head and neck cancer-highlights of the 2018 ASCO Annual Meeting]. HNO 2018; 66:901-6. [PMID: 30421001 DOI: 10.1007/s00106-018-0591-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiotherapy is an important treatment option in patients with advanced head and neck cancer. At the 2018 Annual Meeting of the American Society of Clinical Oncology (ASCO), study results were presented that could further develop and modify existing therapy concepts in the future. MATERIALS AND METHODS All ASCO abstracts and presentations concerning radiotherapy of head and neck cancer were screened and the most interesting abstracts were selected for further review. RESULTS One major topic was the combination of radiation with immunotherapy. Presented trials included combination treatment of epidermal growth factor receptor (EGFR) antibodies and platin-based chemoradiotherapy, as well as programmed cell death protein 1 (PD-1) antibodies in combination with platin-based chemoradiotherapy or cetuximab radiotherapy. In one study, the impact of adjuvant (chemo)radiotherapy for overall survival of human papillomavirus (HPV)-associated head and neck cancer with low to intermediate risk was analyzed. Additionally, studies focusing on the prophylaxis or reduction of radiation-mediated oral mucositis were presented. CONCLUSION The data presented do not justify a change of current treatment paradigms just yet. However, interesting developments can be expected in the coming years, particularly in the field of immunotherapy.
Collapse
|
12
|
Baek SH, Bae SJ, Yoon CI, Park SE, Cha CH, Ahn SG, Kim YS, Roh TS, Jeong J. Immediate Breast Reconstruction Does Not Have a Clinically Significant Impact on Adjuvant Treatment Delay and Subsequent Survival Outcomes. J Breast Cancer 2019; 22:109-119. [PMID: 30941238 PMCID: PMC6438834 DOI: 10.4048/jbc.2019.22.e7] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/25/2018] [Indexed: 01/11/2023] Open
Abstract
Purpose The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. Methods We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. Results Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. Conclusion IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.
Collapse
Affiliation(s)
- Seung Ho Baek
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ik Yoon
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - So Eun Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Hwan Cha
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Departments of Plastic & Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Departments of Plastic & Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Shen J, Guo SW, Jin G. [Progress in clinical research of pancreatic cancer: from "resection" to "cure"]. Zhonghua Wai Ke Za Zhi 2019; 57:72-77. [PMID: 30612395] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Because of the high malignancy of pancreatic ductal adenocarcinoma, the cancer-related mortality of pancreatic ductal adenocarcinoma is increasing year by year. Despite advance in surgical techniques, the 5-year survival rate of patients after resection is still less than 30%. Recent studies have found that pancreatic ductal adenocarcinoma is a systemic disease, which may not be cured completely by up-front resection, but requires perioperative multidisciplinary therapy. With the concept of "potentially curable pancreatic cancer" , clinicians need to evaluate the resectability of pancreatic ductal adenocarcinoma accurately before operation, and use the innovative multidisciplinary therapy including neoadjuvant chemoradiotherapy,surgery and adjuvant chemoradiotherapy to improve the R0 resection rate and reduce the risk of early metastasis. Therefore, the therapeutic goal of pancreatic ductal adenocarcinoma is no longer "simple resection" , but long survival through perioperative multidisciplinary treatment. In this article, we briefly introduce the progress of resectability assessment, surgical techniques and perioperative adjuvant therapy of "potentially curable pancreatic cancer" .
Collapse
Affiliation(s)
- J Shen
- Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China (Shen Jing is working on the Department of General Surgery, No.971 Hospital of NAVY, Qingdao 266071, China)
| | | | | |
Collapse
|
14
|
Abstract
Skeletal lesions caused by multiple myeloma often lead to pain, pathological fractures, spinal instability, and compression of the spinal cord and nerve roots. The choice of therapy options is made by an interdisciplinary basis with oncologists and radiotherapists on the basis of comorbidities, prognosis, localization, and number of lesions. Surgical management has a supportive role in pain relief, the prevention and treatment of pathological fractures, and the decompression of the spinal cord and nerve roots. An adequate preoperative workup is essential for planning surgical treatment, which includes magnetic resonance imaging of the spine. In the case of unstable spinal lesions, minimally invasive and open surgical procedures, as well as their combination, are available for stabilization and decompression. In impending and pathological fractures of the extremities, surgical procedures are superior to conservative therapy for pain relief, restoring stability, walking ability, and limb function. There are multiple options available, including osteosynthesis using bone cement and plates, intramedullary nails, and bone replacement with implants and tumor endoprostheses with good functional results. Permanent reconstruction of the lesions should be the goal of any surgical intervention. The indication for curative, wide resection of the tumor should be considered for solitary plasmocytomas of the bone. Adjuvant radiotherapy leads to significantly improved local tumor control and should be considered after resection and stabilization.
Collapse
|
15
|
Budäus L, Schiffmann J, Graefen M, Huland H, Tennstedt P, Siegmann A, Böhmer D, Budach V, Bartkowiak D, Wiegel T. Defining biochemical recurrence after radical prostatectomy and timing of early salvage radiotherapy : Informing the debate. Strahlenther Onkol 2017; 193:692-699. [PMID: 28470414 DOI: 10.1007/s00066-017-1140-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/30/2016] [Accepted: 04/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal prostate-specific antigen (PSA) level after radical prostatectomy (RP) for defining biochemical recurrence and initiating salvage radiation therapy (SRT) is still debatable. Whereas adjuvant or extremely early SRT irrespective of PSA progression might be overtreatment for some patients, SRT at PSA >0.2 ng/ml might be undertreatment for others. The current study addresses the optimal timing of radiation therapy after RP. PATIENTS AND METHODS Cohort 1 comprised 293 men with PSA 0.1-0.19 ng/ml after RP. Cohort 2 comprised 198 men with SRT. PSA progression and metastases were assessed in cohort 1. In cohort 2, we compared freedom from progression according to pre-SRT PSA (0.03-0.19 vs. 0.2-0.499 ng/ml). Multivariable Cox regression analyses predicted progression after SRT. RESULTS In cohort 1, 281 (95.9%) men had further PSA progression ≥0.2 ng/ml and 27 (9.2%) men developed metastases within a median follow-up of 74.3 months. In cohort 2, we recorded improved freedom from progression according to lower pre-SRT PSA (0.03-0.19 vs. 0.2-0.499 ng/ml: 69 vs. 53%; log-rank p = 0.051). Patients with higher pre-SRT PSA ≥0.2 ng/ml were at a higher risk of progression after SRT (hazard ratio: 1.8; p < 0.05). CONCLUSION The vast majority of patients with PSA ≥0.1 ng/ml after RP will progress to PSA ≥0.2 ng/ml. Additionally, early administration of SRT at post-RP PSA level <0.2 ng/ml might improve freedom from progression. Consequently, we suggest a PSA threshold of 0.1 ng/ml to define biochemical recurrence after RP.
Collapse
Affiliation(s)
- Lars Budäus
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Siegmann
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Detlef Bartkowiak
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
16
|
Abstract
BACKGROUND Metastasis is a common event in renal cell carcinoma. Surgical resection of metastases may be feasible in two scenarios: aiming at palliation, which may be feasible due to reduced radiosensitivity of renal cell cancer, and aiming at prolonging survival, which may be feasible given the rather good prognosis of some patterns of metastasis. OBJECTIVE This review intends to reflect on current evidence for surgical resection of metastases in both scenarios. The literature was searched in PubMed and respective guidelines were reviewed. RESULTS AND CONCLUSIONS Palliative resection is mainly feasible to control symptoms like spinal compression; adjuvant radiation is advisable. Resection is markedly feasible, however, for improvement of cancer-specific survival in probably all resectable patterns of metastasis-solitary, multiple, syn- and metachronous, and in all organs-provided complete resection can be achieved. A fairly good prognosis is seen in solitary pulmonary metastasis without concomitant hilar or mediastinal lymph node metastasis and a metachronous appearance following long recurrence-free survival after tumor nephrectomy; complete resection may be considered curative in certain cases. Neo- or adjuvant medical therapy or radiation is not established. In cases lacking complete resectability, stereotactic radiation may be considered as an alternative.
Collapse
Affiliation(s)
- M Burger
- Klinik für Urologie Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland.
| |
Collapse
|
17
|
de Campos TPR, de Lima CF, Cuperschmid EM. Balloon-based adjuvant radiotherapy in breast cancer: comparison between (99m)Tc and HDR (192)Ir. Radiol Bras 2016; 49:92-7. [PMID: 27141131 PMCID: PMC4851477 DOI: 10.1590/0100-3984.2015.0010] [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: 01/27/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To perform a comparative dosimetric analysis, based on computer simulations, of temporary balloon implants with (99m)Tc and balloon brachytherapy with high-dose-rate (HDR) (192)Ir, as boosts to radiotherapy. We hypothesized that the two techniques would produce equivalent doses under pre-established conditions of activity and exposure time. MATERIALS AND METHODS Simulations of implants with (99m)Tc-filled and HDR (192)Ir-filled balloons were performed with the Siscodes/MCNP5, modeling in voxels a magnetic resonance imaging set related to a young female. Spatial dose rate distributions were determined. In the dosimetric analysis of the protocols, the exposure time and the level of activity required were specified. RESULTS The (99m)Tc balloon presented a weighted dose rate in the tumor bed of 0.428 cGy.h(-1).mCi(-1) and 0.190 cGyh(-1).mCi(-1) at the balloon surface and at 8-10 mm from the surface, respectively, compared with 0.499 and 0.150 cGyh(-1).mCi(-1), respectively, for the HDR (192)Ir balloon. An exposure time of 24 hours was required for the (99m)Tc balloon to produce a boost of 10.14 Gy with 1.0 Ci, whereas only 24 minutes with 10.0 Ci segments were required for the HDR (192)Ir balloon to produce a boost of 5.14 Gy at the same reference point, or 10.28 Gy in two 24-minutes fractions. CONCLUSION Temporary (99m)Tc balloon implantation is an attractive option for adjuvant radiotherapy in breast cancer, because of its availability, economic viability, and similar dosimetry in comparison with the use of HDR (192)Ir balloon implantation, which is the current standard in clinical practice.
Collapse
Affiliation(s)
- Tarcísio Passos Ribeiro de Campos
- Postdoctoral Fellow, Professor in the Department of
Nuclear Engineering, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte,
MG, Brazil
| | - Carla Flavia de Lima
- MD, Nuclear Medicine Physician, Doctoral Student in the
Graduate Program in Nuclear Sciences and Techniques, Núcleo de
Radiações Ionizantes (NRI) at the Universidade Federal de Minas Gerais
(UFMG), Belo Horizonte, MG, Brazil
| | - Ethel Mizrahy Cuperschmid
- PhD, Docent at the Center for the History of Medicine,
Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
18
|
Bottke D, Bartkowiak D, Bolenz C, Wiegel T. [Radiotherapy in node-positive prostate cancer]. Urologe A 2016; 55:345-9. [PMID: 26893137 DOI: 10.1007/s00120-016-0044-2] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are numerous randomized trials to guide the management of patients with localized (and metastatic) prostate cancer, but only a few (mostly retrospective) studies have specifically addressed node-positive patients. Therefore, there is uncertainty regarding optimal treatment in this situation. Current guidelines recommend long-term androgen deprivation therapy (ADT) alone or radiotherapy plus long-term ADT as treatment options. OBJECTIVES This overview summarizes the existing literature on the use of radiotherapy for node-positive prostate cancer as definitive treatment and as adjuvant or salvage therapy after radical prostatectomy. In this context, we also discuss several PET tracers in the imaging evaluation of patients with biochemical recurrence of prostate cancer after radical prostatectomy. As for definitive treatment, retrospective studies suggest that ADT plus radiotherapy improves overall survival compared with ADT alone. These studies also consistently demonstrated that many patients with node-positive prostate cancer can achieve long-term survival - and are likely curable - with aggressive therapy. RESULTS The beneficial impact of adjuvant radiotherapy on survival in patients with pN1 prostate cancer seems to be highly influenced by tumor characteristics. Men with ≤ 2 positive lymph nodes in the presence of intermediate- to high-grade disease, or positive margins, and those with 3 or 4 positive lymph nodes are the ideal candidates for adjuvant radiotherapy (plus long-term ADT) after surgery. CONCLUSION There is a need for randomized trials to further examine the potential role of radiotherapy as either definitive or adjuvant treatment, for patients with node-positive prostate cancer.
Collapse
Affiliation(s)
- D Bottke
- Fachbereich Strahlentherapie und Radioonkologie, MVZ Klinikum Esslingen GmbH, Hirschlandstraße 97, 73730, Esslingen a. N., Deutschland.
| | - D Bartkowiak
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - T Wiegel
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland
| |
Collapse
|