			Home About us Contact

Tumor Diameter (tumor + diameter)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Clinical outcomes of laparoscopic adrenalectomy according to tumor size

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2005
ISAO HARA
Objectives: In order to evaluate the indication and usefulness of laparoscopic adrenalectomy, clinical outcomes of laparoscopic adrenalectomy for patients with adrenal tumors were examined. Whether tumor size affects surgical outcome was analysed, along with the long-term clinical outcome for these patients. Patients and methods: A total of 63 patients with adrenal tumor underwent laparoscopic adrenalectomy in our institute between 1999 and 2003. A laparoscopic transperitoneal approach was used in all cases. Underlying pathologies comprised Cushing syndrome (n = 12), pheochromocytoma (n = 13), primary aldosteronism (n = 21), non-functioning adenoma (n = 12) and others (n = 5). Results: No open conversion was performed. Mean operative duration was 239 min, and mean estimated blood loss was 134 mL. Tumor diameter was significantly smaller for primary aldosteronism than for Cushing syndrome, which in turn was significantly smaller than for adrenocorticotropic hormone-independent macronodular hyperplasia (AIMAH). No significant differences in surgical outcome and postoperative recovery were noted between large (,5 cm) and small (<5 cm) tumors. Long-term clinical outcome was better for patients with pheochromocytoma or primary aldosteronism than for patients with Cushing syndrome. Conclusions: Laparoscopic adrenalectomy for benign tumor offers excellent surgical outcomes and convalescence. This is true for both small and large tumors. [source]

Prognostic factors derived from a prospective database dictate clinical biology of anal cancer

CANCER, Issue 17 2010
The intergroup trial (RTOG 98-11)
Abstract BACKGROUND: Only 4 prospective randomized phase 3 trials have been reported for anal cancer. A prognostic factor analysis for anal cancer from a prospective database has been published from only 1 study (N = 110). To confirm and uncover new prognostic factors, we analyzed the prospective database of intergroup RTOG 98-11. METHODS: Univariate and multivariate analyses of the baseline characteristics for 5-year overall survival (OS) and disease-free survival (DFS) were carried out. Various combinations of tumor diameter and clinically positive nodes (N+) were analyzed to identify subgroups. RESULTS: A total of 644 were assessable and analyzed. Tumor diameter >5 cm was associated with poorer 5-year DFS (P = .0003) and poorer 5-year OS (P = .0031), and N+ was associated with poorer 5-year DFS (P , .0001) and poorer 5-year OS (P = , .0001) in the multivariate analysis. In stratified analyses, N+ had more adverse influence on DFS and OS than did tumor diameter. Patients with >5-cm tumor and N+ had the worst DFS (only 30% at 3 years compared with 74% for the best group; <5 cm primary and N0) and OS (only 48% at 4 years compared with 81% for the best group; <5 cm primary and N0). Men had worse DFS (P = .02) and OS (P = .016). These factors maintained their influence in each treatment arm. CONCLUSIONS: This prospective prognostic factor analysis establishes tumor diameter as an independent prognosticator of poorer 5-year DFS and OS and confirms N+ and male sex as poor prognostic factors. This analysis also uncovers novel subgroups (derived from combining prognostic factors) with incremental worsening of DFS and OS. Cancer 2010. © 2010 American Cancer Society. [source]

Diameter of Involved Nerves Predicts Outcomes in Cutaneous Squamous Cell Carcinoma with Perineural Invasion: An Investigator-Blinded Retrospective Cohort Study

DERMATOLOGIC SURGERY, Issue 12 2009
AMY S. ROSS MD
BACKGROUND Perineural invasion (PNI) has been associated with poor prognosis in cutaneous squamous cell carcinoma (CSCC), but it is unclear how different degrees of nerve involvement affect prognosis. OBJECTIVE To determine whether the diameter of nerves invaded by CSCC affects outcomes of recurrence, metastasis, and disease-specific and overall survival. METHODS A retrospective cohort study was conducted of patients with CSCC with PNI. Dermatopathologists blinded to subject outcomes determined the diameter of the largest involved nerve. RESULTS Data were obtainable for 48 patients. Small-caliber nerve invasion (SCNI) of nerves less than 0.1 mm in diameter was associated with significantly lower risks of all outcomes of interest. Disease-specific death was 0% in subjects with SCNI, versus 32% in those with large-caliber nerve invasion (LCNI) (p=.003). Other factors associated with significantly worse survival were recurrent or poorly differentiated tumors or tumor diameter of 2 cm or greater or depth of 1 cm or greater. On multivariate analysis, only tumor diameter and age predicted survival. CONCLUSIONS The individual prognostic significance of factors associated with poor survival remains uncertain. Small-caliber nerve invasion may not adversely affect outcomes. Defining PNI as tumor cells within the nerve sheath and routine recording of diameter of involved nerves, tumor depth, and histologic differentiation on pathology reports will facilitate further study. [source]

Fractional Cryosurgery for Skin Cancer

DERMATOLOGIC SURGERY, Issue 11 2009
JOSE CARLOS ALMEIDA GONÇALVES MD
BACKGROUND Cryosurgical treatment of facial skin cancers 10 mm or larger in diameter can originate retractile scars that may alter physiognomic features. OBJECTIVES To treat skin cancers 10 mm or larger in diameter on the face with a cryosurgical method that prevents retractile scars. Also, to clarify the differences between this method and Zacarian's segmental cryosurgery. METHODS AND MATERIALS Fractional cryosurgery is performed in stages. First, the center of the lesion is frozen, reducing its size, then this procedure is repeated as necessary until the tumor diameter is smaller than 10 mm, at which point the standard cryosurgical procedure is performed. Eighty-seven basal cell carcinomas (BCCs) and nine squamous cell carcinomas (SCCs) of the face (65 of which were orbital or periocular) measuring between 9 and 45 mm were treated. RESULTS The cure rate of BCCs was related to tumor size. All SCCs were cured without recurrence. Global mean follow-up was 4.5 years. CONCLUSION Fractional cryosurgery does not cause deformity, and the final scar has no relation to the mass of the original tumor but instead corresponds to the size of the lesion preceding the last cryosurgical procedure. [source]

Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis,,

HEPATOLOGY, Issue 3 2008
Francis Y. Yao
We previously reported encouraging results of down-staging of hepatocellular carcinoma (HCC) to meet conventional T2 criteria (one lesion 2,5 cm or two to three lesions <3 cm) for orthotopic liver transplantation (OLT) in 30 patients as a test of concept. In this ongoing prospective study, we analyzed longer-term outcome data on HCC down-staging in a larger cohort of 61 patients with tumor stage exceeding T2 criteria who were enrolled between June 2002 and January 2007. Eligibility criteria for down-staging included: (1) one lesion >5 cm and up to 8 cm; (2) two to three lesions with at least one lesion >3 cm and not exceeding 5 cm, with total tumor diameter up to 8 cm; or (3) four to five lesions with none >3 cm, with total tumor diameter up to 8 cm. A minimum observation period of 3 months after down-staging was required before OLT. Tumor down-staging was successful in 43 patients (70.5%). Thirty-five patients (57.4%) had received OLT, including two who had undergone live-donor liver transplantation. Treatment failure was observed in 18 patients (29.5%), primarily due to tumor progression. In the explant of 35 patients who underwent OLT, 13 had complete tumor necrosis, 17 met T2 criteria, and five exceeded T2 criteria. The Kaplan-Meier intention-to-treat survival at 1 and 4 years after down-staging were 87.5% and 69.3%, respectively. The 1-year and 4-year posttransplantation survival rates were 96.2% and 92.1%, respectively. No patient had HCC recurrence after a median posttransplantation follow-up of 25 months. The only factor predicting treatment failure was pretreatment alpha-fetoprotein >1,000 ng/mL. Conclusion: Successful down-staging of HCC can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome. (HEPATOLOGY 2008.) [source]

Surgical outcomes of partial nephrectomy for renal cell carcinoma: A joint study by the Japanese Society of Renal Cancer

INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007
Yutaka Senga
Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed, even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life. [source]

Evaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2006
KOBAYASHI YASUYUKI
Aim: We evaluated the functions of an affected kidney after laparoscopic partial nephrectomy (LPN) using renal scintigraphy with 99mtechnetium-mercaptoacetyltriglycine (99mTc-MAG3). Methods: Split renal function of 10 patients who underwent LPN for renal tumors was assessed using renal scintigraphy with 99mTc-MAG3 before surgery, and 1 week and 3 months post-surgery. Results: Median operating time was 196.5 min, median tumor diameter was 2.3 cm, mean blood loss was 64 mL and mean ischemic time was 38.5 min. Median change in serum creatinine level pre- to post-surgery was 0.15 mg/dL. Median contribution of the affected kidney to total renal function (calculated using 99mTc-MAG3) was 50.0%, 41.7% and 36.1% before surgery, 1 week and 3 months after LPN, respectively. In one patient, the tumor was resected after cooling of the affected kidney with ice slush for 15 min, and the split renal function ratio remained as high as 50% at 3 months post-operatively despite a total ischemic time of 61 min. Conclusions: This paper evaluated renal function on the affected side before and after surgery by measuring split renal function with renal scintigraphy using 99mTc-MAG3. Risk factors for renal dysfunction in the affected kidney after LPN include age over 70 years with more than 30 min warm ischemic time, re-clamping of the renal artery procedure, and a warm ischemic time greater than 60 min. We believe that renal cooling with slush ice prevents renal dysfunction of the affected kidney after LPN with longer warm ischemic times. However, an easier renal cooling technique should be sought for regular use of cooling procedures in LPN. [source]

Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: Usefulness of adrenocortical scintigraphy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006
HIROFUMI IZAKI
Aim:, Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non-functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non-functional adrenal tumors with hypertension in a retrospective fashion. Methods:, Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre- and postoperative hypertension, were reviewed. Forty-five patients underwent laparoscopic adrenalectomy for non-functional adrenal tumors, and [131I]6,-iodomethyl-19-norcholest-5(10)-en-3,-ol (NP-59) scintigraphy was performed for patients with preoperative hypertension. Results:, Mean patient age was 55.0 years (range, 22,77 years). Mean maximum tumor diameter was 42 mm (range, 20,105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP-59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results. Conclusions:, The indication of laparoscopic adrenalectomy for non-functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP-59 scintigraphy are present. [source]

Predictive factors for lymph node metastasis and endoscopic treatment strategies for undifferentiated early gastric cancer

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 1 2008
Byong D Ye
Abstract Background and Aim:, Although more than 80% of undifferentiated early gastric cancers (EGC) are not associated with lymph node metastasis, endoscopic mucosal resection is not generally accepted as a means of curative treatment because of an abundance of conflicting data concerning clinicopathological characteristics and prognoses. The aim of this study was to define a subgroup of undifferentiated EGC that could be cured by endoscopic treatment without the risk of lymph node metastasis. Method:, A total of 591 patients surgically resected for undifferentiated EGC between January 1999 and March 2005 were reviewed. Associations between various clinicopathological factors and the presence of lymph node metastasis were analyzed to identify the risk factors of lymph node metastasis. Results:, Lymph node metastasis was found in 79 patients (13.4%). By multivariate logistic regression analysis, a tumor diameter 2.5 cm or larger, invasion into the middle third of the submucosal layer or deeper, and lymphatic involvement were identified as independent risk factors of lymph node metastasis (P < 0.001, respectively). Lymph node metastasis was not found in any patient with undifferentiated EGC smaller than 2.5 cm confined to the mucosa or upper third of the submucosal layer without lymphatic involvement. Conclusions:, Undifferentiated intramucosal EGC smaller than 2.5 cm without lymphatic involvement was not associated with lymph node metastasis. Thus, we propose in this circumstance that endoscopic mucosal resection could be considered a definitive treatment without compromising the possibility of cure. [source]

Surgical resection of primary and metastatic hepatic malignancies following portal vein embolization

JOURNAL OF SURGICAL ONCOLOGY, Issue 3 2009
Brian Mailey MD
Abstract Background Portal vein embolization (PVE) has been used to induce hypertrophy in future liver remnants (FLRs) in preparation for major hepatic resection. We report our initial experience with PVE and identify potential predictors of unresectability following PVE. Methods Patients with primary and metastatic hepatic malignancies (n,=,20) who underwent PVE between 2004 and 2008 were categorized by surgical resection status and clinicopathologic factors were compared. Results The cohort had the following histologies: colorectal adenocarcinoma (45%, n,=,9), hepatocellular carcinoma (20%), cholangiocarcinoma (20%), and other (15%). Seven patients (35%) had previous liver-directed or regional therapy; 55% subsequently underwent successful liver resection, whereas 45% were deemed unresectable. Patients who underwent successful resection had tumor shrinkage after PVE compared to unresectable patients (% change in maximal tumor diameter, ,6% vs. +45%, respectively; P,=,0.027) and had a lower rate of baseline liver function test abnormality (0% vs. 56%, respectively; P,=,0.004). Resected patients had an 83% 5-year overall survival. Conclusions Baseline liver dysfunction may predict subsequent unresectable hepatic disease following PVE and tumor progression after PVE appears to increase the likelihood for finding unresectable hepatic disease. Select patients should be considered for PVE with careful surveillance during the period of FLR hypertrophy. J. Surg. Oncol. 2009;100:184,190. © 2009 Wiley-Liss, Inc. [source]

The effect of 595,nm pulsed dye laser on superficial and nodular basal cell carcinomas

LASERS IN SURGERY AND MEDICINE, Issue 6 2009
Sonali M. Shah MD
Abstract Background and Objective Basal cell carcinomas (BCCs) have supporting vasculature that could serve as a target for 595,nm pulsed dye laser (PDL). The objective of this study was to determine the effect of repeated PDL treatments on BCCs of superficial and nodular subtypes and of varying diameters. Study Design/Materials and Methods Twenty biopsy-proven BCCs received four 595,nm PDL treatments at 2-week intervals. The tumor and 4,mm of peripheral skin were treated using a set of previously optimized laser parameters: one pass, 15,J/cm2 energy, 3,ms pulse length, no cooling, and 7,mm spot size with 10% overlap. The treated area was excised and evaluated histologically for residual tumor. Histologic response rates of the PDL treated BCCs were compared with that of non-PDL treated, matched control tumors. Results Nearly all BCCs <1.5,cm in diameter (n,=,12) showed complete response to four PDL treatments (91.7%; n,=,11/12) versus 16.7% of controls (n,=,2/12, P -value,= 0.0003). BCCs ,1.5,cm in diameter (n,=,8) showed a complete response rate of 25% (n,=,2/8) versus 0% of controls (n,=,0/8, P -value,=,0.2). Mean clinical tumor diameter of the complete responders was 1.1,cm (n,=,13) versus 2.2,cm (n,=,7) for incomplete responders (P -value,=,0.005). Tumor histologic types among the complete responders included superficial, nodular, micronodular, and keratinizing. Incompletely responding BCCs showed a significant reduction in tumor burden after PDL treatment, with residual histologic tumor burden ranging from <1% to 29% of the original clinical tumor diameter, compared to 13,68% residual tumor burden for the corresponding controls (P -value,=,0.05). Conclusions PDL is an effective means of reducing tumor burden in patients with large BCCs and may be an alternative therapy in BCCs <1.5,cm in diameter. Lasers Surg. Med. 41:417,422, 2009. © 2009 Wiley-Liss, Inc. [source]

A prospective study on downstaging of hepatocellular carcinoma prior to liver transplantation,

LIVER TRANSPLANTATION, Issue 12 2005
Francis Y. Yao
In patients with hepatocellular carcinoma (HCC) exceeding conventional (T2) criteria for orthotopic liver transplantation (OLT), the feasibility and outcome following loco-regional therapy intended for tumor downstaging to meet T2 criteria for OLT are unknown. In this first prospective study on downstaging of HCC prior to OLT, the eligibility criteria for enrollment into a downstaging protocol included 1 lesion >5 cm and ,8 cm, 2 or 3 lesions at least 1 >3 cm but ,5 cm with total tumor diameter of ,8 cm, or 4 or 5 nodules all ,3 cm with total tumor diameter ,8 cm. Patients were eligible for living-donor liver transplantation (LDLT) if tumors were downstaged to within proposed University of California, San Francisco (UCSF) criteria.13 A minimum follow-up period of 3 months after downstaging was required before cadaveric OLT or LDLT, with imaging studies meeting criteria for successful downstaging. Among the 30 patients enrolled, 21 (70%) met criteria for successful downstaging, including 16 (53%) who had subsequently received OLT (2 with LDLT), and 9 patients (30%) were classified as treatment failures. In the explant of 16 patients who underwent OLT, 7 had complete tumor necrosis, 7 met T2 criteria, but 2 exceeded T2 criteria. No HCC recurrence was observed after a median follow-up of 16 months after OLT. The Kaplan-Meier intention-to-treat survival was 89.3 and 81.8% at 1 and 2 yr, respectively. In conclusion, successful tumor downstaging can be achieved in the majority of carefully selected patients, but longer follow-up is needed to further access the risk of HCC recurrence after OLT. (Liver Transpl 2005;11:1505,1514.) [source]

MOSHER AWARD HONORABLE MENTION,

THE LARYNGOSCOPE, Issue 4 2000
Natural History of Acoustic Neuromas
Abstract Objectives/Hypothesis 1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas. Study Design A retrospective study from 1974 to 1999 of patients with unilateral acoustic neuromas who had conservative treatment by serial imaging studies (80 patients) or subtotal resection (49 patients). Methods All patient charts were evaluated for presenting symptoms, reasons for the type of management given, and clinical outcome. Charts were also reviewed with respect to serial audiological assessment, electronystagmography, and brainstem auditory evoked response. Imaging studies were analyzed using a computer technique so that serial studies could be compared to determine growth rates. Results Rigorous computer analysis of tumor size and growth rate was statistically the same as the radiologist's description of the tumor size and growth rate. Of 70 patients who were older than 65 years of age old at the time their tumor was discovered, 4 (5.7%) required intervention and 18 (26%) were dead of unrelated causes. These patients had a mean follow-up of 4.8 years (range, 0.01,17.2 y). Overall, growth rate for nonsurgical patients was 0.91 mm per year. Nonsurgical tumors did not grow or regressed in 42.3%. Overall postoperative growth rate for surgical subtotal resection patients was 0.35 mm per year. Surgical tumors did not grow or regressed after subtotal resection of acoustic neuroma in 68.5% of patients. Three patients (6.1%) required revision surgery because of tumor growth or the development of symptoms. Neither auditory nor vestibular testing was a reliable measure for determining tumor growth. Conclusion Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms. [source]

Estrogen receptor ,, an independent prognostic marker in estrogen receptor , and progesterone receptor-positive breast cancer?

APMIS, Issue 9 2009
BJØRN O. MÆHLE
Both subtypes of estrogen receptor (ER), ER, and ER,, are normally present in the mammary gland. The role of ER, as a prognostic marker in breast cancer is well established due to the beneficial effect of providing tamoxifen as adjuvant therapy. The role of ER,, however, is less clear. To gain insight into the importance of ER, in breast cancer, 145 primary breast cancers were examined by immunohistochemistry for ER,, and the expression level was compared with ER, and progesterone receptor (PR) status. Especially, we wanted to examine the significance of ER, in the contrasting ER,+/PR+ and ER,,/PR, subgroups. In the ER,+/PR+ subgroup (dual positive), the survival difference between patients with low, medium and high ER , level was statistically significant (p = 0.004), with more than 70% of patients with medium and high ER, levels surviving 100 months, compared with less than 30% in the group with low ER, level. Further, for ER,+/PR+ patients there was a reduced risk of fatal outcome by multivariate analysis with increasing ER, levels (p(trend) < 0.01 [univariate analysis]; p(trend) = 0.05 [multivariate analysis]). The risk was 31% and 27% for medium and high ER, levels, respectively, compared with low ER, level, adjusting for standard prognostic factors such as tumor diameter, nuclear tumor grade (quantified by mean nuclear area), lymph node status, and patient age at operation. For patients with ER,,/PR, tumors (dual negative), however, there was no association between ER, levels and patient outcome. Our findings indicate that ER, expression provides independent prognostic information for breast cancers with ER,/PR-positive status, a feature typical among screen-detected breast cancers. The role of ER, needs to be further evaluated especially in this group of breast cancers. [source]

Prognostic factors derived from a prospective database dictate clinical biology of anal cancer

Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance

CANCER, Issue 13 2009
Paul L. Crispen MD
Abstract BACKGROUND: The growth kinetics of untreated solid organ malignancies are not defined. Radiographic active surveillance (AS) of renal tumors in patients unfit or unwilling to undergo intervention provides an opportunity to quantify the natural history of untreated localized tumors. The authors report the radiographic growth kinetics of renal neoplasms during a period of surveillance. METHODS: The authors identified patients with enhancing renal masses who were radiographically observed for at least 12 months. Clinical and pathological records were reviewed to determine tumor growth kinetics and clinical outcomes. Tumor growth kinetics were expressed in terms of absolute and relative linear and volumetric growth. RESULTS: The authors identified 172 renal tumors in 154 patients under AS. Median tumor diameter and volume on presentation were 2.0 cm (mean, 2.5; range, 0.4-12.0) and 4.18 cm3 (mean, 20.0; range, 0.033-904). Median duration of follow-up was 24 months (mean, 31; range, 12-156). A significant association between presenting tumor size and proportional growth was noted, with smaller tumors growing faster than larger tumors. Thirty-nine percent (68 of 173) of tumors underwent delayed intervention, and 84% (57 of 68) were pathologically malignant. Progression to metastatic disease was noted in 1.3% (2 of 154) of patients. CONCLUSIONS: The authors demonstrated the association between a tumor's volume and subsequent growth, with smaller tumors exhibiting significantly faster volumetric growth than larger tumors, consistent with Gompertzian kinetics. Surveillance of localized renal tumors is associated with a low rate of disease progression in the intermediate term, and suggests potential overtreatment biases in select patients. Cancer 2009. © 2009 American Cancer Society. [source]

Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma

CANCER, Issue 4 2004
Subnormal levels as an indicator of favorable prognosis
Abstract BACKGROUND Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. METHODS Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan,Meier method, and differences in survival were assessed by log-lank analysis. RESULTS Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1,4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). CONCLUSIONS Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels. Cancer 2004. © 2004 American Cancer Society. [source]

18 years experience of the use of proton beam in ophthalmic tumours

ACTA OPHTHALMOLOGICA, Issue 2009
L DESJARDINS
Purpose Since 1991, more than 3000 patients were treated at Curie Institute by proton beam for uveal melanoma. All datas concerning tumor characteristics, treatment planning and follow up are registered in the data base Methods We have performed a retrospective review of patients treated before 2005. Patients were sent to Curie by their local ophtalmologist. Clip positioning and proton beam therapy with a dose of 60 grays in 4 fractions was scheduled; All patients were seen once a year in our clinic after treatment with liver ultrasounds twice a year. Results 2214 patients were treated, median age 61 years, median diameter 13,6 mm, median Thickness 4,7 mm. 20% of patients develloped metastasis,25% of patients died, 4% had local recurrences, 6,7% had secondary enucleations; With multivariate analysis Significant risk factors for metastasis were age (>60 ), tumor location, tumor diameter and tumor thickness( p<0,0001); Significant risk factor for local recurrence was tumor diameter (p<0,001) significant risk factor for secondary enucleation were tumor diameter (p<0,0001) and tumor thickness (p= 0,003) Neovascular glaucoma was 10% at 2years , 30% at 5 years and 34% at 10 years. Maculopathy was 40% at 2 years, 62% at 5 years and 66% at 10 years Optic neuropathy was 14% at 2 years, 29% at 5 years and 38% at 10 years At last follow up 36,2% of patients have more than 20/40 vision Conclusion Tumor control obtained by proton beam is excellent with a long follow up For big tumors news additional techniques like endoresections, additional TTT or antiVEGF could enhance globe preservation [source]

Metastatic disease in small uveal melanomas : retrospective review of 368 patients

ACTA OPHTHALMOLOGICA, Issue 2009
L DESJARDINS
Purpose To determine the metastatic rate and survival curves of small uveal melanomas and find the smallest uveal melanoma associated with metastatic disease. Methods We studied uveal melanomas patients treated with radiotherapy in Curie Institute between 1992 and 2004. We selected the tumors with a diameter inferior or equal to 12 mm and a thickness inferior or equal to 3 mm. All the datas concerning initial tumor findings, radiotherapy treatment and follow up were routinely entered in the data base. Retrospective review and statistical analysis were performed. Results Among 2258 patients treated during this period, 368 had small tumors. Median tumor diameter was 9 mm and median tumor thickness was 2,5 mm. Retinal detachment was present in 32 patients. 282 patients were treated by proton beam therapy, 77 by iodine plaque and 9 by transpupillary thermotherapy. Median follow up is 109 months. 71 patients died and 20 patients developped metastatic disease. Local recurrence was observed in two cases. Overall survival at 5 years was 92%and at 10 years 78% survival without metastasis at 5 years was 96% and at 10 years 93%. According to our data the smallest tumor associated with metastatic death was 5mm in diameter and 1,5 mm in thickness and 14 of the tumors had a diameter of less than 10 mm develloped. Half of the metastatic patients developped metastasis 5 years or more after treatment. Conclusion Very small uveal melanoma can be responsible for metastatic death. [source]

Uveal melanoma: management and outcome of patients with extraocular spread

ACTA OPHTHALMOLOGICA, Issue 2009
N CASSOUX
Purpose Extraocular spread is thought to be a negative prognostic factor on survival of the patient with uveal melanoma. Depending on the size of the tumor and the type of extraocular extension conservative treatments can be employed. Methods 2256 patients were treated between 2000 and 2007 at the Institut Curie, Paris, France for an uveal melanoma. 67 patients (3.0%) presented an extraocular extension. A retrospective study was performed to evaluate the patients outcome with regard to tumour recurrence and their survival. Results Results: Eye-conserving treatment was employed in 38 (52.8%) patients. An enucleation was performed in 29 (47.2%) patients. The median follow-up was 38 (range 7 - 79) months with an overall survival rate at 5-years of 40.4% in enucleated patients and 79.3% in the eye- conserving treatment group (protons n=19, iodine-125 plaque n = 19) (p = 0.01; Kaplan- Meier analysis). No tumor recurrence was observed in any group. Degree of extraocular spread as well as the clinical characteristics tumor location, retinal detachment, ciliary body involvement (p < 0.01; Chi-square test) and tumor thickness (p = 0.04; Chi-square test) influenced the choice of treatment. Age, tumor diameter, involving optic nerve, vitreous hemorrhage, achromic lesion was without any influence. Conclusion Conclusion: No tumor recurrence and no lower survival rate were observed in patients receiving an eye-conserving treatment. They may represent thus a therapeutic option in selected patients with extraocular spread. [source]

Ocular conservation in patients with uveal melanoma by a multimodality approach to treatment

ACTA OPHTHALMOLOGICA, Issue 2007
C GARCIA-ALVAREZ
Purpose: To analyse eye survival in patients with uveal melanoma with a multimodality approach to treatment Methods: 273 patients with uveal melanoma diagnosed at Ocular Oncology Unit of the University Hospital of Valladolid from 1997 September to 2007 April. Pearson's Chi-square test was used to identify between variables and primary enucleation. Logistic regression was used to identify independent variables predicting primary enucleation. Cox's univariate proportional hazards model was used to identify associations between variables and time to secondary enucleation.Kaplan-Meier estimates were used to draw survival curves for time to secondary enucleation Results: 273 patients were included in the study. Primary enucleation was performed in 80 patients. Secondary enucleation in 12. Gender (p=0,032), basal tumour diameter >15mm (p<0,001), tumour weight >10mm (p<0,001), anterior tumour margin (p<0,001) and extraocular spread (p<0,001) were associated with primary enucleation. Predictive factors for primary enucleation were largest basal tumor diameter (odds ratio [OR], 3,8; 95% confidence interval [IC], 1,5-9,1) and tumour weight (OR, 2,7; IC, 1-7,5). Ocular conservation probability 5 years after conservative treatment was 88%. Largest basal tumor diameter, anterior tumour margin and extraocular spread had influence in ocular survival after conservative treatment. Only largest basal tumor diameter was a predictive factor of secondary enucleation Conclusions: In the present series 69,9% of patiens had a conservative treatment and 88% of them conserved treated eye 5 years [source]

What is the best approach to an apparently nonmetastatic adrenocortical carcinoma?

CLINICAL ENDOCRINOLOGY, Issue 5 2010
Martin Fassnacht
Summary In suspected nonmetastatic adrenocortical carcinoma (ACC) a careful preoperative diagnostic work up is needed including comprehensive endocrine analysis as recommended by the European Network for the Study of Adrenal Tumors (http://www.ENSAT.org/ACC.htm). Staging prior surgery, in particular chest CT, is indispensable to exclude distant metastases. Open surgery is still the recommended approach in ACC. However, in localized non-invasive ACC with a diameter <10 cm laparoscopic adrenalectomy by an expert surgeon is probably similarly effective and safe. As many patients will suffer from tumor recurrence after seemingly complete removal of ACC, adjuvant treatment based on the individual risk status is recommended. Key factors for risk assessment are tumor stage, resection status and the proliferation marker Ki67. All patients considered at high risk for recurrence should receive adjuvant mitotane for a minimum of 2 years aiming at a drug level of 14,20 mg/l. In selected patients (e.g. R1 resection) we recommend additional radiotherapy of the tumor bed. Patients with a low/intermediate risk for recurrence should be included in the Adiuvo trial comparing adjuvant mitotane with observation only (http://www.adiuvo-trial.org). In low/intermediate risk patients who cannot be included in this trial observation only can be justified in cases with a tumor diameter of <8 cm and no microscopic evidence for invasion of blood vessels or tumor capsule. In all patients a structured follow-up for 10 years is strongly recommended. [source]