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Local Tumour Recurrence (local + tumour_recurrence)
Selected AbstractsRedefining resection margin status in pancreatic cancerHPB, Issue 4 2009Caroline S. Verbeke Abstract Curative resection is crucial to survival in pancreatic cancer; however, despite optimization and standardization of surgical procedures, this is not always achieved. This review highlights that the rates of microscopic margin involvement (R1) vary markedly between studies and, although resection margin status is believed to be a key prognostic factor, the rates of margin involvement and local tumour recurrence or overall survival of pancreatic cancer patients are often incongruent. Recent studies indicate that the discrepancy between margin status and clinical outcome is caused by frequent underreporting of microscopic margin involvement. Lack of standardization of pathological examination, confusing nomenclature and controversy regarding the definition of microscopic margin involvement have resulted in the wide variation of reported R1 rates that precludes meaningful comparison of data and clinicopathological correlation. [source] Intermandibular malignant mesenchymoma in a crossbreed dogJOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2006S. Murphy A 12-year-old German shepherd crossbreed dog was presented with a submandibular mass that was initially diagnosed as myxosarcoma on incisional biopsy. Chest radiographs were taken for staging, and magnetic resonance imaging was performed to assess the feasibility of cytoreductive surgery before adjuvant radiotherapy. The dog underwent debulking surgery, and histology permitted reclassification of the tumour as a malignant mesenchymoma (with myxosarcomatous and osteosarcomatous differentiation). The dog was subsequently treated with four fractions of radiotherapy given at seven-day intervals and three doses of carboplatin. The dog remained stable following therapy until its condition acutely deteriorated, and it was euthanased 153 days after surgery. On postmortem examination, there were no signs of local tumour recurrence, but metastases were observed both in the thorax and in the abdomen. [source] The histological extent of the local spread of carcinoma of the penis and its therapeutic implicationsBJU INTERNATIONAL, Issue 3 2000A. Agrawal Objective,To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. Patients and methods,Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test. Results,Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. Conclusions,Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable. [source] An audit of eccentrically-positioned ruthenium plaque radiotherapy of choroidal melanoma in LiverpoolACTA OPHTHALMOLOGICA, Issue 2009A RUSSO Purpose Brachytherapy is usually administered with the plaque overlapping the entire tumour margin by at least 1-2mm. With posterior tumours, our practice is to position the plaque with its posterior edge aligned with the posterior tumour margin. We audited ocular outcomes after eccentrically-placed ruthenium plaque radiotherapy of choroidal melanoma. Methods Patients were included if receiving primary ruthenium brachytherapy for choroidal melanoma during the three years up to the 31st July 2007. A perforated template was used to facilitate plaque positioning. For posterior tumors, the template was positioned so that trans-illumination produced a glow at the posterior tumour margin (,sunset sign'). Minimum doses of 300-350 Gy and 80-90 Gy were prescribed to the sclera and apex, respectively. Results The cohort comprised 162 patients (93 female and 69 male). The time to the last known visual acuity had a median of 23 months. The initial visual acuity was 20/40 or better in 94.6%, 20/60 to 20/200 in 13.0% and worse than 20/200 in 1.9% of patients. The tumours had a mean basal diameter of 11.7mm. Ten tumours exceeded 5.4 mm in height. Tumour extension to within 5mm of optic disc, fovea or both occurred in 18 (11.1%), 28 (17.3%) and 27 (16.7%) cases respectively. Risk factors for visual loss were proximity to optic disc or fovea, initial visual acuity worse than 20/40 and tumour height exceeding 5.4 mm. In 66 patients with none of these risk factors, 92% retained 20/40 or better and 5 had vision of 20/60 , 20/200. In 72 with one risk factor, 74.3% retained 20/16 , 20/40 and 95.7% had vision of 20/200 or better. In 12 patients with 2 risk factors, these percentages were 25.0% and 91.7%. Only 3 patients had 3 risk factors and one retained vision of 20/200 or better. Tumours distanced < 5 mm to fovea were divided in 3 groups, and visual acuity analysed. Three patients had local tumour recurrence and were treated respectively by proton beam radiotherapy, plaque radiotherapy and enucleation (the only eye lost in this series). Conclusion Eccentric plaque radiotherapy of choroidal melanoma achieves good rates of local tumour control, ocular retention and preservation of vision. [source] Long-term prognosis of medullary thyroid carcinomaCLINICAL ENDOCRINOLOGY, Issue 3 2008G. Rendl Summary Objective, The clinical course of patients with medullary thyroid carcinoma (MTC) is variable, even in the subgroup of patients after surgery with curative intent and postoperatively persistent elevated calcitonin levels. This study aimed to evaluate the long-term prognosis of survival in patients with MTC. Patients, Long-term survival was analysed in 32 patients with MTC being treated in an endocrine centre over a 40-year period. Patients were classified as having sporadic MTC, familial MTC (FMTC), multiple endocrine neoplasia (MEN) IIA or MEN IIB. Results, Seventeen patients had sporadic MTC (53·1%), eight had MEN IIA (25%) and three had MEN IIB (9·4%); the remaining four patients (12·5%) had not undergone genetic analysis until now. The overall average age at diagnosis was 42·0 years, and the median follow-up time was 9·5 years (range 0·5,39 years). Mortality due to progressive MTC was 15·6%. The 5-year survival rate was 96% (95% CI 89,100), the 10-year survival rate 91% (95% CI 79,100), and the 15-year survival rate 85% (95% CI 78,100). The estimated mean survival time after initial diagnosis was 31 years (95% CI 26·7,37·0). There is a significant difference in survival time between patients achieving complete remission compared with patients with biochemical persistent disease (P = 0·038) or metastasis (P = 0·0003). In five patients, advanced imaging with positron emission tomography/computed tomography (PET/CT) identified additional sites of tumour load. Eight more lymph node metastases were found in four patients and one local tumour recurrence in one patient by PET/CT. Conclusion, The overall prognosis of MTC is favourable, even if the rate of biochemical cure is lower in MTC than in differentiated types of thyroid cancer. This is also true for patients with biochemically persistent disease. Whether the identification of further tumour sites by advanced imaging procedures such as PET/CT translates into a better prognosis in patients with persistently elevated calcitonin levels remains to be investigated. [source] | ||||||||||