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Margin Status (margin + status)
Kinds of Margin Status Selected AbstractsPrediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2006J Verguts Objectives, The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue. Design, Prospective follow-up study. Setting, Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven. Population, Seventy-two women treated with conisation for CIN2 or CIN3. Methods, Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene®) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePathÔ). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+. Main outcome measures, Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear. Results, In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 ± 9.6 versus 39.8 ± 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (,atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status. Conclusion, Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence. [source] Surgical Monotherapy Versus Surgery Plus Adjuvant Radiotherapy in High-Risk Cutaneous Squamous Cell Carcinoma: A Systematic Review of OutcomesDERMATOLOGIC SURGERY, Issue 4 2009ANOKHI Jambusaria-PAHLAJANI MD BACKGROUND Adjuvant radiotherapy (ART) has been recommended for squamous cell carcinoma (SCC) with a high risk of recurrence, particularly perineurally invasive disease. The utility of ART is unknown. This study compares reported outcomes of high-risk SCC treated with surgical monotherapy (SM) with those of surgery plus ART (S+ART). METHODS The Medline database was searched for reports of high-risk SCC treated with SM or S+ART that reported outcomes of interest: local recurrence, regional or distant metastasis, or disease-specific death. RESULTS There were no controlled trials. Of the 2,449 cases of high-risk SCC included, 91 were treated with S+ART. Tumor stage and surgical margin status before ART were generally unreported. In 74 cases of perineural invasion (PNI), outcomes were statistically similar between SM and S+ART. In 943 high-risk SCC cases in which clear surgical margins were explicitly documented, risks of local recurrence, regional metastasis, distant metastasis, and disease-specific death were 5%, 5%, 1%, and 1%, respectively. CONCLUSIONS High cure rates are achieved in high-risk cutaneous SCC when clear surgical margins are obtained. Current data are insufficient to identify high-risk features in which ART may be beneficial. In cases of PNI, the extent of nerve involvement appears to affect outcomes, with involvement of larger nerves imparting a worse prognosis. [source] Anterior skull base surgery for malignant tumors: A multivariate analysis of 27 years of experience,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2003Brandon G. Bentz MD Abstract Introduction. Few studies have examined prognostic factors that have an impact on outcomes in anterior skull base surgery by multivariate analysis. Methods. We retrospectively examined our institution's skull base experience from 1973,2000. Results. During this time, 166 patients underwent an anterior skull base resection for malignancy (median age, 53 years; range, 6,92 years). The 5-year relapse-free and disease-specific survival was 41% and 57% (median follow-up, 53 months). Multivariate analysis found that dural invasion, primary histologic diagnosis, and margin status had a significant impact on relapse-free and disease-specific survival. Conclusions. These data indicate that patients with anterior skull base malignancies are treated successfully with skull base surgery. Patients demonstrating adverse prognostic variables such as dural invasion, adverse histologic findings, and/or positive margins should be considered for the addition of adjuvant therapy or innovative therapies as they become available in the future. © 2003 Wiley Periodicals, Inc. Head Neck 25: 515,520, 2003 [source] Redefining 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] Adenoid cystic carcinoma: A retrospective clinical reviewINTERNATIONAL JOURNAL OF CANCER, Issue 3 2001Atif J. Khan M.D. Abstract Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion. Also of interest was the association of perineural invasion with margin status, with 15 of 20 patients with positive margins displaying perineural invasion, while only 5 of 17 with negative margins showed nerve invasion (P = 0.02). On immunohistochemistry, 2 cases of the 29 (7%) tumor specimens found displayed HER-2/neu positivity. No correlation between clinical behavior and positive staining could be demonstrated. Our data concur with previous reports on ACC in terms of survival and recurrence statistics. Stage and site of primary were important determinants of outcome. Grade may still serve a role in decision making. We could not demonstrate any differences attributable to primary modality of therapy, perhaps due to the nonrandomization of patients into the various treatment tracks and the inclusion of palliative cases. Similarly, perineural invasion, radiation dose and field size, and HER-2/neu positivity did not prove to be important factors in our experience. © 2001 Wiley-Liss, Inc. [source] Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapyJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2001Frank A. Vicini MD Abstract Background and Objectives We reviewed our institution's experience treating patients with ductal carcinoma-in-situ (DCIS) with breast-conserving therapy (BCT) to help define the interrelationship between excision volume, margin status, and tumor size with local recurrence. Methods From January 1980 to December 1993, 146 patients received BCT for DCIS. All patients underwent excisional biopsy and 95 cases (64%) underwent re-excision. Each patient received whole breast radiation to a median dose of 45 Gy. An additional 139 cases (94%) received a supplemental boost to the tumor bed (median total dose 60.4 Gy). The median follow-up is 7.2 years. Results Seventeen patients developed an ipsilateral breast failure for a 5- and 10-year actuarial rate of 10.2 and 12.4%, respectively. On multivariate analysis, patient age, margin status, the number of slides containing DCIS, the number of DCIS/cancerization of lobules (COL) foci near (< 5,mm) the margin, and a smaller volume of excision (< 60,cm3) were all independently associated with outcome. Although the local recurrence rate generally decreased as margin distance increased, these differences did not achieve statistical significance unless the volume of excision was taken into consideration. Conclusions These findings suggest that the success of BCT is directly related to the degree of surgical removal of DCIS and that margin status alone may be suboptimal in defining excision adequacy. J. Surg. Oncol. 2001;76:245,254. © 2001 Wiley-Liss, Inc. [source] Autofluorescence and diffuse reflectance spectroscopy and spectral imaging for breast surgical margin analysisLASERS IN SURGERY AND MEDICINE, Issue 1 2010Matthew D. Keller MS Abstract Background and Objective Most women with early stage breast cancer have the option of breast conserving therapy, which involves a partial mastectomy for removal of the primary tumor, usually followed by radiotherapy. The presence of tumor at or near the margin is strongly correlated with the risk of local tumor recurrence, so there is a need for a non-invasive, real-time tool to evaluate margin status. This study examined the use of autofluorescence and diffuse reflectance spectroscopy and spectral imaging to evaluate margin status intraoperatively. Materials and Methods Spectral measurements were taken from the surface of the tissue mass immediately following removal during partial mastectomies and/or from tissues immediately after sectioning by surgical pathology. A total of 145 normal spectra were obtained from 28 patients, and 34 tumor spectra were obtained from 12 patients. Results After correlation with histopathology, a multivariate statistical algorithm classified the spectra as normal (negative margins) or tumor (positive margins) with 85% sensitivity and 96% specificity. A separate algorithm achieved 100% classification between neo-adjuvant chemotherapy-treated tissues and non-treated tissues. Fluorescence and reflectance-based spectral images were able to demarcate a calcified lesion on the surface of a resected specimen as well. Conclusion Fluorescence and reflectance spectroscopy could be a valuable tool for examining the superficial margin status of excised breast tumor specimens, particularly in the form of spectral imaging to examine entire margins in a single acquisition. Lasers Surg. Med. 42:15,23, 2010. © 2010 Wiley-Liss, Inc. [source] Review of 125 SiteSelect Stereotactic Large-Core Breast Biopsy ProceduresTHE BREAST JOURNAL, Issue 3 2003Christa C. Corn MD Abstract: Advances in stereotactic breast biopsies have introduced a variety of devices that yield different sizes of tissue samples. The choice of biopsy device should be based on which technique is most likely to yield a definitive diagnosis at the time of the initial biopsy. This is a prospective study of 104 patients who underwent a total of 125 stereotactic breast biopsies using the SiteSelect large-core biopsy device. From May 1999 to June 2001, 104 patients underwent 125 stereotactic breast biopsies with the SiteSelect large-core biopsy device. One hundred four 15 mm SiteSelect biopsies, eighteen 10 mm SiteSelect biopsies, and three 22 mm SiteSelect biopsies were performed. Atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were found in 15% of the biopsies and infiltrating cancer was found in another 15% of the biopsies. Seventy-eight percent of the ADH and 90% of the DCIS lesions were associated with indeterminate calcifications noted on mammogram. Two of the 22 mm SiteSelect excisions yielded a specimen that contained the entire cancer with clear surgical margins. All of the patients with DCIS or invasive carcinoma underwent definitive surgical and adjuvant therapy. The sensitivity and specificity of SiteSelect in this series of patients was 100%. The SiteSelect biopsy procedure is safe, well tolerated by patients, and can be performed under local anesthesia. SiteSelect is comparable to an open excisional biopsy in its ability to obtain adequate tissue for accurate diagnosis, but excises significantly less normal surrounding breast tissue. Based on the data, indications for primary use of SiteSelect are indeterminate calcifications on mammogram, rebiopsy of a vacuum-assisted biopsy site that yielded atypia on pathologic examination, and complete excision of a lesion suspicious for invasive carcinoma in order to assess actual size and margin status. [source] Role for Postoperative Radiation Therapy in Adenoid Cystic Carcinoma of the Head and Neck,THE LARYNGOSCOPE, Issue 7 2004Damon A. Silverman MD Objective: Clarify the role for postoperative radiation for adenoid cystic carcinoma (ACC) of the head and neck as it relates to tumor site, T-stage, and surgical margin status. Study Design: Retrospective cohort study at an academic tertiary care hospital. Methods: A review of 129 patients with biopsy-proven ACC was performed. Previous treatment failures and nonoperative candidates were excluded, with 75 patients considered eligible for further study. Patients were grouped according to treatment modality and Kaplan-Meier estimates of overall survival, locoregional control, and distant control were compared using log-rank tests. Patients were also stratified according to tumor site, T-stage, and surgical margin status, and pair-wise comparisons of treatment outcome within each group were performed using Wald tests from Cox proportional hazards models. Results: Twenty-five patients were treated with surgery alone, and 50 were treated with surgery and postoperative radiation. There was no significant difference in outcome between treatment groups when correlated with tumor site (P = .89). However, postoperative radiation was associated with improved overall survival for advanced T-stage (T4) tumors (P = .019) and greater locoregional control for patients with microscopically positive margins (P = .018). There was no demonstrated benefit of postoperative radiation for patients with microscopically negative margins (P = .93). Conclusions: The findings of this study suggest that advanced T-stage and positive microscopic margins are important factors in determining the necessity for postoperative radiation therapy for ACC of the head and neck and that radiation therapy may not be necessary for patients with early T-stage tumors and negative surgical margins. [source] Characterization of ZAG protein expression in prostate cancer using a semi-automated microscope systemTHE PROSTATE, Issue 10 2006Aurelien Descazeaud Abstract OBJECTIVE Zinc-alpha-2-glycoprotein 1 (ZAG) is a 41-kD secreted protein that is known to stimulate lipid degradation in adipocytes. The aim of this study was to determine how ZAG protein expression is associated with prostate cancer (PCa). MATERIALS AND METHODS An immunohistochemistry analysis was performed on a 227 PCa tissue microarray cases. ZAG protein expression was assessed using a semi-automated cellular image analysis system. RESULTS ZAG expression was associated with tumor stage (pT2,>,pT3,>,metastasis cases, P,<,0.001), and was inversely associated with Gleason score on pathology (P,=,0.01). ZAG intensity was predictive of biochemical recurrence (P,=,0.002). On multivariate analysis including pT2 patients, the predictive factors of biochemical recurrence were ZAG expression (P,=,0.016), Gleason score (P,=,0.011), and surgical margin status (P,=,0.047). CONCLUSIONS This study characterized ZAG protein expression in PCa using a semi-automated system. ZAG expression level found to have an independent prognostic value for pT2 patients. Prostate 66: 1037,1043, 2006. © 2006 Wiley-Liss, Inc. [source] TREATMENT FOR DUCTAL CARCINOMA IN SITU IN AN ASIAN POPULATION: OUTCOME AND PROGNOSTIC FACTORSANZ JOURNAL OF SURGERY, Issue 1-2 2008Esther W. L. Chuwa Background: Breast cancer is the most common cancer among Singapore women and ductal carcinoma in situ (DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution's results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence. Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re-excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4,151 months). Results: Sixty-two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5,90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions , with a significantly higher incidence of smaller and non-palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12,120 months). The cumulative 5-year recurrence-free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (,1 mm) and lack of adjuvant radiotherapy. There were no cancer-specific deaths during the period of follow up. Conclusion: Our results indicate that rates of cancer-specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (,1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population. [source] Malignancies of the external auditory canal and temporal bone: A reviewANZ JOURNAL OF SURGERY, Issue 2 2002P. Yeung Background: Malignancies of the external auditory canal and temporal bone are uncommon. A retrospective review was conducted of a large series treated at the Prince of Wales hospital between 1974 and 1995. Methods: Retrospective review of 59 cases of ear canal and temporal bone malignancies. These were analysed according to histopathology, disease extent, surgery, margin status and survival. A TNM-type staging system was applied to 51 cases and Kaplan,Meier survival analysis applied to this group. Results: The 5-year cancer-specific survival (CSS) for the series was 54%. For stages 1, 2, 3 and 4 disease, the CSS were 90, 45, 40 and 19%, respectively. Survival was significantly higher where clear surgical margins were achieved (80 vs 35%). Conclusions: Carcinoma of the external ear canal is rare and, in Australia, is often related to recurrence of periauricular cutaneous malignancy. Surgical extirpation with clear margins provides the best survival. [source] Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2006J Verguts Objectives, The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue. Design, Prospective follow-up study. Setting, Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven. Population, Seventy-two women treated with conisation for CIN2 or CIN3. Methods, Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene®) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePathÔ). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+. Main outcome measures, Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear. Results, In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 ± 9.6 versus 39.8 ± 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (,atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status. Conclusion, Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence. [source] Long-term data on the survival of patients with prostate cancer treated with radical prostatectomy in the prostate-specific antigen eraBJU INTERNATIONAL, Issue 1 2010Hendrik Isbarn Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To examine the long-term rates of biochemical recurrence (BCR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) in patients with prostate cancer treated with open radical prostatectomy (RP) in the prostate-specific antigen (PSA) era. PATIENTS AND METHODS The study comprised 436 patients who were treated with RP between 1992 and 1997 at our institution. None received adjuvant/salvage therapy in the absence of BCR. The BCR-free, CSM-free and OS rates were defined using the Kaplan-Meier method. Multivariable Cox-regression models were used to test the effect of age, preoperative PSA level, neoadjuvant hormonal therapy, pT stage, lymph node status, RP Gleason sum and surgical margin status on BCR. RESULTS The median follow-up of censored patients was 122, 128, and 132 months for, respectively, BCR-free, CSM-free and OS estimates. The 10-year event-free survival rates for the same endpoints were 60%, 94% and 86%, respectively. Preoperative PSA level, RP Gleason sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (all adjusted P < 0.05). CONCLUSIONS This study is the first to evaluate the long-term cancer control outcomes after RP from a European country in the PSA era. Our data indicate that RP provides excellent long-term survival rates in patients with clinically localized prostate cancer. Although ,40% of patients have BCR after 10 years of follow-up, the CSM rate after 10 years is as low as 6%. [source] Characterization of the anatomical extension pattern of localized prostate cancer arising in the peripheral zoneBJU INTERNATIONAL, Issue 11 2010Mototsugu Muramaki Study Type , Diagnostic (non-consecutive series) Level of Evidence 3b OBJECTIVES To characterize the anatomical extension pattern of prostate cancer arising in the peripheral zone (PZ) in radical prostatectomy (RP) specimens and to evaluate its prognostic significance. PATIENTS AND METHODS Of 174 consecutive patients undergoing RP, 128 diagnosed as having PZ cancer (PZC) were enrolled. The maximum tumour area (MTA) and maximum tumour volume (MTV) in RP specimens were measured using digital planimetry. A circle with an area equal to the MTA, in which the central point was the intersection of the longest line of the MTA and the line perpendicularly bisecting the first line, was defined as a hypothetical extension area, regardless of anatomical structure. The area within this circle that did not overlap the MTA was defined as ,TA. RESULTS There was a significant correlation between the MTV and ,TA/MTA, introduced as a variable representing the degree of PZC extension along the anatomical shape of the PZ. The ,TA/MTA in patients with a MTV of >5 mL was significantly greater than that in those with a MTV of ,5 mL. Furthermore, ,TA/MTA was significantly associated with several prognostic indicators, including extracapsular extension, surgical margin status and perineural invasion. Multivariate analysis identified ,TA/MTA in addition to preoperative serum prostate-specific antigen level, extracapsular extension and surgical margin status as independent predictors of biochemical recurrence after RP. CONCLUSIONS PZC tends to extend along the anatomical shape of the PZ during progression, resulting in higher ,TA/MTA value in advanced PZC than that in early PZC. [source] The number of negative pelvic lymph nodes removed does not affect the risk of biochemical failure after radical prostatectomyBJU INTERNATIONAL, Issue 2 2010Alana M. Murphy Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVES To assess patients who had radical prostatectomy (RP) and pelvic lymph node dissection (PLND) for pT2,4 N0M0 prostate cancer, to determine if LN yield affects the risk of biochemical failure (BCF), as the extent of PLND at the time of RP has become increasingly uncertain with the decreasing trend in tumour stage. PATIENTS AND METHODS We reviewed the Columbia University Urologic Oncology Database for patients with pT2,4 N0M0 prostate cancer treated with RP from 1990 to 2005. Exclusion criteria included <12 months of follow-up, incomplete clinical and pathological data, and neoadjuvant androgen-deprivation therapy (ADT) or immediate adjuvant ADT or external beam radiotherapy. Unadjusted and adjusted models were used to determine the ability of clinical and pathological variables to predict BCF. RESULTS The final dataset included 964 patients, with a mean age of 60.5 years and median preoperative prostate-specific antigen (PSA) level of 6.2 ng/mL. The median (range) LN yield was 7 (1,42) and the median follow-up 59 (12,190) months. In the unadjusted and adjusted models, preoperative PSA, pathological Gleason score, pathological stage, surgical margin status and year of surgery were significant predictors of BCF. The LN group was not a significant predictor of BCF in both the unadjusted and adjusted model (P = 0.759 and 0.408, respectively). When patients were stratified into high- and low-risk groups, LN yield remained an insignificant predictor of BCF. CONCLUSION A higher LN yield at the time of RP does not increase the chance of cure for patients with pT2,4N0M0 prostate cancer. This lack of a survival advantage holds true for patients with high-risk disease. [source] Invasion of renal sinus fat is not an independent predictor of survival in pT3a renal cell carcinomaBJU INTERNATIONAL, Issue 12 2009Stephen A. Poon OBJECTIVE To clarify the significance of the location of extrarenal tumour extension of renal cell carcinoma (RCC) as in the 2002 Tumour-Nodes-Metastasis classification. Renal cortical tumours with perirenal fat invasion (PFI) or sinus fat invasion (SFI) are consolidated within the pT3a grouping; tumours with SFI are close to the renal veins, lymphatics and the collecting system. This might carry a worse prognosis for disease-specific survival (DSS), but reports are limited and contradictory. PATIENTS AND METHODS We retrospectively reviewed 1244 patients treated with nephrectomy from 1988 to 2007, to identify patients with pT3a renal tumours. They were classified as having PFI or SFI. Kaplan-Meier analysis and Cox proportional hazards regression models were used to assess predictors of survival. RESULTS The 230 patients who met the inclusion criteria had a median follow-up of 24 months. SFI was found in 63 (27.4%) patients and was associated with a worse 5-year DSS than the 167 (72.6%) with PFI (62.5% vs 75.0%; log rank P = 0.022). On univariate analysis, diameter (hazard ratio, HR 1.1), nuclear grade (HR 4.5), margin status (HR 5.8), lymph node metastases (HR 6.4), and systemic metastases (HR 15.4) were significant for DSS. In a multivariate model, only nuclear grade (HR 3.1), margin status (HR 8.9) and systemic metastases (HR 9.8) were independent predictors. CONCLUSION Patients with renal tumours with SFI are more likely to die from RCC than those with PFI. However, in the present patients the presence of SFI was not an independent predictor of DSS. [source] Oncological control after radical prostatectomy in men with clinical T3 prostate cancer: a single-centre experienceBJU INTERNATIONAL, Issue 9 2009Evanguelos Xylinas OBJECTIVE To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer. PATIENTS AND METHODS We retrospectively reviewed data for patients treated by RP for clinical stage T3 prostate cancer between 1995 and 2005. The following case characteristics were analysed: patient age, clinical presentation, preoperative prostate-specific antigen (PSA) level, Gleason score, tumour stage (2002 Tumour-Node-Metastasis), surgical procedure, pathological data, margin and lymph node status, and recurrence. Biochemical recurrence was defined as an increase in PSA level of >0.2 ng/mL after surgery. Kaplan-Meier survival curves were generated, and prognostic factors were evaluated. RESULTS Overall, 100 patients were included; only 79% of them had pT3 disease based on the pathological specimen. The median follow-up after RP was 69 months. The RP was open in 77 and laparoscopic in 23, with no significant difference between these approaches (P = 0.38). The 5-year PSA-free survival after surgery was 45%, and 5-year cancer-specific survival was 90%. On univariable analysis, Gleason score >7 (P = 0.01), pathological stage (pT2-T3a vs T3b) (P < 0.001), positive lymph node (P < 0.001), and positive margin (P < 0.001) were associated with recurrence. On multivariable analysis, lymph node, margin status and Gleason score were also significant (P < 0.05). CONCLUSIONS RP can be recommended as an alternative primary treatment that results in acceptable cancer control for clinical stage T3 prostate cancer in selected cases. However, the patient should be warned that surgery alone might not be sufficient to control the cancer, and that adjuvant therapy might be needed during the course of the disease. [source] After radical retropubic prostatectomy ,insignificant' prostate cancer has a risk of progression similar to low-risk ,significant' cancerBJU INTERNATIONAL, Issue 2 2008Shomik Sengupta OBJECTIVE To assess progression and survival among patients with small-volume, well-differentiated, organ-confined prostate cancer found at radical retropubic prostatectomy (RRP), often defined as being ,insignificant', thus testing whether they are indeed ,insignificant'. PATIENTS AND METHODS We identified 6496 men treated for prostate cancer by RRP between 1990 and 1999, and defined ,insignificant' tumours as those in men having a prostate-specific antigen (PSA) level of <10 ng/mL before RRP, a cancer volume of ,0.5 mL, a specimen Gleason of score ,6 and stage ,pT2. Survival was assessed using the Kaplan-Meier method and compared using the two-sided log-rank test. RESULTS ,Insignificant' tumours were found in 354 (5.5%) men, of whom only one had metastatic progression and none died from prostate cancer, with a median (range) follow-up of 9.2 (0.8,15.6) years. Biochemical progression-free survival (87% vs 85%, respectively, at 10 years, P = 0.5), systemic progression-free survival (100% vs 99%, P = 0.3), overall survival (91% vs 88%, P = 0.16) and cancer-specific survival (100% in each group, P = 0.32) were each similar among men with ,insignificant' prostate cancer and men with low-risk (defined by Gleason score, preoperative PSA level, seminal vesicle and surgical margin status) ,significant' cancer. Clinical stage, biopsy Gleason score and preoperative PSA doubling time were multivariably predictive of ,insignificant' tumours at RRP. CONCLUSIONS ,Insignificant' prostate cancer at RRP is associated with a comparable risk of biochemical progression as low-risk ,significant' cancer. Although clinical predictors for ,insignificant' pathology can be identified, it remains to be established whether such patients can be safely managed conservatively. [source] Significance of micrometastases in pelvic lymph nodes detected by real-time reverse transcriptase polymerase chain reaction in patients with clinically localized prostate cancer undergoing radical prostatectomy after neoadjuvant hormonal therapyBJU INTERNATIONAL, Issue 2 2007Hideaki Miyake OBJECTIVE To clarify the significance of micrometastases in pelvic lymph nodes in patients treated by radical prostatectomy (RP) for prostate cancer after neoadjuvant hormonal therapy (NHT). PATIENTS AND METHODS The study included 52 patients with clinically localized prostate cancer who received NHT followed by RP. The expression of prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) in 989 lymph nodes isolated from the 52 patients were assessed by a fully quantitative real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We regarded specimens in which either PSA or PSMA mRNA were positive as showing the ,presence of micrometastasis'. Lymph node specimens were also stained immunohistochemically with an antibody against PSA. RESULTS Pathological examinations detected tumour cells in 11 lymph nodes from four patients, and real-time RT-PCR further identified micrometastasis in 40 lymph nodes from 19 patients with no pathological evidence of nodal involvement. The presence of micrometastatic cancer cells was confirmed by immunohistochemical staining in 19 lymph nodes from 11 patients with pathologically negative nodes. The presence of micrometastases was significantly associated with other conventional prognostic variables, including the pretreatment serum PSA level, biopsy Gleason score and surgical margin status. The biochemical recurrence-free survival rate in patients with no micrometastasis was significantly higher than that in those with micrometastasis. Furthermore, multivariate analysis identified the presence of micrometastasis as an independent factor predicting biochemical recurrence. CONCLUSIONS Although residual foci of atrophic prostate cancer cells in resected lymph nodes after NHT can be difficult to diagnose by routine pathological examination, the present results show the usefulness of quantitative real-time RT-PCR targeting PSA and PSMA genes for detecting micrometastatic tumour foci in pelvic lymph nodes from patients with localized prostate cancer treated by NHT followed by RP. Furthermore, the present findings suggest that micrometastases in pelvic lymph nodes might be, at least partly, important in the development of biochemical recurrence in some patients undergoing RP after NHT. [source] Telomerase activity in disseminated prostate cancer cellsBJU INTERNATIONAL, Issue 6 2006JESCO PFITZENMAIER OBJECTIVE To analyse telomerase activity in disseminated prostate cancer cells isolated from bone marrow aspirates taken from men with localized prostate cancer before radical prostatectomy (RP). PATIENTS AND METHODS Disseminated epithelial prostate cancer cells were isolated from bone marrow aspirates from 69 men with localized prostate cancer before RP, by magnetic column-chromatography enrichment, followed by isolation of fluorescently labelled epithelial cells by micropipetting. We used pools of 10 non-epithelial bone marrow cells after tumour cell enrichment as control samples. These pure cell pools were tested for the presence of telomerase activity. RESULTS In all, 49 of the patient samples contained disseminated prostate cancer cells. Homogeneous pools of 10 cells were obtained from 35 of these; 49% of the 35 specimens showed telomerase activity, whereas all five control samples did not. Telomerase activity in the 35 samples was not significantly associated with Gleason score, preoperative prostate-specific antigen level, tumour stage, or surgical margin status. Follow-up is continuing to assess an association with disease recurrence. CONCLUSION This work shows the feasibility of isolating disseminated cancer cells for analysing individual or pooled cells. Compared to tissue staining, where telomerase is detected in 80,90% of samples, we found lower rates of telomerase activity in the disseminated tumour cells (49%). Telomerase-negative cells might provide information about cell dormancy, as telomerase is a marker of cell proliferation in immortal and cancer cells. Telomerase-positive cells might predict early disease recurrence, but a longer follow-up is needed to test this possibility. [source] 7 Positive margin rates in patients with a single positive core on extended TRUS biopsyBJU INTERNATIONAL, Issue 2006D. DANGERFIELD Introduction:, Extended TRUS biopsy (12 biopsies or more) is now a standard technique performed in many centres. The management of small volume prostate cancer (<0.05cc) found in a single TRUS biopsy is controversial and may have implications in nerve-sparing versus non-nerve sparing radical prostatectomy. The aims of this study are: , To assess the incidence of prostate cancer in the unaffected contralateral prostate lobe on final histopathology , To assess the incidence of extracapsular extension and margin status in the ipsilateral and contralateral lobes Patients and methods:, Of 897 radical prostatectomy specimens examined through Sullivan Nicolaides Pathology between 2002 and 2005, 78 had a single positive core in preoperative TRUS biopsy. Histopathalogy, PSA and Gleason sum were reviewed. Results:, For patients with a Gleason sum of 6 on TRUS biopsy the mean PSA was 7.00 mcgm/dl. A majority (85%) of the positive cores had low volume disease with tumour occupying less than 30% of the core. Of those with Gleason 3 + 3 = 6 on TRUS biopsy, 34% had their Gleason sum upgraded on final histopathology. Ipsilateral positive margin was seen in 14% of cases. Contralateral positive margin was present in only 2.8% of cases despite tumour being found in 61% of cases in the contralateral lobe on final histopathology. Conclusion:, This study shows that in patients with a single positive core of low volume disease, the incidence of contralateral margin involvement on final histopathology is very low. This data is useful in counselling patients who intend to undergo nerve sparing radical prostatectomy. [source] Proliferating-cell nuclear antigen (PCNA) as an independent prognostic marker in patients after prostatectomy: a comparison of PCNA and Ki-67BJU INTERNATIONAL, Issue 4 2005Reza Taftachi OBJECTIVE To investigate the prognostic value of prostatic tumour cell proliferation, as measured by Ki-67 and proliferating cell nuclear antigen (PCNA), and to compare these measures in men at low and high risk for progression of tumour. PATIENTS AND METHODS Two groups of patients with prostate cancer, i.e. ,metastatic' (M, 22) who had pT3b-4aN0M0 and pTanyN1M0, and ,nonmetastatic' (NM, 18), who had ,pT3aN0M0 disease, were selected from a well-examined and mapped group of 114 treated by radical prostatectomy. Patients in the NM group were selected by the criteria of having a Gleason score of ,,7. To assess proliferation, 1000 cells were counted at ×,400 magnification by two observers and the percentage of tumour cells positively stained with Ki-67 and PCNA defined as the Ki-67 and PCNA labelling index (LI), respectively. The two LI were compared in the NM and M groups, and the correlation of the LIs with pathological stage, progression and prostate-specific antigen (PSA)-free survival evaluated. Prognostic values of the LI were analysed using multivariate analysis. RESULTS The mean (range) follow-up was 33 (4,78) months. The mean LIs were higher in the M than the NM group for both PCNA and Ki-67 (P = 0.02 and 0.019, respectively). Both LIs were markedly different between the groups when stratified by progression, with both significantly higher in men with progression in the NM group. Both LIs had a significant association with Gleason score, pathological stage, progression and PSA-free survival. In multivariate analysis the PCNA LI, surgical margin status and pathological stage were independent factors for progression. CONCLUSION Tumour cell proliferation as assessed by Ki-67 or PCNA correlate significantly with progression. The PCNA LI was an independent predictor of progression, especially in patients with a low risk of progression according to predefined criteria. [source] Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ,8BJU INTERNATIONAL, Issue 6 2003M. Manoharan The use of radical prostatectomy to treat patients with high-grade prostate cancer is the subject of much discussion, and the authors from Miami present their considerable experience in this field. They show that patients with a pre-treatment biopsy of Gleason score of ,8 may benefit from radical prostatectomy, assuming a clinical stage of T1,T2, and particularly if their PSA level is <20 ng/mL. Authors from Palermo present data on the long-term outcome of antiandrogen monotherapy in advanced prostate cancer, with the 12-year results of a phase II study. This is a very interesting evaluation, showing that patients with an early objective response have a prolonged progression-free and overall survival. In a large series of superficial bladder tumours, urologists from Tokyo identify a group of patients with tumours of low malignant potential with a high recurrence rate, but a very low invasive property. They suggest that those tumours should be referred to as having a low malignant potential, rather than being called superficial bladder carcinoma. OBJECTIVE To determine the outcome and predictors of recurrence in patients with a pretreatment prostate biopsy Gleason score (GS) of ,,8 and treated with radical prostatectomy (RP). PATIENTS AND METHODS We retrospectively reviewed 1048 consecutive patients who underwent RP by one surgeon (M.S.S.); patients who had a pretreatment biopsy GS of ,,8 were identified. Information was recorded on patient age, initial prostate specific antigen (PSA) level, clinical stage, biopsy GS, pathology GS, extraprostatic extension (EPE), tumour volume, surgical margin status, seminal vesicle invasion (SVI), and lymph node involvement. The results were assessed statistically using the Kaplan-Meier method, univariate log-rank tests and multivariate analysis using Cox's proportional hazards regression. RESULTS In all, 123 patients met the initial selection criteria; 44 were excluded from further analyses (five salvage RP, 23 <,1 year follow-up and 16 adjuvant treatment). Thus 79 patients were included in the uni- and multivariate analyses; 25 (31%) patients had a GS of ,,7 in the RP specimen and 54 (69%) remained at GS ,,8. The mean follow-up was 55 months, the age of the patients 63 years and the mean (sd) initial PSA level 13 (12) ng/mL. The overall biochemical failure rate was 38% (41% if the final GS was , 8 and 32% if it was ,,7). For those with a GS of ,,8 in the RP specimen, 20% (11/54) were organ-confined; two patients (2.5%) in this group developed local recurrence. If the final GS was ,,7, 52% (13/25) were organ-confined. In the univariate analysis, significant risk factors for recurrence were PSA ,,20 ng/mL, EPE, SVI, a positive surgical margin and tumour volume. Cox's proportional regression indicated that a PSA of ,,20 ng/mL (hazard ratio 7.9, 95% confidence interval 2.6,24.2, P < 0.001), the presence of EPE (4.2, 1.6,10.9, P = 0.004) and a positive surgical margin (3.8, 1.5,9.7, P = 0.005) were significant independent predictors in a multivariate analysis. CONCLUSION RP is a reasonable treatment option for patients with a prostate biopsy GS of ,8 and clinical stage T1,2. These patients have a high chance of remaining disease-free if their PSA level is ,,20 ng/mL. Patients with a pretreatment biopsy GS of ,,8 should be counselled about the potential differences between the biopsy and the RP specimen GS. [source] The prognostic value of inducible nitric oxide synthase in local prostate cancerBJU INTERNATIONAL, Issue 3 2000S.H. Aaltomaa Objective To compare the clinical and histological data from patients with prostate cancer with the results of the immunohistochemical analysis of inducible nitric oxide synthase (iNOS), and thus determine the prognostic value of iNOS. Patients and methods The study included 82 patients (mean age 64.6 years, sd 6.1) with local prostate cancer treated by radical prostatectomy in two Finnish hospitals. Their mean ( sd) follow-up was 3.3 (2.2) years. An immunohistochemical method was used to detect the expression of iNOS in these specimens, and the expression graded according to staining intensity as none, weak or strong. Results There was weak or strong expression of iNOS in 25 (31%) and 56 (68%) of the patients, respectively, and one specimen was negative for iNOS. Strong expression of iNOS was related to high a preoperative prostate specific antigen (PSA) level (P = 0.006) and high pT classification (P < 0.001), but not to nodal status, grade, seminal vesicle or capsular invasion, surgical margin status, perineural infiltration, tumour infiltrating lymphocytes or proliferation rate of cancer cells. A PSA failure was detected in 29 patients but was not predicted by iNOS expression. A Cox multivariate analysis showed that surgical margin positivity, seminal vesicle involvement and number of tumour infiltrating lymphocytes predicted the PSA failure. Conclusion A high expression of iNOS was related to a high pT classification and the preoperative PSA level but not to other established prognostic factors; iNOS expression was not a predictor of PSA failure in patients with local prostate cancer. [source] Clinical impact of intraoperative histological examination of the ductal resection margin in extrahepatic cholangiocarcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2010M. Konishi Background: Although ductal resection margin status in extrahepatic cholangiocarcinoma is evaluated by intraoperative histological examination of frozen sections, its clinical relevance remains controversial. Methods: Material taken from patients who underwent R0 or R1 resection for extrahepatic cholangiocarcinoma with intraoperative histological examination of the final ductal resection margins between 1994 and 2003 were reviewed. The following histological classification was used: insufficient, negative for malignancy (NM), undetermined lesion (UDL) or positive for malignancy (PM). Multivariable analyses of overall survival and anastomotic recurrence in relation to ductal margin status were performed. Results: Resection material from 363 patients was identified. For the proximal ductal margin, only PM in intramural lesions was significantly associated with poor survival (hazard ratio (HR) 1·72, 95 per cent confidence interval (c.i.) 1·06 to 2·74) and anastomotic recurrence (HR 6·39, 95 per cent c.i. 1·89 to 21·62) compared with NM. In analysis of overall survival according to distal ductal margin status, the HRs for UDL and PM lesions in comparison with NM were not significant. Conclusion: PM in intramural lesions found during intraoperative histological examination of the proximal ductal resection margin was related to clinical outcome. This finding favours additional resection of the bile duct. A similar association was not found for histology results of the distal resection margin. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Compliance with quality assurance measures in patients treated for early oral tongue cancerCANCER, Issue 14 2010Amy C. Hessel MD Abstract BACKGROUND: The objective of this study was to identify measurable parameters that provide quality data for assessing how well cancer care adheres to accepted treatment guidelines and is delivered to any given patient with oral tongue cancer. METHODS: A retrospective chart review included 116 patients treated for T1-T2/N0-N1 squamous cell carcinoma (SCC) of the oral tongue between 1998 and 2003. A set of quality measures considered critical for outcome included: 1) accurate TNM staging at presentation, 2) documentation of margin status, 3) appropriate referral for adjuvant radiation therapy, and 4) neck dissection for depth of invasion >4 mm. In addition, 26 clinical endpoints involving pretreatment assessment, staging, treatment, surveillance, and symptom control were analyzed. RESULTS: Patients comprised 73 men and 43 women (median age, 57 years). Forty-one (35.3%) patients presented with stage I disease, 61 (52.6%) with stage II, and 14 (12.1%) with stage III. The overall 5-year survival rate for all patients was 68.6%. There was a 90.5% compliance with TNM staging at presentation, 99.1% for documentation of margin status, 98.2% for adequate referral to radiation therapy, and 88.7% for appropriate neck dissection based on depth of invasion. Compliance with clinical endpoints was variable and ranged from 100% for endpoints related to radiation therapy to <40% for endpoints related to speech pathology and rehabilitation. CONCLUSIONS: Overall compliance with documenting the 4 parameters designated as quality measures for treatment of oral tongue SCC was acceptable, thus demonstrating that it is possible to use these data for measuring effective cancer care. Cancer 2010. © 2010 American Cancer Society. [source] Osteosarcoma of the jaw/craniofacial regionCANCER, Issue 14 2009Outcomes after multimodality treatment Abstract BACKGROUND: The current study was performed to evaluate outcomes in patients with osteosarcoma of the head and neck (OHN) who were treated with surgery with or without radiotherapy (RT). METHODS: Between 1960 and 2007, 119 patients with OHN underwent macroscopic total resection with or without RT. The median age of the patients was 33 years (range, 7-77 years). Of these 119 patients 92 (77%) underwent surgery alone whereas 27 (23%) patients were treated with combined modality treatment (CMT) comprised of surgery and RT (median dose, 60 Gray [Gy]; range, 50-66 Gy). RESULTS: The median follow-up was 5.8 years. Overall survival (OS) rates at 5 years and 10 years were 63% and 55%, respectively. Corresponding disease,specific survival (DSS) rates were 67% and 61%, respectively. Stratified analysis by resection margin status demonstrated that CMT compared with surgery alone improved OS (80% vs 31%; P = .02) and DSS (80% vs 35%; P = .02) for patients with positive/uncertain resection margins. Multivariate analysis indicated that CMT for patients with positive/uncertain resection margins improved OS (P < .0001). A total of 44 (37%) patients experienced local disease recurrence (LR) and 25 (21%) developed distant metastases (DM). There was no difference noted with regard to DSS if disease recurrence was isolated (LR vs DM: 26% vs 29%, respectively, at 5 years; P = .48) The use of CMT versus surgery alone improved local control (LC) (75% vs 24%; P = .006) for patients with positive/uncertain resection margins. The rate of surgical complications was 28% at 5 years. The rates of RT-associated complications were 40% and 47% at 5 years and 10 years, respectively. CONCLUSIONS: The results of the current study indicated that RT in addition to surgery improves OS, DSS, and LC for patients with OHN who have positive/uncertain resection margins. Cancer 2009. © 2009 American Cancer Society. [source] Influence of compartmental involvement on the patterns of morbidity in soft tissue sarcoma of the thighCANCER, Issue 1 2009Andreas Rimner MD Abstract BACKGROUD: The authors sought to determine whether differences existed in patterns of outcome and morbidity between the 3 thigh compartments after limb-sparing surgery and postoperative radiation therapy (RT). METHODS: A total of 255 patients with primary soft tissue sarcoma (STS) of the thigh were identified in our sarcoma database (1982,2002). More than 80% of tumors were >5 cm, high grade, and deep; 33% had close or positive microscopic resection margins. Adjuvant RT consisted of brachytherapy alone (BRT; 63%), external beam RT alone (EBRT; 31%), or a combination of brachytherapy and EBRT (6%). There were 125 anterior, 58 medial, and 72 posterior lesions. The 3 compartments were balanced as to tumor grade, size, depth, margin status, and RT type. RESULTS: Overall local control (LC) was 89%, distant metastases-free survival (DMFS) was 61%, and overall survival (OS) was 66% at 5 years (median follow-up, 71 months). Overall rates for complications at 5 years were wound reoperation (10%), edema (13%), joint stiffness (12%), nerve damage (8%), and bone fractures (7%). Wound reoperation and edema were significantly higher for medial-compartment tumors (P = .01 and .005, respectively), whereas nerve damage occurred more frequently in posterior-compartment tumors (P < .001). There were no differences among bone fracture, joint stiffness, DMFS, or OS rates between compartments. CONCLUSIONS: Although tumor control was similar for all 3 compartments, more wound reoperation and edema were observed in the medial compartment, and more nerve damage was noted in the posterior compartment. These results may help guide decisions concerning current patients and improve the design of future treatments tailored to compartments. Cancer 2009. © 2008 American Cancer Society. [source] Treatment and survival outcomes based on histologic grading in patients with head and neck mucoepidermoid carcinomaCANCER, Issue 8 2008Melonie A. Nance MD Abstract BACKGROUND. Histopathologic grade of mucoepidermoid carcinoma (MEC) is an established predictor of prognosis and affects treatment protocol. Tumor behavior is more aggressive in high-grade than in low-grade MEC, leading to a more intensive treatment protocol. Outcomes for patients with intermediate-grade MEC are less clear; therefore, the optimal treatment protocol for this group is not well defined. The treatment protocol and survival outcomes of patients treated for MEC of the head and neck was investigated. METHODS. A retrospective clinical review and prospective review of histopathologic grading were undertaken using the most recently established grading system of 50 patients with MEC of the head and neck from 1983 through 2004. RESULTS. As histologic grade increased from low to intermediate to high, overall survival (P < .0001) and disease-free survival (P < .001) were significantly decreased. Overall and disease-free survival were significantly better for patients with intermediate-grade MEC than those with high-grade disease. Overall and disease-free survival were similar for patients with low-grade and intermediate-grade MEC. There was a low rate of disease recurrence in patients with intermediate-grade MEC, but this did not lead to death from disease. Although no patients with low-grade or intermediate-grade MEC died of disease, 52% of patients with high-grade MEC died of disease. Multivariate analysis revealed that histologic grade, age, and surgical margin status significantly predicted prognosis. CONCLUSIONS. These findings suggest that, under the current histopathologic classification system, the behavior of intermediate-grade MEC is comparable to that of low-grade MEC and different from high-grade MEC, allowing for the establishment of an evidence-based treatment protocol. Cancer 2008. © 2008 American Cancer Society. [source] | ||||||||||||||||||||||||||||