Candidates For Surgical Treatment Research Articles

Case Report of Lipomyoma

Report: Uterine lipoleiomyoma are rare forms of leiomyomas that are often only described in literature as case reports. Lipoleiomyomas could increase in size despite menopause and most commonly occur in postmenopausal women with an incidence rate of 0.03% to 0.2% Clinical symptoms of lipoleiomyoma are very similar to leiomyoma. Radiologic imaging can aid in the diagnosis of lipoleiomyoma with smooth muscle confined to the tumor periphery. In our case, we describe a 53y/o G0P0 perimenopausal patient who complained of abnormal uterine bleeding with irregular menses, urinary retention and difficulty completely emptying her bladder due to the large mass compressing her bladder. She was diagnosed with a large 8.8 cm hyperechoic lesion with internal vascularity arising from the central uterus/ endometrium. Radiology recommended a pelvic MRI for further differentiation of mass. Office hysteroscopy with endometrial biopsy was performed. Pathology confirmed limited inactive endometrium, benign endometrial surface epithelium. The patient requested a hysterectomy through a minimally invasive gynecologic surgery approach. A pelvic MRI was performed that revealed a large, round, circumscribed mass measuring 7.3 X 7.2 X 7.5 cm favoring to represent an intramural lipoleiomyoma. The patient had a robotic assisted laparoscopic hysterectomy which was uncomplicated. Final histopathologic diagnosis was uterine lipomyoma. As benign masses, management for lipoleiomyoma are guided by symptoms, fertility preservation desires, and whether or not a patient is a candidate for surgical intervention. Given the rarity of these cases, the histogenesis is still relatively unknown although various theories exist such as differentiation of embryonic fat cells, metaplastic changes of existing cells into fat cells, and pluripotent cell migration. Although there was not evidence of malignancy in our case report, certain literature has suggested the presence of coexisting malignancies and in an even rarer occasion the presence of liposarcoma from a lipoleiomyoma. More information is needed on these rare cases in order to further lead management and any recommendations regarding cancer screening on top of age related recommendations already in place.

Abstract PO4-20-09: Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up

Abstract Background Solid organs recipients with subsequent cancer comprise a group of patients with unmet medical needs: they lack any clinical trials or guidelines for treatment. There are only individual case reports in literature. Meanwhile their number is growing due to achievements in transplantology and improved cancer diagnosis. Case presentation А young 34-year-old female attended our center in September 2019 with a palpable mass and peau d'orange of the left breast. A core-needle biopsy of the left breast mass revealed invasive ductal carcinoma G3, estrogen receptor 7 (Allred), progesterone receptor 6 (Allred), HER-2 (3+), Ki-67 49%. Left axillary lymph node biopsy revealed metastatic breast cancer. After a complete examination the clinical stage was cT4bN1fM0, IIIB stage. The patient had a history of Type 1 diabetes mellitus since 2003 leading to multiple complications including terminal diabetic nephropathy, which required renal replacement therapy with the use of long-term hemodialysis since July 2014. The other complications consisted of severe retinopathy with corneal transplantation on the left eye in April 2013, an episode of right eye hemophthalmia in March 2016 with consequent loss of vision in the right eye, polyneuropathy, gastropathy and enteropathy. The patient underwent a simultaneous pancreas-kidney transplantation in April, 2016 and was on permanent immunosuppressive therapy with tacrolimus 8 mg daily and methylprednisolone 8 mg daily. The function of both transplants was satisfactory. This unique case was published by Pinchuk A. et al. in Transplant Proceedings, 2017 [doi: 10.1016/j.transproceed.2017.10.005]. A multidisciplinary approach was applied to tailoring treatment plan for this patient. Initially immunosuppressive therapy was modified: the patient discontinued methylprednisolone and started everolimus with simultaneous tacrolimus dose reduction (their doses adjusted according to blood concentrations). The tumor board decision was to start neoadjuvant therapy with regimen with the mildest and the most manageable toxicity profile and to avoid anthracyclines. From October to December 2019 the patient received 12 cycles of paclitaxel 80 mg/m2 day 1 weekly and 4 cycles of anti-HER2 dual blockade: trastuzumab 8 mg/kg day 1 followed by 6 mg/kg day 1 every 21 days + pertuzumab 840 mg day 1 followed by 420 mg day 1 every 21 days. Adverse events were: stomatitis grade 1, palmar-plantar erythrodysesthesia grade 1, diarrhea grade 2. Partial response was evaluated in the end of December 2019, but due to persistent skin edema, she was not a candidate for surgical treatment. The tumor board decision was to proceed with T-DM1 + pertuzumab based on the results of the KRISTINE trial [doi:10.1016/s1470-2045(17)30716-7]. From January to March 2020 the patient received 4 cycles of trastuzumab-emtansine 3,6 mg/kg day 1 every 21 days + pertuzumab 420 mg day 1 every 21 days. The patient tolerated this treatment with mild toxicity: ALT & AST increase grade 2 and diarrhea grade 2. Considering that the edema was significantly reduced, surgical treatment was planned. The patient underwent a modified radical mastectomy for left breast cancer on 14 of April 2020. The pathological stage was ypT1аN0 R0, RCB I. The patient continued trastuzumab emtansine until November 2020 (up to 1 year of anti-HER2 targeted therapy) in the adjuvant setting. In June 2020 she underwent locoregional radiation therapy. Tamoxifen with ovarian function suppression (LHRH agonists) for 5 years was started in June 2020. Fortunately, after 3 years of follow-up after surgery there is no evidence of disease and no delayed cancer treatment complications. Conclusion: Personalized multidisciplinary team decisions for cancer patients after organ transplantation are crucial to further improve the long-term outcome of these patients. Citation Format: Lyudmila Zhukova, Natalya Polshina. Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-09.

Transcatheter mitral valve therapies: A comprehensive review

Less invasive approaches offer an optimal treatment option for patients with severe mitral regurgitation who is not a candidate for surgical intervention. Favorable outcomes of transcatheter aortic valve replacement have produced great interest in the development of novel minimally invasive transcatheter technologies for repair and replacement of the mitral valve. In this review we aimed to provide an overview of the current transcatheter technologies used to treat mitral regurgitation and help clinicians in selecting the optimal therapy for their patients. We also wanted to provoke clinicians and researchers on how these technologies could be further developed in the future.

Current Role of Surgery in the Treatment of Neurocysticercosis.

Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low- and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy-and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC.

High-resolution 3-dimensional tomography may be a useful tool for understanding the anatomy of hiatal hernias and surgical planning of patients eligible for laparoscopic or robotic antireflux surgery.

3D computed tomography (CT) has been seldom used for the evaluation of hiatal hernias (HH) in surgical patients. This study aims to describe the 3D CT findings in candidates for laparoscopic or robotic antireflux surgery or HH repair and compare them with other tests. Thirty patients with HH and/or gastroesophageal reflux disease (GERD) who were candidates for surgical treatment and underwent high-resolution CT were recruited. The variables studied were distance from the esophagogastric junction (EGJ) to the hiatus; total gastric volume and herniated gastric volume, percentage of herniated volume in relation to the total gastric volume; diameters and area of the esophageal hiatus. HH was diagnosed with CT in 21 (70%) patients. There was no correlation between the distance EGJ-hiatus and the herniated gastric volume. There was a statistically significant correlation between the distance from the EGJ to the hiatus and the area of the esophageal hiatus of the diaphragm. There was correlation between tomographic and endoscopic findings for the presence and size of HH. HH was diagnosed with manometry in 9 (50%) patients. There was no correlation between tomographic and manometric findings for the diagnosis of HH and between hiatal area and lower esophageal sphincter basal pressure. There was no correlation between any parameter and DeMeester score. The anatomy of HH and the hiatus can be well defined by 3D CT. The EGJ-hiatus distance may be equally measured by 3D CT or upper digestive endoscopy. DeMeester score did not correlate with any anatomical parameter.

Abstract 13750: Concomitant Transcatheter Debulking of Right Heart Vegetations During Extraction of Transvenous Device System for Endocarditis: An Eight Case Series

Background: Right heart (RH) infective endocarditis (IE) is a rare but serious complication of transvenous devices (TVD) often requiring system extraction. Surgery is often necessary for large vegetations or when bacteremia persists despite antibiotics. Objective: To evaluate outcomes of patients who underwent transcatheter debulking of IE-related RH vegetations in the setting of a transvenous device endocarditis. Methods: Patients with TVD and IE with RH vegetations were included in this analysis. Half of the patients were debulked using a thrombus aspiration system, while in the other half a hydrodynamic thrombectomy system was used. This was completed via a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded. Results: Eight patients with a median age of 58 years, 62.5% male, with TVD, IE, and RH vegetations were included. Vegetations were located on the TV (2), RA lead (4), RV lead (2) and the floor of the RA along the cavotricuspid isthmus (1). The largest vegetation in this series was 5 cm by 2 cm with a volume of 62.83 cm3 and the smallest was 0.4 cm by 0.3 cm with a volume of 0.15 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all eight cases. Post-procedure imaging in all eight patients showed at least a 80% reduction in vegetation burden. All patients with TVP leads underwent successful extraction of the pacing systems. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention. Conclusion: TCD is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Long-term implications of this intervention in this high-risk population needs further studies.

A Case Report on Rasmussen Encephalopathy (RE)

Summary: Rasmussen's encephalitis (RE) is a rare and severe chronic inflammatory brain disease resulting in drug-resistant epilepsy and progressive hemispheric destruction with neurological deficit. ER is associated with deterioration of background EEG activity, progressive atrophy of the affected hemisphere on MRI and extensive PET hypometabolism over the affected hemisphere. We report the case of a 6-year-old girl who presented with pharmacoresistant epilepsy.
 Observation: A 6-year-old child with no particular medical history presented 6 months prior to admission with epilepsy resistant to all therapeutic classes (antiepileptic drugs). Clinical examination revealed left hemiparesis with facial involvement and constant left hemi-myoclonus.
 An EEG showed a pattern compatible with a continuous epileptic encephalopathy that could correlate with Rasmussen syndrome.
 Cerebral MRI Revealed: right cerebral hemiatrophy with secondary homolateral hippocampal sclero-atrophy, compatible with Rasmussen encephalitis.
 The patient received immunoglobulins and a corticosteroid bolus, but without improvement; she was therefore a candidate for surgical treatment.
 Rasmussen's encephalopathy is a rare and serious disease that can be responsible for paresis and cognitive decline. Its pathophysiology is still poorly defined, and it mainly affects children.

Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients.

To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH). This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated. Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5cm to 1.9cm (P<0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients. TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.

Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only).At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH.In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.

The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial

Background: Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).&#x0D; Methods: This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.&#x0D; Results: No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).&#x0D; Conclusion: In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

A rare case of Carotid Dissection seen in Vascular Eagle Syndrome (P3-5.024)

<h3>Objective:</h3> NA <h3>Background:</h3> Vascular eagle syndrome occurs when an elongated styloid process causes impingement to a carotid artery. Four percent of the general population have an elongated styloid process; only four percent are symptomatic. Clinical manifestations occur due to angulation in the middle or end of the styloid, in which turning the head might compress the carotid artery or even tear the vessel itself. Some manifestations include syncope from irritation of the sympathetic plexus, restriction in blood flow, transient ischemic attack, and carotid dissection. <h3>Design/Methods:</h3> NA <h3>Results:</h3> This is an 82-year-old man who presented due to sudden onset of left-sided hemiparesis, urinary incontinence, and aphasia upon awakening. His medical history was significant for recent atrial fibrillation with a pacemaker (not on anticoagulation), hypertension, and hyperlipidemia. Neurological examination revealed left pronator drift, hemisensory neglect on simultaneous tactile stimulation, and a positive left plantar reflex. Computed tomography angiogram (CTA) head and neck revealed a short segment nonflow-limiting dissection of the right mid-cervical internal carotid artery. Magnetic resonance imaging (MRI) of the brain showed multiple areas of cortical and subcortical hyperintense diffusion and T2 foci involving the right frontoparietal and insular cortex most consistent with late acute infarct. Further review showed an elongated styloid process impinging on the right carotid artery. Due to this patient’s age and risk factors, he was not a candidate for surgical intervention. He was started on a heparin drip and bridged to warfarin for secondary stroke prevention for both extracranial cervical dissection and concurrent atrial fibrillation. Stent placement at a later date would be considered if he failed medical therapy. <h3>Conclusions:</h3> An elongated styloid process should be considered in an atraumatic, symptomatic cervical dissection presenting with ischemic infarcts. There is limited data regarding management of vascular eagle syndrome and should be studied further to compare medical management versus surgical intervention. <b>Disclosure:</b> Dr. Kokikian has nothing to disclose. Dr. Ly has nothing to disclose. Dr. Al-Khoury has nothing to disclose.

A comparative study between HoLEP and bipolar TURP in the treatment of benign prostatic hyperplasia

&lt;b&gt;Introduction: &lt;/b&gt;Benign Prostatic Hyperplasia (BPH) is one of the most frequent diseases in men. The laser treatment for BPH has challenged TURP due to advances in laser technology, a better understanding of tissue-laser interactions and rowing clinical experience.&lt;br /&gt; &lt;b&gt;Objective: &lt;/b&gt;To evaluate the safety and efficacy of HoLEP, comparing it to Bipolar TURP.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt;This was a prospective study to evaluate the outcomes in BPH patients undergoing surgery by HOLEP and Bipolar TURP done between January 2018 to December 2019. A total of 80 Patients were enrolled, 40 undergoing HoLEP and the other 40 Bipolar TURP for BPH. The procedures were performed by a single surgeon. All patients with symptomatic BPH and who were candidates for surgical treatment were included. Patients with previous prostate surgery, urethral surgery, history of prostate cancer or neurogenic bladder were excluded.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Baseline parameters were almost similar between both the groups in terms of age, IPSS, QOL, Q max, PVR, and gland size. Operative time and resected gland weight were more in HoLEP arm (p&amp;lt;0.001). Catheter time and Hospital stay were significantly low in the HoLEP group (p&amp;lt;0.0001). Hemoglobin drop was not significant (p=0.148). IPSS at three months was similar in both groups (p=0.608). Qmax improved significantly in both groups, with 18.87 ml/s in TURP and 17.87 ml/s in HoLEP with a p-value of 0.261. PVR and QOL were similar between the two groups (P=0.914 and P=0.781).&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;Both Bipolar TURP and HoLEP were effective in relieving BOO. HoLEP has equal efficacy compared to conventional bipolar TURP, with decreased hospital stay and catheter indwelling time. The learning curve of HoLEP is steep; however, it can be overcome gradually.

Acupuncture Treatment for Breast Cancer-Related Lymphedema: A Randomized Pilot Study.

Background: Methods of conservative management for breast cancer-related lymphedema (BCRL) are burdensome in terms of time, cost, and convenience. In addition, many patients are not candidates for surgical treatment. Preliminary results have demonstrated possible beneficial effects of acupuncture for patients with BCRL. In this small pilot study, we examined the safety and feasibility of an acupuncture randomized control trial (RCT) in this patient cohort, utilizing a battery of standardized clinical and patient-centered outcome measures. Methods and Results: Patients with BCRL were randomized 2:1 to the acupuncture (n = 10) or the control (n = 4) group. Patients received acupuncture to the unaffected extremity biweekly for 6 weeks. Feasibility was defined as enrollment ≥80%, completion of ≥9 of 12 acupuncture sessions per person, and ≥75% completion of three of three measurement visits. To inform a future adequately powered RCT, we describe within-group changes in patient-centered outcomes, including circumferential measurements, bioimpedance spectroscopy, perometry, cytokine levels, and patient quality of life. Adverse events were systematically tracked. Fourteen patients completed the study. Of those who received acupuncture (n = 10), 8 completed all 12 acupuncture sessions, and 2 patients completed 11 sessions. Ninety-three percent of all participants completed all three measurement visits. There was no consistent improvement in arm volumes. Inflammatory marker levels had inconclusive fluctuations among both groups. All patients receiving acupuncture demonstrated an improvement in their functional quality-of-life score. No severe adverse events occurred. Conclusions: A randomized controlled study of acupuncture for BCRL is feasible. The acupuncture intervention is acceptable in this population, without safety concerns in a small sample and warrants further investigation.

Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery

Introduction: Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. Methods: To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers’ concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one’s aspirations. Results: In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. Conclusion: Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.

Standard approach and future perspective for the management of benign prostatic hyperplasia from a health-economics point of view: the role of transperineal laser ablation

IntroductionBenign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population over 60 years and it is associated with the development of lower urinary tract symptoms (LUTS): dysuria, nocturia, increased frequency of urination, etc. LUTS negatively affect the patient’s daily activities and the quality of life. Patients with severe and persisting symptoms, not responding to pharmacological therapy, are candidates for surgical intervention. Transurethral resection of the prostate (TURP) has been the gold standard for surgical approach despite it can be associated with significant complications. Indeed, laser vaporization or enucleation are today the most broadly used surgical techniques and other minimally invasive surgical therapies (MISTs) have been introduced to reduce some complications during- and post-surgery. Moreover, a new micro-invasive approach for LUTS is represented by EchoLaser SoracteLite™ transperineal laser ablation (TPLA), an innovative, safe and feasible approach that can be performed under local anaesthesia and in an outpatient setting.ObjectiveThe paper aims to analyse and discuss the economic implications of standard surgical techniques and innovative approaches with a focus on TPLA thought a literature review.ResultsThe literature review highlights that at present there are few studies related to the economic implications of surgical therapies for LUTS. Preliminary results show that the TPLA is a promising technique in terms of clinical and economic benefit for the treatment of obstructive LUTS. Furthermore, TPLA can be performed in an outpatient setting implying an advantage from an economic and also organizational point of view, in particular in a health emergency situation.ConclusionsEconomic literature on minimally invasive techniques and surgical approaches for the treatment of BPH is still lacking. Multicentre and long-term economic studies are needed to assess the estimated disease burden. However, direct and indirect costs associated with TPLA are minimized vs TURP and laser vaporization/enucleation.

Metastatic Malignant Melanoma of the Stomach: An Unexpected Phenomenon of the Disease

Regarding the unfavorable outcome of gastric metastatic melanoma, the treatment choice is still under investigation. However, early diagnosis is important for the appropriate assessment of patients as candidates for surgical interventions.

Extended Pulmonary Resection for T4 Non-Small Cell Lung Cancer.

T4 non-small cell lung cancer is a locally advanced disease with poor prognosis. The operation can be challenging even for an experienced surgeon. N2 disease has been shown repeatedly as a risk factor for poor outcome, and these patients should not be candidates for surgical treatment. Surgery for locally advanced T4 tumors without mediastinal lymph node involvement (T4N0 and T4N1) has been demonstrated to result in good outcomes in carefully selected patients. Patients with T4N0-1M0 should be rejected for surgery only after consulting an expert surgical center. As with other stages, the decision for resectability and surgery should be made by a multidisciplinary team.

Very late local recurrences of hepatocellular carcinoma with macrovascular invasion treated with stereotactic body radiotherapy: Report of two cases

AbstractBackground and AimsStereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) is becoming an accepted local therapy in patients who are not candidates for surgical intervention, ablation or transarterial chemo‐embolization. In patients with HCC with macrovascular invasion, SBRT is sometimes the treatment of choice, especially when systemic therapies are contraindicated, not available or if the HCC is refractory to systemic therapy.MethodsWe present two cases of HCC with tumour macrovascular invasion treated with SBRT. Both tumours appeared to have a complete response to SBRT over the subsequent 5 years.ResultsVery late, in‐field local recurrences of HCC were diagnosed 73 and 78 months following SBRT. One patient underwent re‐irradiation, was started on Levatinib and remains alive at 12 months following his recurrence. The other patient experienced rapid hepatic and extra‐hepatic HCC progression shortly after the local recurrence occurred, and they expired 6 months later.ConclusionsWe demonstrate that patients treated with SBRT for HCC, with or without vascular invasion, may have prolonged tumour control and overall survival beyond 5 years. As more HCC patients are living longer compared to historical cohorts, it has become apparent that very late local recurrences of HCC may occur highlighting the need for long‐term surveillance.

Stereotactic Body Radiotherapy for Kidney Cancer: Ready for Prime Time?

The standard treatment for renal cell carcinoma (RCC) is surgery. However, a number of patients will not be candidates for surgical treatment or will reject this therapeutic approach. Therefore, alternative approaches are required. Historically, radiotherapy has been considered an ineffective treatment for RCC due to the radioresistance of renal tumour cells to conventional fractionation and the increased rate of toxicity. Stereotactic body radiotherapy (SBRT) is a radiotherapy technique that provides a non-invasive ablative treatment with remarkable rates of local control in both primary tumours and metastases in several locations, with a low associated morbidity due to the highly conformal dose and the use of image-guided techniques. Current evidence shows that a higher dose per fraction, achieving a higher biological effective dose, can overcome the radioresistance of RCC cells. Therefore, SBRT, as well as the combination of SBRT and new emerging immune therapies, has a potential role in the local treatment of primary RCC and oligometastatic RCC patients.

RF11 | PSAT274 A Dramatic Response of a Thyroid Lymphoma to R-CHOP Chemotherapy Reversing Mechanical Airway Obstruction and Respiratory failure, A Case Report

Abstract Introduction Primary thyroid lymphoma is extremely rare and accounts for &amp;lt;5% of all thyroid malignancies, with an estimated incidence of 2 per 1 million each year. It usually occurs in patients with preexisting Hashimoto thyroiditis and commonly presents between 60 to 70 years. Almost all thyroid lymphomas are non-Hodgkin's lymphoma of B-cell origin, with diffuse large B-cell lymphoma being the most common subtype. Chemotherapy and radiotherapy are the primary treatment of thyroid lymphomas. This case report shows a dramatic response to chemotherapy in a patient with mechanical airway obstruction due to large thyroid lymphoma, which facilitated her extubation. Case Presentation An 83-year-old woman with a past medical history significant for type 2 diabetes, coronary heart disease, and hypothyroidism controlled on L-thyroxine replacement therapy was presented with 3 months history of gradually progressive dysphagia. It was associated with left-sided neck pain with swallowing, choking on food, and shortness of breath. She denied fever, chills, or excessive sweats. Local examination of her neck revealed a large firm thyroid mass associated with left cervical lymphadenopathy. Her CT neck scan with intravenous contrast showed an enlarged, probably malignant thyroid gland with marked amount of adjacent pathologic lymph nodes and marked transverse narrowing of the trachea to approximately 8.6 mm with no retrosternal extension. Also, Her CT abdominal scan with intravenous contrast showed a 3.6 cm lesion of the medial right hepatic lobe (segment 8) concerning for metastases. The patient underwent an ultrasound-guided thyroid biopsy, and the results confirmed the diagnosis of diffuse large B cell lymphoma of the neck and thyroid. A few days later, the patient experienced respiratory distress and failure secondary to mechanical airway obstruction that required urgent intubation and mechanical ventilation. The discussion among different specialties, including general surgery, concluded that the patient was not a candidate for surgical intervention or tracheostomy, and recommendations were to proceed to palliative chemotherapy. She started R-CHOP chemotherapy (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), followed by a marked reduction in the thyroid size and relieving of the tracheal compression on the following CT neck scan. Her condition dramatically improved, and she was extubated after 5 days of receiving the first cycle of R-CHOP chemotherapy. Conclusion Our case report demonstrates dramatic reversal of mechanical airway obstruction caused by a thyroid lymphoma within a few days of initiation of R-CHOP chemotherapy. These cases are usually considered terminal and do not undergo aggressive surgical interventions. R-CHOP chemotherapy needs to be considered in these cases before considering hospice care. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m.