Cent Of Stage Research Articles

Current Imaging Modalities Understage One-Third of Patients with Stage I Rectal Cancer: Implications for Treatment Selection

Accurate preoperative clinical staging is essential to optimize the treatment of rectal cancer. Primary surgical resection is typically indicated for stage I disease, whereas neoadjuvant therapy is recommended for stages II and III. The objective of this study is to examine the accuracy of clinical staging using current imaging modalities in predicting pathologic stage and, thus, selecting appropriate treatment. Adult patients with nonmetastatic rectal cancer who underwent primary surgical resection were identified from the National Cancer Database between 2006 and 2014. Data on clinical and pathologic staging was obtained. Kappa index was used to determine the correlation between clinical and pathologic staging. A total of 13,175 patients were identified. The correlation between clinical and pathologic staging was 69 per cent for stage I (31% upstaged) (Kappa 0.54, P < 0.001). One-third of patients who were clinically staged as stage I, and were therefore treated with primary surgical resection, had pathologic stage II or III disease. Based on their clinical staging, those patients did not receive the neoadjuvant therapy recommended by present guidelines. Where accurate clinical staging is in doubt, oncologists should carefully examine the quality of staging modality and perhaps consider multimodal imaging using both endorectal ultrasound and MRI.

The Rationality of Resectional Surgery and Palliative Interventions in the Management of Patients with Gallbladder Cancer

The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were retrospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was significantly longer in stage II and III diseases than in stage IV disease (P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival.

Gold Import: A Capital Account Acquisition? (Counter-View)

Gold import has been an issue of national debate in India. Economists opine that gold import is responsible for the bloating current account deficit (CAD). To check the widening current account deficit, United Progressive Alliance (UPA) government raised import duty on gold to 10 per cent from 2 per cent in stages. It also instructed all importers of gold to export 20 per cent of gold from every consignment of import. Gold import restrictions led to the CAD fell to 1.7 per cent of GDP of India. The next Bharatiya Janata Party (BJP) Government under Narendra Modi lifted the restriction on gold import. The jump in gold import widened the CAD. By December 2014, the CAD became 99 per cent of the annual estimate. But, the easing of gold import was supported by a few economists including Swaminathan S Ankalesaria Aiyer. Swaminathan termed gold import a ‘capital account acquisition’. He thought that gold import would work for inclusive growth for the ‘aam aadmi’ or the common man of India and proposed a change in the composition of capital account so as to accommodate gold in it. This article surveyed literature and compiled data on how gold import contributed to the CAD and fiscal (mis)management of India. It also tried to identify research gaps so that future fiscal management of the country could be studied comprehensibly in the presence of gold import. As India is bound by multilateral obligations, the paper tried to recommend necessary steps so that the country would not be put on defensive.

Laryngeal cancer management in a small, rural, multidisciplinary team setting: 15-year review

The Cumberland Infirmary, Carlisle, serves a largely remote, rural population of 330 000. The aim of this study was to report the treatment and survival figures for patients treated for laryngeal cancer at this centre. The study included 209 consecutive patients with squamous cell carcinoma of the larynx diagnosed between 1996 and 2010 at the Cumberland Infirmary. Disease-specific survival was 100 per cent for stage one, 76 per cent for stage two, 87 per cent for stage three and 46 per cent for stage four. In total, 76 patients (36 per cent) had a laryngectomy, either as primary treatment or as a salvage procedure. Our tumour-specific survival rate was very high, and this success may be due in part to high rates of surgical intervention. Survival data compared favourably with other centres, despite less radical radiotherapy regimes. Laryngeal cancer can be managed effectively in a small, relatively remote, multidisciplinary team setting.

Supraglottic carcinoma treatment results analysed by therapeutic approach

This study reviewed 161 patients with supraglottic squamous cell carcinoma who underwent radical therapy at Kurume University Hospital between 1989 and 2003. The five-year survival rate was 89 per cent in patients with stage III disease and 75 per cent in stage IV patients, thus demonstrating favourable results even for patients with advanced cancer. The five-year local control rate and the laryngeal preservation rate were poor in patients with T3 tumours (being 75 per cent for both), but the overall five-year local control rate for all patients was 86 per cent. Laser surgery plus chemo-radiotherapy was the most frequently used treatment. The local control rates and laryngeal preservation rates were poor in patients with tumour infiltration to the glottis and the laryngeal ventricle. In conclusion, the indications for combination laser therapy for supraglottic carcinoma should in future be extended, and the type and number of chemotherapy courses for this cancer should be further clarified.

The survival of patients with colorectal cancer treated in a regional hospital.

Abstract The survival rate for 301 patients who had a resection for colorectal cancer in Oxford over a 6-year period between 1966 and 1971 has been reviewed. The crude and age-adjusted 5-year survival rates for those who had a resection for cure were 37·3 per cent and 53·8 per cent respectively. The corresponding survival rates for all patients after resection were 25·8 and 37·2 respectively. The most important determinant of survival was the pathological stage of the primary tumour, the agecorrected 5-year survival being 100 per cent for stage A lesions, 58 per cent for stage B, 27·1 for stage C and 5·5 per cent for stage D. Patients who presented with either intestinal obstruction or perforation of their carcinoma had a significantly worse prognosis than those who did not. Patients under 35 years of age did not survive as long as older patients. Those patients who had an anterior resection survived longer than those who underwent colectomy or abdominoperineal resection, probably due to the selection of pathologically favourable cases in the former group. The occurrence of infection in the postoperative period did not influence survival. Thus, in general, patients with colorectal cancer have a poor 5-year survival (with the exception of stage A lesions), and this indicates the need for development of effective adjuvant therapy after surgery for this disease.

Circulating breast tumour antigen-sensitive T lymphocytes in early breast cancer and high risk benign breast disease

Levels of circulating T lymphocytes sensitized to breast tumour associated antigens (BTA) were correlated with pathological tumour stage or benign histopathology in preoperative studies of 180 patients by the antigen-stimulated active rosette-forming T cell (AgARFC) assay. Incubation of lymphocytes with allogeneic BTA extracts produced increased AgARFC compared with incubation without BTA. Significant levels of BTA-sensitive T cells were found in 78 per cent of breast cancer patients compared with 23 per cent of patients with benign disease (P less than 0.0005, by X2). Over 93 per cent of stage I cancer patients responded to BTA, compared with 69 per cent of stage II patients (P less than 0.025) and 59 per cent of stages III-IV patients (P less than 0.005). Twenty-nine per cent of 42 patients with fibrocystic disease were positive to BTA in contrast to 8 per cent of 25 patients with fibroadenomas. This was a 3.6-fold higher incidence of BTA-sensitive T cells associated with fibrocystic disease than with fibroadenomas, which was in agreement with the increased breast cancer risk rate associated with fibrocystic disease. These findings suggest that the AgARFC assay may detect early malignant change in fibrocystic disease. The AgARFC assay was found to reliably detect early invasive carcinoma.

Metaplastic Breast Cancer: Clinical Features and Outcomes

Metaplastic carcinoma of the breast, a neoplasm with both epithelial and mesenchymal elements, represents less than 1 per cent of all breast cancer. We reviewed the records of all patients diagnosed with localized metaplastic breast cancer from 1991 to 2003 at our institution. We identified 21 patients. Mean primary tumor size was 4.62 cm. Eight patients (38%) had axillary node involvement at presentation. All the tumors were high grade. Only two (10%) of the tumors were hormone receptor positive. Seventeen (81%) of the patients received adjuvant chemotherapy, and 12 (57%) of the patients received radiation. Ten (29%) patients suffered a local recurrence. With a mean follow-up of 46 months, the 5-year disease-free and overall survival was 42 per cent (95% CI: 20% to 65%) and 71 per cent (95% CI: 46% to 96%), respectively. Stage-specific overall survival was 100 per cent, 83 per cent, and 53 per cent for stages I, II, and III, respectively. By multivariate analysis, there was no impact on recurrence or survival with regard to size, age, menopausal status, nodal status, histologic subtype, adjuvant therapy, or extent of surgery. Metaplastic breast cancer is a unique neoplasm that tends to present at an advanced stage and has a propensity for local recurrence. When stratified by stage, however, survival appears similar to that of adenocarcinoma of the breast, and these tumors should be treated as such.

Sore throat in adults – does the introduction of a clinical scoring system improve the management of these patients in a secondary care setting?

To audit sore throat management in adults, introduce proforma-based guidelines and to re-audit clinical practice. Adult emergency department of an inner city teaching hospital. A literature search was carried out to identify relevant guidelines. In stage one, patients presenting to the emergency department with sore throat were identified retrospectively from the emergency department attendance register. Proformas were completed retrospectively. In stage two, new guidelines were introduced and staff educated about the guidelines. In stage three, patients presenting with sore throat were identified at triage and proformas were completed at time of consultation. (1) appropriate clinical assessment of the likelihood of bacterial infection using the clinical scoring system, (2) appropriateness of antibiotic prescription, (3) recommendation of supportive treatments to patients. Introduction of a clinical scoring system reduced the inappropriate prescribing of antibiotics from 44 per cent to 11 per cent. Correct antibiotic prescription rose from 60 per cent to 100 per cent. Although the variety of advice given about supportive treatment increased, the actual number of patients receiving documented supportive advice fell from 67.8 per cent in stage one to 58 per cent in stage three. The introduction of clinically based guidelines for the diagnosis and management of sore throat in adults can reduce inappropriate antibiotic prescribing.

Treatment of gallbladder cancer by radical resection.

The use of radical resection for gallbladder cancer is controversial. This study evaluated results of resection for gallbladder cancer and analysed prognostic factors. A retrospective review of 135 patients who underwent surgical resection for gallbladder cancer between 1976 and 1998 was performed. Of these, 123 patients underwent radical resection and the remaining 12 had palliative resection. The resections included 32 hepatopancreatoduodenectomies and 57 with adjuvant radiotherapy. Twelve prognostic factors were analysed. A subset of 96 patients with stage IV disease was analysed separately with respect to residual tumour level and adjuvant radiotherapy. Surgical resection was associated with a 5-year survival rate of 36 per cent, with a mean follow-up time of 870 days. Twenty-two patients have survived more than 5 years including three with stage IV disease. Overall operative morbidity and mortality rates were 13 and 4 per cent respectively. The 5-year survival rate decreased with disease stage: 100, 78, 69 and 11 per cent for stages I (n = 13), II (n = 19), III (n = 7) and IV (n = 96) respectively. Performance status, jaundice, histopathological type and grade, primary tumour, lymph node, distant metastasis, stage grouping, residual tumour level and adjuvant radiotherapy were significant prognostic factors. With careful patient selection, radical resection for gallbladder cancer improves the prognosis with acceptable operative mortality and morbidity rates, even for stage IV disease, provided that complete gross tumour resection is combined with radiotherapy.

A magnetic investigation of a Late Quaternary loess/palaeosol record in Siberia

SUMMARY A Late Quaternary loess/palaeosol sequence at Kurtak in the Yenisey River valley, southern Siberia, has been studied magnetically. The 34 m section (340 samples) exhibits variations in magnetic susceptibility which can be correlated with oxygen isotope stages 1‐7. A detailed sampling of stage 5 (a further 209 samples) permits the identification of substages 5a‐e. The susceptibility variations themselves are in the opposite sense to that found in the classic sections of the Chinese Loess Plateau, but are in agreement with the ‘wind-intensity’ model which has been put forward to explain similar findings in loess sequences in Alaska. Published results for the susceptibility of magnetite imply volume fractions of #0.2 per cent in glacial stages 2 and 4, dropping to #0.05 per cent in stages 1, 3 and 5. These fluctuations match the aeolian flux variations observed in core V21‐146 from the north Pacific. Even though the warmer intervals are characterized by lower susceptibilities, the observed frequency dependence of susceptibility indicates that new magnetic material is produced as a result of pedogenesis during interglacial and interstadial times.

TP53 protein accumulation and gene mutation in relation to overexpression of MDM2 protein in ovarian borderline tumours and stage I carcinomas.

Three hundred and seventy-four early-stage ovarian tumours, including 27 borderline tumours and 347 stage I carcinomas, were investigated immunohistochemically for overexpression of the TP53 and MDM2 proteins. TP53 (p53) and MDM2 alterations were detected in 15 and 4 per cent of borderline tumours, and in 50 and 13 per cent of stage I carcinomas, respectively. Mutations in the TP53 gene (exons 5-8) were demonstrated in 29 of the 50 stage I carcinomas studied, using denaturing gel electrophoresis followed by direct sequencing. TP53 overexpression was seen less often in tumours of mucinous and endometrioid type than in tumours of other histological types and more often in moderately and poorly differentiated than in well differentiated tumours. MDM2 protein overexpression was seen more often in clear cell carcinoma than in tumours of other histological types. These results indicate that TP53 abnormalities play a crucial role, and MDM2 abnormalities a minor role, in the development of early-stage ovarian carcinoma. There was no significant association between TP53 or MDM2 alterations and survival in multivariate analysis.

Ten years of ovarian cancer. Progress or disappointment?

SummarySummaryTen years of treatment of ovarian cancer in a district general hospital have been reviewed. Stage, age and residual disease were the main factors which determined survival. Maximum debulking to less than 1 cm was associated with improved disease free survival, but in this series this was only possible in 43 per cent of stage 3 disease. Age also proved a significant factor for survival. Sadly, we have not seen an overall improvement in long term survival since the introduction of platinum compounds.

Multimodality therapy for small cell carcinoma of the lung —The role of surgical treatment

Reviewing the outcome of 70 cases of clinically localized small cell lung cancer (SCLC) treated with combined modality treatment, we attempted to define the role of resection in this disease. The survival rate for all cases was 37 per cent at 2 years and 23 per cent at 3 years with a median survival time (MST) of 14 months. For 25 resected cases the overall 5-year survival rate was 37 per cent with an MST of 26 months. According to clinical staging, 5-year survival was 64 per cent for stage I and 20 per cent for stage II. However, none of the stage III cases achieved long-term survival, of over 3 years. In 45 non-resected cases, the overall response rate was 84 per cent with a 44 per cent complete response. The overall survival rate was 27 per cent at 2 years and 14 per cent at 3 years with an MST of 11 months. The 20 cases who achieved complete response had an MST of 26 months with 51 per cent alive at 2 years and 19 per cent at 5 years. Thus, we consider that lung resection is definitely indicated in cases with stage I and probably stage II SCLC. For stage III, however, particularly in cases with N2 disease, resection seems to offer no special benefit in favor of survival compared to combination chemotherapy and radiotherapy.

The management of early‐stage aggressive non‐Hodgkin's lymphoma

Sixty-one patients with stage I or II non-Hodgkin's lymphoma of aggressive histological subtype were treated at the Royal Marsden Hospital between 1972 and 1984. The overall 5-year survival probability was 69 per cent (60 per cent continuously relapse-free). The 5-year survival probability was 80 per cent for stage I disease and 55 per cent in stage II (p = 0.05). Survival was significantly higher in non-bulky than bulky presentations (85 per cent versus 44 per cent at 5 years, p = 0.003). There was no significant 2-year survival difference between those treated initially with chemotherapy and those treated with radiotherapy alone (65 per cent versus 83 per cent), however chemotherapy had been employed predominantly in patients with adverse presentations. The 2-year survival in 41 patients treated initially with doxorubicin-containing chemotherapy combinations was 76 per cent. Combined modality treatments should be considered especially in patients with stage II or bulky disease.

Carcinoma of the penis. A 12-year review.

Seventy-eight patients with carcinoma of the penis treated over a period of twelve years (1972-1983) were retrospectively analyzed. According to Jackson's clinical staging, 18.0 per cent were in stage I, 20.5 in stage II, 26.9 in stage III, and 34.6 per cent in stage IV. Some early-stage patients (12 with stage I and 4 with stage II) were primarily treated by external irradiation to a dose of 55 Gy/5 week/25 fr. Thirteen of these 16 patients had local control with preservation of the organ. The remaining patients with stage II were treated by partial or total penectomy. In stage III penectomy with inguinopelvic lymph node dissection was done. Stage IV patients received palliative irradiation and/or chemotherapy. There years' disease-free survival (including salvage surgery) was 93 per cent in stage I, 62.5 per cent in stage II and 38 per cent in stage III.

Adjuvant radiation therapy in stages C and D 1 prostatic adenocarcinoma: Preliminary results

Twenty patients with adenocarcinoma of the prostate underwent postradical prostatectomy adjuvant external beam megavoltage radiation therapy because of periprostatic disease in histologic evaluation of the resected specimen. Fourteen of these patients had pathologic Stage C and 6 pathologic Stage D 1 disease. Treatment in most patients consisted of 5,000 rad delivered to the true pelvis. The five-year recurrence free survival was 75 per cent for pathologic Stage C and 41 per cent for Stage D 1 disease. The median time to first evidence of treatment failure was fifty months for D 1 patients and has not been reached by the C group. Minor complications occurred in 85 per cent of patients and major complications in 5 per cent. In 1 patient with mild, postoperative stress incontinence total urinary incontinence developed after radiation therapy. These preliminary observations suggest a prolonged disease free interval with an acceptable morbidity is obtained utilizing this regimen.

A therapeutic approach to early vocal cord carcinoma.

One hundred and twenty patients with early glottic carcinoma received radiation therapy at the University of Maryland Hospital from 1959 to 1977. The radiation dose ranged from 55 Gy in 4 weeks for small T1a lesions to 65 Gy in 61/2 weeks for T2 lesions. The local control rates by irradiation alone for stages T1a, T1b, and T2 were 92, 91 and 88 per cent, respectively, while 5-year determinate disease-free survival rates were 96 per cent for stage I disease and 88 per cent for stage II disease. Most of the local failures were salvaged by surgery, with a low complication rate. Regional metastases were uncommon, and occurred in 7 per cent in stage I and in 6 per cent in stage II disease. Factors increasing the risk of failures appeared to be bulky tumor, anterior commissure involvement and subglottic extension.

Prognostic factors in stage I and II non-Hodgkin's lymphoma of Waldeyer's ring.

Sixty-nine stage I and II patients treated for non-Hodgkin's lymphoma of Waldeyer's ring were retrospectively analysed. Diffuse histiocytic lymphoma (Rappaport's classification) was the most common histology (67%). Staging without laparotomy revealed 31 patients in stage I and 38 in stage II. Sixty-five patients received radiation therapy against involved or extended fields. In 43 patients adjuvant chemotherapy with single or multiple agents was given and 4 patients received only chemotherapy. A relapse occurred in 34 (49%) patients. The 5-year relapse-free survival was 67 per cent and 36 per cent in stage I and stage II, respectively. Radiation doses of 50 Gy gave no recurrence within treated volumes. However, since relapse below the clavicles and especially below the diaphragm was common, the radiation doses did not seem important for reduction of the overall failure rate. In stage II, patients with a single neck node less than 5 cm in diameter seemed to have a better prognosis than patients with large or multiple neck nodes. In this non-randomized study adjuvant chemotherapy seemed to reduce the risk of relapse, especially in stage II patients.

Results of radiation therapy in carcinoma of the larynx.

Between 1973 and 1977, 254 patients with previously untreated squamous cell carcinoma of the larynx received 60Co external beam therapy; 161 patients (63.4%) survived without evidence of malignancy for five years after the radiation therapy alone, and 21 patients survived after salvage surgery. The overall crude survival rate was 182/254, i.e. 71.7 per cent at five years. Five-year survival rates without evidence of malignancy were 81.6 per cent in stage I, 73.4 per cent in stage II, and 40.8 per cent in stage III.