Complete Tumor Resection Research Articles

Association of extent of resection on recurrence-free survival and functional outcome in vestibular schwannoma of the elderly.

Despite the ongoing debate on the risk-benefit ratio of vestibular schwannoma (VS) treatment options, watchful observation and radiation are usually favored in the elderly (>65 years). If surgery is inevitable, a multimodal approach after deliberate subtotal resection has been described as a valid option. The relationship between the extent of resection (EOR) of surgical and functional outcomes and recurrence-free survival (RFS) remains unclear. This present study aims to evaluate the functional outcome and RFS of the elderly in relation to the EOR. This matched cohort study analyzed all consecutive elderly VS patients treated at a tertiary referral center since 2005. A separate cohort (<65 years) served as a matched control group (young). Clinical status was assessed by the Charlson Comorbidity Index (CCI), the Karnofsky Performance (KPS), and the Gardner and Robertson (GR) and House & Brackmann (H&B) scales. RFS was evaluated by Kaplan-Meier analysis using contrast-enhanced magnetic resonance imaging to identify tumor recurrence. Among 2,191 patients, 296 (14%) patients were classified as elderly, of whom 133 (41%) were treated surgically. The elderly were characterized by a higher preoperative morbidity and worse gait uncertainty. Postoperative mortality (0.8% and 1%), morbidity (13% and 14%), and the functional outcome (G&R, H&B, and KPS) did not differ between the elderly and the young. There was a significant benefit in regard to the preoperative imbalance. Gross total resection (GTR) was accomplished in 74% of all cases. Lower grades of the EOR (subtotal and decompressive surgery) raised the incidence of recurrence significantly. Mean time to recurrence in the surgELDERLY was 67.33 ± 42.02 months and 63.2 ± 70.98 months in the surgCONTROL. Surgical VS treatment aiming for complete tumor resection is feasible and safe, even in advanced age. A higher EOR is not associated with cranial nerve deterioration in the elderly compared to the young. In contrast, the EOR determines RFS and the incidence of recurrence/progression in both study cohorts. If surgery is indicated in the elderly, GTR can be intended safely, and if only subtotal resection is achieved, further adjuvant therapy, e.g., radiotherapy, should be discussed in the elderly, as the incidence of recurrence is not significantly lower compared to the young.

Spinal meningiomas.

Spinal meningiomas (SM) are lesions with a mostly favorable oncological and surgical prognosis and a low incidence of tumor recurrence. SM account for approximately 1.2-12.7% of all meningiomas and 25% of all spinal cord tumors. Typically, SM are located in the intradural extramedullary space. SM grow slowly and spread laterally into the subarachnoid space, stretching and sometimes incorporating the surrounding arachnoid but rarely the pia. Standard treatment is surgery with the primary aims of achieving complete tumor resection as well as improving and recovering neurologic function. Radiotherapy may be considered in case of tumor recurrence, for challenging surgical cases, and for patients with higher-grade lesions (World Health Organization grade 2 or 3); however, radiotherapy is mostly used as an adjuvant therapy for SM. New molecular and genetic profiling increases the understanding of SM and may uncover additional treatment options.

Full Endoscopic Resection of Intralabyrinthine Schwannomas: A Case Series.

Objective: To investigate the technique and efficacy of fully endoscope resection of intralabyrinthine schwannomas (ILS) by transcanal transpromontorial endoscopic approach (TTEA). Study Design: Retrospective case review. Setting: Hospital. Patients: All patients who were affected by ILS, without extension to the internal auditory canal and underwent surgery with TTEA in our hospital in 2020. Intervention(s): Therapeutic. Main Outcome Measure(s): Recovery status, postoperative complications and remaining symptoms after surgery. Results: Three patients were included, all of which underwent gross total resections. The follow-up period was from 10 months to 2 years. No intraoperative and postoperative major complications were observed. There was no facial paralysis or cerebrospinal fluid leakage postoperatively. The hospitalization time of TTEA was 5 days. Three patients' vertigo was relieved after 1 week without receiving vestibular therapy. Only 1 patient complained of transient episodes of vertigo when climbing or holding heavy objects. Conclusions: TTEA has the advantages of clear vision to identify the anatomical structure, enabling complete tumor resection, reduced operation time, and faster postoperative recovery.Level of Evidence: IV.

P.135 Dura splitting technique for surgical resection of spinal meningioma

Background: Spinal meningiomas are intradural extramedullary tumors that account for 25–46% of all primary spinal tumors. A growing body of literature suggests that the extent of resection significantly affects the recurrence rate of spinal meningiomas and that Simpson grade II resection may not be as adequate as previously thought. Dura Splitting Technique (DST) can be used with no major perioperative complications. Methods: Retrospect review of six cases of spinal meningiomas where DST was used. The patients ranged in age at presentation from 38 to 80 years. All presented with symptoms including gait unsteadiness and lower limbs weakness. Spinal MRI was used to establish the diagnosis. All of the tumors were located ventral or ventrolateral to the spinal cord. Results: DST was applying to spinal meningioma cases,complete tumor resection by separating the involved dura into inner and outer layer. Preserving the dura outer layer and avoiding the need for dural graft reconstruction and CSF leak. A total of six cases, four in thoracic spine and two in cercical spine one anterior and one posterior, all four cases had no reported surgical complications or tumor recurrenc. Conclusions: We confirm that DST is safe and a superior method in the treatment of spinal meningiomas.

Differential overall survival and treatment for non-dedifferentiated liposarcoma in academic and non-academic facilities: An NCDB analysis.

e23556 Background: Liposarcoma is a malignant soft tissue tumor sarcoma which most commonly arises in subcutaneous fat of the limbs and abdomen. Previous studies found overall survival and treatments to vary between patients treated at academic and non-academic facilities. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with non-dedifferentiated liposarcoma from 2004 to 2019 using the histology codes 8850, 8851, 8852, 8853, 8855, and 8857 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 15,256 patients queried, 72% were treated at an academic/research facility (AF). Patients treated at an AF had an improved median survival compared to a non-academic facility (NA) (184 months versus 154 months; p &lt; 0.001). After controlling for stage, income, and therapy type, treatment at an AF was associated with an independent decrease in hazard (HR = .824; p &lt; 0.001). AF patients disproportionately came from a higher income bracket and were more likely to carry private insurance. Additionally, AF patients were more likely to receive surgery, have margins with complete tumor resection, and receive adjuvant chemotherapy (p &lt; 0.001). There were no significant differences in stage or metastasis at presentation between the two groups. Conclusions: Patients with non-dedifferentiated liposarcoma treated at an academic/research facility had improved overall survival, higher rates of surgery, higher rates of chemotherapy, and better surgical margins compared to patients treated at a non-academic facility.

Investigation of the prognostic significance of CD5, CD117, EZH2, POU2F3, MTAP and BAP1 in thymic carcinoma.

e20646 Background: Thymic carcinomas tend to be aggressive malignancies with variable patterns of immunostaining. We aimed to assess whether the outcome of patients with thymic carcinomas was associated with immunoreactivity for conventional and emerging immunohistochemical markers of thymic carcinoma versus thymoma. Methods: Scoring of CD5, CD117, EZH2, POU2F3, BAP1, and MTAP immunohistochemistry on whole slide sections was compared to overall survival (OS) and progression free survival (PFS) for 36 thymic carcinoma patients, 28 of whom had complete tumor resection and 8 of whom had incomplete tumor resection. Results: Positive CD5 staining (defined as staining in ≥50% of tumor cells) was present in 13/36 cases (36%) and was significantly associated with longer OS (P = 0.005, hazard ratio = 0.18, CI 0.03-0.63) but not PFS (P = 0.14, hazard ratio = 0.48, CI 0.16-1.26), whereas the other markers were not significantly associated with OS or PFS. Positive CD5 staining remained significantly associated with OS in squamous cell carcinoma subgroup analysis (n = 23, HR = 0.17, CI 0.03-0.65, P = 0.009), patients who did not receive neo-adjuvant treatment (n = 24, HR = 0.21, CI 0.03-0.85, P = 0.03) and after adjusting for incomplete resection (HR = 0.20, CI0.03-0.73, P = 0.01), M1 stage (HR = 0.19, CI 0.03-0.71, P = 0.01) or neoadjuvant treatment (HR = 0.19, CI 0.03-0.71, P = 0.01) in bivariate models. Positive CD5 staining was also significantly associated with age ≥60 years, absence of neoadjuvant treatment, and positive POU2F3 staining. Conclusions: CD5 staining in ≥50% of tumor cells was significantly associated with longer OS for thymic carcinoma patients. Our study supports the notion that CD5 immunohistochemistry may have utility as a prognostic marker for thymic carcinomas.

P.111 5-ALA guided surgical resection of newly diagnosed high grade gliomas at Health Sciences North (HSN) in Sudbury, Ontario

Background: Since its approval by Health Canada in 2020, several neurosurgical centres across Canada have used 5-ALA, an oral drug that assists with surgical resection of malignant gliomas by causing tumour cells to fluoresce under the microscope. The study’s objective is to prospectively evaluate the extent of resection (EOR) and clinical outcomes in 5-ALA-guided surgery at HSN compared to historical controls. Methods: A retrospective analysis was performed of patients with malignant gliomas having undergone surgery at HSN from 2011 to December 2020, assessing the EOR (contrast-enhanced tumour on post-operative CT/MRI), progression-free survival (PFS), overall survival (OS). Results: 235 patients underwent surgery for malignant glioma including 51 newly-diagnosed patients felt to be surgically resectable and with post-operative imaging. 25/51 (49%) had no residual tumour. The median PFS and OS were 7.1 and 11.5 months respectively. To date, 3 patients have successfully undergone 5-ALA-guided surgery with complete resection of contrast-enhancing tumour and no new focal neurological deficit post-operatively. Conclusions: We continue to recruit and follow prospectively patients having undergone 5-ALA-guided resection of malignant gliomas at HSN. Patients living in Northern Ontario may derive significant benefits from the use of 5-ALA-guided surgery, particularly since other technologies, such as intraoperative MRI and ultrasound, are costly and not available.

Open-label, single arm phase II trial investigating the efficacy, safety and quality of life of neoadjuvant chemotherapy with liposomal irinotecan combined with oxaliplatin and 5-fluorouracil/folinic acid followed by curative surgical resection in patients with hepatic oligometastatic adenocarcinoma of the pancreas (HOLIPANC).

TPS4193 Background: As of today, the recommendation for patients with adenocarcinoma of the pancreas and hepatic metastases is systemic chemotherapy alone regardless of the number and location of metastases. In the past, case reports have repeatedly reported survival data of patients who received metastatic and primary tumor resection outside the guidelines. However, there are currently no controlled clinical data from prospective studies that have evaluated the effectiveness of systemic chemotherapy in combination with tumor and metastasis resection in the context of hepatic oligometastasis in pancreatic cancer. Methods: In this single arm, phase-2 trial, survival data from patients receiving neoadjuvant chemotherapy followed by R0/R1 resection will be compared to historic data from patients with oligometastatic adenocarcinoma of the pancreas. Inclusion criteria are patients with a maximum of 5 liver metastases and histology proven PDAC. The combination of liposomal irinotecan (nal-IRI), oxaliplatin (OX) and 5-fluouracil (5-FU)/folinic acid (FA) (Nal-IRIFOX) was chosen as neoadjuvant chemotherapy since recent data suggested superior efficacy and less toxicity compared to mFOLFIRINOX. The primary endpoint is overall survival (OS) after R0/R1 resection. Secondary efficacy endpoints are R0/R1 resection rate and progression-free survival (PFS). Secondary safety endpoints are type, frequency and severity of adverse events with severity according to NCI CTCAE version 5.0 and perioperative morbidity and mortality. Eligible patients with hepatic oligometastatic adenocarcinoma of the pancreas will receive neoadjuvant combination chemotherapy in cycles of 14 days for a duration of 16 weeks in total. In patients with progressive disease during or after the first 4 cycles, neoadjuvant chemotherapy will be permanently discontinued. Patients with tumor response or stable disease after the first 4 cycles according to RECIST v1.1 but a non-resectable primary tumor will receive 4 more cycles. Patients with tumor response or stable disease and a resectable primary tumor after the first 4 cycles will undergo explorative laparotomy and synchronous resection of the tumor and hepatic metastases, if feasible. In total 150 patients will be enrolled for this trial with an aim of 55 patients receiving a complete macroscopic synchronous tumor and metastatic resection. The study is currently ongoing on 11 high-volume centers for pancreatic surgery within Germany. This is the first clinical study to prospectively evaluate the value of multimodality therapy concepts in oligometastatic pancreatic cancer. Clinical trial information: NCT04617457 .

The efficacy and safety of antibody drug conjugate for high-risk non-muscle-invasive bladder cancer.

e16616 Background: RC48 is a novel antibody drug conjugate that targets the Her2 protein and has shown promising efficacy in advanced urothelial cancer. However, its efficacy and safety in early-stage urothelial carcinoma are yet to be fully explored. To address this, we retrospectively collected the clinical data of patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) who received rc48. Methods: In this retrospective study, 19 patients with Her2-overexpressing (IHC 2+ or 3+) HR-NMIBC who were unable to undergo complete tumor resection or tolerate surgery were included， and clinical data were retrospectively collected. Pathological complete response (CR), partial response (PR), stable disease (SD), objective response rate (ORR), duration of response (DOR), cystectomy-free survival (CFS), and event-free survival (EFS) were used for data analysis. Results: We collected clinical data from a total of 19 patients. The median age of patients was 69 years (range: 58 to 81). Seven patients (36.8%) received RC48 monotherapy, while 12 patients (63.2%) received RC48 combined with tislelizumab. A CR was achieved in 14 patients (73.7%, 95% CI: 48.6% to 89.9%), with a partial response (PR) in 1 patient (5.3%, 95% CI: 0.3% to 8.1%) and stable disease (SD) in 4 patients (21.1%, 95% CI: 7.0% to 46.1%). The overall ORR was 78.9% (95% CI: 53.9%, 93.0%). In 14 pts (73.7%) with Her2 IHC 3+, 12 achieved ORR, with an ORR of 85.7% (95% CI: 56.2%, 97.5%). Among the 5 pts with Her2 IHC 2+, 3 achieved ORR, with an ORR of 60.0% (95% CI: 17.0%, 92.7%). In addition, among the 5 pts who had prior PD-1 treatment failure, ORR was 60.0% (95% CI: 17.0%, 92.7%), and 2 achieved CR (40.0%, 95% CI: 7.3%, 83.0%). 1 patient died due to non-treatment-related causes. The duration of response (DOR) rate was 92.9% (95% CI: 80.3%, 100.0%), and the twelve-month DOR rate was 61.9% (95% CI: 27.4%, 100.0%). The twelve-month cystectomy-free survival (CFS) rate was 84.2% (95% CI: 69.3%, 100.0%), and the median CFS was not achieved. The twelve-month EFS rate was 75.8% (95% CI: 48.3%, 100.0%), and the median EFS was not achieved. The most commonly occurring grade 1-2 treatment-related adverse events (TRAEs) were alopecia (36.8%), rash (36.8%), pruritus (36.8%), anorexia (31.6%), and fatigue (26.3%). Grade 3-4 TRAEs were reported in 3 patients (6.3%), including rash, pruritus, leukopenia, and neutropenia. No grade 5 adverse events were reported. Conclusions: The results of this retrospective study show that both RC48 monotherapy and RC48 combined with tislelizumab have promising efficacy in the treatment of NMIBC. The overall response rate was high, with tolerable and manageable treatment-related adverse events. These findings suggest that RC48 monotherapy and RC48 combined with tislelizumab may be successful strategies for the treatment of NMIBC. Now, we are conducting a prospective study to further clarify the value of RC48 combining tislelizumab in NMIBC.

Time dependent risk factors for epileptic seizures in glioblastoma patients: A retrospective analysis of 520 cases.

Epilepsy is a common comorbidity of glioblastoma. Seizures may occur in various phases of the disease. We aimed to assess potential risk factors for seizures in accordance with the point of time at which they occurred. We retrospectively analysed medical files of adult patients with de novo glioblastoma treated at our institution between 01/2006 and 01/2020. We categorized seizures as preoperative seizures (POS), early postoperative seizures (EPS; before initiation of radio(chemo)therapy, RCT), seizures during radiotherapy (SDR; during or < 30 days after RCT) and post-therapeutic seizures (PTS; ≥ 30 days after completion of RCT). We addressed associations between patients' characteristics and their seizures. In the final cohort (N = 520), 292 patients experienced seizures. POS, EPS, SDR and/or PTS occurred in 29.6 % (154/520), 6.0 % (31/520), 13.8 % (70/509) and 36.1 % (152/421) of patients, respectively. POS occurred more frequently in patients with higher Karnofsky performance scores (odds ratio (OR) 3.27, p = 0.001) and tumour location in the temporal lobe (OR 1.51, P = 0.034). None of the parameters we analysed was related to the occurrence of EPS. SDR were independently associated with tumour location (parietal lobe, OR 1.86, P = 0.027) and POS, but not EPS, and were independent of RCT. PTS were independently associated with tumour progression (OR 2.32, P < 0.001) and with occurrence of SDR (OR 3.36, P < 0.001), and negatively correlated with temporal lobe location (OR 0.58, p < 0.014). In patients with tumours exclusively located in the temporal lobe, complete tumour resection was associated with a decreased risk of postoperative seizures. Seizures in glioblastoma patients have various, time-dependent risk factors. Temporal lobe localisation was a risk factor for preoperative seizures; surgery may have had a protective effect in these patients. RCT did not have dose-dependent pro- or anticonvulsive effects. PTS were associated with tumour progression.

Photodynamic Diagnosis-guided Transurethral Resection of Bladder Tumour in Participants with a First Suspected Diagnosis of Intermediate- or High-risk Non–muscle-invasive Bladder Cancer: Cost-effectiveness Analysis Alongside a Randomised Controlled Trial

BackgroundRecurrence of non–muscle-invasive bladder cancer (NMIBC) is common after transurethral resection of bladder tumour (TURBT). Photodynamic diagnosis (PDD) may reduce recurrence. PDD uses a photosensitiser in the bladder that causes the tumour to fluoresce to guide resection. PDD provides better diagnostic accuracy and allows more complete tumour resection. ObjectiveTo estimate the economic efficiency of PDD-guided TURBT (PDD-TURBT) in comparison to white light–guided TURNT (WL-TURBT) in individuals with a suspected first diagnosis of NMIBC at intermediate or high risk of recurrence on the basis of routine visual assessment before being scheduled for TURBT. Design, setting, and participantsThis is a health economic evaluation alongside a pragmatic, open-label, parallel-group randomised trial from a societal perspective. A total of 493 participants (aged ≥16 yr) were randomly allocated to PDD-TURBT (n = 244) or WL-TURBT (n = 249) in 22 UK National Health Service hospitals. Outcome measurements and statistical analysisCost effectiveness ratios were based on the use of health care resources associated with PDD-TURBT and WL-TURBT and quality-adjusted life years (QALYs) gained within the trial. Uncertainties in key parameters were assessed using sensitivity analyses. Results and limitationsOn the basis of the use of resources driven by the trial protocol, the incremental cost effectiveness of PDD-TURBT in comparison to WL-TURBT was not cost saving. At 3 yr, the total cost was £12 881 for PDD-TURBT and £12 005 for WL-TURBT. QALYs at three years were 2.087 for PDD-TURBT and 2.094 for WL-TURBT. The probability that PDD-TURBT is cost effective was never >30% above the range of societal cost-effectiveness thresholds. ConclusionsThere was no evidence of a difference in either costs or QALYs over 3-yr follow-up between PDD-TURBT and WL-TURBT in individuals with suspected intermediate- or high-risk NMIBC. PDD-TURBT is not supported for the management of primary intermediate- or high-risk NMIBC. Patient summaryWe assessed overall costs for two approaches for removal of bladder tumours in noninvasive cancer and measured quality-adjusted life years gained for each. We found that use of a photosensitiser in the bladder was not more cost effective than use of white light only during tumour removal.

Hypofractionated Radiation Therapy (Hypo-RT) for the Treatment of Localized Bladder Cancer.

Various radiotherapeutic regimens are used in the treatment of bladder cancer. We aimed to evaluate early toxicity and outcomes associated with hypofractionated radiation therapy (Hypo-RT), 55Gy in 20 fractions. We identified 40 patients who received definitive Hypo-RT for localized bladder cancer. Most patients were men (62.5%), elderly (median age 82), had high Charlson Comorbidity Index score (median 7, range 4-9) and were nonsurgical candidates (80%). Sixty-eight percent had a macroscopically complete transurethral resection of bladder tumor (TURBT) and 33 patients (82.5%) received concurrent chemotherapy. Acute (< =3mo) and late (>3mo) toxicities were assessed according to CTCAE v4.0. Survival outcomes were estimated using the Kaplan-Meier method. Median follow up after Hypo-RT was 32 months (95% CI: 28-49 months). Overall rates of acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities were 40% each, most commonly urinary frequency and diarrhea. Two cases of acute grade 3 GU/GI toxicity occurred. Late grade 2+ toxicity occurred in 3 patients (7.5%): 2 grade 2 GU and 1 grade 3 GI. Seventy-seven percent achieved a complete response (CR). Six patients (20%) developed disease recurrence at a median time of 9.1 months. The estimated 2-year DFS and 2-year DSS rate were 59% (95% CI, 45-78%) and 78% (95% CI, 65-93%), respectively. Receipt of concurrent chemotherapy (p = 0.003) and achieving a CR (p = 0.018) were univariably associated with improved DSS. Tis component was associated with worse DSS (p = 0.015). Hypo-RT had a favorable toxicity profile and encouraging cancer control outcomes in this mostly elderly and frail patient cohort.

Micrographic controlled surgery in everyday dermatosurgery

Micrographic controlled surgery (MCS) has become established in dermatosurgery in recent years and includes various methods to enable the histologically proven complete resection of malignant cutaneous tumors, while at the same time sparing tumor-free tissue in the immediate vicinity as much as possible. MCS is of great importance in the surgical treatment of cutaneous malignancies in so-called problem locations and aggressive tumor subtypes. Indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease and Bowen's carcinoma, melanoma in chronic light-damaged skin with acral lentiginous melanoma, dermatofibrosarcoma protuberans (DFSP), and Merkel cell carcinoma. However, other tumor entities are also treated using MCS, such as extramammary Paget's disease and various cutaneous sarcomas. All procedures subsumed under MCS have in common the marking of the surgical specimen for topographical orientation, which provides assignment of remaining tumor remnants. Various methods of MCS (3D histology, the horizontal method or Mohs surgery) are presented in this article. Furthermore, this article aims to raise awareness of the possibilities and limitations of micrographically controlled surgery.

Bioinspired color-near infrared endoscopic imaging system for molecular guided cancer surgery.

Fluorescently guided minimally invasive surgery is improving patient outcomes and disease-free survival, but biomarker variability hinders complete tumor resection with single molecular probes. To overcome this, we developed a bioinspired endoscopic system that images multiple tumor-targeted probes, quantifies volumetric ratios in cancer models, and detects tumors in ex vivo samples. We present a new rigid endoscopic imaging system (EIS) that can capture color images while simultaneously resolving two near-infrared (NIR) probes. Our optimized EIS integrates a hexa-chromatic image sensor, a rigid endoscope optimized for NIR-color imaging, and a custom illumination fiber bundle. Our optimized EIS achieves a 60% improvement in NIR spatial resolution when compared to a leading FDA-approved endoscope. Ratio-metric imaging of two tumor-targeted probes is demonstrated in vials and animal models of breast cancer. Clinical data gathered from fluorescently tagged lung cancer samples on the operating room's back table demonstrate a high tumor-to-background ratio and consistency with the vial experiments. We investigate key engineering breakthroughs for the single-chip endoscopic system, which can capture and distinguish numerous tumor-targeting fluorophores. As the molecular imaging field shifts toward a multi-tumor targeted probe methodology, our imaging instrument can aid in assessing these concepts during surgical procedures.

Unusual presentation of a large GIST: a challenging diagnostic dilemma

Introduction: Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated withhigh rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computedtomography (CT) scan and most stain positive for CD 117 (C-Kit), CD34, and/ or DOG-1. There have been many riskstratification classifications systems which are calculated based on tumor size, mitotic rate, location and perforation. Case presentation: A 42 years old man presented with dysphagia and weight loss for 2.5 months. On examination, hewas severely anaemic having a huge intra-abdominal lump. He underwent laparotomy followed by removal of tumormass with partial left lobectomy of the Liver. Conclusion:We present a case of GIST of unusual location and presentation pattern. In general, only completeresection of tumor can lead to cure, although recurrence is common after surgery. Bangladesh Crit Care J March 2023; 11 (1): 54-60

A-252 A SINGLE CENTER SERIES OF TRACHEA RESECTIONS FOR LOCALLY ADVANCED TUMOR INFILTRATION

Abstract Background Infiltration of the cervical-visceral axis in advanced thyroid carcinoma determines the prognosis of the patients. Complete locoregional tumour resection therefore prolongs the survival even in presence of distant metastases. Results of trachea resections performed at the University Medical Center (UMC) Mainz are presented and discussed with regard to the literature. Methods Patients who underwent neck surgery along with trachea resection in a time period from January 2007 to December 2022 were retrospectively included in the study. Surgical resection strategy and operation-associated complications were documented. Overall survival and post resection survival were analysed. Results From 2007 to 2022, at the single-center UMC Mainz 36 patients (16 female, 20 male) were treated with neck surgery with trachea resections for locally advanced carcinomas. Of these, 18 underwent trachea shaving, 15 partial trachea resection and 3 circular trachea resections. Underlying histology was papillary (16/36), follicular (8/36) and poorly differentiated (4/36) thyroid carcinoma, and 8 other diagnoses. 10 patients suffered from postoperative complications (of these, 5 patients ≥ Dindo Clavien grade 4). Tumor recurrence was registered in 5 cases, whereas 19 patients remained tumour free after the operation (tumour persistence in 12 individuals). Mean overall survival from diagnosis was 75 months, mean postoperative survival was 31 months (mean postoperative follow-up period: 31 months). Conclusion Trachea resections for locally advanced tumour infiltration are feasible within highly individualised treatment concepts.

Stereotactic radiosurgery for recurrent skull base polymorphous adenocarcinoma invading the cavernous sinus: illustrative case.

Polymorphous adenocarcinomas (PACs) are rare tumors arising from the salivary glands. Radical resection and postoperative radiotherapy are the mainstays of treatment. However, complete tumor resection is not always achievable when the tumor invades the skull base. Stereotactic radiosurgery (SRS) could be a less invasive alternative for treating skull base PACs. A 70-year-old male with a history of surgery for a right palatine PAC presented with right visual impairment, diplopia, and ptosis. Imaging studies revealed tumor recurrence invading the right cavernous sinus (CS). SRS using a gamma knife was performed for this recurrence, prescribing a marginal dose of 18 Gy at a 50% isodose line. Five months after SRS, his symptoms were relieved, and the tumor was well-controlled for 55 months without any adverse events. To the best of the authors' knowledge, this is the world's first case of recurrent skull base PAC invading the CS that was successfully treated with salvage SRS. Thus, SRS may be an applicable treatment option for skull base PACs.

Analysis of the efficacy of microdissection of paravebous sinus meningiomas invading large venous sinuses

ObjectiveThe management of paravebous sinus meningiomas that invade major venous sinuses is a subject of debate, particularly concerning the necessity of complete resection of the tumor and reconstruction of the venous sinus. This article aims to demonstrate the outcomes of total removal of the lesion (including the invading venous sinus portion) and the effects of restoring or not restoring venous circulation in terms of recurrence of the tumor, mortality, and post-operative complications.MethodsThe authors conducted a study involving 68 patients with paravebous sinus meningiomas. Of the 60 parasagittal meningiomas, 23 were located in the anterior third, 30 in the middle third, and 7 in the posterior third. Additionally, 3 lesions were located in the sinus confluence area, and 5 in the transverse sinus. All patients underwent surgery, and the degree of venous sinus involvement was classified into six types. For type I meningiomas, the outer layer of the sinus wall was stripped off. For types II to VI, two strategies were employed: non-constitutional, wherein the tumor and affected venous sinuses were removed without repair, and reconstructive, wherein the tumor was completely removed and the venous sinuses were sutured or repaired. Karnofsky Performance Status (KPS) scale and Magnetic Resonance Venography (MRV) were utilized to assess the outcomes of the surgical procedures.ResultsThe study group of 68 patients underwent complete tumor resection in 97.1%, with sinus reconstruction attempted in 84.4% of cases with sinus wall and sinus cavity invasion. The recurrence rate of this group was 5.9%, with follow-up ranging from 33 to 57 months. It was found that the recurrence rate was significantly higher in cases with incomplete resection than in those with complete resection. The overall mortality rate was 4.4%, with all cases resulting from malignant brain swelling due to the failure to perform venous reconstruction after resectioning of the meningioma type VI. Furthermore, 10.3% of patients experienced worsening symptoms of neurological deficits or complete loss of neurological function, with a significantly higher incidence in those without venous reconstruction than in the venous reconstruction group (P < 0.0001, Fisher test). No statistically significant pre-operative and post-operative KPS differences were observed in patients with type I to V. However, in patients with type VI (who did not receive venous reconstruction), the post-operative KPS score was significantly worse.ConclusionThe results of this study suggest the necessity of a complete resection of the tumor, including the invasive venous sinus component, as the recurrence rate was found to be relatively low at 5.9%. Moreover, patients who did not undergo venous reconstruction showed significant deterioration in their clinical condition compared to other subgroups, thus highlighting the importance of venous sinus reconstruction.

A giant orbital solitary fibrous tumor treated by surgical excision: a case report and literature review

BackgroundSpindle cell tumors, called solitary fibrous tumors (SFTs), are of mesenchymal origin, and can develop in the orbit. As ‘intermediate malignancy’ tumors, only a small percentage show malignant behavior, such as invasion of surrounding tissue.Case presentationA 57-year-old woman presented with a 19-year history of a giant right orbital mass. Orbital computed tomography (CT) revealed an inhomogeneously-enhancing mass compressing and engulfing the eyeball and optic nerve. She underwent lid-sparing orbital exenteration. Microscopic characteristics and immunohistochemistry (IHC) tests were indicative of a benign SFT. No recurrence was observed at the 4-year follow-up.ConclusionEarly and complete tumor resection is recommended.

Epigenetic profiling reveals a strong association between lack of 5-ALA fluorescence and EGFR amplification in IDH-wildtype glioblastoma.

5-aminolevulinic acid (5-ALA) fluorescence-guided resection increases the percentage of complete CNS tumor resections and improves the progression-free survival of IDH-wildtype glioblastoma patients. A small subset of IDH-wildtype glioblastoma shows no 5-ALA fluorescence. An explanation for these cases is missing. In this study, we used DNA methylation profiling to further characterize non-fluorescent glioblastomas. Patients with newly diagnosed and recurrent IDH-wildtype glioblastoma that underwent surgery were analyzed. The intensity of intraoperative 5-ALA fluorescence was categorized as non-visible or visible. DNA was extracted from tumors and genome-wide DNA methylation patterns were analyzed using Illumina EPIC (850k) arrays. Furthermore, 5-ALA intensity was measured by flow cytometry on human gliomasphere lines (BT112 and BT145). Of 74 included patients, 12 (16.2%) patients had a non-fluorescent glioblastoma, which were compared to 62 glioblastomas with 5-ALA fluorescence. Clinical characteristics were equally distributed between both groups. We did not find significant differences between DNA methylation subclasses and 5-ALA fluorescence (P = .24). The distribution of cells of the tumor microenvironment was not significantly different between the non-fluorescent and fluorescent tumors. Copy number variations in EGFR and simultaneous EGFRvIII expression were strongly associated with 5-ALA fluorescence since all non-fluorescent glioblastomas were EGFR-amplified (P < .01). This finding was also demonstrated in recurrent tumors. Similarly, EGFR-amplified glioblastoma cell lines showed no 5-ALA fluorescence after 24 h of incubation. Our study demonstrates an association between non-fluorescent IDH-wildtype glioblastomas and EGFR gene amplification which should be taken into consideration for recurrent surgery and future studies investigating EGFR-amplified gliomas.