First Diagnosis Of Recurrence Research Articles

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation

BackgroundsDespite publication of international guidelines, there are notable controversial points of clinical target volume (CTV) delineation in nasopharyngeal carcinoma (NPC). Recently, scholars proposed a novel way of delineation of CTV in NPC—individualization of CTV delineation based on T classification and spread patterns, which yielded excellent long-term local control with limited late toxicities. The aim of this study was to clarify the anatomic patterns and pathways of local recurrence of NPC and provide a clinical reference for the delineation of CTV.MethodsA total of 869 patients with non-metastatic NPC were treated with intensity-modulated radiation therapy (IMRT) at our institution between 2009 and 2010. Among the 57 cases of local/locoregional recurrence, 52 cases with traceable radiotherapy plans and magnetic resonance imaging at the time of the first diagnosis of recurrence were included. Anatomical structures and gross tumor volume of local recurrence were contoured. The incidence of relapse of each anatomic structure, route of local recurrence, and their correlation were analyzed.ResultsLocally advanced disease had a significantly increased risk of recurrence in the posterior nasal cavity and a trend towards higher risk of recurrence in the clivus, lateral pterygoid muscle, and hypoglossal canal. Based on the incidence of local recurrence, we constructed a high-risk map for the early and locally advanced stages. Local recurrences were classified into five routes, where anterior extension accounted for the majority (30.8%), and caudal tumor extension pathway had the lowest incidence (5.8%). There was a significant correlation between the local recurrences of neural foramina and neighboring anatomical structures along each pathway. All cases relapsed at unilateral cavernous sinus, most at the same side of primary tumor. Based on our findings, we proposed some suggestions on delineations of CTV, based on T classification and local extension pattern.ConclusionsLocal recurrence of NPC varied according to T classification, followed a stepwise pattern, spread via neural foramina, and recurred at ipsilateral cavernous sinus. This provides meaningful clinical evidence for delineation of CTV, especially individualized delineation.

Risk Factors of Brain Metastasis and Prognosis in HER2-Positive Breast Cancer: A Single-Institution Retrospective Analysis from China.

BackgroundBrain metastasis (BM) frequently occurs in HER2-positive breast cancer (BC) patients, but the risk factors of BM in this type of patients are still unknown. Our study aims to assess the risk factors of BM and prognostic analysis in HER2-positive BC patients.MethodsUnivariate analysis used t-test, chi-square test, and Fisher’s exact test to find out the risk factors for BM, and multivariable analysis was done with stepwise logistic regression analysis. Prognostic data analysis was estimated by the Kaplan–Meier method.ResultsA total of 228 HER2-positive BC patients were included, of whom 214 patients were postoperative metastatic patients and 14 patients were de novo stage IV patients. Through comparing the stratified variables between 51 postoperative metastatic patients with BM and 163 postoperative metastatic patients without BM, the multivariate analysis showed that age ≤40 years (OR 2.321, 95% CI: 1.089 to 4.948) and first metastatic site with lung metastasis (OR 2.168, 95% CI: 1.099 to 4.274) were independent risk factors for BM in HER2-positive BC patients. Prognostic data of all 65 HER2-positive BC patients with BM showed that the time from the diagnosis of BC to the development of breast cancer brain metastasis (BCBM) was 36.3 months (95% CI: 30.0 to 42.1 months). The time from the diagnosis of first recurrence and metastasis stage to the diagnosis of BCBM was 11.35 months (95% CI: 7.1 to 18.4 months). The time from the diagnosis of BCBM to the time of follow-up was 24.1 months (95% CI: 13.9 to 37.5 months). Up until the time of follow-up data, a total of 38 patients had died, and the time from the diagnosis of BM of these 38 patients to death was 11.0 months (95% CI: 9.0 to 20.4 months).ConclusionThe prognosis of HER2-positive BC patients with BM was poor due to the lack of effective treatments for BM. Age ≤40 years and first metastatic site with lung metastasis were the independent risk factors for BM in HER2-positive BC patients. Future research about pre-emptive medical interventions may help to improve the prognosis of HER2-positive BC patients with high risk to develop BM.

Abstract P1-21-06: Phase I study of T-DM1 and metronomic temozolomide in secondary prevention of HER2+ breast cancer brain metastases following local radiation therapy

Abstract Background: The incidence of breast cancer brain metastases is rising, and, these lesions in the central nervous system (CNS) and their treatments cause physical and neurocognitive impairment. Only modest incremental advances in progression free survival have been achieved with drugs to treat CNS lesions, while nearly half of the patients who receive SRS will develop new brain metastases within 1 year. In murine models of breast cancer, we demonstrated that low doses of temozolomide (TMZ) administered in a prophylactic, metronomic fashion significantly prevented development of brain metastases. No effect, however, was seen in established brain metastases or systemic breast cancer metastases. We hypothesize that low dose, metronomic TMZ will prevent the outgrowth of brain lesions in HER2+ patients, when added to an active anti-HER2 treatment. We present here the results of the phase I trial combining T-DM1 to TMZ for the prevention of additional brain metastases after their first occurrence and local treatment. Methods: Eligible patients had HER2+ breast cancer with brain metastases and were within 12 weeks of local brain metastases therapy (WBRT, SRS and or surgery), with PS 0-2 and adequate end organ function. Standard doses of T-DM1 were administered IV every 21 days (3.6 mg/kg) and TMZ was given PO daily in a 3+3 design at 30, 40 or 50 mg/m2, continuously. The DLT period was one 21d cycle. Safety was assessed by CTCAEv4.0 and response by RECISTv1.1 and RANO-BM. Brain MRI and systemic CT scans were performed every 6 weeks. Blood samples for correlatives evaluation were collected at baseline and every cycle while on trial. CSF was collected at baseline and C3D1 for all patients. Questionnaires (MDASI-BT and PROMIS®) for evaluation of symptoms and quality of life were completed every 6 weeks. Results: Twelve women with median age 55.5yr (44-67) were enrolled. Only 3 (25%) patients had HR+/HER2+ tumors at initial diagnosis. Nine (75%) patients presented stages II and III disease at initial diagnosis, and developed brain metastases at the diagnosis of first recurrence. Nine (75%) patients received SRS therapy and 3 (25%) received WBRT prior to trial enrollment. Grade 3 or 4 AEs included thrombocytopenia (1/12), neutropenia (1/12), lymphopenia (6/12) and decreased CD4 (6/12), requiring pentamidine for PCP prophylaxis. No DLT was observed. Four patients underwent dose reductions (thrombocytopenia, fatigue and peripheral neuropathy), all of them enrolled on the highest TMZ dose. Median follow-up on study is now 9.6m (1.2-32) and no patient developed new parenchymal brain metastases. Five patients remain on study, while 7 are off study due to progression at previously irradiated CNS lesion (2), progression of systemic disease (2), focal leptomeningeal involvement (1), new cancer (1) and persistent thrombocytopenia (1). Completion rates for the questionnaires were 99% by Cycle 15 (81 completed out of expected 82) and 90% by Cycle 41 (123/137), and will be reported at presentation. Conclusion: Metronomic TMZ in combination with standard dose T-DM1 is tolerable and shows promising activity in secondary prevention of HER2+ brain metastases. Systematic longitudinal symptom assessments in breast cancer patients with brain metastasis are feasible. A randomized phase II expansion of this trial with T-DM1 or T-Dxd +/- TMZ is planned. Citation Format: Alexandra S Zimmer, Seth Steinberg, Mark Gilbert, Terri Armstrong, Eric Burton, Nicole Houston, Dee Dee Smart, Nadia Biassou, John Butman, Priscilla K Brastianos, Carey K Anders, Stanley Lipkowitz, Patricia S Steeg. Phase I study of T-DM1 and metronomic temozolomide in secondary prevention of HER2+ breast cancer brain metastases following local radiation therapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-21-06.

Non-exenterative surgical management of recurrent endometrial carcinoma

ObjectiveTo examine the role of non-exenterative secondary cytoreductive surgery (SCS) compared with non-surgical treatments and identify predictors of improved survival for patients with recurrent endometrial cancer (EC). MethodsAll patients undergoing primary surgical management for EC 1/1/2009–12/31/2017 who subsequently developed recurrence were retrospectively identified. Survival was determined from date of diagnosis of first recurrence to last follow-up and estimated using Kaplan-Meier method. Differences in survival were analyzed using Log-rank and Wald tests, based on Cox Proportional Hazards model. ResultsAmong 376 patients with recurrent EC, median time to recurrence was 14.3 months (range, 0.2–102.2), post-recurrence median survival 29 months, median follow-up 29.2 months (range, 0–116). Sixty-one patients (16.2%) received SCS, 257 (68.4%) medical management (MM) (chemotherapy and/or radiation therapy), 32 (8.5%) hormonal therapy, 26 (6.9%) no further therapy. Patients selected for SCS were younger, had more endometrioid histology, more stage I disease at initial diagnosis, no residual disease after primary surgery, longer interval to first recurrence or progression, and the longest OS (57.6 months) (95% CI, 33.3–not reached). On multivariate analysis SCS was an independent predictor of improved survival. Among the 61 SCS patients, age < 70 at time of initial diagnosis, and endometrioid histology, were associated with improved post-relapse survival univariately (p = 0.008, 0.03, respectively). ConclusionsWhile MM was the most common treatment for first recurrence of EC, patients selected for surgery demonstrated the greatest survival benefit even after controlling for tumor size, site, histology, stage, time to recurrence. Careful patient selection and favorable tumor factors likely play a major role in improved outcomes. Surgical management should be considered whenever feasible in medically eligible patients, with additional consideration given to our suggested criteria.

The prognosis of recurrent low-grade endometrial stromal sarcoma: a retrospective cohort study

BackgroundThe prognosis of recurrent low-grade endometrial stromal sarcoma (LGESS) is little known. This study was to investigate the survival outcomes of a cohort of patients with recurrent LGESS.MethodsPatients with primary LGESS diagnosed and treated for first recurrence confirmed by histology in the study center from February 2012 to June 2019 were retrospectively included. The progression-free interval (PFI) after the last treatment for first recurrence and overall survival (OS) since the diagnosis of first recurrence, which were followed up to June 1, 2020, were compared between groups of various therapy modalities.ResultsFifty-six patients were included, and 43 patients (76.8%) had definite follow-up outcomes. The 5-year PFI and OS rates were 30.0% (95% confidence interval [95% CI] 29.2–30.8) and 75.0% (68.0–82.0), respectively. In univariate analysis, only fertility-sparing treatment, ovarian preservation and surgical treatment had a significant impact on the PFI (hazard ratio [HR] 4.5, 3.1, and 0.2; 95% CI 1.5–13.1, 1.3–7.3, and 0.1–0.7; and p = 0.006, 0.009 and 0.006, respectively), but no factor was found to be associated with increased mortality risk. After adjusted with hormone treatment or chemotherapy, surgical treatment had significant effectiveness on OS (HR 0.3 and 0.3, 95% CI 0.1–1.0 and 0.1–1.0, p = 0.045 and 0.049, respectively). None of the patients with fertility-sparing treatment had successful conception, and all experienced repeated relapse.ConclusionFor patients with recurrent LGESS, fertility-sparing treatment or ovarian preservation should not be provided. Surgery is the treatment of choice, and hormone treatment and/or chemotherapy was effective for the survival benefits of surgical treatment.

Validity of Surgical Resection for Lymph Node or Pulmonary Recurrence of Esophageal Cancer After Definitive Treatment

BackgroundDespite the poor prognosis of recurrent esophageal squamous cell cancer (ESCC), long-term survival could be achieved in a subset of patients who successfully underwent surgical resection for recurrence. In this study, we investigated the outcomes of surgical resection for lymph node (LN) or pulmonary (PUL) recurrence in ESCC patients.MethodsWe retrospectively analyzed the outcomes of ESCC patients who underwent surgical resection between January 2008 and March 2015 for either LN or PUL recurrence after complete response (CR) by chemoradiotherapy or R0 esophagectomy. Every patient fulfilled the original institutional criteria: no recurrence at primary site; recurrence involving in only one organ; expectation of complete resection; and for PUL recurrence, no rapid growth with at least 2 months of observation.ResultsAmong the 13 patients analyzed, surgical resection was performed in nine and four patients with LN and PUL recurrence, respectively. R0 resection was achieved in all patients with no fatal surgical complications. Mean duration from the day of the first CR/R0 to the recurrence was 809 (110–2575) days. Median recurrence-free survival following surgical resection for recurrence and overall survival following the first diagnosis of recurrence was 387 and 1297 days, respectively.ConclusionSurgical resection for LN or PUL recurrence of ESCC according to our institutional criteria can be performed safely for selected patients.

Validity of eleven prognostic scores with respect to intra- and extrahepatic recurrence of hepatocellular carcinoma after liver transplantation.

Tumor recurrence is the most frequent cause of death after liver transplantation for hepatocellular carcinoma. We selected ten other prognostic classifications to evaluate their potential to predict the risk of recurrence after LT for HCC as compared to the Milan classification. All of the other scores have not been compared with one another in a single cohort. Data of 147 consecutive patients transplanted at our department between 1996 and 2014 were analyzed and staged for morphological and functional scores of underlying liver disease. For long-term follow-up, we analyzed intrahepatic (within the liver±distant metastases) and extrahepatic (distant metastases only) recurrence separately. The median survival time for all patients was 106months. The 5- and 10-year observed survival rates were 61 and 43%, respectively. The observed cumulative 5- and 10-year recurrence rates were 37 and 39%, respectively, 10-year intrahepatic and extrahepatic recurrence rates were 12 and 27%, respectively. Median survival time after diagnosis of first recurrence was 7.5 (0-120) months; 2 and 18months for all, intra- and extrahepatic recurrence, respectively. UCSF-, up to seven-, Shanghai Fudan- or Duvoux classifications can identify patients with a cumulative 10-year recurrence rate below 20%. The pre-therapeutic AFP level should be considered in addition to the geometry of the intrahepatic lesions.

Outcomes of salvage high-dose-rate brachytherapy with or without external beam radiotherapy for isolated vaginal recurrence of endometrial cancer.

PurposeThis study was designed to retrospectively analyze outcomes of high-dose-rate (HDR) brachytherapy, with or without external beam radiotherapy (EBRT), in patients with vaginal recurrence of endometrial carcinoma, and to identify factors prognostic of patient outcomes.Material and methodsThe medical records of all patients who underwent HDR brachytherapy for initial recurrence in the vagina of endometrial cancer after definitive surgery between 1992 and 2014 were retrospectively reviewed. All patients underwent either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT) with or without EBRT. Late toxicity was graded using the EORTC (LENT/SOMA) scale, revised in 1995.ResultsThirty-seven patients were identified. The median follow-up time was 48 months (range: 6-225 months). Of these 37 patients, 23 underwent ICBT, 14 underwent ISBT, and 26 underwent EBRT. Tumor size at first examination of initial relapse was significantly larger in the ISBT than in the ICBT group. The 4-year respective overall survival (OS), local control (LC), and progression-free survival (PFS) rates in the entire cohort were 81.0%, 77.9%, and 56.8%, respectively. The interval between diagnosis of first recurrence and radiotherapy (< 3 months, ≥ 3 months) was a significant predictor of LC and PFS. OS and LC rates did not differ significantly in the ICBT and ISBT groups. Two patients experienced grade 2 rectal bleeding, and four experienced grade 2 hematuria. No grade 3 or higher late complications were observed.ConclusionsSalvage HDR brachytherapy is an optimal for treating vaginal recurrence of endometrial carcinoma with acceptable morbidity. Early radiotherapy, including brachytherapy, should be considered for women who experience vaginal recurrence of endometrial cancer.

Recurrent glioblastoma: who receives tumor specific treatment and how often?

The recurrence of glioblastoma (rGBM) is inevitable and often short-term. Therefore, information on the prognosis and effectiveness of tumor-specific versus purely palliative approaches should be more in-depth than a mere list of available treatment options for patients in this situation. However, follow-up data on the course of the disease in unselected patient populations after completion of primary treatment are scarce. This single-center analysis investigated the rate and number of glioblastoma recurrences after initial radiotherapy in 189 consecutive GM patients, focusing on the incidence of early death and the frequency of tumor-specific treatment (TST) versus best-supportive care (BSC) as well as the outcomes for the different approaches. In 61% of initial population first recurrence (rGBM) could be determined by histology or imaging. 47% received TST. 58% of the patients with rGBM and TST were diagnosed with a second recurrence. Up to five recurrences were treated. 35-45% of patients died before undergoing imaging studies to confirm the next recurrence. Multivariate analysis identified male sex and KPS score as independent factors (p<0.01) for the choice of TST over BSC. Median overall survival from the diagnosis of first recurrence was 267days in the TST group versus 65days in patients receiving BSC (p<0.0001). Nearly half of all rGBM patients received second-line TST, but a remarkably high proportion died early. Gender and KPS played a role in the choice of TST over BSC for recurrence treatment.

Prognostic significance of serum Her2/neu, BCL2, CA15-3 and CEA in breast cancer patients: A short follow-up

Breast cancer is the most common malignancy in women, options for treatment of breast cancers are complex and varied, there is a need for biological prognostic indicators that would, alone or in combination with others, be sufficient to predict disease recurrence and hence, the basis for supplemental treatment after local therapy. The aim of this study was to determine prognostic significance of serum Her2/neu, BCL2, CA 15-3 and CEA during the follow-up of the patients with breast cancer, also, to investigate the association between these biomarkers and clinicopathological parameters and patient outcomes in breast cancer. Eighty nine patients with breast cancer stage I and II are enrolled in our study. Their age ranged from 35-59 years. Patients underwent radical mastectomy or breast-conserving surgery with axillary lymph node dissection. After the surgical treatment they had supplementary therapy. The size of the tumor was < 2 cm in 35 patients and > 2 cm in 54 patients. Their histological type was invasive duct carcinoma, 49 patients had lymph node positive and 40 had negative lymph node. Nine patients had recurrence of the disease during the 18 months of follow up. BCL2, Her2/neu, CEA and CA15-3 in sera had been monitored by ELISA before and after operation, every 6 months and at the time of diagnosis of first recurrence for 18 months. Preoperative serum levels of Her2/neu, BCL2, CA15-3 and CEA were significantly higher compared with the levels of the control group, these markers dropped significantly after operation. Univariate analysis of parameters associated with relapse showed that the clinicopathological factors (histologic grade, tumor stage and lymph nodes) and serum markers (HER2/neu, BCL2, CA15-3 and CEA) were significantly associated with recurrence of disease. Multivariate analysis of investigated parameters revealed that tumor stage, lymph nodes and serum tumor markers were significant variables predicting recurrence of tumor. Serum Her2/neu, BCL2, CA15-3 and CEA in breast cancer patients were useful markers for predicting aggressive behavior of tumor and elevated serum levels are associated with breast cancer relapse. Our relatively small study population limits the predictive power of the panels presented here, but the benefits of a serum biomarker and multimarker approach are clearly illustrated and further studies utilizing larger clinical cohorts are well warranted.

Aurora kinase B is a predictive factor for the aggressive recurrence of hepatocellular carcinoma after curative hepatectomy

Patterns of cancer recurrence hold the key to prognosis after curative resection. This retrospective study aimed to identify a predictor and therapeutic candidate for aggressive recurrence of hepatocellular carcinoma (HCC). Primary HCC tissues from 107 patients who had curative resection were analysed. Genome-wide gene expression profiles were investigated using a microarray technique, and clustering analysis was carried out based on the first diagnosis of recurrence according to the Milan criteria. Immunohistochemical expression and array-based comparative genomic hybridization (array-CGH) were also assessed. Microarray analysis revealed overexpression of Aurora kinase B, a chromosome passenger protein kinase, as the most significant predictor of the aggressive recurrence of HCC. Aurora kinase B protein expression was significantly associated with aggressive recurrence (P < 0.001) and prognosis (P < 0.001). Multivariable analysis identified Aurora kinase B as the only independent predictor of aggressive recurrence of HCC (P = 0.031). Array-CGH analysis showed that genomic instability was closely related to Aurora kinase B expression (P = 0.011). Aurora kinase B is an effective predictor of aggressive HCC recurrence, in relation to the genomic instability. It might be worth considering as a molecular target for the adjuvant therapy of HCC.

Outcomes and Recurrence of Initially Resectable Hepatocellular Carcinoma Meeting Milan Criteria: Rationale for Partial Hepatectomy as First Strategy

Partial hepatectomy and liver transplantation are considered curative treatments for small hepatocellular carcinoma (HCC) meeting the Milan criteria (solitary tumor <5 cm or up to 3 nodules <3 cm). This study was designed to clarify whether partial hepatectomy can be the first option in patients eligible for both treatments. All patients (n = 152) underwent curative surgical operation for primary HCC during 2000 to 2005 at our hospital. Eighty-seven patients met Milan criteria and the remaining 65 did not. Outcomes were examined according to Milan criteria. After partial hepatectomy, 3-year survival rate was 89.6% for the group that met Milan criteria, compared with 60.8% for the group that did not (p = 0.0044). Among patients with HCC who initially met the criteria, tumor recurrences were observed in 30 patients; 23 patients met criteria and 7 patients exceeded the criteria at first diagnosis of recurrence. Patients with recurrence within the criteria showed a higher 3-year survival rate compared with patients with recurrence exceeding the criteria (100% versus 19.8%; p < 0.0001). Analysis of clinicopathologic variables to predict mode of recurrence revealed tumor size (p < 0.0001) and lower histologic differentiation (p = 0.0326) as positive factors for recurrence exceeding Milan criteria. Our results suggest that it is an appropriate strategy to treat HCC patients who meet Milan criteria with partial hepatectomy. It should be noted that approximately one-tenth of patients who initially met Milan criteria experienced postoperative recurrence that exceeded the criteria.

Combination therapy of docetaxel, carboplatin or paclitaxel, carboplatin for patients with metastatic/recurrent carcinoma of the head and neck (SCCHN)

5576 Background: The five-year survival for patients with recurrent disease has not been significantly increased in the last years. Despite aggressive initial management of the primary tumor, patients suffer from locoregional recurrence in up to 50% and distant metastasis is seen in about 25% of cases. Materials and Methods: 96 patients with recurrent or metastatic carcinoma of the head and neck received therapy as follows. From August 1996 to May 2000, 52 patients received chemotherapy with paclitaxel 100 mg/m2 in combination with carboplatin AUC2. Between May 2000 and October 2004, 44 patients with recurrent or metastatic disease were treated with docetaxel 35 mg/m2 in combination with carboplatin AUC2. Both chemotherapy regimens were administered weekly for a maximum of six cycles. Results: Most of the patients underwent a combination first line therapy with CT/Surg/RT (48%/47.7%) or CT/RT (36%/23%) before suffering from rec. disease. After recurrence local, regional or distant, we observed 9.6% complete response for the combination-therapy with paclitaxel/carboplatin and 25% with docetaxel/carboplatin, partial response in 38.5% and 34.1% of the patients, yielding an overall response rate of 48.1% with weekly paclitaxel/carboplatin and 59.1% with weekly docetaxel/carboplatin. Stable disease was documented for 25% of the patients treated with paclitaxel/carboplatin and 18.2% after treatment with docetaxel/carboplatin. Median survival was measured after first diagnosis of recurrence or metastatic disease. We observed a median survival of 10.9 month for the group treated with paclitaxel/carboplatin and 37 month for patients treated with docetaxel/carboplatin. Therapy with both treatment-options was well tolerated, all 96 patients received six cycles. Most frequent toxicity was leucopenia (Grade I/II/III: paclitaxel 12%/27%/15%; docetaxel 25%/23%/16%). Conclusions: Chemotherapy for recurrent carcinoma of the head and neck with weekly docetaxel/carboplatin is well tolerated and effective. The toxicitiy profile makes this combination favourable for an outpatient setting. No significant financial relationships to disclose.

Response and Survival in Patients With Progressive or Recurrent Serous Ovarian Tumors of Low Malignant Potential

In Brief OBJECTIVE To evaluate the response to therapy and survival of patients with progressive or recurrent serous ovarian tumors of low malignant potential. METHODS Fifty-three patients with progressive or recurrent serous ovarian tumors of low malignant potential were identified. Response was assessed and progression-free and overall survival were analyzed. The influence of clinicopathologic factors on survival was determined. RESULTS In 49 patients with known histology of progression or recurrence, 36 (73%) had low-grade serous carcinoma, and 13 (27%) had serous ovarian tumors of low malignant potential. Forty-five patients received nonsurgical therapy and had an evaluable response. There were six (13%) patients with a complete response and six (13%) patients with a partial response. The median time to first progression or recurrence was 5.6 years. Median survival from diagnosis of first recurrence was 7.7 years. Median survival from initial diagnosis was 21 years. Nineteen (36%) patients are dead of tumor. Patients who recurred with low-grade serous carcinoma were more likely to die of tumor than those with serous ovarian tumors of low malignant potential (47% versus 0%, P = .045). Optimal cytoreduction was associated with improved survival (P = .007). CONCLUSION Patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival. Recurrence as low-grade serous carcinoma and failure to achieve optimal secondary cytoreduction were adverse prognostic factors. There were few responses to nonsurgical therapy. Patients with progressive or recurrent serous ovarian tumors of low malignant potential have prolonged survival despite a low rate of response to nonsurgical treatment.

Response and survival in patients with progressive or recurrent serous ovarian tumors of low malignant potential

OBJECTIVE: To evaluate the response to therapy and survival of patients with progressive or recurrent serous ovarian tumors of low malignant potential. METHODS: Fifty-three patients with progressive or recurrent serous ovarian tumors of low malignant potential were identified. Response was assessed and progression-free and overall survival were analyzed. The influence of clinicopathologic factors on survival was determined. RESULTS: In 49 patients with known histology of progression or recurrence, 36 (73%) had low-grade serous carcinoma, and 13 (27%) had serous ovarian tumors of low malignant potential. Forty-five patients received nonsurgical therapy and had an evaluable response. There were six (13%) patients with a complete response and six (13%) patients with a partial response. The median time to first progression or recurrence was 5.6 years. Median survival from diagnosis of first recurrence was 7.7 years. Median survival from initial diagnosis was 21 years. Nineteen (36%) patients are dead of tumor. Patients who recurred with low-grade serous carcinoma were more likely to die of tumor than those with serous ovarian tumors of low malignant potential (47% versus 0%, P = .045). Optimal cytoreduction was associated with improved survival ( P = .007). CONCLUSION: Patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival. Recurrence as low-grade serous carcinoma and failure to achieve optimal secondary cytoreduction were adverse prognostic factors. There were few responses to nonsurgical therapy.

Health System Costs of Metastatic Breast Cancer

To assess the costs of treating patients with incurable breast cancer, all health system costs during the interval from diagnosis of first recurrence or metastasis until death for 75 female subjects randomly selected from those known to have died of breast cancer in British Columbia, Canada between July 1, 1995 and December 31, 1996, were identified. Costs were determined from several databases within the British Columbia (BC) Ministry of Health, as well as from BC Cancer Agency patient charts. The mean total cost to the health system was CDN $36,474.33 (95% confidence interval $29,752-$43,196) per subject. The mean costs were highest for the youngest age group and lowest for the middle age group, but these only differed by $2,300. Inpatient costs accounted for the greatest proportion of the total, over 50% in all age groups. This data may be valuable in assessing the cost-effectiveness of interventions that are known to affect mortality due to breast cancer.

An optimal follow-up protocol for renal cell carcinoma based on the occurrence of recurrences after surgery

The tumor biology of renal cell carcinoma (RCC) remains poorly understood and the prognosis of which is unpredictable. To define an optimal follow-up protocol in nonmetastatic RCC, tumor recurrences and the clinical course were assessed in the patients who had undergone nephrectomy. Between March 1972 to July 1999, 265 patients with PT1-3N0 (Nx) M 0 RCC underwent radical or partial nephrectomy. Clinicopathological variables were compares with the time of the first recurrence, site of metastasis and reason for diagnosis. In July 1999, the median (range) follow-up for the surviving patients was 50 (1-244) months. Metastases were diagnosed in 45 of the 265 patients (17%). Sixty percent of the patients had their metastases diagnosed within 3 years and 87% by 6 years. The incidence and the mean time to first diagnosis of recurrence were 9.0% and 43.6 months for pT1, 32.4% and 39.6 months for pT2, and 32.7% and 25.0 months for pT3. Metastatic sites and the mean time of diagnosis were 40.6 months in lung (46.7%), 26.1 months in bone (17.8%), 18.6 months in retroperitoneal organs (11.1%), 38.0 months in liver (6.7%), 51.0 months in thyroid gland (4.4%) and 31.0 months in brain (2.2%). Most recurrence in lung, retroperitoneal organs and liver were incidentally diagnosed, whereas recurrences in bone, thyroid gland and brain had some symptoms associated with metastases. Incidence of lung metastasis in pT1 (9 patients, 56%) and pT2 (6, 55%) was greater than that in PT3 (6, 33%). In contrast, incidence of abdominal metastasis (retroperitoneal organs and the liver) in pT3 (4 patients, 33%) was grater than pT1 (2, 12%) and PT2 (1, 16%). The results indicate that the risk of tumor progression and site of metastasis seemed to depend on original TNM stage. Therefore stage specific postoperative follow-up protocol should be considered. The yearly follow-up may suffice for pT1a patients after surgery. For pT1b and pT2 patients, the follow-up should be intense during the first 3 years by a routine chest X-ray. For pT3 patients, the follow-up during the first 2 years may be important. Particularly, considering the high incidence of abdominal metastasis in these patients, examination by CT scan is recommended every 6 months in the first 2 years. No need for bone scintigraphy and brain CT was indicated for asymptomatic patients.

Recurrence rate after laparoscopic myomectomy

To determine the recurrence rate of myomas after laparoscopic myomectomy. Retrospective review (Canadian Task Force classification II-2). Tertiary referral center. One hundred fourteen women (age 25-51 yrs, median 38 yrs) who were followed for an average of 37 months (range 6-120 mo). Laparoscopic myomectomy. Follow-up data were obtained by chart review and from returned questionnaires. Variables were date of surgery, first diagnosis of recurrence, and last follow-up visit. There were 38 (33.3%) recurrences after an average interval of 27 months. Twenty-four of these women did not require treatment. Eight underwent a second laparoscopic myomectomy, and one had a third. One patient had myomectomy and then hysterectomy, and six patients chose hysterectomy to treat the first recurrence. Cumulative risk of recurrence (Kaplan-Meier curve) was 10.6% after 1 year, 31.7% after 3 years, and 51.4% after 5 years. Although laparoscopic myomectomy is associated with less morbidity than removal by laparotomy, our results suggest that recurrence of myomas may be higher with the laparoscopic approach. Of 38 women with recurrent myoma, however, only 14 (36.8%) required additional surgery.

Sexuality and Spousal Support Among Women with Advanced Breast Cancer

: This study examines the relationships of mood, age, living with a spouse, and time elapsed since diagnosis of first recurrence to sexual interest. Seventy-two women with metastatic breast cancer and 26 of their spouses were recruited through their oncologists. Women and their spouses were administered a battery of measures designed to assess psychosocial and medical variables. Eighty-three percent of the women and 100% of the spouses indicated that sexual pleasure was something they wanted to experience; however, only 25% of the women indicating this interest and only 19% of the spouses reported that it had been easy for them to experience sexual pleasure. For patients, living with a spouse was significantly associated with being interested in experiencing sexual pleasure [p <.05]. Patients with lower mood disturbance were significantly more able to experience sexual pleasure than those with high mood disturbance scores [p <.05]. Ability to experience sexual pleasure was significantly and positively correlated between patients and their spouses (r=.56, p <.01). Sexuality is an important aspect of quality of life for metastatic breast cancer patients and their spouses. Further research is needed to examine psychosocial factors that affect sexuality for this population.

A LONG TERM SURVIVAL AFTER SURGICAL RESECTION FOR EACH REPEATED LOCAL RECURRENCE OF RECTAL CANCER

A long term survival case following surgical resection for each repeated local recurrence of rectal cancer was reported. A 49-year-old male patient was performed rectal amputation by abdomino-perineal approach on December 4, 1979. Histological study revealed that the cancer was mucinous type, a1, no, lyo, vo, aw(-), ow(-), ew(-), Po, Ho, and stage II. On November 1982, he underwent tumor excision with combined coccygeal bone resection for local recurrence around the perineo-pelvic cavity. On December 1984, a possible curative resection for locally recurred tumor was also tried. On August 1987, pelvic exenteration was finally performed according to MRI findings displayed that the cancer had extended from the cervical portion of urine bladder toward the prostate gland. He is still surviving without any distant metastases for 5 years and 6 months from the first diagnosis of recurrence. The other 6 recurrence cases out of 64 curative and resectable rectal cancer cases in our department were also presented.