Difference In Local Recurrence Research Articles

Intraoperative Pathologic Margin Analysis and Re-Excision to Minimize Reoperation for Patients Undergoing Breast-Conserving Surgery.

Reoperation rates following breast-conserving surgery (BCS) range from 10 to 40%, with marked surgeon and institutional variation. The aim of this study was to identify factors associated with intraoperative margin re-excision, evaluate for any differences in local recurrence based on margin re-excision and determine reoperation rates with use of intraoperative margin analysis. We analyzed consecutive patients with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent BCS at our institution between 1 January 2005 and 31 December 2016. Routine intraoperative frozen section margin analysis was performed and positive or close margins were re-excised intraoperatively. Univariate analysis was used to compare margin status and the Kaplan-Meier method was used to compare recurrence. Multivariable logistic regression was utilized to analyze factors associated with re-excision. We identified 3201 patients who underwent BCS-688 for DCIS and 2513 for invasive carcinoma. Overall, 1513 (60.2%) patients with invasive cancer and 434 (63.1%) patients with DCIS had close or positive margins that underwent intraoperative re-excision. Margin re-excision was associated with larger tumor size in both groups. The permanent pathology positive margin rate among all patients was 1.2%, and the 30-day reoperation rate for positive margins was 1.1%. Five-year local recurrence rates were 0.6% and 1.2% for patients with DCIS and invasive cancer, respectively. There was no difference in recurrence between patients with and without intraoperative margin re-excision (p = 0.92). Both DCIS and invasive carcinoma had similar rates of intraoperative margin re-excision. Although intraoperative margin re-excision was common, the reoperation rate was extremely low and there was no difference in recurrence between those with or without intraoperative re-excision.

Comparison of subtotal vertebral resection with reconstruction and percutaneous vertebroplasty for treatment of metastasis in the lumbar spine

Purpose: Tumor metastasis in the spine can cause pain and fractures, leading to deformities, and deficits in movement, sensation, and bowel/bladder function. Percutaneous vertebroplasty (PVP) and subtotal vertebral resection with reconstruction (SVR) are suitable treatments, but their relative clinical efficacy is uncertain. The purpose of this retrospective cohort study was to compare the management and clinical effect of SVR for lumbar metastatic tumor with PVP.Methods: Sixty-seven patients (mean age: 58.6 years) with metastases in the lumbar spine received SVR or PVP at our institution between 2010 and 2013. Thirty-three patients received SVR via a posterior approach, in which vertebrae were resected, with the anterior and lateral walls retained using polymethylmethacrylate (PMMA), followed by reconstruction and pedicle screw fixation. Thirty-four patients received PVP via the vertebral pedicle. Patients were followed for 3–26 months.Results: None of the patients experienced serious complications after surgery, and all patients experienced significant amelioration of pain. Twelve patients (8 in the PVP group and 4 in the SVR group) died during the follow-up, and the survival time was significantly longer in the SVR group. Two patients in the SVR group and 7 patients in the PVP groups experienced recurrence during follow-up, but the groups had no significant difference in local recurrence. Both treatments significantly reduced scores for pain on a visual analog scale (pain-VAS) and disability (Oswestry Disability Index [ODI]), and increased performance status (Karnofsky Performance Status [KPS]). Compared with the PVP group, the SVR group had better ODI score at 1 month and 3 months after surgery and a higher KPS score at 1 month after surgery. The two groups had no significant difference in pain-VAS scores during follow-up.Conclusions: SVR is a reliable treatment for lumbar metastatic tumor and provides good survival rate and satisfying follow-up results.

Recurrence and Mortality of Melanoma In Situ of the Trunk or Extremities: A Surveillance, Epidemiology, and End Results Analysis.

Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck. The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE. The Surveillance, Epidemiology, and End Results (SEER) database (2000-2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed. Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56-1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12-6.47), nor overall mortality (HR 1.10, 95% CI 0.82-1.48) between MMS versus LE. There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.

Evaluation of 2014 margin guidelines on re-excision and recurrence rates after breast conserving surgery: A multi-institution retrospective study

IntroductionA 2014 consensus statement from the Society of Surgical Oncology and American Society for Radiation Oncology supported “no ink on tumor” as an adequate margin for breast conserving therapy (BCT). This study evaluates this statement in a multi-institution cohort. MethodsA retrospective review of BCT cases at 3 comprehensive cancer centers was performed. Women age >18 receiving BCT for T1-2 breast cancer from 2008-2012 were included. Pre-2014, all sites considered 2 mm adequate. Estimated re-excision rates using the 2014 guidelines were calculated and factors predictive of re-excision were analyzed. Results542 patients (545 lumpectomies) were eligible. Using a ≥2 mm margin standard, 32.8% of patients underwent re-excision compared to 14.1% after 2014 (p < 0.0001). Tumor size (p= 0.003), grade (p=0.015), and lymphovascular invasion (p=0.021) were predictive of re-excision. Patients with additional intraoperative margins excised were less likely to require reoperation (p=0.002). Local recurrence was unaffected by re-excision after mean followup of 66 months. ConclusionsThe 2014 margin guidelines markedly reduce re-excision rates. There is no difference in local recurrence for patients after re-excision for a close margin versus without Powered.

In the Era After the European Organisation for Research and Treatment of Cancer ‘Boost’ Study, is the Additional Radiotherapy to the Breast Tumour Bed Still Beneficial for Young Women?

AimsThe European Organisation for Research and Treatment of Cancer (EORTC) 22,881–10,882 trial showed significant benefit of a radiotherapy boost (RTB) in women ≤40 years in a pre-hormone therapy (HT) era. We determined how the use of HT and RTB changed in response to clinical guidelines and whether the benefit of routine RTB was still observed in the HT era. Materials and methodsBetween 1996 and 2004, a provincial database identified all women ≤40 years with breast cancer who met the inclusion criteria of the EORTC trial. In total, 411 patients were classified into three eras defined by the guidelines: era 1 (discretionary HT, discretionary RTB); era 2 (routine HT, discretionary RTB); era 3 (routine HT, routine RTB). HT use, RTB use and cumulative incidence of local recurrence were calculated and compared across eras. ResultsHT use increased after the first policy change from 13% to 75% for oestrogen receptor-positive patients (P < 0.01). RTB use also increased from 33% to 76% following the second policy change (P < 0.01). At 10 years, the cumulative incidence of local recurrence was 12% in era 1, 6% in era 2 and 6% in era 3 (era 2 versus era 3, P = 0.92). For patients in the routine HT era (eras 2 and 3 combined) there was no significant difference in local recurrence between RTB and ‘no RTB’ patients (6% versus 7%, P = 0.81). ConclusionsThe routine use of HT and RTB increased significantly after new practice guidelines. Introduction of the HT guideline was associated with a 6% improvement in local recurrence at 10 years. No improvement in local recurrence was associated with the introduction of the RTB guideline in the HT era. The routine use of a boost in unselected young women with negative margins should be re-evaluated in the current HT era.

Surgical margins for borderline and malignant phyllodes tumours.

Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.

Breast cancer treatment in the elderly: Do treatment plans that do not conform to NCCN recommendations lead to worse outcomes?

BackgroundAging remains one of the greatest risk factors for development of new breast cancer with more than 30% of breast cancers occurring after the age of 75. Elderly women have been found to not conform with all aspects of treatment recommendations. Our study compared outcomes of elderly breast cancer patients whose treatment did or did not conform to NCCN guidelines. MethodsA retrospective review was conducted of breast cancer patients over the age of 70. Comparisons were made between patients whose treatment did or did not conform to NCCN guidelines for recurrence, metastatic disease, and breast cancer related deaths. ResultsPatients whose treatment did not conform to NCCN guidelines were older (80.5 vs. 77.7 years, P = 0.001). No significant difference was seen between groups for tumor size, breast cancer type, or nodal status; however, more nonconforming women were ER/PR positive (90.3% vs. 76.6%, P = 0.020). There was no significant difference in local recurrence, metastatic disease, or breast cancer related deaths. ConclusionsWomen whose treatment did not conform to NCCN guidelines were not associated with worse outcomes.

Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer.

The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or diseasefree survival rate between laparoscopic and open surgery. However, the noninferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to complete TME. Although TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and meta-analyses of ongoing large-scale RCTs. Laparoscopic rectal cancer surgery has been steadily improving its safety for oncology surgery, which has been reported consistently in various multicenter RCTs. To improve surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.

Less is more in solid-dominant lung cancer? Sublobar resection versus lobectomy for solid-dominant stage IA non-small-cell lung cancer: A meta-analysis study.

Although lobectomy is well established as the standard surgical procedure for stage IA non-small-cell lung cancer (NSCLC), sublobar resection is increasingly preferred, particularly in intentional segmentectomy for radiologically less-invasive small NSCLC. However, the indication for sublobar resection of radiologically pure solid or solid-dominant NSCLC remains controversial, owing to its invasive pathological characteristics. Therefore, the present meta-analysis was conducted to compare the efficacy of sublobar resection with lobectomy for treating solid-dominant stage IA NSCLC. An electronic search was conducted using four online databases from their dates of inception to April 2017. The hazard ratio (HR) was used as a summary statistic for censored outcomes and the odds ratio (OR) was used as the summary statistic for dichotomous variables. A total of nine studies met the selection criteria, including a total of 2,265 patients (1,728 patients underwent lobectomy, 425 segmentectomy and 112 wedge resection). From the available data, patients treated with a sublobar resection had a higher risk of local recurrence compared with patients treated with lobectomy [OR=1.89; 95% confidence interval (CI), 1.02–3.50; P=0.04]. However, no obvious difference in local recurrence was found in a subgroup analysis of segmentectomy compared with lobectomy (OR=1.19; 95% CI, 0.68–2.10; P=0.61). Sublobar resection was not associated with a significantly negative impact on distant recurrence (OR=1.09; 95% CI, 0.55–2.16; P=0.796). Patients in the sublobar resection group had no significant differences in recurrence-free survival (RFS; HR=1.43; 95% CI, 0.76–2.69; P=0.27) and overall survival (OS; HR=0.96; 95% CI, 0.75–1.23; P=0.77) compared with those in the lobectomy group. In the subgroup analysis of anatomic segmentectomy compared with lobectomy, there was no significant difference in RFS, with mild inter-study heterogeneity. The current meta-analysis suggested that segmentectomy had a comparable oncologic efficacy to lobectomy for solid-dominant stage IA NSCLC. Therefore, segmentectomy may be a feasible alternative in selected cases of solid-dominant stage IA NSCLC. However, these findings should be confirmed by prospective randomized controlled trials in the future.

Evaluation of the utility of localized adjuvant radiation for node-negative primary cutaneous squamous cell carcinoma with clear histologic margins

Though the National Comprehensive Cancer Network recommends consideration of localized adjuvant radiation after clear-margin surgery for cutaneous squamous cell carcinoma (cSCC) with large-caliber (≥0.1-mm) nerve invasion (LCNI) and other high-risk features, only a single small study has compared surgery plus adjuvant radiation therapy (S+ART) to surgical monotherapy (SM) for cSCC. Compare S+ART to SM for primary cSCCs with LCNI and other risk factors. Matched retrospective cohort study of primary cSCCs (matched on sex, age, immune status, type of surgery, diameter, differentiation, depth, and LCNI) treated with S+ART versus SM. A subgroup analysis of cSCCs with LCNI was performed. In total, 62 cSCCs were included in matched analysis (31 S+ART and 31 SM) and 33 cSCCs in the LCNI analysis (16 S+ART and 17 SM). There were no significant differences in local recurrence, metastasis, or death from disease in either analysis. Risk of local recurrence was low (8%, 7/89), with 3 of the local recurrences being effectively treated upon recurrence. Single academic center and nonrandomized design. Adjuvant radiation did not improve outcomes compared with SM due to a low baseline risk of recurrence, although adjuvant radiation for named nerve invasion and LCNI of ≥3 nerves has been shown to improve outcomes in a prior study. Randomized studies are needed to define the subset of cSCC for whom adjuvant radiation has utility.

Comparing the benefits of postoperative adjuvant chemotherapy vs. observation for stage IB non-small cell lung cancer: a meta-analysis.

The aim of this meta-analysis was to compare the benefits of postoperative adjuvant chemotherapy vs. observation for stage IB non-small cell lung cancer (NSCLC). A literature search was performed in PubMed, Embase, and Cochrane Library databases, and stage IB NSCLC patients were assigned to the postoperative adjuvant chemotherapy and observation groups. The 5-year overall survival (OS), 5-year disease-free survival (DFS), local recurrence, and distant metastasis were then assessed. In addition, statistical analysis was conducted using Review Manager 5.3 software. The meta-analysis involved nine articles and included 1,645 stage IB patients. There was no significance in the 5-year OS [relative risk (RR) =1.05; 95% confidence interval (CI): 0.98-1.13; P=0.14] and 5-year DFS (RR =1.29; 95% CI: 0.97-1.72; P=0.08) between the postoperative adjuvant chemotherapy and observation groups. However, there was a significant difference in local recurrence (RR =0.43; 95% CI: 0.23-0.80; P=0.007) and distant metastasis (RR =0.68; 95% CI: 0.48-0.97; P=0.03) between the two groups. Adjuvant chemotherapy might not be recommended for stage IB NSCLC.

Functional surgery versus amputation for in situ or minimally invasive nail melanoma: A meta-analysis

Evidence on whether functional surgery is not inferior to amputation for the treatment of in situ or minimally invasive (Breslow thickness ≤0.5mm) nail melanoma is limited. To investigate the difference in local recurrence between the 2 interventions for in situ or minimally invasive nail melanoma using available published studies. We performed systematic search on PubMed, Embase, Cochrane Library, trial registers, and grey literature databases from inception to June 28, 2018. We included observational studies with at least 5 patients with in situ or minimally invasive nail melanoma. Main outcome was local recurrence. The odds ratio synthesized from 5 studies including 109 patients (88 functional operations and 21 amputations) was 1.57 (95% confidence interval, 0.31-8.00). Small sample size and possible interstudy heterogeneity. Our meta-analysis revealed no difference in local recurrence between the 2 interventions. Considering the functional deficit after amputation, conservative surgery should be the treatment of choice for in situ or minimally invasive nail melanoma.

Factors affecting differential outcomes in the definitive treatment of anal cancer between HIV+ and HIV- patients.

3572 Background: Anal cancer is an uncommon malignancy with numerous factors that influence treatment outcomes. Historically, HIV+ patients were restricted from entering clinical trials, limiting data on their outcomes to small retrospective reports. This study seeks to understand the factors related to anal cancer outcomes, specifically the differences between HIV+ and HIV- patients. Methods: Inclusion criteria was non-metastatic anal squamous cell carcinoma treated with a definitive course of chemotherapy and radiation between 2005 and 2018 at a single institution. Clinical data related to baseline characteristics, treatment parameters, and post-treatment follow-up were extracted for calculation of freedom from local recurrence (FFLR) and overall survival (OS). Univariate analysis (UVA) and multivariate analysis (MVA) were done using cox proportional hazard model, and FFLR and OS were calculated using the Kaplan-Meier method. Results: During the study period, 111 patient initiated definitive treatment for anal cancer. Median age was 56.7 years (IQR: 51.4-63.5), and 47% (N = 52) were HIV+. At median follow-up of 28 months, 12 and 24-month FFLR was 84.1% and 78.2% respectively, with 24-month OS of 87.3%. MVA demonstrated significant association between FFLR and T-stage HR 4.02 (95% CI: 2.14-7.55) p &lt; 0.001, elapsed treatment time (median of 50 days) 1.08 (95% CI: 1.04-1.12) p &lt; 0.001, and diagnosis to treatment start (median time of 15 weeks) 1.05 (95% CI: 1.01-1.08) p = 0.005. Additional analysis with log-rank test for FFLR demonstrated significant difference between patients taking &lt; 50 days to complete treatment (p = 0.03), and &lt; 15 weeks from diagnosis to treatment completion (p = 0.006). In HIV+ patients, post-treatment CD4 &lt; 150 was significantly associated with worse OS on log-rank test (p = 0.016), with pretreatment CD4 values being non-significant. Conclusions: This study represents the largest single institution report of HIV positive patients treated for anal cancer. No difference in local recurrence or overall survival between HIV+ and HIV- patients was elucidated; however, HIV+ patients with lower post-treatment CD4 counts had worse OS. The most significant predictors of local recurrence were advanced T-stage, increased time from diagnosis to treatment initiation, and prolonged treatment time.

Patterns of adjuvant care and outcomes of elderly women with stage I breast cancer after breast-conserving surgery: a population-based analysis.

Randomized trials studying endocrine therapy (ET) with and without radiation therapy (RT) following breast-conserving surgery (BCS) have detected differences in local recurrence (LR) but not survival among elderly women with hormone receptor positive stage I breast cancer (BC). We assembled a population-based cohort of such women to examine the use and outcomes associated with or without the administration of adjuvant radiotherapy (RT) or ET. Women aged ≥ 65years with stage I BC treated with BCS in Ontario between 2010 and 2016, their treatments and outcomes were ascertained using deterministic linkages of administrative databases. Multivariable Cox regression models were used to evaluate risks of ipsilateral LR and of any first in-breast event, categorizing women by their treatment. 5076 women were treated with BCS followed by RT + ET (n = 1964), RT alone (n = 1325), ET alone (n = 719), or no adjuvant treatment (n = 1068). Median follow-up was 5years. LR occurred in 0.9% after adjuvant RT + ET, 1.4% after RT alone, 3.1% after ET alone, and 9.4% after BCS alone (p < 0.001). The adjusted risk of LR was increased in those who received no adjuvant therapy (HR = 13.43, CI: 7.89, 22.85), or ET alone (HR = 4.03, CI: 2.14, 7.59). The adjusted risk of any first in-breast event was greatest among those without any adjuvant therapy (HR = 7.61, 95%CI: 5.21, 11.11, p < 0.0001). Absolute and adjusted risks of any first in-breast event were comparable between those with ET alone (HR = 2.09, 95%CI: 1.27, 3.43, p = 0.0038) and those with RT alone (HR = 1.91, 95% CI: 1.25, 2.91, p = 0.0028). Older women with stage I BC who receive no adjuvant therapy have a significant absolute risk of LR and any first in-breast event, whereas the absolute risk of these events among those with either RT alone or ET alone is only slightly higher than among those treated with both.

Safety and efficacy of microwave ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile ducts through a percutaneous transhepatic cholangial drainage tube

Background and aimsBiliary thermal injury caused by microwave ablation (MWA) for a hepatocellular carcinoma (HCC) close to the central bile ducts always results in severe complications and leads to mortality. Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications. In this study, we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage (PTCD) tube for preventing biliary thermal injury caused by MWA, and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage (ENBD) tube. MethodsParticipants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube. The main study outcomes were bile duct complications related to MWA and local tumor recurrence. p value < 0.05 was considered to indicate a statistically significant difference. ResultsA total of 23 patients with an HCC (23 nodules) close to a central bile duct were enrolled in this study. Of these patients, 12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions. There were no PTCD- and ENBD-related mortality cases. There was no complication related to the PTCD procedure; however, 3 patients (27.27%) developed acute pancreatitis and 1 patient (9.09%) had hemorrhage in the ENBD group (p = 0.037). One patient (8.33%) in the PTCD group had bile leakage and 2 patients (18.18%) in the ENBD group developed a biloma. Within 5 years, 1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence. There was no significant difference in local recurrence, nonlocal hepatic recurrence, mortality rate, or median cumulative overall survival between the 2 groups. ConclusionsThe intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts. It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.

Does size matter? Investigating the optimal planning target volume margin for postoperative stereotactic radiosurgery to resected brain metastases.

The optimal margin size in postoperative stereotactic radiosurgery (SRS) for brain metastases is unknown. Herein, the authors investigated the effect of SRS planning target volume (PTV) margin on local recurrence and symptomatic radiation necrosis postoperatively. Records of patients who received postoperative LINAC-based SRS for brain metastases between 2006 and 2016 were reviewed and stratified based on PTV margin size (1.0 or > 1.0 mm). Patients were treated using frameless and framed SRS techniques, and both single-fraction and hypofractionated dosing were used based on lesion size. Kaplan-Meier and cumulative incidence models were used to estimate survival and intracranial outcomes, respectively. Multivariate analyses were also performed. A total of 133 patients with 139 cavities were identified; 36 patients (27.1%) and 35 lesions (25.2%) were in the 1.0-mm group, and 97 patients (72.9%) and 104 lesions (74.8%) were in the > 1.0-mm group. Patient characteristics were balanced, except the 1.0-mm cohort had a better Eastern Cooperative Group Performance Status (grade 0: 36.1% vs 19.6%), higher mean number of brain metastases (1.75 vs 1.31), lower prescription isodose line (80% vs 95%), and lower median single fraction-equivalent dose (15.0 vs 17.5 Gy) (all p < 0.05). The median survival and follow-up for all patients were 15.6 months and 17.7 months, respectively. No significant difference in local recurrence was noted between the cohorts. An increased 1-year rate of symptomatic radionecrosis was seen in the larger margin group (20.9% vs 6.0%, p = 0.028). On multivariate analyses, margin size > 1.0 mm was associated with an increased risk for symptomatic radionecrosis (HR 3.07, 95% CI 1.13-8.34; p = 0.028), while multifraction SRS emerged as a protective factor for symptomatic radionecrosis (HR 0.13, 95% CI 0.02-0.76; p = 0.023). Expanding the PTV margin beyond 1.0 mm is not associated with improved local recurrence but appears to increase the risk of symptomatic radionecrosis after postoperative SRS.

04:21 PM Abstract No. 92 Therapeutic outcomes of thermal ablation for endophytic versus exophytic renal cell carcinoma

To compare the safety and oncological outcomes of computed tomography (CT)-guided thermal ablation for endophytic versus exophytic renal cell carcinoma (RCC). A retrospective analysis of 394 patients (M:F = 267:127, mean age = 71 yrs) who underwent CT-guided thermal ablation between October 2006 and December 2017 was performed. Exophytic RCC was defined as a tumor lesion with more than 50% tumor volume protruding out of the renal parenchyma. Endophytic RCC was defined as a tumor lesion completely within the renal parenchyma. Rates of complications, residual disease and local recurrence were compared between exophytic and endophytic RCCs. Of the 405 biopsy-proven cT1N0M0 RCCs that were treated with percutaneous CT-guided thermal ablation, 242 (59%) were exophytic and 63 (16%) were endophytic. The rate of complications was significantly higher in endophytic tumors (5/63, 8%), compared to exophytic tumors (6/242, 2%; p = 0.038). Residual disease was observed in 6/63 (10%) of the endophytic tumors and 18/242 (7%) of the exophytic tumors. There was no significant difference in local recurrence between endophytic tumors (4/65, 6%) and exophytic tumors (19/242, 7%; p = 0.64). CT-guided thermal ablation of endophytic RCC poses a significantly higher risk of major complications compared to exophytic RCC. However, there is no increased risk of residual or locally recurrent disease.TableComparison of Complication and Residual and Recurrent Disease Rates Between Endophytic and Exophytic Renal Cell CarcinomasEndophyticExophyticP ValueMajor complication Yes5 (8%)6 (2%)0.038 No58 (92%)236 (98%)Residual disease Yes6 (9%)18/242 (7%)0.58 No57 (91%)224 (93%)Recurrent disease Yes4 (6%)19 (7%)0.64 No61 (94%)223 (93%) Open table in a new tab

Abstract P5-16-11: Intraoperative central nipple biopsy in subcutaneous mastectomies - A retrospective analysis of 200 patients

Abstract Background: Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant-based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that a general recurrence risk reduction occurs due to elimination of glandular and ductal components within the nipple. In addition, intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. This trial aimed to evaluate complication rates, local recurrence and clean margin resection rates in a head-to-head retrospective manner. Methods: Starting in 2015, intraoperative central nipple biopsy in NSM with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial evaluates global complication rates (necrosis, implant loss, seroma and hematoma), long term local recurrence and clean margin status for cohort 1 (n=100) SSM with nipple biopsy vs. cohort 2 (control, n = 100) without nipple biopsy. In case of an involved central nipple biopsy, the nipple areola complex was removed. This analysis is a single center, multi-surgeon, retrospective, head to head analysis. Median follow-up is three years. All IBR procedures used an epipectoral implant pocket. Results: Global complication rates did not differ significantly between both cohorts. There was no increased rate of implant loss and or revision surgery. Within the medium three-year follow-up there was no case of local recurrence within nipple areola complex for both cohorts. An Involved central nipple biopsy was however found in 2% (n=2 /100) of the performed SSM procedures leading to the immediate removal of the nipple areola complex. Surgical time did not increase with central biopsy. A significantly higher rate of re-surgery due to involved margins was shown in the control cohort. Conclusions: This analysis showed that intraoperative evaluation of the ductal components of the nipple is a safe procedure. At least 2% of the patients showed an immediate advantage of this procedure since clean margins were obtained by removing the nipple areola complex during the same surgery. The medium follow-up showed no significant difference in local recurrence. We therefore strongly, recommend a central nipple biopsy for all NSM procedures. Citation Format: Eichler C, Stephan S, Thangarajah F, Puppe J, Mathias W. Intraoperative central nipple biopsy in subcutaneous mastectomies - A retrospective analysis of 200 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-11.

Prognosis of endoscopic surgery and traditional open resection in mucosal melanoma of the nasal cavity and paranasal sinus

Mucosal melanoma of the nasal cavity and paranasal sinus is always associated with poor prognosis, and 5-year overall survival does not exceed 40%. Our study aimed to compare the intraoperative conditions and prognosis of different surgical techniques to determine the optimum surgical approach for patients with mucosal melanoma of the nasal cavity and paranasal sinus. This was a retrospective analysis of 54 patients who received treatment at Beijing Tongren Hospital between January 2004 and December 2016. The patients were divided into two groups: those who received endoscopic surgery and those who underwent traditional open resection. The study analyzed the operative methods, the intraoperative conditions, and the prognosis of the patients. SAS JMP Pro software was used for statistical analysis of the data. There were 27 patients in the endoscopic surgery group and 27 patients in the open surgery group. Each group had the same distribution in terms of AJCC staging, with seven stage III, 12 stage IVA, and eight stage IVB patients in each group. There were statistically significant differences in operative time, complications, and cosmetic effects between the two groups, but no difference in local recurrence, disease-free survival, or overall survival. In the endoscopic surgery group and open surgery group, local recurrence rates were 14.81 and 11.11%, respectively, and metastasis rates were the same in both groups (40.74%). With regard to long-term prognosis, there was no statistically significant difference between the different surgical techniques, especially in terms of survival benefit. We believe that endoscopic surgery with protection of local function can be recommended for mucosal melanoma of the nasal cavity and paranasal sinus on the basis of its advantages in terms of shorter duration of surgery and fewer complications. In addition, it achieves better postoperative cosmetic effects with minimal scarring on the face of the patient, and thus improves postoperative quality of life.

Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: A meta-analysis.

Background:Although laparoscopic colorectal cancer resection is an oncologically safe procedure equivalent to open resection,the effects of conversion of a laparoscopic approach to an open approach remain unclear.This study evaluated the cancer characteristic and oncological outcomes associated with conversion of laparoscopic colorectal resection to open surgery.Method:We conducted searches on PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We included the literature published until 2018 that examined the impact of laparoscopic conversion to open colorectal resection. Only randomized control trials and prospective studies were included. Each study was reviewed and the data were extracted. Fixed-effects methods were used to combine data, and 95% confidence intervals (CIs) were used to evaluate the outcomes.Results:Twelve studies with 5427 patients were included. Of these, 4672 patients underwent complete laparoscopic resection with no conversion (LAP group), whereas 755 underwent conversion to an open resection (CONV group). The meta-analysis showedsignificant differences between the LAP group and converted (CONV) group with respect to neoadjuvant therapy (P = .002), location of the rectal cancer (P = .01), and recurrence (P = .01). However, no difference in local recurrence (P = .17) was noted between both groups.Conclusion:Conversion of laparoscopic to open colorectal cancer resection is influenced by tumor characteristics. Conversion of laparoscopic surgery for colorectal cancer is associated with a worse oncological outcome.