Early-stage Carcinoma Research Articles

Catching Gall Bladder Cancer Early- Importance of Cholelithiasis and Radiologist

Introduction: Increased relative risk of Gall Bladder (GB) cancer in patients with gall stones has been reported in literature but there are few reports on nature of stones. However, it is difficult to predict which patient suffering from cholelithiasis and cholecystitis may develop or already has early stages of carcinoma. Aim: The present study was undertaken to assess the malignant potential and relevance of gall stones, age and gender in GB carcinoma to propose a screening protocol and early intervention for high risk patients. Materials and Methods: This was a retrospective study done at Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India from May 2012 to May 2019. This study included 200 histopathologically- Fine Needle Aspiration Cytology (FNAC) or postoperative specimen biopsy proven GB carcinoma and 200 control patients with upper abdominal pain but without any evidence of neoplastic changes on USG. All cases and controls were subjected to USG evaluation first followed by plain CT scan with oral contrast only and Contrast Enhanced CT (CECT) scan of whole abdomen as per protocol. Scans were evaluated for detection of gall stone profile in terms of number (solitary/multiple), size (small/large) and density (radio-opaque/ radiolucent). The statistical analysis was done by using IBM Statistical Package for the Social Sciences (SPSS) version 18.0. Results: Male to female ratio in this study was 1:2. GB calculi cannot be considered as bystander as overall 25% patients of both sexes had cholelithiasis. In the present study, 25% who were having carcinoma GB have been detected to have gall stones and out of which 74% were having small calculi. The study showed the association between GB cancer and solitary and multiple large calculi over different age groups to be not statistically significant (p-value=0.3976; χ2=0.716). Association of small and multiple calculi came out to be highly significantly associated with carcinoma in 67% of patients. Furthermore, it was observed that the association between multiple small calculi and GB cancer over the different age groups came out to be extremely statistically significant (p-value=0.0001; χ2=28.62). The association between gall stones in GB cancer patients differ statistically significant over the age groups from cases with gall stones in control group (p-value=0.005497; χ2=7.7082). Conclusion: From the findings of the study author proposed screening via ultrasound and guided FNAC for females over 40 years of age with multiple small calculi not undergoing immediate cholecystectomy to detect early emergence of carcinoma. It is also suggested that clinicians should post patients with multiple, small GB calculi for cholecystectomy on a priority basis and histopathology should be done in each case of GB wall thickening.

Carcinoma cervix with ectopic kidney, its treatment and outcome

The occurrence of pelvic malignancies along with an ectopic kidney is a rare finding. In the patients of early stage carcinoma of cervix presenting with pelvic kidney, surgery is preferred to radiation to avoid irradiating the kidney. However, advanced stage carcinoma of cervix in such scenario poses a therapeutic dilemma and conformal radiotherapy in the form of intensity-modulated radiotherapy (IMRT) is preferred option. This helps to achieve the desired dose to the target while reducing the dose to the surrounding organs at risk particularly to the pelvic kidney. Herein, we present a case of International Federation of Gynecology and Obstetrics Stage IIB carcinoma of cervix having ectopic right pelvic kidney in a 40-year-old female, and the patient was successfully treated with chemoradiotherapy in IMRT technique. The patient is disease free with normal renal function at 2-year follow-up. The previously reported cases of pelvic malignancies with ectopic kidney in the literature are discussed here briefly.

Tumor Recurrence Rate and Survival Outcomes of Uterine Serous Carcinoma after Surgical Treatment

Background: Uterine serous carcinoma is a rare histologic subtype of endometrial cancer. Oncologic outcomes for this disease are sparsely reported, and adjuvant therapy after surgery is considerably heterogeneous. Objective: To determine the 2-year recurrence rate, recurrence-free survival, overall survival, and associated factors among patients with uterine serous carcinoma after surgical treatment at Siriraj Hospital. Materials and Methods: One hundred thirty uterine serous carcinoma patients diagnosed between December 2007 and June 2015 were enrolled. Patients who did not undergo surgery as a primary treatment or not achieve clinically complete response were excluded. Pathological slides were reviewed. Data were retrieved from the medical records including gynecologic data, surgical and pathological results, post-operative treatment, response status, recurrence status, and follow-up data. The recurrence rate at two years was calculated. Recurrence-free survival and overall survival were analyzed, and various characteristics were used to determine associated treatment outcomes. Results: One hundred nine patients were analyzed, 50 in stage I, 15 in stage II, 38 in stage III, and six in stage IV. Median follow-up time was 23 months. At two years, the recurrence rate was 35.8%. Post-operative treatment was performed in 91.7%, and chemotherapy was the most common modality used. Eleven patients (16.9%) in early-stage and twenty-five patients (56.8%) in the advanced stage had disease recurrence. Thirty patients (83.3%) had disease recurrence intra-abdominal or multiple metastases. No patient in stage I that received adjuvant chemotherapy had relapsed disease. Two-year recurrence-free survival and 2-year overall survival were 71.2% and 83.4%, respectively. FIGO staging was the only factor associated with recurrence-free survival. Conclusion: Uterine serous carcinoma represents a rare disease with a high recurrence rate and poor prognosis. FIGO staging is related to recurrence-free survival. Adjuvant chemotherapy showed survival benefits in early-stage uterine serous carcinoma. Keywords: Uterine serous carcinoma, Adjuvant therapy, Recurrence, Survival

Impact of adjuvant therapy on oncologic outcomes in early-stage uterine clear cell carcinoma

Impact of adjuvant therapy on oncologic outcomes in early-stage uterine clear cell carcinoma

Recurrence patterns and recurrence free survival following primary surgical staging among women with early-stage uterine serous carcinoma who receive adjuvant vaginal brachytherapy in addition to chemotherapy versus chemotherapy alone

Objective: The purpose of this study was to evaluate the effect of adding vaginal brachytherapy (VBT) to adjuvant chemotherapy on patterns of recurrence and recurrence-free survival (RFS) among women with stage I–II uterine serous carcinoma (USC).

Oncological Outcomes and Safety of Ovarian Preservation in Early Stage Carcinoma of the Cervix

Oncological Outcomes and Safety of Ovarian Preservation in Early Stage Carcinoma of the Cervix

Super-selective transarterial chemoembolization of hepatocellular carcinoma with doxorubicin-eluting beads sized 40–75 microns: assessment of efficacy and safety

We aimed to evaluate the effectiveness and safety of super-selective transarterial chemoembolization (TACE) with doxorubicin-loaded drug-eluting beads (DEB) sized 40-75 μm for hepatocellular carcinoma (HCC) in early and intermediate stages according to Barcelona Clinic Liver Cancer (BCLC) staging system. This single-center retrospective study was conducted with 45 consecutive HCC patients treated by 72 sessions of DEB-TACE during the 2012-2017 period. Thirty-seven patients (82.2%) had single tumor staged BCLC A and B (53.3% and 46.7%, respectively). All procedures were performed by super-selective approach using 1.7-2.0 F microcatheters. Cone beam CT was performed to detect all tumor-feeding arteries and assess the treatment results immediately. Dynamic MRI and laboratory tests were obtained at 1-month follow-up and every 3 months thereafter. Response to treatment according to modified Response Evaluation Criteria in Solid Tumors, demographic and clinical status, laboratory tests, time-to-event durations and rates, complications according to the National Cancer Institute Criteria for Adverse Events were evaluated. A total of 45 patients (median age, 65.6 years; range, 35-88 years; 33 men, 73.4%) were included. Eight patients (17.7%) underwent liver transplantation after DEB-TACE, and 20 (44.4%) died during the follow-up period. Median follow-up was 22 months (range, 13-31), and 42 (93.3%) patients were followed up for more than 1 year. Overall complete response, partial response, and progressive disease rates were 53.3%, 33.3%, and 13.4% at one year and 22.2%, 26.7%, and 13.3% at three years, respectively. For target lesions, these rates were 60.0%, 26.7%, and 13.3% at one year and 28.9%, 6.7%, and 4.4% at three years, respectively. Median overall survival (OS) duration was 24 months (95% CI, 20.9-31.9 months). At one year and three years, OS rates were 71.0% and 44.4%, respectively. The only statistically significant relationship with OS was presence of chronic liver disease, which worsened the OS rate (P = 0.031). Time-to-progression (TTP) was 23 months (95% CI, 15.1-40.0), and progression-free survival (PFS) was 28 months (95% CI, 6.2-39.8). Post-embolization syndrome occurred in 10 patients (22.2%). Transient grade I/II bilirubin and aminotransferase elevation was observed in 26 (57.7%) and 18 (40%) patients, respectively. Super-selective DEB-TACE with doxorubicin-loaded beads sized 40-75 μm is an effective and safe treatment method with prolonged TTP and PFS in early and intermediate stages of HCC. Presence of chronic liver disease is the only significant factor that worsened OS ratios after DEB-TACE.

A forward-viewing radial-array echoendoscope is useful for diagnosing the depth of colorectal neoplasia invasion.

It is important to accurately diagnose the depth of colorectal neoplasia invasion. We aimed to evaluate the usefulness of a new forward-viewing radial-array echoendoscope (FRE), relative to the pit pattern method. In this prospective study, the invasion depth of suspected early-stage carcinoma was diagnosed using the pit pattern and FRE methods. The diagnoses were classified as T1a (submucosal invasion distance < 1,000μm) or shallower and T1b (≥ 1,000μm) or deeper. Pathological diagnoses were used to compare the diagnostic capabilities of the two methods. The final analyses included 110 lesions. The FRE was successfully inserted to the lesion in all cases. There were no significant differences between the two methods regarding the correct prediction rate (79.1% vs. 75.5%, P = 0.57), accuracy (81.3% vs. 79.0%, P = 0.68), specificity (81.3% vs. 70.8%, P = 0.135), positive predictive value (65.0% vs. 60.4%, P = 0.649), negative predictive value (91.0% vs. 98.1%, P = 0.108), or frequency of unevaluable cases (2.7% vs. 4.5%, P = 0.471). The correct prediction rate was calculated by adding the number of unevaluable cases to the denominator of accuracy. Relative to the pit pattern method, the FRE method offered significantly higher sensitivity for predicting T1b or deeper invasion (81.3% vs. 97.0%, P = 0.048). The pit pattern method had significantly poorer accuracy for large lesions (> 36mm) than for smaller lesions (≤ 36mm). In contrast, the accuracy of the FRE method did not differ significantly with lesion size. When using the FRE method, no cases were unevaluable because of attenuation. The FRE method provided correct diagnoses in 2 of 3 cases that were unevaluable using the pit pattern method. The pit pattern and FRE methods offered similar diagnostic performance for invasion depth. Furthermore, the FRE method may be used to correctly diagnose cases that are unevaluable using the pit pattern method.

Eukaryotic translation initiation factor 5A in the pathogenesis of cancers.

Cancer is the leading cause of death worldwide. The absence of obvious symptoms and insufficiently sensitive biomarkers in early stages of carcinoma limits early diagnosis. Cancer therapy agents and targeted therapy have been used extensively against tissues or organs of specific cancers. However, the intrinsic and/or acquired resistance to the agents or targeted drugs as well as the serious toxic side effects of the drugs would limit their use. Therefore, identifying biomarkers involved in tumorigenesis and progression represents a challenge for cancer diagnosis and therapeutic strategy development. The eukaryotic translation factor 5A (eIF5A), originally identified as an initiation factor, was later shown to promote translation elongation of iterated proline sequences. There are two eIF5A isoforms (eIF5A1 and eIF5A2). eIF5A2 protein consists of 153 residues, and shares 84% amino acid identity with eIF5A1. However, the biological functions of these two isoforms may be significantly different. Recently, it was demonstrated that eIF5Ais widely involved in the pathogenesis of a number of diseases, including cancers. In particular, eIF5A plays an important role in regulating tumor growth, invasion, metastasis and tumor microenvironment. It was also shown to serve as a potential biomarker and target for the diagnosis and treatment of cancers. The present review briefly discusses the latest findings of eIF5A in the pathogenesis of certain malignant cancers and evolving clinical applications.

Abstract B10: A simple immunohistochemical algorithm to evaluate molecular subtypes and clinical associations in non-muscle invasive bladder cancer

Abstract Introduction: Recent large-scale transcriptomic studies in muscle-invasive bladder cancer (MIBC) have identified promising predictive and prognostic properties of luminal, basal, and additional molecular subtypes. Transcriptomic profiling is laborious, expensive, and prone to errors due to infiltrating lymphocytes and variations in tumor cellularity. Immunohistochemistry (IHC) provides a faster, cheaper, and clinically feasible subtyping method that has been validated to subtype MIBC (1) and simplified into a three-antibody algorithm (2). Here we utilize this algorithm in non-muscle invasive bladder cancer (NMIBC), where, in contrast to MIBC, there are few data exploring IHC subtypes. Methods: We implemented the simplified three-antibody IHC-based algorithm to subtype a cohort of 523 non-muscle invasive (stages pTa low grade, pTa high grade, and pT1 high grade) transurethral resections of bladder tumor (TURBT) samples. Cases were sampled in duplicate on six tissue microarray blocks. Spatial localization, prevalence, and intensity of antibody staining was scored using digital image analysis. Results: Similar to previous transcriptome-based work (3), preliminary analysis identified the prevalence of Urothelial-Like (Uro-like), Genomically Unstable (GU), Basal-Squamous Cell Carcinoma-Like (BSq), and unclassified subtypes at 33% n=171, 48%, n=251, 9%, n=46, and 10%, n= 55, respectively. As expected, GU was enriched in pTa high grade and pT1 tumors, but surprisingly, BSq cancers were more similar to Uro-like in stage and grade distribution. Discussion: Molecular subtypes of bladder cancer can be identified easily using a three-antibody assay. Subtypes that signify high risk of metastasis in MIBC are surprisingly prevalent in NMIBC but may not yet have acquired the molecular lesions that drive metastatic progression. Further research into subtype and progression should be accelerated by the availability of rapid and inexpensive IHC-based assays.

Single-Stage Tongue Reconstruction in Early Malignant Lesions (T2–T3) with Islanded Nasolabial Flap: Reliable Alternative to Free Radial Artery Forearm Flap in Rural Set Up

Nasolabial flaps are widely used in reconstruction of orofacial structures using trans-buccal tunnel in two stages. Inferiorly based islanded nasolabial flaps can be harvested with meticulous skeletonization of facial vessels proximal to flap and transferred behind mandible through mylohyoid tunnel. This variation in technique of harvest and transfer increases the flap distal reach, avoids restriction in tongue mobility and allows single-stage tongue reconstruction. We present a series of operated patients of early lesions of tongue carcinoma with this newer technical modification and their functional outcome. This study included biopsy proven 8 patients diagnosed with early stage (T2, T3) carcinoma tongue. Single-stage islanded nasolabial flaps based on facial artery and vein were harvested and tunnelled behind mandible onto the tongue defect. Follow up of all patients was recorded with respect to speech, deglutition and tongue mobility. All operated patients had good functional outcome in terms of swallowing, speech and tongue mobility. All patients were satisfactory with the postoperative results. In comparison to microvascular reconstruction, this option justifies a reliable and a cost-effective approach especially in co-morbid patients.

Management of Synchronous Locally Advanced Carcinoma Tongue and Early-Stage Carcinoma Esophagus in a Tertiary Cancer Center: A Rare Case Report

AbstractSynchronous malignancy of tongue and esophagus is difficult to diagnose and treat since both the malignancies are aggressive and have poor survival. We report an unusual case study of locally advanced carcinoma tongue (Stage IVA) with early-stage carcinoma esophagus (Stage II) in a 43-year-old male for whom both the malignancies were treated with concurrent chemoradiation in a sequential manner and the patient had a complete response of both malignancies without much treatment-related morbidity and the patient is coming for follow-up with the disease-free survival of 6 months.

Value of PAP’s Smear with Regard to DNA Testing for Identification of Cervical Precancerous Lesions in VIA Positive Cases

Background: Carcinoma cervix is one of the cause of female death in developing country like Bangladesh. Prevention can be done by several screening procedure like VIA, Pap's smear, HPV DNA testing, Colposcopy and colposcopy directed biopsy. We can markedly reduce the mortality and morbidity by these procedures and can be detected carcinoma in precancerous and very early carcinoma stage. This study was conducted to compare HPV DNA testing and pap’s smear for identification of cervical precancerous lesions in VIA positive cases.&#x0D; Materials and methods: It was an analytical type of cross sectional study. Data were obtained in outpatient Department of Gynecology and Obstetrics, Chattogram Medical College Hospital, Chattogram from July 2014 to December 2014. Total 90 subjects were included in the study consecutively after considering inclusion and exclusion criteria and taking written informed consent. Data analysis was done by SPSS (Version 17).&#x0D; Results: Histopathology findings of biopsy materials of colposcopy positive cases where 8(28.6%) were chronic cervicitis, 10(35.7%) were CIN I, 7(25.0%) were CIN II, 3(10.7%) were CIN III. Total 20(71.4%) cases were found positive or precancerous. Regarding validity analysis of different tests that were performed for cervical precancerous conditions taking histopathology results as a gold standard, sensitivity of Pap’s smear was found lower (75.0%) than the HPV DNA whereas specificity of Pap’s Smear was higher (87.5%) then the specificity of HPV DNA (75.0%).&#x0D; Conclusion: HPV DNA testing was both more sensitive and specific near to Pap cytology. So the use of a less invasive and more user friendly primary screening strategy like HPV-DNA testing may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 27-32

Is ABO blood group a risk or prognostic factor for patients with endometrioid endometrial cancer? A retrospective analysis in Germany.

A relationship is known to exist between gastric and pancreatic cancers and ABO antigens, caused by various immune modulations related to the ABO blood group of the patient. A similar relationship with regard to gynaecological cancers remains controversial. Patients who underwent surgery for endometrioid endometrial cancer in International Federation of Gynaecology and Obstetrics (FIGO) stage I, II, III or IV from 2006 to 2018 were identified. The research explored the existence of a relationship between the patients' blood group or Rhesus factor and the incidence of endometrial cancer, grade (G1, G2, G3), FIGO stage, nodal status, recurrence, menopausal status, parity, and body mass index. Statistical methods such as the chi-square test, analysis of variance and the Scheffé post-hoc test were used. Two hundred and two patients with endometrioid endometrial cancer were included: 96 had blood group A, 19 blood group B, 75 blood group 0, and 12 had blood group AB. This distribution corresponds to the general blood group distribution in Germany. The vast majority of the dependent variables, such as grade, FIGO stage, nodal status or recurrence were not significantly associated with ABO blood group or Rhesus factor status. The relative frequencies of G1 and G3 endometrial cancers with respect to blood group were similar. Menopausal status, parity, and body mass index were not related to more advanced FIGO stages at initial diagnosis or to ABO blood group. Blood group screening would probably not be helpful in the diagnosis of endometrioid endometrial carcinomas in early stages compared to the current gold standard. Furthermore, a specific blood group does not increase either the risk of recurrence or the risk of a dedifferentiated type of endometrial carcinoma.

Identification of an Individualized Prognostic Signature Based on the RWSR Model in Early-Stage Bladder Carcinoma.

Bladder cancer (BLCA) is the fourth common cancer among males in the United States, which is also the fourth leading cause of cancer-related death in old males. BLCA has a high recurrence rate, with over 50% of patients which has at least one recurrence within five years. Due to the complexity of the molecular mechanisms and heterogeneous cancer feature, BLCA clinicians find it hard to make an efficient management decision as they lack reliable assessment of mortality risk. Meanwhile, there is currently no screening suitable prognostic signature or method recommended for early detection, which is significantly important to early-stage detection and prognosis. In this study, a novel model, named the risk-weighted sparse regression (RWSR) model, is constructed to identify a robust signature for patients of early-stage BLCA. The 17-gene signature is generated and then validated as an independent prognostic factor in BLCA cohorts from GSE13507 and TCGA_BLCA datasets. Meanwhile, a risk score model is developed and validated among the 17-gene signature. The risk score is also considered an independent factor for prognosis prediction, which is confirmed through prognosis analysis. The Kaplan-Meier with the log-rank test is used to assess survival difference. Furthermore, the predictive capacity of the signature is proved through stratification analysis. Finally, an effective patient classification is completed by a combination of the 17-gene signature and stage information, which is for better survival prediction and treatment decisions. Besides, 11 genes in the signature, such as coiled-coil domain containing 73 (CCDC73) and protein kinase, DNA-activated, and catalytic subunit (PRKDC), are proved to be prognosis marker genes or strongly associated with prognosis and progress of other types of cancer in published literature already. As a result, this paper would more accurately predict a patient's prognosis and improve surveillance in the clinical setting, which may provide a quantitative and reliable decision-making basis for the treatment plan.

Human epidermal growth factor 2 (HER2) in early stage uterine serous carcinoma: A multi-institutional cohort.

6084 Background: Uterine serous carcinoma (USC) is a rare and aggressive malignancy, accounting for 40% of all endometrial cancer deaths. Human Epidermal Growth Factor Receptor 2 (HER2) has emerged as an important prognostic and therapeutic target in USC. Given recent randomized trial results, HER2-directed therapy is now recommended in advanced-stage or recurrent, HER2-positive disease. The significance of tumoral HER2 expression in early-stage disease has not yet been established. Methods: In this IRB-approved, retrospective, multi-institutional cohort, women diagnosed with stage I USC from 2000-2018 were identified. Patient demographic, treatment, and survival data were collected. Immunohistochemistry (IHC) was performed for HER2 and scored 0-3+. Equivocal IHC results (2+) were further tested with in-situ hybridization (ISH) per the 2007 ASCO-CAP HER2 breast cancer guidelines. HER2 overexpression (“positive”) was defined as 3+ IHC or ISH positive. Kaplan-Meier analyses and Cox-proportional hazards were used to compare survival between the cohorts. Results: In total, 173 patients with stage I USC were tested for HER2; 25% were HER2-positive, 77.4% had stage IA and 22.6% had stage IB disease. Adequate clinical follow up was available for 168 patients. There were no significant differences in age, race/ethnicity, body mass index, surgical management, sub-stage, tumor size, adjuvant therapy, or follow-up duration between the HER2-positive and negative cohorts. On univarite analysis, presence of lymph-vascular space invasion was correlated with HER2-positive tumors (p=0.003). After a median follow-up of 50 months, there were 41 (24.4%) recurrences. Significantly more recurrences were observed in the HER2-positive cohort (47.6% vs. 16.7%, p&lt;0.001). HER2 overexpression was also associated with poorer progression-free (PFS) and overall survival (OS) (p&lt;0.001 and p=0.012). After adjusting for prognostic factors including sub-stage and adjuvant treatment, those with HER2-positive tumors experienced inferior PFS (aHR 3.67, 95%CI 1.92-6.98; p&lt;0.001) and OS (aHR 2.03, 95%CI 1.03-4.01; p=0.042) compared to HER2-negative tumors. Conclusions: Uterine serous carcinoma is a poor prognostic tumor, even in patients with early-stage disease. Given its significant association with worse survival outcomes, tumoral HER2 overexpression appears to be a prognostic biomarker in women with stage I disease. These data provide rationale for clinical trials with HER2-directed therapy in early-stage uterine serous carcinoma.

Integrative genomics approach identifies molecular features associated with early-stage ovarian carcinoma histotypes

Ovarian cancer comprises multiple subtypes (clear-cell (CCC), endometrioid (EC), high-grade serous (HGSC), low-grade serous (LGSC), and mucinous carcinomas (MC)) with differing molecular and clinical behavior. However, robust histotype-specific biomarkers for clinical use have yet to be identified. Here, we utilized a multi-omics approach to identify novel histotype-specific genetic markers associated with ovarian carcinoma histotypes (CCC, EC, HGSC, and MC) using DNA methylation, DNA copy number alteration and RNA sequencing data for 96 primary invasive early-stage (stage I and II) ovarian carcinomas. More specifically, the DNA methylation analysis revealed hypermethylation for CCC in comparison with the other histotypes. Moreover, copy number imbalances and novel chromothripsis-like rearrangements (n = 64) were identified in ovarian carcinoma, with the highest number of chromothripsis-like patterns in HGSC. For the 1000 most variable transcripts, underexpression was most prominent for all histotypes in comparison with normal ovarian samples. Overall, the integrative approach identified 46 putative oncogenes (overexpressed, hypomethylated and DNA gain) and three putative tumor suppressor genes (underexpressed, hypermethylated and DNA loss) when comparing the different histotypes. In conclusion, the current study provides novel insights into molecular features associated with early-stage ovarian carcinoma that may improve patient stratification and subclassification of the histotypes.

Prognostic impact of solid tumor component diameter in early-stage non-small cell lung carcinoma treated with intensity-modulated fractionated radiotherapy: a retrospective analysis impact of solid tumor component diameter in NSCLC treated with IMRT.

Objective:To investigate the suitability of the new diameter-based subgroupings of the eighth edition Tumor Node Metastasis (TNM) classification system regarding radiotherapy treatment for early-stage non-small-cell lung cancer (NSCLC), we retrospectively re-analyzed the clinical data of patients treated with intensity-modulated radiotherapy using non-coplanar beams (ncIMRT) for Stage I NSCLC.Methods:Between March 2011 and March 2018, 92 patients with 94 tumors who were diagnosed with Stage I NSCLC according to the seventh edition TNM classification system were enrolled and underwent ncIMRT of 75 Gy in 30 fractions. Local control (LC), progression-free survival (PFS), and overall survival (OS) were retrospectively investigated according to the T-classification subdivisions of the eighth edition and maximal solid tumor component diameter.Results:The median follow-up period was 32.5 months. The median maximum tumor and solid tumor component diameters were 22 mm and 18 mm, respectively. 3-year LC, PFS, and OS rates were 84.1%, 69.4%, and 85.3%, respectively. The 3-year LC rates were 91.0 and 76.8% in the groups with tumor diameter ≤2 cm and >2 cm, corresponding to the T1c and T1b subdivisions of the eighth edition, respectively (p = 0.24). In the ≤2 cm and >2 cm solid tumor component groups, the 3 year LC rates were 93.6 and 63.2%, respectively, which were significantly different (p = 0.007).Conclusion:LC rates after radiotherapy in patients with Stage I NSCLC were correlated with solid tumor component diameter. High LC rates in patients with solid tumor components <2 cm in diameter were associated with high PFS and OS rates.Advances in knowledge:This study suggests that the eighth edition TNM classification system, which focuses on solid tumor components rather than tumor diameter, can be applied to radiotherapy.

Use of the sublingual gland for reconstruction of a defect in the floor of the mouth after resection of early stage carcinoma

Use of the sublingual gland for reconstruction of a defect in the floor of the mouth after resection of early stage carcinoma

A rare case of grade 1 endometrioid adenocarcinoma of the uterus with omental metastasis with brenner tumor of the ovary in a postmenopausal female

Early-stage endometrial cancer may have microscopic omental metastases which is associated with a poor prognosis. There are no standard guidelines for omentectomy in early-stage endometrial cancer without risk factors. Brenner tumor is a rare ovarian tumor which is usually benign, but rarely, it may be malignant. Some Brenner tumors are endocrinologically active. Various studies have shown an association of Brenner tumor with endometrial hyperplasia, polyp, or early-stage carcinoma, probably due to its estrogen-secreting nature. We report a rare case of well-differentiated endometrioid adenocarcinoma of the uterus with <50% myometrial invasion with omental metastases associated with benign Brenner tumor of the ovary in a postmenopausal female.