Excision Of Primary Lesion Research Articles

Occurrence of Second Oral Potentially Malignant Disorder following Excision of Primary Lesion: A Prospective Study of Cases from a Tertiary Care Centre

BackgroundEarly diagnosis and timely management of potentially malignant oral disorders may prevent malignant transformation and prompt diagnosis of frank malignancies favours better prognosis. The aim of this study was to evaluate the outcome of surgical management of oral potentially malignant disorders of the oral cavity and observe the prevalence of recurrence at the primary site and occurrence of another potentially malignant lesion in these patients.MethodsThe study participants included patients who had undergone clinical oral examination, surgical excision of biopsy-proven cases of dysplastic oral potentially malignant disorders (leukoplakia, erythroplakia, non-healing ulcerative and erosive areas, etc.) who were on routine follow-up as per the standard guidelines. These patients were followed up closely during each monthly follow-up visit for the first year. The patients were then prospectively analysed for any recurrence of lesion. On follow-up visits, detailed clinical oral examination was done to note the prevalence of a new lesion in any oral cavity sub site other than the previous site. If a new lesion was detected, then biopsy followed by surgical excision was followed as per standard guidelines. The follow-up period after the second surgical intervention was 12 months.ResultsFifty patients with potentially malignant oral disorders underwent surgical excision. The majority of the study subjects were males (39/50) and 41 of them were below 65 years of age. Of 50 patients, 13 (26%) had second oral potentially malignant lesion other than the primary site. The rate of recurrence of the lesions at the primary site was 4% (2/50). Of these patients with recurrence, all had malignant transformation (2/2). Also, patients who were initially diagnosed with moderate dysplasia had a higher chance of recurrence. A second lesion at a site different from the primary lesion was seen in 26% of the cases.ConclusionSurgical management of such lesions with one-centimetre oncological margins in all dimensions contrary to the routine five millimetre surgical margins reduces the chance of recurrence.

Efficacy and Safety of Regorafenib Combined with Toripalimab in the Third-Line and beyond Treatment of Advanced Colorectal Cancer.

Background The most effective treatment of immune checkpoint inhibitors (ICIs) is restricted in microsatellite instability (MSI-H) subsets of advanced colorectal cancer, but MSI-H only accounts for 4-5% among them. ICIs are completely ineffective in advanced colorectal cancer patients with microsatellite stable (MSS), according to literatures published. Regorafenib is a novel tyrosine kinase inhibitor (TKIs) that could normalize tumor blood vessels by inhibiting vascular endothelial growth factor receptor and its downstream, thus improving cytotoxic T cell infiltration in tumor microenvironment, which has a synergistic effect with ICIs. Toripalimab is a type of anti-PD-1 monoclonal antibody produced by Junshi Biosciences in China. Herein, we aimed to explore the efficacy and safety of regorafenib combined with toripalimab in the third-line and beyond treatment of advanced colorectal cancer. Methods We evaluated the outcomes of MSS patients with advanced colorectal cancer who received regorafenib combined with toripalimab in the Second Affiliated Hospital of Nanchang University from June 2019 to January 2021. These patients had previously received at least second-line treatment; the regimens were oxaliplatin and irinotecan-based chemotherapy and/or accompanied with bevacizumab or cetuximab. Thirty-three patients were treated orally with regorafenib 80 mg or 120 mg once daily for 21 days, 28 days as a cycle, combined with intravenous toripalimab until disease progression or intolerant to adverse reactions. We used the Kaplan–Meier method to estimate the rate of progression-free survival (PFS) and log-rank method to do a statistical test of the survival curve. The Cox regression model was used to analyze the influence of multiple factors on PFS. The primary endpoints were objective remission rate (ORR) and disease control rate (DCR). The secondary endpoints were the incidence of adverse reactions and median progression-free survival (mPFS). Results The evaluation of treatment effects was assessed according to RECIST 1.1. Four patients (12.12%) got partial response, twelve patients (36.36%) experienced stable disease, and seventeen patients (51.52%) suffered progressive disease. ORR was 12.12% and DCR was 48.48%. mPFS was 113 days (95% CI: 0–272.1). In univariate analysis, patients who had previously received second-line treatment were significantly better than those who had received third-line or more treatment (p=0.005). Lung metastasis was a negative factor in combined therapy (p=0.032). Five patients without previous treatment of bevacizumab were effective. Previous treatment without bevacizumab showed a trend of effective when combination therapy (p=0.034). It was also a positive factor that the Eastern Cooperative Oncology Group performance status (ECOG) score was 0 (p=0.034). Multivariable Cox regression analysis showed the number of previous chemotherapy lines and excision of primary lesions were independent prognostic factors. The most common treatment-related adverse reactions were hand-foot syndrome (33.33%), liver dysfunction (27.27), hypothyroidism (24.24%), fever (24.24%), fatigue (21.21%), leukopenia (15.15%), hypertension (12.12%), platelet count decreased (6.06%), diarrhea (3.03%), and myocarditis (3.03%); one patient stopped treatment as myocarditis. The incidence of grade 3/4 adverse reactions was 9.09%. Conclusions Regorafenib combined with toripalimab has a promising effect in the third-line and beyond treatment of advanced colorectal cancer. In the early use of combination therapy, excision of primary lesions can have a positive impact in regorafenib and toripalimab combination. This treatment-related adverse reactions are tolerant in combined therapy.

How Long to Keep the Surgical Drains- Looking for Evidence

Objective: Closed suction drainage is the standard of care for head and neck surgical wounds. The aim of study is to determine the effective duration of surgical drains in different types of Head and Neck procedures. Study design: Prospective randomized trial in a tertiary referral center. Methods: A total of 153 patients were divided into five groups. The study included patients with Head and Neck malignancies undergoing surgery. The patients in each group were assigned to two groups (Day 2 and Day 5) and drain output was measured. Results: The total drainage was found to be more in laryngectomy group followed by neck dissection group, then by primary lesion excision with neck dissection followed by thyroidectomy group and lowest in Parotidectomy group. It was found that maximum drainage occurred in first 24 hours after surgery, with subsequent decrease in drainage volume in all the groups. Conclusion: It is safe to remove the surgical drain after 48 hours of major Head and Neck surgery. There were minimum drain related side effects in patients who had their drain removed in 48 hours. There was a positive correlation between intraoperative blood loss and postoperative drainage in all groups. The drainage fluid after Major Head and Neck surgery is transudative in nature.

Metastatic malignant melanoma

The aim of this study is to evaluate the therapeutic efficacy of computed tomography (CT)-guided interstitial iodine-125 (I) seed implantation for metastatic malignant melanoma treatment. From November 2008 to May 2011, 24 patients with metastatic malignant melanoma who had undergone surgery for excision of primary lesions and repeated chemotherapy underwent CT-guided I seed implantation. Their clinical situations, biochemical indicators, MRIs, and CTs were observed. The follow-up time ranged from 5 to 24 months (mean 19.6 months). The local control rates of metastatic malignant melanoma after surgery excision for primary lesion after 2, 6, 12, and 24 months were 86.8, 78.6, 62.1, and 55.0%, respectively. One patient died of liver failure 5 months after brachytherapy and another died of a metastatic brain tumor 8 months after brachytherapy. Two patients died of lung dysfunction from pulmonary metastases 15 months after brachytherapy. All other patients survived throughout the follow-up period. The 2-year survival rate was 83.3%. During the procedure, one patient presented with minimal bleeding from the applicator route and another presented with pneumothorax with 20% pulmonary compression, which improved after intraprocedure suctioning. Four patients had low-grade fever on day 3. Three showed mild decreases in their white blood cell counts. CT-guided I seed implantation is a safe, feasible, and promising approach to the treatment of patients with metastatic malignant melanoma after surgery excision for primary lesions and repeated chemotherapy, but large-scale randomized clinical trials should be conducted before the technique can be used routinely.

Czerniaki złośliwe głowy i szyi w materiale Katedry i Kliniki Laryngologii SUM: analiza histo-kliniczna

Summary Introduction In 2008 in Poland, there were over 2,200 cases of malignant melanomas. This tumor is characterized by considerable malice. Malignant melanoma of the head and neck region is a vast concept. Therefore it includes cutaneous, ocular, mucous membranes and metastatic melanomas. Methods A retrospective analysis of patients admitted to ENT Department of Silesian Medical University in Katowice with diagnosis of head and neck malignant melanoma. Results Between 1983 and 2009 10 cases of melanoma of head and neck were registered in our Department. Six patients presented ocular melanoma. They manifested disturbed vision and exophtalmus. All of them underwent orbital exenteration of affected eye. One case of melanoma arising from palatine tonsil was registered. Main symptom was tumor of the neck. One patient suffered from melanoma of nasal cavity, which manifested as reccurent epistaxis. Metastatic melanoma was found in 2 cases. One of them involved parotid gland tumor, another- supraclavicular nodes. Every patient underwent excision of tumor. Patient with supraclavicular nodes involvement – Crile operation. Discussion The most important diagnostic procedure in every form of melanoma is histopathological examination which reaveles atypical melanocytes. Radical excision of primary lesion has a great importance in long term prognosis. Radio-, chemo- and immunotherapy remain auxiliary treatment, often in advanced stage of disease.

Lomber Deriden Köken Alan ve Yaygın Lenfadenopatilerle Seyreden Agresif Ekstra-Oküler Sebase Karsinoma: PET-BT Değerlendirmesi

Sebaceous carcinoma (SC) is a malignant adnexal tumor, usually originating from eyelids. Extra-orbital sebaceous carcinoma is a rare carcinoma localized commonly in head and neck region. Although extra-orbital SC has an indolent course, it may have highly invasive properties and may cause distant metastases rapidly. We report a 46 year-old-woman with extra-orbital SC originating from lumbar skin. Just after two months from the excision of primary lesion, patient readmitted with axillary lymphadenopathies. positron emission tomography (PET-CT) was used for evaluation of both extent of disease and treatment response. Partial remission was observed with docetaxel treatment. This case illustrates how extra-ocular SC can behave aggressively despite the traditional belief. PET-CT can help to evaluate the extent of disease and response to therapy.

Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I).

A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence. We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastases, it may be possible to prolong survival time.

Postoperative radiotherapy for cutaneous melanoma of the head and neck region

Purpose: To assess the efficacy and toxicity of elective-adjunctive radiotherapy given in five 6-Gy fractions to patients with cutaneous melanoma of the head and neck at high risk for local-regional relapse. Methods and Materials: From 1983 to August 1992, 174 patients (132 men and 42 women) were enrolled. The ages ranged from 16 to 89 years (median: 54 years). One group ( n = 79) received elective irradiation after wide local excision of lesions ≥ 1.5 mm thick, or Clark's level IV–V, a second group ( n = 32) received adjunctive irradiation after excision of primary lesions plus limited neck dissection, and a third group ( n = 63) received irradiation after neck dissection for nodal relapse. Each group had a projected local-regional recurrence rate of approximately 50%. The radiotherapy consisted of five fractions of 6 Gy each, specified at D max, delivered twice a week, to a total dose of 30 Gy in 2.5 weeks. Electron beams of appropriate energies were used whenever possible. Junction lines between adjoining fields were moved twice to minimize dose heterogeneity. Patients were seen at regular intervals to assess disease status and therapy-related complications. Patients who relapsed were treated as indicated by the clinical status. Results: With a median follow-up of 35 months, 111 of 174 patients were alive. The disease recurred above the clavicles only in six patients, at distant sites in 58 patients, and both local-regionally and at distant sites in nine patients. The actuarial 5-year local-regional control (LRC) and survival rates for the whole group were 88% and 47%, respectively. The thickness of the primary lesion, presence of more than three positive nodes, and extracapsular extension did not influence the LRC rate after radiotherapy (range: 85 – 92%). However, lesion thickness strongly affected the 5-year survival rate of group 1 patients (i.e., 100% for ≤ 1.5 mm thick, but Clark's level IV, 72% for > 1.5 – 4 mm, and 30% for > 4 mm). In groups 2 and 3, the 5-year survival rate of patients with > three involved nodes was lower than that of patients with one to three positive nodes (23% vs. 39%). The acute tolerance to adjunctive radiotherapy was excellent. Late radiation complications were observed in only three patients. These were moderate neck fibrosis, mild ipsilateral hearing impairment, and transient exposure of external auditory canal cartilage. Conclusion: The safety of this hypofractionated radiotherapy regimen in the management of cutaneous melanoma was established in this study. The overall 5-year actuarial LRC rate of 88% was much higher than that of our historical group and that reported in the literature (50%). The survival rate of patients with lesion of 1.5 – 4 mm thickness was also higher than that observed in other series. Based on these results a prospective randomized study to further define the role of adjunctive postoperative radiotherapy is planned.