High Local Recurrence Rate Research Articles

Retroperitoneal Desmoid Tumour Masquerading as Malignancy: A Case Report

Desmoid tumour is a rare, benign soft tissue tumour. It is noted to be clinically aggressive but pathologically benign, showing a high local recurrence rate; however, it cannot metastasize. Although it is benign, it can impact functionality. The majority of these cases remain sporadic, and the aetiology is unknown. The retroperitoneum is a rare site, and there are few reports of desmoidtype fibromatosis occurring in this region. It is difficult to distinguish from other tumours and to identify the tumour’s origin. Here, the authors present a case of a 36-year-old female who presented with abdominal pain and a mass in her abdomen. Imaging studies revealed a large retroperitoneal mass extending from the L5 vertebral body up to the inferior endplate of the L1 vertebral body. Exploratory laparotomy was performed, and the retroperitoneal mass was resected. Grossly, it was a capsulated dark brown to grey-coloured mass measuring 15×12×10 cm. The mass was sent for histopathology {Haematoxylin and Eosin (H&E)} study and reported as a retroperitoneal desmoid tumour, which was further confirmed on Immunohistochemistry (IHC) by showing immunopositivity for Desmin, Muscle-Specific Actin (MSA), and Beta-catenin. The patient is doing well with no further complaints to date. No disease relapse has occurred. Follow-up has been done every three months till the writing of the present report.

Endoscopic submucosal dissection of anorectal Condyloma acuminatum.

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection. Although it is generally seen in the genital and perianal regions, anal canal and rectum sometimes could be involved. It has been reported to be associated with higher risk of intraepithelial neoplasia and cancer. Surgery excision and fulguration are the primary treatment, while high local recurrence rate of CA remains bothering. We presented a case of CA that detected via colonoscopy and successfully treated with endoscopic submucosal dissection.

A Rare Case of Vulvar Dermatofibrosarcoma Protuberans: A Case Report

Background Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade sarcoma of dermal origin with high local recurrence rate that rarely presents in the vulva. It affects adults between the second and fifth decade of life and the involved areas are most frequently the trunk, proximal extremities, head and neck. Case Presentation A 45-years-old Para 4 women presented with two raised masses on the right part of vulva for the last 17-month duration which increase in size for the last 6-month. First, incisional biopsy was taken from the mass and diagnosed as “Suggestive of leiomyoma”. Following to this, excision of the whole mass was done and sent for histopathologic examination. The final histopathologic diagnosis became DFSP with the classic microscopic picture of a storiform and honeycomb pattern of monomorphic bland spindle cells. Conclusion Dermatofibrosarcoma protuberans infrequently involves the vulva and should be considered in the differential diagnosis of other spindle cell lesions presenting in this unusual site.

Dermatofibrosarcoma protuberans of left temporal area with mass effect causing stenosis of EAM in 66-year-old patient - case report.

ABSTRACT INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive cutaneous sarcoma with a low metastasis potential, but a high local recurrence rate. It was first described in 1890 [1]. DFSP grows slowly and may take various forms in clinical trials - it presents both as a firm plaque, subcutaneous fat atrophy and a single or polycyclic tumor. Immunohistochemically DFSP, stains positive for CD34. The gold standard for DFSP treatment is a complete surgical excision with a margin of healthy tissue. Adjuvant therapy includes both radiotherapy and imatinib therapy. CASE REPORT: In June 2022, a 66-year-old patient with a tumor of left temporal area located behind the earlobe was admitted to the medical ward. The skin above the lesion remained unchanged. The imaging examination performed before the procedure showed a well-defined lesion and the results of the FNA biopsy np. BC-73765 were as follows: numerous neoplastic cells, partially fusiform with atypical features, cytological picture does not allow to determine the malignancy of the tumor. After performing the necessary examination, the patient underwent surgery. Histopathological biopsy report of the specimen came out as DFSP. Therefore, the patient was referred for adjuvant radiotherapy by the decision of the Medical Council.CONCLUSIONS: Due to high risk of recurrence and incidence of unclear margins after surgical excision, adjuvant radiotherapy is often used in the treatment of DFSP as it reduces the recurrence rate. KEY WORDS: DFSP, radiotherapy, Mohs micrographic surgery, surgical treatment.

Review of dermatofibrosarcoma protuberans.

The clinical features, histological subtypes and management of dermatofibrosarcoma protuberans (DFSP) are reviewed in this article. DFSP is an uncommon cutaneous sarcoma first described in 1890. It has a high local recurrence rate, low metastatic rate and low mortality. The crude incidence rate in England in 2019 was reported as 3.0 per million person-years. A fusion of platelet-derived growth factor subunit B (PDGFB) and COL1A1, t(17;22)(q22;q13), has been found in over 90% of people with DFSP. This fusion is thought to upregulate PDGFB expression, stimulating cell growth by activation of Ras mitogen-activated protein kinases and PI3K-AKT-mTOR, potentiating oncogenesis. DFSP usually presents as an asymptomatic flesh-coloured, thickened, rubbery plaque or nodule with an uneven surface. The most common sites are the trunk followed by lower limbs, head and neck and upper limbs. Larger tumours can infiltrate underlying local structures and around 1% metastasize. Key histological features in DFSP are spindle cells arranged in a storiform pattern with intense CD34 staining. Histological subtypes include classical DFSP, Bednar, myxoid, giant cell fibroblastoma, atrophic and DFSP-fibrosarcomatous. The gold standard management for localized tumours is surgical: current recommendations favour Mohs micrographic surgery over wide local excision. Adjuvant radiotherapy may be offered after surgery. Imatinib can be used as neoadjuvant therapy and in patients with inoperable or metastatic tumours. Further research should be conducted to better understand pathogenesis of DFSP, identify associated risk factors and standardize management.

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries.

Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two-team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short- and medium-term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well-trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.

Primary Angiosarcoma of the Spleen: An Aggressive Neoplasm.

Primary tumors of the spleen are rare, with an incidence rate of about 0.1%. These tumors could be benign, usually asymptomatic, or malignant which are usually symptomatic with abdominal pain being the most common symptom. Lymphoid neoplasms are the most common primary splenic tumors. Primary angiosarcoma is one of the extremely rare malignant vascular neoplasms of the spleen, which carries a dismal prognosis. It constitutes almost 7.4% of all primary malignant splenic neoplasms and is well known as an aggressive tumor with high local recurrence and distant metastasis rates. Overall survival is up to 12 months following diagnosis, regardless of management strategy. Due to the broad differential diagnosis of splenic tumors, this tumor is often forgotten, and is very challenging to diagnose early. Less than 300 cases of primary splenic angiosarcoma have been reported in the English literature. The main issue of this article is to review the current English literature to figure out the characteristic demographic features, clinical presentation, imaging findings and management of such tumors, in order to increase awareness of the treating physicians to improve diagnosis, management, as well as overall survival.

Inflammatory myofibroblastic tumour of an unusual site in an infant

Inflammatory myofibroblastic tumors are rare mesenchymal tumors of intermediate malignant potential, usually seen in the first or second decades of life. They have a high local recurrence rate but rarely metastasize. The involvement of paranasal sinuses or the nasal cavity is relatively uncommon, especially in infants. In children, there is a predilection for the abdominal cavity and it is rare in infants. Complete surgical excision is the treatment of choice. We report a case of a 10-month-old girl with an inflammatory myofibroblastic tumor of the left nasal cavity and sinuses who was initially treated with chemotherapy in view of the complicated surgical process and later underwent near-total resection as she was not responding to chemotherapy. Knowledge of such tumors among physicians and ENT surgeons will improve the prognosis, as completely excised tumors have a very low recurrence rate and adjuvant therapy may not be needed.

Progress on Denosumab Use in Giant Cell Tumor of Bone: Dose and Duration of Therapy.

Giant cell tumor of bone (GCTB) is an aggressive non-cancerous bone tumor associated with risks of sarcoma and metastasis. Once malignancy occurs, the prognosis is generally poor. Surgery remains the main treatment for GCTB. Multidisciplinary management is a feasible option for patients wherein surgical resection is not an option or for those with serious surgery-related complications. Denosumab is an anti-nuclear factor kappa B ligand approved for the treatment of postmenopausal women with osteoporosis, bone metastases, and advanced or inoperable GCTB. However, the guidelines for treating GCTB are unclear; its short-term efficacy and safety in inoperable patients have been demonstrated. Lengthier therapies (high cumulative doses) or pre-operative adjuvant therapy may be associated with severe complications and high local recurrence rates. Short-term administration helps attain satisfactory local control and functionality. As a result, lately, the impact of different doses and lengths of treatment on the efficacy of denosumab in GCTB treatment, the incidence of complications, and recurrence rates have gained attention. The efficacy and safety of denosumab against GCTB, its impact on imaging assessment, related complications, and recurrence of GCTB were previously reviewed. For further research direction, this paper reviews the progress of studies evaluating the impact of the dose and duration of denosumab therapy for GCTB.

A case report on a novel use of intraoperative Intrabeam™ radiation therapy for a recurrent malignant peripheral nerve sheath tumor with sciatic nerve involvement

BackgroundMalignant peripheral nerve sheath tumors (MPNST) are sarcomas that arise from peripheral nerves. They generally have a poor prognosis which is exacerbated by high local recurrence rates. This case report discusses the treatment of a patient with a MPNST with local recurrence. This case report is novel due to the use of intraoperative Intrabeam™ (Zeiss, Dublin, CA) radiation therapy use in the protection of neurovascular structures such as the sciatic nerve.Case presentation:The patient was a 65-year-old male who noticed a right posterior thigh mass slowly increasing in size over two months. A planned positive margin wide-resection excision was performed due to sciatic nerve abutment. The mass was determined to be a MPNST via postoperative pathology with positive margins along the sciatic nerve. The patient began adjuvant radiation therapy to the upper and lower thigh fields over a period of three months. Thirty-two months later, the patient was found to have a hypermetabolic mass with venous congestion and hyperemia at the prior surgical site which was confirmed by core needle biopsy to be local recurrence of the MPNST. Re-excision of the tumor was planned and performed followed by intraoperative Intrabeam™ radiation therapy. At two years of follow-up, the patient was doing well with minimal pain in his right buttock region with no new or recurrent neurological deficits. Radiologic imaging was negative for local recurrence of the MPNST.ConclusionWe believe this case report demonstrates a novel treatment strategy for sarcoma management. The unique use of intraoperative Intrabeam™ radiation therapy, which had not previously been used for this indication, may be efficacious in cases involving neurovascular structures. In this case, focal radiation from the intraoperative Intrabeam™ radiation device was used in a way to affect the recurrent tumor yet protect the sciatic nerve.

Benign Multicystic Peritoneal Mesothelioma as a Rare Cause of Death

Abstract Introduction/Objective Benign multicystic peritoneal mesothelioma (BMPM) is a tumor arising from the serosa of the peritoneal cavity, often in the pelvis, and is comprised of multiple cysts lined by bland mesothelial cells. It is a rare entity with less than 200 cases reported. The clinical course is often indolent with nonspecific symptoms. It has a strong predilection for females (90%) and is commonly associated with endometriosis or prior surgeries. A high local recurrence rate (50%) following excision has been reported, but malignant transformation is rare. Methods/Case Report The decedent was a 53-year-old male with a history of multiple hernia repairs who presented following three days of diffuse abdominal pain and obstipation. Imaging showed large volume, complex ascites with multiple rim-enhancing fluid collections, diffuse peritoneal thickening, and a soft tissue density in the lower abdomen/pelvis. Exploratory laparotomy was congruent and revealed 2L of purulent ascites, numerous peritoneal cystic lesions, and a bulky tumor in the pelvis. Blood and ascites cultures later grew Bacteroides species, and Escerichia coli was also isolated from the blood. Postoperatively, the decedent continued to decline, and death occurred the following day. Autopsy demonstrated that the firm pelvic mass entrapped the bladder, rectum, and segments of the small intestine. Sectioning revealed numerous cystic spaces of varying size. Microscopically, they were lined by a single layer of benign cells with mild to focally moderate atypia. These cells stained positive for Calretinin, Pan-cytokeratin, and D2-40 and negative for CD31, which is characteristic of mesothelial cells. These findings are consistent with BMPM. Results (if a Case Study enter NA) NA. Conclusion The decedent’s death is the result of sepsis following acute peritonitis due to BMPM. Death resulting from this entity is exceedingly rare, and to our knowledge this case is only the second reported death due to BMPM.

Clinicopathologic features, prognostic factors, and outcomes of visceral sarcomas: A retrospective 12-year single-center study.

Visceral sarcomas are a rare form of soft tissue sarcoma. This study aimed to evaluate the survival and prognostic factors and effective treatments for visceral sarcomas. All patients with visceral sarcoma referred to our center between January 2010 and December 2021 were retrospectively analyzed. The Kaplan-Meier method and a log-rank test were used for survival analysis. A total of 53 patients with visceral sarcoma were analyzed in this study with the median age at diagnosis of 57 (range, 24-77) years. Among them, 37 (69.8%) and 16 (30.2%) patients had localized and metastatic diseases at the initial presentation, respectively, and 44 patients underwent surgical resection. The median follow-up, event-free survival (EFS) and overall survival (OS) were 63.0 (range, 2-130), 42.0 months (95% confidence interval [CI] 10.879-73.121) and 45.0 months (95% CI 9.938-80.062), respectively. The 5-year EFS and OS rates were 44% and 46%, respectively. Univariate analysis of prognostic indicators illustrated that metastasis at presentation, surgery, surgical margin and the types of surgery were significantly associated with OS and EFS. In this study, combined chemotherapy or radiotherapy had no effects on EFS and OS. Primary visceral sarcoma is an uncommon and aggressive malignant tumor with a higher rate of local recurrence. In the largest cohort of visceral sarcomas in China to date, we identified metastases at presentation, surgery, surgical margin, and the types of surgery as independent predictors of survival. The combination of chemotherapy and radiotherapy did not affect survival.

Superficial low-grade fibromyxoid sarcoma.

Low-grade fibromyxoid sarcoma (LGFMS) typically involves deep soft tissue (beneath the fascia) of the proximal extremities and trunk. Long-term follow-up has shown a high rate of local recurrence, metastasis, and death. To the best of our knowledge, there is only one previous large series focusing on superficial LGFMS suggesting superficial tumors are disproportionately more common in children and may have a better prognosis. Our study's primary goals are to confirm these findings and increase general awareness that LGFMS may arise in superficial soft tissue. We retrieved our cases of superficial LGFMS diagnosed between 2008 and 2020. Available slides were reviewed, and clinical data and follow-up information were obtained. The patients included nine males and 14 females with a median age of 29 years; eight (35%) were children (<18 years) and five (22%) were young adults (18-30 years). The majority involved the lower extremities (65%). The tumors were primarily centered in the subcutis (91%) and dermis (9%). Microscopically, they had typical features of LGFMS with alternating fibrous and myxoid zones composed of bland, slightly hyperchromatic spindled cells. All were positive for MUC4 by immunohistochemistry and/or FUS rearrangement by FISH. Follow-up on 14 cases ranged from 11 to 148 months (median 61 months) with no evidence of recurrences or distant metastases. Compared to conventional deep-seated counterparts, superficial LGFMS is more likely to occur in the extremities of children and young adults and may have a better clinical outcome. Further studies with longer follow-up will likely help support these findings.

ODP550 Giant Cell Tumor of Bone: A Diagnostic Consideration of Sellar Lesions

Abstract Background Giant cell tumor of bone (GCTB) is a skeletal neoplasm that most commonly occurs in long bones and rarely in the skull. These tumors are considered benign but tend to be locally aggressive and carry a high rate of local recurrence. True malignant transformation is rare and even metastatic disease carries a rather benign course. Clinical manifestations depend on tumor location and are mostly due to mass effect into the surrounding tissues. We describe a patient with a GCTB, located at the sellar-suprasellar region which resulted in optic chiasm compression and panhypopituitarism. Clinical Case Case of a 28-years-old female who initially presented with recurrent headaches for which brain imaging was done and a suprasellar mass was noted. It initially measured2.3x 3.2x 2. 0 cm. The mass was invading the left cavernous sinus and displacing the pituitary gland and infundibulum to the right. At that time no optic chiasm compression was noted, and no pituitary hormonal excess or deficiency was identified. The mass was treated conservatively with gamma knife radiation, with reduction in size. About 10 months later, patient complained of visual problems for which brain imaging was repeated and noted with interval increase in tumor size. Patient was started on dexamethasone due to mass effect and referred to ER. Review of systems at that time was remarkable for oligomenorrhea and decreased peripheral vision. Patient denied general malaise, dizziness, galactorrhea, weight changes, palpitations, dry skin or striae, bowel changes, polyuria, increased thirst nor changes in shoe or ring size. Physical examination showed unremarkable vital signs. Upon confrontation there was evidence of bitemporal hemianopsia confirmed on formal visual field testing. Laboratory studies showed mildly elevated prolactin, low-normal TSH with mildly low FT4 suggesting overt central hypothyroidism and suppressed morning cortisol. Patient was scheduled for craniotomy, which resulted in an overall decrease of tumor bulk. After the surgery, patient developed DI requiring desmopressin administration. Currently, patient continues with panhypopituitarism treated with hormonal replacement. Pathology report was compatible with a GCTB. On follow up MRI about 6 months after surgery, there was mild interval increase in size, no distant metastases identified. Treatment with denosumab was started as recommended by oncology service in an attempt to control tumor growth. At this time, patient has tolerated denosumab well and has not developed further headaches or visual symptoms. Follow up imaging is pending to assess response to treatment. Conclusion GCTB of the sella-suprasellar region, albeit rare, have been described and always should be included in the differential diagnosis of sellar lesions. Imaging alone is insufficient to make a definitive diagnosis of these tumors and tissue sampling either by biopsy or surgical resection should be considered in order to determine treatment alternatives. Presentation: No date and time listed

Regulation of epigenetic modifications in the head and neck tumour microenvironment.

Head and neck tumours are common malignancies that are associated with high mortality. The low rate of early diagnosis and the high rates of local recurrence and distant metastasis are the main reasons for treatment failure. Recent studies have established that the tumour microenvironment (TME) can affect the proliferation and metastasis of head and neck tumours via several mechanisms, including altered expressions of certain genes and cytokines. Increasing evidence has shown that epigenetic modifications, such as DNA methylation, histone modification, RNA modification, and non-coding RNAs, can regulate the head and neck TME and thereby influence tumour development. Epigenetic modifications can regulate the expression of different genes and subsequently alter the TME to affect the progression of head and neck tumours. In addition, the cell components in the TME are regulated by epigenetic modifications, which, in turn, affect the behaviour of head and neck tumour cells. In this review, we have discussed the functions of epigenetic modifications in the head and neck TME. We have further examined the roles of such modifications in the malignancy and metastasis of head and neck tumours.

Spindle Cell Carcinoma of the Head and Neck: Clinical Characteristics and Molecular Signatures.

Spindle cell carcinoma of the head and neck (HNSpCC) is a rare variant of head and neck squamous cell carcinoma (HNSCC). This study evaluated the clinical characteristics and molecular signatures of such tumors. Retrospective analysis. Medical records of patients diagnosed with HNSpCC from 1996 to 2018 were reviewed. The clinicopathologic features, treatment modalities, and survival status were carefully recorded. Whole exome sequencing (WES) was performed to evaluate the genetic signatures of HNSpCC. We found that among all 71 patients included in this study, the majority of them were male, with tumors developing predominantly in the oral cavity. The 1-, 3-, and 5-year disease-specific survival (DSS) rates were 64.6%, 49.5%, and 43.9%, respectively. A high local recurrence (LR) and distant metastasis (DM) rate (47.9%-25.3%, respectively) were observed. A significant proportion (28.2%) of patients with the worst prognosis had history of previous head and neck cancer (HNC) and had been treated with radiotherapy (RT). WES revealed that those post-RT SpCC shared common mutations with their previous HNC (pre-RT SCC), but gained additional genetic traits, such as hypoxia and cell-ECM interaction that were favorable for survival in an irradiated microenvironment. Distinct genetic landscapes in primary and post-RT SpCC were also found. This study demonstrates that HNSpCC is a unique entity with more aggressive behavior than conventional HNSCC. HNSpCC arising from a previously irradiated field is a predictor of dismal survival. Both genetic and microenvironmental factors contribute to this highly invasive tumor. 4 Laryngoscope, 133:2183-2191, 2023.

Accelerated Partial Breast Irradiation vs. Intraoperative Radiation Therapy for Early-Stage Breast Cancer and Ductal Carcinoma In Situ

<h3>Purpose/Objective(s)</h3> Accelerated partial breast irradiation (APBI) delivered with intensity modulated radiation therapy (IMRT) over 5 fractions represents an attractive and convenient method of delivering adjuvant radiation therapy without compromising oncologic or aesthetic outcomes. Intraoperative radiation therapy (IORT) is another method of delivering radiation therapy to the lumpectomy cavity. Initial results reported in clinical trials utilizing IORT were encouraging; however, with longer follow up, higher rates of local recurrence have been observed in contrast to APBI. We report the outcomes of a large cohort of patients treated with 5 fraction APBI and IORT at our institution after undergoing breast conservation surgery (BCS) for stage 0-IIA breast cancer. <h3>Materials/Methods</h3> We performed a retrospective review of 482 patients with stage I-IIA stage breast cancer and ductal carcinoma in situ (DCIS) treated with lumpectomy and APBI at our institution. In total, 267 patients in our cohort received IMRT from December of 2015 to May of 2021 while 215 patients received IORT from October of 2011 to May of 2019. All patients in the IMRT group received 30 Gy in 5 fractions. All patients in the IORT group received 20 Gy in 1 fraction prescribed to the applicator surface delivered at the time of surgery without additional radiation. Kaplan-Meier analysis was used to estimate locoregional control (LRC) and overall survival (OS) among the 2 groups. <h3>Results</h3> Mean age at diagnosis of the patients was 67 years in the IMRT group and 71 years in the IORT cohort. The IMRT group included 220 patients with Stage I breast cancer (82%), 4 patients with Stage IIA breast cancer (1%), and 43 (16%) patients with DCIS. The IORT group had 198 (92%) with stage I breast cancer, 12 patients (6%) had Stage IIA breast cancer, and 5 patients (2%) had DCIS. After a median follow up of 16 months in the APBI group, only 1 (0.4%) patient experienced a local recurrence, and no patients experienced a regional or distant recurrence. After a median follow up of 55 months in the IORT group, 12 patients (5.6%) experienced a local recurrence, 1 patient (0.5%) experienced a nodal recurrence, and 4 patients (1.9%) experienced a distant recurrence. There was no significant statistical difference in hormonal therapy receipt between both groups (75.3% vs 76.7%, p=0.64). There was no significant difference in 2-year LRC between the APBI and the IORT groups (98.9% in the APBI group vs. 99% in the IORT group, p=0.32). There were no differences in 2-year OS between the two groups (99.6% vs 98.5%, p=0.33). The 5-year LRC was 92.7% in the IORT group. <h3>Conclusion</h3> In a large institutional series of patients with Stage 0-IIA breast cancer treated with BCS followed by 5 fraction APBI or IORT, despite having low risk features and high rates of endocrine therapy use, IORT was associated with high rates of locoregional recurrence of approximately 7% at 5 years. Longer term follow up is needed for comparative effectiveness observations between the two groups.

Radiation Therapy Techniques in the Management of Locally-Advanced, High-Grade, Soft-Tissue-Sarcoma

<h3>Purpose/Objective(s)</h3> Assess which prognostic factors affect local recurrence (LR) rates and wound complications of locally-advanced, high-grade, soft-tissue-sarcoma (STS). <h3>Materials/Methods</h3> Retrospective analysis was performed on patients 2005 to 2018, with high-grade STS of extremity or trunk, >5cm, histology specific, with central pathology review. Wide-excision was performed in 100 patients along with radiation, whose radiation fields and dose plans were available for review, of which 31 also received Ifosfamide-Doxorubicin, with a minimum follow-up of 1-year. Multi-variable-analysis (MVA) of prognostic factors were calculated to see which variables affected LR, and nonhealing wound rates. <h3>Results</h3> Median follow-up was 5.8 years. Univariate analysis revealed that trunk location, proximal, distal, and radial clinical-target-volume (CTV) margins of 1.5cm had higher rates of LR vs ≥2cm or presence of fascial boundary. MVA of these prognostic factors revealed that trunk location (p=0.048), and radial CTV of 1.5cm (p=0.006) independently predicted for higher LR, as 10 of 15 LR were at the edge of the radial margin. Bolus did not affect LR. The odds ratio for nonhealing wounds at 3 months were higher for T2a disease, larger tumor size, proximal CTV ≥2cm, wider field size, use of chemotherapy, and bolus technique. <h3>Conclusion</h3> Proximal/distal CTV margins of 3cm seem adequate, but high-grade STS ≥ 5cm may benefit from increased radial CTV margins of 2-2.5cm in the absence of a fascial boundary, although larger CTV may increase nonhealing wound rates. Bolus techniques lead to higher wound complications in T2a-b STS, and should be avoided.

Effectiveness of Adjuvant Radiotherapy for High Recurrence Risk Patients with Upper Tract Urothelial Carcinoma

<h3>Purpose/Objective(s)</h3> A recent study has shown that upper tract urothelial carcinoma (UTUC) patients with high-risk factors have a high local recurrence rate. The purpose of this work present study was to investigate the benefit of adjuvant radiotherapy (ART) for patients with high recurrence factors. <h3>Materials/Methods</h3> 424 UTUC patients who received radical nephroureterectomy (RNU) in our hospital between 2010 and 2018 were reviewed. We used univariate and multivariate Cox proportional regression models to identify the independent variables associated with the oncological outcomes. In patients with recurrence factors, propensity score matching was used to adjust the confounding factors for ART. <h3>Results</h3> The median follow-up time was 40 (range 3-77) months. Multivariate analysis showed that multifocal tumor, G3, pT3/4 stage, and positive lymph node (N+) were independent predictors for worse recurrence-free survival (RFS). Multifocal tumor and pT3/4 stage were independent predictors of worse cancer specific survival (CSS) in UTUC after surgery. A total of 286 patients with these high recurrence factors were identified: 192 (67.1%) patients received RNU only, and 94 (32.9%) patients received ART. Overall, ART did not improve CSS (P = 0.11). After propensity score matching, ART significantly improved the CSS of patients with high recurrence factors. The 3-year CSS was 73.1% in patients treated with RNU alone vs 86.1% in patients treated with ART (P=0.016). <h3>Conclusion</h3> Multifocal tumor, G3, pT3/4 stage, and positive lymph node (N+) were high recurrence factors of UTUC. Adjuvant radiotherapy benefited both the CSS and RFS outcomes of these patients. The side effects of ART were mild.

Laryngeal Lipoma: An Uncommon Localization, Case Report and Literature Review.

Lipomas are common mesenchymal begin tumors, the head and neck localization accounts for less than 15% of the body lipomas and the laryngeal locating accounting for 0.6%. Laryngeal lipoma can be isolated and intrinsic, submucosal or even pedicled endoluminal mass. Symptoms of the laryngeal localization of this benign tumor is logically determined by its size and location. Surgical excision remains the key treatment as this tumor characterized by its high rates of local recurrence. We thus report a rare localization of this benign tumor in 76-year-old patient admitted to the emergency room for an acute laryngeal dyspnea.