Impact Of Margin Width Research Articles

Impact of Surgical Margin Width on Prognosis Following Resection of Hepatocellular Carcinoma Varies on the Basis of Preoperative Alpha-Feto Protein and Tumor Burden Score.

We sought to examine the prognosticimpact of margin width at time of hepatocellular carcinoma (HCC) resection relative to the alpha-feto protein tumor burden score (ATS). Patients who underwent curative-intent hepatectomy for HCC between 2000 and 2020 were identified from a multi-institutional database. The impact of margin width on overall survival and recurrence-free survival was examined relative to ATS using univariable and multivariable analyses. Among 782 patients with HCC who underwent resection, median ATS was 6.5 [interquartile range (IQR) 4.3-10.2]. Most patients underwent R0 resection (n = 613, 78.4%); among patients who had an R0 resection, 325 (41.6%) had a margin width > 5mm while 288 (36.8%) had a 0-5 mm margin width. Among patients with high ATS, an increasing margin width was associated with incrementally better overall and recurrence-free survival. In contrast, among patients with low ATS, margin width was not associated with long-term outcomes. On multivariable Cox regression analysis, each unit increase in ATS was independently associated with a 7% higher risk of death [hazard ratio (HR) 1.07; 95% confidence interval (CI) 1.03-1.11, p < 0.001]. While the incidence of early recurrence was not associated with margin width among patients with low ATS, wider margin width was associated with an incrementally lower incidence of early recurrence among patients with high ATS. ATS, an easy-to-use composite tumor-related metric, was able to risk stratify patients following resection of HCC relative to overall survival and recurrence-free survival. The therapeutic impact of resection margin width had a variable impact on long-term outcomes relative to ATS.

Abstract P3-08-07: Margins in breast conserving surgery after neoadjuvant therapy

Abstract Background:The margin consensus guideline for patients undergoing primary breast conserving surgery (BCS) and whole breast radiotherapy defines a negative margin as no tumor on ink and concludes that wider margins do not improve local recurrence (LR) rates. There are few studies examining BCS margin width after neoadjuvant chemotherapy (NAC).We sought to determine the impact of margin width on LR and survival rates after NAC and BCS. Methods: Institutional database were reviewed to identify patients with stage I-III breast cancer treated with NAC and BCS from 2002-2014. Patients with inflammatory breast cancer were excluded. Chart review was performed to collect detailed patient and treatment factors. Margins widths were collected as reported and grouped as: positive (ink on tumor), close (&amp;lt;2mm), and negative (&amp;gt;2mm), for the purposes of this analysis. Cox regression was used to determine the relationship between margin width and local recurrence, disease free survival (DFS) and overall survival (OS). Result: 395 patients underwent NAC followed by BCS during the study period. The result was same as below. results Patients, n (%)Age at diagnosis (yrs)51 [22;79]Initial tumor size (cm)3.0 [0.6;11.0]Clinical node status - negative207 (52.4%)- positive188 (47.6%)subtype - HR-/Her2-148 (37.5%)- HR-/Her2+48 (12.2%)- HR+/Her2-124 (31.4%)- HR+/Her2+72 (18.2%)- unclassified3 ( 0.8%)pCR* status - pCR97 (24.6%)- non pCR295 (74.7%)- unclassified3 ( 0.8%)Final margin state - no residual tumor in breast108 (27.3%)- positive8 ( 2.0%)- close (≤2)99 (25.1%)- negative (&amp;gt;2)180 (45.6%)*pCR was defined as no invasive or in situ disease in breast and no tumor in axillary node Median patient age was 51 yrs (range 22-79); median tumor size at presentation was 3.0 cm (range 0.6-11.0) and 188 (47.6%) patients (pts) presented with clinically node positive disease. Breast cancer subtypes included 148 (37.5%) pts with HR-/Her2-, 48 (12.2%) pts with HR-/Her2+, 124 (31.4%) pts with HR+/Her2- and 72 (18.2%) pts with HR+/Her2+, disease. Among all patients the pCR rate, defined as no invasive or in situ disease, in the breast was 27.3% (108/395) and the pCR rate in the breast and axillary nodes was 24.6% (97/395). Final margin status included 8 (2.0%) pts with positive margins, 99 (25.1%) with close &amp;lt;2mm and 180 (45.6%) with negative (&amp;gt;2mm) margins. Among the patients with “positive margins”; all were noted to be posterior or anterior and the surgeon noted that re-excision was not possible. At a median follow-up of 53.0 months the LR rate was 2.8% and DFS was 87.4%. On cox regression, HR positive subtype (p=0.048), pCR (p=0.035), and pathologic negative node (p&amp;lt;0.001) were correlated with favorable DFS and pathologic negative node (p&amp;lt;0.001) was correlated with favorable OS. There was no difference in LR rate, DFS or OS between 'close/positive margin' and '&amp;gt;2mm margin groups. Conclusion: In this cohort of patients treated with NAC followed by BCS, LR rates were very low and there was no difference in DFS between patients with margins &amp;lt; 2mm or &amp;gt; 2mm. Further studies are needed to confirm the effect of margin width in the NAC setting. Citation Format: Choi J, Golshan M, Hu J, Gagnon HC, Densantis S, Barry B, King T. Margins in breast conserving surgery after neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-07.

KRAS Mutation Status Dictates Optimal Surgical Margin Width in Patients Undergoing Resection of Colorectal Liver Metastases.

The optimal tumor-free margin width remains controversial and may be inappropriate to investigate without considering differences in the underlying tumor biology. R1 resection was defined as margin clearance less than 1mm. R0 resection was further divided into 3 groups: 1-4, 5-9, and ≥10mm. The impact of margin width on overall survival (OS) relative to KRAS status [wild type (wtKRAS) vs. mutated (mutKRAS)] was assessed. A total of 411 patients met inclusion criteria. Median patient age was 58years (interquartile range, 49.7-66.7); most patients were male (n=250; 60.8%). With a median follow-up of 28.3months, median and 5-year OS were 69.8months and 55.1%. Among patients with wtKRAS tumors, although margin clearance of 1-4mm or more was associated with improved OS compared to R1 (all P<0.05), no difference in OS was observed when comparing margin clearance of 1-4mm to the 5-9mm and the ≥10mm groups (all P>0.05). In contrast, among patients with mutKRAS tumors, all three groups of margin clearance (1-4, 5-9, and ≥10mm) fared no better in terms of 5-year survival compared to R1 resection (all P>0.05). While a 1-4mm margin clearance in patients with wtKRAS tumors was associated with improved survival, wider resection width did not confer an additional survival benefit. In contrast, margin status-including a 1cm margin-did not improve survival among patients with mutKRAS tumors.

Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate?

The impact of margin width on overall survival (OS) in the context of other prognostic factors after resection for colorectal liver metastases is unclear. We evaluated the relationship between resection margin and OS utilizing high-resolution histologic distance measurements. A single-institution prospectively maintained database was queried for all patients who underwent an initial complete resection of colorectal liver metastases between 1992 and 2012. R1 resection was defined as tumor cells at the resection margin (0 mm). R0 resection was further divided into 3 groups: 0.1 to 0.9 mm, 1 to 9 mm, and 10 mm or greater. A total of 4915 liver resections were performed at Memorial Sloan Kettering Cancer Center between 1992 and 2012, from which 2368 patients were included in the current study. Half of the patients presented with synchronous disease, 43% had solitary metastasis, and the median tumor size was 3.4 cm. With a median follow-up for survivors of 55 months, the median OS of the R1, 0.1 to 0.9 mm, 1 to 9 mm, and 10 mm or more groups was 32, 40, 53, and 56 months, respectively (P < 0.001). Compared with R1 resection, all margin widths, including submillimeter margins correlated with prolonged OS (P < 0.05). The association between the margin width and OS remained significant when adjusted for all other clinicopathologic prognostic factors. Resection margin width is independently associated with OS. Wide margins should be attempted whenever possible. However, resection should not be precluded if narrow margins are anticipated, as submillimeter margin clearance is associated with improved survival. The prolonged OS observed with submillimeter margins is likely a microscopic surrogate for the biologic behavior of a tumor rather than the result of surgical technique.

Impact of Margin Width on Outcome After Resection of Colorectal Liver Metastases

Impact of Margin Width on Outcome After Resection of Colorectal Liver Metastases

Impact of Margin Width on Outcome After Resection of Colorectal Liver Metastases

Impact of Margin Width on Outcome After Resection of Colorectal Liver Metastases

Impact of margin on tumour and normal tissue dosimetry in prostate cancer patients treated with IMRT using an endorectal balloon for prostate immobilization

In IMRT treatment, margin for planning target volume is determined by organ motion and set-up error. The margin width that achieves the desired dose escalation, while minimizing normal tissue exposure is dependent upon patient immobilization and/or organ localization techniques. In this study, we compare the impact of margin width on the dosimetry of tumour and normal tissues using an endorectal balloon filled with 100 cc of air. Plans were generated for ten patients using margin widths of 0, 3, 5, 8 and 10 mm. The prescription dose to prostate and seminal vesicles was 70 Gy in 35 fractions with 15% of bladder allowed to receive above 65 Gy, 15% of rectum above 68 Gy and 10% of femurs above 45 Gy. Margins above 5 mm produced significantly lower mean doses for both prostate and seminal vesicles without affecting TCP. For normal tissues, mean doses, percent volumes above prescription constraints and NTCP increased as a function of margin width, especially when this was 5 mm or above. We conclude that planning with tighter margins of < or =5 mm improves IMRT dosimetry for prostate and normal tissues and is only possible when target localization and/or immobilization devices are routinely used.

Treatment margins and treatment fractionation in conformal radiotherapy of muscle-invading urinary bladder cancer

Background and purpose Different treatment margins and fractionation schedules are used in conformal radiotherapy (CRT) of urinary bladder cancer. This study compared intestine and rectum dose–volume histogram (DVH) data and normal tissue complication probability (NTCP) estimates for various clinically applied margins and fractionation schedules in bladder irradiation. Patients and methods Normal tissue dose distributions in fifteen bladder cancer patients treated with CRT were studied using standard three- and four-field configurations. The impact of margin width on intestine and rectum dose distributions was initially evaluated using DVH data. NTCP modelling with the probit model was used to compare the impact of choice of margin size and fractionation schedule. The analysis included margin combinations of 1.0 cm isotropic (narrow margins) and 1.2–2.0 cm non-isotropic (wide margins) and fractionation schedule alternatives of 52.5 Gy/20, 55 Gy/20, 57.5 Gy/20 and 64 Gy/32. Results Using wide as compared to narrow margins, the volumes of intestine and rectum receiving high doses increased by factors of approximately two and four, respectively. Similar differences between wide and narrow margins were found when calculating intestine and rectum NTCPs. The impact of margin size depended strongly on the volume effect expressed by the NTCP model parameters. With standard parameters, however, the choice of margins and fractionation schedule had a similar impact on intestine NTCPs, while for the rectum, the choice of margin had a greater impact than the choice of fractionation. For a given margin size, the intestine and rectum NTCPs for the 55 Gy/20 and the 64 Gy/32 schedules were comparable. For clinics using narrow margins and a fractionation of 52.5 Gy/20, the NTCP modelling suggested that a change in fractionation schedule (to 55 Gy/20 or 64 Gy/32) or a change to wide margins would have a similar effect on the intestine NTCP predictions. Conclusions This modelling study documented that the choice of margins was as important as the choice of fractionation in terms of intestine and rectum DVH data and NTCP predictions.