Instances Of Local Recurrence Research Articles

An Image-Guided Percutaneous Core Needle Biopsy for Accurate Assessment of Musculoskeletal Tumors: A Targeted Diagnosis.

Background Accurate diagnosis of musculoskeletal tumors is essential for guiding appropriate treatment strategies. Percutaneous core needle biopsy (PCNB) is increasingly recognized as a valuable method for obtaining tissue samples for histopathological examination. This study aims to evaluate the diagnostic accuracy and clinical utility of PCNB in diagnosing musculoskeletal tumors. Methodology A total of 152 cases suspected of musculoskeletal tumors underwent PCNB at our tertiary care center between 2020 and 2023. Pre-biopsy evaluation included comprehensive clinical assessment and imaging studies. Core biopsies were performed under image guidance, with specimens sent for histopathological examination and culture sensitivity analysis. Diagnostic yield, accuracy, and performance metrics of PCNB were assessed. Results PCNB demonstrated a diagnostic yield of 93.4%. However, in cases where initial biopsies were inconclusive, repeat core biopsy or open biopsy provided the necessary diagnostic clarity. PCNB demonstrated a remarkable diagnostic accuracy of 97.9%, with a specificity and positive predictive value of 100%. There were no post-biopsy complications and no instances of local recurrence from the biopsy tract. Conclusions PCNB can be a reliable method for diagnosing musculoskeletal tumors, offering high diagnostic accuracy and minimal complications. The utilization of image guidance enhances precision and reduces the risk of complications. PCNB proves effective in diagnosing both primary tumors and bone infections, facilitating timely and appropriate treatment strategies in orthopedic oncology.

Stereotactic radiosurgery for brain metastases arising from gynecological malignancies: A retrospective treatment outcome analysis

BackgroundThis retrospective study aims to assess the efficacy of stereotactic radiosurgery (SRS) in the treatment of brain metastases (BM) originating from gynecological cancers. It focuses on local control (LC), distant tumor control (DTC), and overall survival (OS). MethodsThe analysis comprised 18 individuals with gynecological-origin BM treated with SRS at the Hadassah Medical Center from 2004 to 2021. Statistical analyses evaluate factors impacting LC, DTC, and OS. ResultsA total of 36 BM of gynecological origin underwent SRS. The median age at the first SRS treatment was 60 years, with a median time of 24.5 months from the primary malignancy diagnosis to BM detection. The 12-month LC rate per patient was 84.6 %, and 5.6 % per BM. Only two instances of local recurrence were observed. The DTC at 12 months was 75 %, with a 29 % overall. Non-significant trends indicating a correlation with distant brain failure with increased cumulative volume and the occurrence of craniotomy before SRS. The median OS of the cohort was 16.5 months from SRS treatment. The 6, 12, 18, and 24-month survival rates were 77.8 %, 66.7 %, 50 %, and 22.2 % respectively. Higher number of BM was associated with lower OS (p = 0.046). On multivariate analysis, age was a significant factor for OS (p = 0.03), demonstrating that older age was associated with a more favorable prognosis. ConclusionThis study supports SRS effectiveness for treating BM from gynecological cancers and suggests similar outcomes to more common malignancies.

Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques.

Stereotactic body radiotherapy (SBRT) has been firmly established as atreatment choice for patients with oligometastases, as it has demonstrated both safety and efficacy by consistently achieving high rates of local control. Moreover, it offers potential survival benefits for carefully selected patients in real-world clinical settings. Between January 2008 and May 2020, atotal of 149 patients (with 414 liver metastases) received treatment. The Active Breathing Coordinator device was used for 68 patients, while respiratory gating was used for 65 and abdominal compression was used for 16patients. The most common histological finding was colorectal adenocarcinoma, with 37.6% of patients having three or more metastases, and 18% having two metastases. The prescribed dose ranged from 36 to 60 Gy, delivered in 3-5fractions. Local control rates at 2 and 3years were 76.1% and 61.2%, respectively, with no instances of local recurrence after 3years. Factors negatively impacting local control included colorectal histology, lower prescribed dose, and the occurrence of new liver metastases. The median overall survival from SBRT was 32months, with the presence of metastases outside the liver and the development of new liver metastases after SBRT affecting survival. The median disease-free survival was 10months. No substantial differences in both local control and survival were observed between the respiratory motion control techniques employed. Treatment tolerance was excellent, with only one patient experiencing acute gradeIV thrombocytopenia and two patients suffering from ≥ gradeII chronic toxicity. For radical management of single or multiple liver metastases, SBRT is an effective and well-tolerated treatment option. Regardless of the technology employed, experienced physicians can achieve similarly positive outcomes. However, additional studies are required to elucidate prognostic factors that can facilitate improved patient selection.

Abstract 5449: Calretinin can be the specific marker for phyllodes tumor

Abstract Background Rare phyllodes tumors (PT) comprise a mixture of stromal and epithelial cells, and they can acquire malignant potential, which results in rapid progression and metastasis. Therefore, PT should be resected with an adequate free margin for curative intent. Fibroadenoma (FA) is a benign type of tumor that rarely becomes malignant, and usually does not require resection. However, PT and FA are morphologically and pathologically similar, which makes them difficult to distinguish in clinical practice. Thus, we aimed to determine a means of distinguishing them using a proteomic approach called Isobaric Tag for Relative and Absolute Quantitation (iTRAQ). We added different isobaric tags to normal and phyllodes tumor tissues, detected proteins using a database search and selected those that were at least three-fold more abundant than in normal tissue. Among them, we found high expression levels of calretinin, a specific marker for mesothelioma, in PT. Methods Tissue specimens were collected from 36 patients with PT (benign, n = 16; borderline, n = 15; malignant, n = 5), from 37 with FA and from three local recurrence sites of PT. All patients were treated by surgical resection at the Department of Breast Surgery, Tokyo Medical and Dental University, Japan, between March 2003 and August 2012. The specimens were analyzed by immunohistochemistry (IHC) using a calretinin antibody, and malignant mesothelioma as a positive control. Immunostaining for calretinin was analyzed by light microscopy in three high-power fields (HPF) and calretinin expression was assessed using Allred scores calculated on a scale from 0 to 8 as proportion (PS) plus intensity (IS) scores. We defined Allred scores of 0 and 2 as low (CLG) and those > 3 as high (CHG) calretin as reported for malignant mesothelioma. Data were analyzed using chi-square tests. Results All samples were stained. Stromal, but not epithelial cells tended to be positively stained for calretin. We found 20 and 17 FA, and 9 and 27 PT in CLG and CHG, respectively. More calretinin was expressed in PT than in FA (p = 0.011). Six and 25 benign or borderline PT were found in CLG and CHG, respectively. More calretinin was expressed in benign and borderline PT than in FA (p = 0.006). Three patients had local recurrence and one had distant metastasis. Recurrence did not significantly correlate with calretinin expression in PT; calretinin expression was low in all instances of local recurrence. Conclusion We found that calretinin could distinguish between PT and FA and could therefore function as an important marker when planning surgery. Malignant PT and sites of local recurrence tended to express low levels of calretinin. Further investigation of calretinin with PT and FA is needed. Citation Format: Tohiyuki Ishiba, Tomoyuki Aruga, Miyako Nara, Sakiko Yabe, Chiaki Saita, Mai Onishi, Naoko Iwamoto, Rika Yonekura, Hiromi Miyamoto, Yayoi Honda, Goshi Oda, Tsuyoshi Nakagawa, Akira Nakanishi, Hiroyuki Uetake, Yoshio Miki. Calretinin can be the specific marker for phyllodes tumor [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5449.

Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates.

Early rectal cancer can be managed effectively with local excision, which is now the standard of care for many T1 lesions. However, the presence of unexpected adverse histopathological factors may indicate an increased risk of local recurrence, prompting consideration of completion radical surgery. Many patients are unfit or prefer to avoid radical surgery, relying instead on surveillance and early detection of recurrent disease. Recently, radiotherapy has shown promise as an adjuvant therapy in this group. This study assesses local recurrence rates after local excision with adjuvant radiotherapy at a single centre. This was a retrospective review of a prospective database of all patients undergoing transanal endoscopic microsurgery (TEM) in a single institution. Data covering a 10-year period were analysed. Of 197 patients undergoing TEM for rectal cancer, 33 (17%) had adjuvant radiotherapy because of adverse histopathological features. At 3.2years' median follow-up, there were three instances of local recurrence (9.1%). Estimated local recurrence at 1 and 3years was 0% and 6.9%, compared to 16.8% and 21.2% in a propensity-score-matched group who were followed by surveillance alone. Local recurrence was diagnosed at a median of 23months post-TEM in the radiotherapy group, compared to 8months in the matched group. Radiotherapy after TEM is associated with a trend towards a reduced rate of local recurrence, even for high-risk disease. Radiotherapy would appear to offer a viable alternative to radical completion surgery in the presence of unforeseen adverse histopathological features, as long as a meticulous surveillance programme is in place.

Metaplastic Breast Carcinoma: Analysis of Clinical and Pathologic Characteristics - A Case Series

Metaplastic breast cancer (MBC) is a rare type of breast cancer that is considered to be clinically aggressive. The clinical significance and prognostic risk factors of MBC are limited. This study comprises a retrospective analysis of the clinical and pathologic findings of a series of patients treated for MBC. The files of 657 patients who underwent surgery because of breast cancer at our clinic were examined and the data found on 11 patients who were diagnosed as having MBC were analyzed. With a median age of 56 years, all patients were postmenopausal and presented with a palpable mass on physical examination. Symptoms of ulceration and skin involvement were seen in only one patient. Eight patients were diagnosed as having squamous cell carcinoma (SCC), and 3 had both SCC and osseous differentiation. The median diameter was 3.8 cm (max. 14 cm; min. 1.5 cm). Lymph node metastasis was detected in 5 (45%) patients. Progesterone (PR) and estrogen (ER) were both negative in 11 (100%) patients and 10 (90.9%) patients, respectively, and CerbB2 was negative in 7 (63.6%) patients. Patients were followed up for a median period of 15 months (range, 6-40 months); at the end of which, 10 patients survived and one died of cardiac arrest at 7 months post-operatively. No instances of local recurrence or distant organ metastasis were found in any patients. The overall patient survival rate was 90%. There is no consensus on the clinical significance or best treatment approach for metaplastic carcinoma. In our study, patients with MBC were of advanced age, had tumors with large margins, high negativity for hormone receptors, and moderate- to well-differentiated histology.

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Whether current postoperative surveillance regimes result in improved overall survival (OS) of patients with extremity sarcomas is unknown. We hypothesized that a less intensive followup protocol would not be inferior to the conventional followup protocol in terms of OS. We (1) assessed OS of patients to determine if less intensive followup regimens led to worsened survival and asked (2) whether chest radiograph followup group was inferior to CT scan followup group in detecting pulmonary metastasis; and (3) whether less frequent (6-monthly) followup interval was inferior to more frequent (3-monthly) followup in detecting pulmonary metastasis and local recurrence. A prospective randomized single-center noninferiority trial was conducted between January 2006 and June 2010. On the basis of 3-year survival of 60% with intensive, more frequent followup, 500 nonmetastatic patients were randomized to demonstrate noninferiority by a margin (delta) of 10% (hazard ratio [HR], 1.36). The primary end point was OS at 3years. The secondary objective was to compare disease-free survival (DFS) (time to recurrence) at 3years. At minimum followup of 30months (median, 42months; range, 30-81months), 178 deaths were documented. Three-year OS and DFS for all patients was 67% and 52%, respectively. Three-year OS was 67% and 66% in chest radiography and CT groups, respectively (HR, 0.9; upper 90% confidence interval [CI], 1.13). DFS rate was 54% and 49% in chest radiography and CT groups, respectively (HR, 0.82; upper 90% CI, 0.97). Three-year OS was 64% and 69% in 6-monthly and 3-monthly groups, respectively (HR, 1.2; upper 90% CI, 1.47). DFS was 51% and 52% in 6-monthly and 3-monthly groups, respectively (HR, 1.01; upper 90% CI, 1.2). Almost 90% of local recurrences were identified by patients themselves. Inexpensive imaging detects the vast majority of recurrent disease in patients with sarcoma without deleterious effects on eventual outcomes. Patient education regarding self-examination will detect most instances of local recurrence although this was not directly assessed in this study. Although less frequent visits adequately detected metastasis and local recurrence, this trial could not conclusively demonstrate noninferiority in OS for a 6-monthly interval of followup visits against 3-monthly visits. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Retroperitoneal Lipomatous Tumors Without Cytologic Atypia: Are They Lipomas?

Most well-differentiated liposarcomas can be readily distinguished from lipomas on histologic grounds alone. However, occasional retroperitoneal lipomatous tumors show no cytologic atypia. To determine whether these tumors are well-differentiated liposarcomas devoid of cytologic atypia or lipomas was the major aim of this investigation. We comprehensively and prospectively studied 19 retroperitoneal adipocytic tumors devoid of cytologic atypia at the cytogenetic and molecular genetic levels. Median patient age was 56 years (range: 36 to 78 y). Median tumor size was 21 cm (range: 8 to 46 cm) and the median weight was 1127 g (range: 173 to 2440 g). All tumors were well-circumscribed and showed no cytologic atypia. Standard cytogenetic analysis demonstrated rearrangements of 12q15 in 4 (of 7) cases. None showed ring or giant marker chromosomes. Fluorescence in situ hybridization failed to identify amplification of MDM2, carboxypeptidase M(CPM), SAS, CDK4, DDIT3, or HMGA2 in all cases. HMGA2 rearrangement was observed in 8 (of 19) cases (42%) and was more common in larger tumors (P=0.046). HMGA2-LPP fusion was seen in only 1 case. All tumors were completely excised. Follow-up information was available from 10 cases (median, 6 mo; range: 1 to 58 mo). No tumor recurred or metastasized. In contrast, a control group of 20 well-differentiated liposarcomas diagnosed during the same time period (matched per year of diagnosis) showed 4 instances of local recurrence. We conclude that this group of retroperitoneal lipomatous tumors shows clinico-pathologic and genetic features more akin to lipomas than well-differentiated liposarcomas. Owing to their apparent rarity, additional studies are necessary to more fully understand their natural biology in this anatomic location.

Periosteal Osteosarcoma

The long-term outcome of periosteal osteosarcoma is not well defined. We sought to examine the disease-specific survival and risk of late recurrence or dedifferentiation in a cohort of 29 patients with average of 15.8 years followup. Disease-free survival was 83%, with five patients dying of disease at an average of 26 months after presentation. Survival was similar with respect to anatomic location, pathologic grade, and limb-salvage resection. All instances of local recurrence, metastatic disease, and death occurred within 3 years after presentation. There were no instances of dedifferentiation. Long-term disease-free survival is possible after resection of the local recurrence. Limb-salvage therapy seems to offer survival equivalent to amputation, and there does not seem to be a substantial risk of late recurrence, dedifferentiation, or disease progression.

Possible Mechanism for Seeding of Tumor During Radical Prostatectomy

Prostatic adenocarcinoma sometimes recurs locally in the operative bed after radical prostatectomy. Having observed local recurrence in several patients who had a small tumor confined to the prostate on whole mount serial sections, we postulated that some instances of local recurrence could arise from malignant cells shed in prostatic secretions expressed during surgery. To evaluate whether prostatic secretions contain malignant cells and to estimate the frequency of this phenomenon, we collected fresh prostatic secretions from radical prostatectomy specimens immediately after removal. The secretions were analyzed by cytology for the presence of malignant cells.Of 76 samples collected from consecutive patients with clinical stages T1 and T2 prostate cancer at 3 institutions 11 (14%) contained malignant cells. Positive cytology results were most frequent in patients with poorly differentiated tumors. Of 11 cancers with a Gleason sum of 8 to 10 in the prostatectomy specimen 6 (55%) had a positive cytology result. However, of 63 tumors with a Gleason sum of 5 to 7 only 4 (6%) were positive (p <0.0001). There was no significant correlation with either clinical or pathological stage of the tumor in this small series.Our findings suggest that malignant cells shed during prostatectomy may seed the surgical bed and could be responsible for some instances of local tumor recurrence. The rate of positive cytology results in our study is similar to the local recurrence rates reported in the literature. Surgeons should make prudent attempts to avoid seeding from this source.

Sacrococcygeal teratomas: a review of 68 cases.

Sixty-eight cases of sacrococcygeal teratoma were reviewed and graded according to the quantity of immature tissue present. Seventy-five percent were benign (grade 0), 11.8% immature (Grades 1-3), and 13.2% malignant. Although the immature component in most tumors was neuroepithelial, in two cases it was exclusively renal. There were no instances of local recurrence or metastasis of immature elements. The malignant lesions were all endodermal sinus tumor, stained positively for alpha-fetoprotein and were uniformly fatal, with an average duration of survival of 8.9 months. Early adequate treatment of sacrococcygeal teratomas results in a favorable prognosis. This experience is different from that reported for immature ovarian teratomas. Immature metanephric tissue in sacrococcygeal teratomas should be interpreted the same way as immature neuroepithelial elements. Immature sacrococcygeal teratomas should be separated from tumors containing malignant elements because of their vastly different prognoses.