Local Residual Tumor Research Articles

Predictive factors of residual tumor for the patients with non-curative resection after endoscopic submucosal dissection for early gastric cancer.

32 Background: Endoscopic submucosal dissection (ESD) is commonly performed for the patients who diagnosed with early gastric cancer. Although additional gastrectomy is recommended for the patients with non-curative ESD in the points of potential risk of residual tumor, many cases have neither lymph node (LN) metastasis nor local residual tumor in surgical specimens. Clinically, it can be difficult to decide whether to perform additional surgery according to patients’ conditions. This study aimed to analyze the clinicopathological features of patients who underwent additional gastrectomy as well as to detect the predictive factors for residual tumor after non-curative ESD. Methods: The patients who underwent additional gastrectomy after non-curative ESD in our institution from January 2005 to August 2016 were retrospectively reviewed. The incidence rates of LN metastasis or local residual tumor were calculated, and furthermore the predictive factors for these outcomes were estimated. Results: 211 patients were enrolled in this study. Pathological examination after additional surgery revealed LN metastasis in 18 patients (8.5%) and local residual tumor in 26 patients (12.3%). Multivariable analysis revealed that lymphatic invasion ( p< 0.0001, odds ratio = 15.6), vascular invasion ( p= 0.042, odds ratio = 3.92) and macroscopic findings (flat/elevated type) ( p= 0.03, odds ratio = 3.53) are predictors for lymph node metastasis. All of the patients without LN metastasis revealed no lymphovascular invasion. Positive vertical margin ( p= 0.0045, odds ratio = 4.17) and horizontal margin ( p= 0.0002, odds ratio = 6.6) were predictors for local residual tumor. Conclusions: The risk of residual tumor can be estimated based on histopathology of ESD. Patients without lymphovascular invasion appear to be a low risk subpopulation for LN metastasis.

Pulmonary Resection for a Residual Tumor after Definitive Radiation in Locally Advanced Non-Small Cell Lung Cancer.

To clarify the benefits of surgery for a persistent tumor following definitive radiation in locally advanced non-small cell lung cancer, five patients were retrospectively reviewed. All patients received definitive radiation, and three received concurrent chemotherapy followed by anatomical lung resection for a residual local tumor. The median time from the radiation to surgery was 8.2 weeks. There were no postoperative mortalities. Four patients developed distant metastasis with a mean recurrence-free interval of 7.5 months. Distant metastasis frequently occurred within a relatively short period after surgery. Further studies with a larger sample size are needed.

Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases.

Endoscopic submucosal dissection is recommended for early gastric cancer with a low risk of lymph node metastasis. When the pathological findings do not meet the curative criteria; then, an additional gastrectomy with lymph node dissection is recommended. However, most cases have neither lymph node metastasis nor a local residual tumor during an additional surgery. This was a single-institutional retrospective cohort study, analyzing 200 patients who underwent an additional gastrectomy after non-curative endoscopic submucosal dissection from January 2005 to October 2015. We reviewed the patients' clinicopathological data and evaluated the predictors for the presence of a residual tumor. Histopathology revealed lymph node metastasis in 15 patients (7.5%) and a local residual tumor in 23 (11.5%). A multivariable analysis revealed macroscopic findings (flat/elevated type) (p=0.011, odds ratio=4.63), lymphatic invasion (p<0.0001, odds ratio=14.2), and vascular invasion (p=0.04, odds ratio=4.00) to be predictors for lymph node metastasis. A positive vertical margin (p=0.0027, odds ratio=3.26) and horizontal margin (p=0.0008, odds ratio=5.74) were predictors for a local residual tumor. All cases with lymph node metastasis had lymphovascular invasion with at least one other non-curative factor. The risk of a residual tumor can, therefore, be estimated based on the histopathology of endoscopic submucosal dissection samples. Lymphovascular invasion appears to be a pivotal predictor of lymph node metastasis.

The proposed physiology-based FDG PET/CT criteria in reducing false-positive results in advanced head and neck cancer after chemoradiotherapy.

Distinguishing benign complications after concurrent chemoradiotherapy (CCRT) from a local residual tumor in advanced head and neck squamous cell carcinoma (HNSCC) remains a clinical challenge. In this study, we propose criteria when considering physiological uptake patterns on F-18-fluorodeoxyglucose (FDG) PET/CT in patients with advanced HNSCC after CCRT. We retrospectively reviewed FDG PET/CT images of 62 patients with advanced HNSCC, which were taken within 16 weeks following CCRT. Visual interpretation criteria were rated by three nuclear medicine physicians, independently, according to the uptake patterns of the primary site. The Cohen k coefficient was calculated to assess inter-reader agreement. The histology of the primary site within a 1 month of the PET/CT study was used as the gold standard for sensitivity, specificity, positive predictive value and negative predictive value. PET/CT was arranged at a median interval of 10.5 weeks (range 4-16 weeks) after CCRT, and the pathologic residual rate was 55.7% at the primary site. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of identifying residual disease were 91.1%, 50.0%, 68.9%, 82.3%, and 72.6%, respectively, by the previously established criteria, and 88.2%, 92.9%, 93.8%, 86.7%, and 90.3%, respectively, by our physiology-based criteria. Our visual rating criteria corrected 12 of 14 (84.6%) false-positive results from the established criteria, while two more false-negative cases identified with our criteria were proven to be small residual tumors. By incorporating physiological changes following CCRT, our visual rating criteria improved the accuracy of the currently used FDG PET/CT visual rating system, especially the number of false-positive cases with advanced HNSCC after CCRT.

Consecutive magnetic resonance imaging during brachytherapy for cervical carcinoma: predictive value of volume measurements with respect to persistent disease and prognosis.

BackgroundCervical cancer is associated with a high yearly mortality. The presence of persistent disease after radiotherapy is a significant predictor of patient survival.The aim of our study was to assess if tumor volume regression measured with MR imaging at the time of brachytherapy can discriminate between patients who eventually will achieve a complete response to radiotherapy from those who will not. The second objective was to evaluate whether tumor volume regression predicts overall treatment failure.MethodsMRI was evaluated quantitatively in 35 patients; by means of tumor volumetry on T2-weighted MR images before treatment, at the first BCT application, and at the final BCT. The MR images were independently analyzed by two investigators. As a reference standard histopathologic confirmation of residual tumor and/or clinical exam during follow-up > 1 year were used. Area under the curve were compared, P-values <0.05 were considered significant.ResultsThere was a good correlation between volume measurements made by the two observers. A residual tumor volume >9.4 cm3 at final BCT and tumor volume regression < 77 % of the pre-treatment volume were significantly associated with local residual tumor after completion of therapy (p < 0.02) (AUC, 0.98-1.00). A volume >2.8 cm3 at final BCT was associated with overall treatment failure (p < 0.03).ConclusionOur study shows that volume analysis during BCT is a predictive tool for local tumor response and overall treatment outcome. The potential of local response assessment to identify patients at high risk of overall treatment failure is promising.

Dormancy programs as emerging antimetastasis therapeutic alternatives

We recently published that the retinoid-responsive gene NR2F1 (nuclear receptor subfamily 2, group F, member 1) mediates postsurgical dormancy of local residual tumor cells and disseminated tumor cells. Importantly, the combination of azacytidine with retinoids induces dormancy of malignant tumor cells by reinstating the NR2F1-regulated gene program. These findings open the door to the development of strategies that may stop minimal residual disease from becoming life-threatening metastases.

Anterior Hepatic Parenchymal Transection for Complete Caudate Lobectomy to Treat Liver Cancer Situated in or Involving the Paracaval Portion of the Caudate Lobe

BackgroundComplete caudate lobectomy using the anterior hepatic parenchymal transection approach is a proper but technically demanding operation for tumors situated in or involving the paracaval portion of the caudate lobe. This study was intended to share our experience on this operation. MethodForty-nine consecutive patients who received complete caudate lobectomy using the anterior hepatic parenchymal transection approach were studied. The clinicopathologic and perioperative data, complications, and survival were analyzed. ResultsOf the 49 patients, 15 (30.6 %) received isolated complete caudate lobectomy and 34 (69.4 %) received complete caudate lobectomy associated with segmentectomy IV. The median tumor size was 7.3 cm (2.4–18.0 cm), the operating time was 200 min (120–370 min), and the operative blood loss was 700 ml (200–3000 ml). The postoperative complication rate was 36.7 %. There was no perioperative death. Patients in the associated complete caudate lobectomy group had larger tumors (P < 0.001), higher platelet counts (P = 0.033), shorter operation time (P = 0.004), and less patients with residual tumor (P = 0.03) than those in the isolated complete caudate lobectomy group. There were no significant differences in cirrhosis, surgical resection margin, blood loss, postoperative complications, and prognosis between the two groups. ConclusionComplete caudate lobectomy using the anterior hepatic parenchymal transection approach was technically feasible and safe for patients with tumors situated in or involving the paracaval portion of the caudate lobe. Associated resection of segment IV can be used to facilitate the surgery and decrease the chance of local residual tumor.

Microscopically Controlled Surgery

I am a co-author of the S2k-guideline on basal cell carcinoma (BCC), which is in its final stages of development. Supported by 40 years’ experience in tumor surgery on facial skin and by long-term analyses of more than 3800 operations for facial BCC, my views differ somewhat from those expressed in the article. Hedgehog signaling pathway inhibitors allow a new therapeutic principle in BCC. Because of their short time of use, however, many questions remain open. In the guideline indications are defined for so extensive and metastatic cases of BCC, which therefore can be neither treated by radiation nor by surgery. — A tumor board decides on their use. Competent surgeons and radiologists are a mandatory on such a board. Non-surgical local therapies (laser, cryotherapy, immunomodulators imiquimod, 5-fluorouracil, photodynamic therapy) are reserved for individual cases because of barely predictable oncological and esthetic results. Local recurrences or residual tumors occur in more than 10% of cases after such treatments. For the surgery that is potentially required subsequently, these cause problems regarding R0 resection because of multilocal and poorly localizable tumor residues. According to the guideline, the surgical approach with the highest possible degree of control of the resection margin (Microscopically controlled surgery- MCS) is the method of choice. Compared with conventional surgery, MCS lowers the recurrence rate in primary BCC by only 1% and thus does not significantly improve the prognosis. When treating tumor recurrences, MCS reduces the recurrence rate from 12% to 2.4%. According to my own analyses, surgical treatment for BCC by means of MCS using plastic-surgical or rare epithetic defect repairs on the face, will—in primary BCC—yield a probability for 20 tumor-free years of 98.2%; in the treatment of recurrences in a retrospective analysis of 74%; and in a prospective analysis, consistenly using our variant of MCS, of 98%. Untreated R1 results lower this probability of success drastically, to 52% (primary BCC) and 29% (BCC recurrence). This confirms the validity of the R1 finding for tumor clearance. It does not affect survival. Diverse methods for reconstructions of the defects in the repertoire of maxillofacial surgeons in association with MCS allow a high degree of oncological certainty even in extensive BCC in combination with good esthetic results, even in the problematic facial region.

Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma

BackgroundEndoscopic endonasal (EE) transsphenoidal surgery is an important surgical approach to the treatment of sellar pathology, particularly for pituitary adenomas. Risk factors for the radiographic recurrence of pituitary adenomas resected using a purely endoscopic approach have not been established. This study investigates outcomes and identifies risk factors for recurrence following EE transsphenoidal surgery for pituitary adenoma. MethodsWe performed a retrospective review of 64 patients with pituitary adenomas undergoing EE surgery by a single, right-handed surgeon preferentially operating through the right nares. Post-operative MRI studies were utilized to monitor for residual disease or disease recurrence. ResultsResidual tumor was found in 31.2% of patients. Over a median follow-up period of 23.1 months (range 4–62.5), 4 (20%) of these patients showed recurrence. Two patients with inconclusive post-operative imaging had subsequent imaging consistent with recurrence, making the total recurrence in our series 9.4%. While no statistically significant effects of gender, age or history of previous treatment were seen, amenorrhea on presentation and maximum tumor diameter >10 mm were significant risk factors for radiographic recurrence (p = 0.044 and 0.005, respectively). No predominant side of residual tissue was identified in these tumors operated through the right nares. ConclusionsOnly 20% of patients with residual tumor developed recurrent disease over a median follow up of 23.1 months. This recurrence rate may be an important consideration in cases where gross total resection is not feasible. Preferentially operating from the right does not seem to influence the location of residual tumor.

Salvage Photodynamic Therapy Is an Effective and Safe Treatment for Patients with Local Failure after Definitive Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

Although chemoradiotherapy (CRT) is one curative treatment option for patients with esophageal squamous cell carcinoma (ESCC), local failure after CRT remains a major problem for patients’ curability. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) as a salvage treatment for local failure. From August 2007 to March 2012, 193 consecutive ESCC patients were treated with definitive CRT in Kyoto University Hospital. Eighteen of the patients with T2 or earlier T-stage local failure after CRT underwent salvage PDT. After the salvage PDT, 11 patients (61.1%) achieved a complete response at the primary site. Over a median follow-up period of 28.3 months, the 1-year survival and progression-free survival rates were 77.8% and 38.9%, respectively; and the 2-year survival and progression-free survival rates were 60.6% and 33.3%, respectively. Adverse events were mild esophageal stricture in seven (38.9%), esophageal obstruction because of necrotic tissue in nine (50.0%), and photosensitivity in three (16.7%) patients. There were no severe complications or treatment-related deaths. Salvage PDT may be a promising treatment option for the patients with a local residual or recurrent tumor after CRT for ESCC when the lesion is suspected to be in T2 or earlier.

Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a widely accepted technique for the management of gastric tumors. However, residual or recurrent tumors can occur after ESD; currently, there is no adequate management strategy for these tumors. Thus, the aim of the present study was to establish a strategy of secondary ESD (sESD) for cases with positive lateral margins (LM+), which cause post-ESD residual or recurrent tumors. Fifty-three lesions that were subjected to ESD were diagnosed as LM+ with suspected local residual tumor. The short- and long-term outcomes of early sESD (performed shortly after the initial ESD in LM+ cases to prevent local recurrence) were retrospectively compared with those of late sESD (performed after the detection of recurrent tumors). Of the 53 LM+ cases, the local residual positive rate was 38.5 % (10/26) in those undergoing early sESD or additional surgery and the local recurrence rate was 29.6 % (8/27) in those that were not treated. Thus, the overall incidence of residual or recurrent tumors in LM+ cases was 34.0 % (18/53). Both early and late sESD had favorable outcomes with no severe complications: 100 % of early sESD resections were curative, compared with 86.7 % of late sESD resections, over the course of a mean (±SD) observation period of 50.8 ± 16.7 months. The performance of early sESD was significantly greater than that of late sESD (in terms of dissection speed). Early sESD is more reliable than late sESD as a therapeutic strategy for salvaging residual tumors and for preventing recurrence. However, if a tumor has already recurred, late sESD remains useful.

Residual Esophageal Cancer after Neoadjuvant Chemoradiotherapy Frequently Involves the Mucosa and Submucosa

To gain insight into the exact location of residual esophageal cancer in the esophageal wall and regional lymph nodes after neoadjuvant chemoradiotherapy (nCRT) and to determine the pattern of regression. Data from the recently published chemoradiotherapy for oesophageal cancer followed by surgery study trial showed that 49% of squamous cell carcinomas and 23% of adenocarcinomas had a pathologically complete response (pCR) in the resection specimen after nCRT. These results impose the ethical imperative to reconsider the necessity of esophagectomy with its substantial morbidity and mortality in patients with pCR. However, it remains challenging to accurately identify these patients before resection. Between January 2003 and July 2011, all patients with esophageal cancer in a tertiary referral center, who underwent nCRT (5 weekly courses of carboplatin and paclitaxel plus 41.4 Gy concurrent radiotherapy) and surgical resection, were analyzed. The resection specimens were carefully re-evaluated by an experienced gastrointestinal pathologist. Tumor regression grade (TRG) was meticulously scored for each specific layer of the esophageal wall and for all removed lymph nodes. One hundred two consecutive patients were included. Seventy-one (70%) of 102 patients were noncomplete responders (≥TRG2) and in 63 of these patients (89%), residual tumor cells were seen in the mucosa and/or submucosa. Five of 8 patients without involvement of the mucosa and the submucosa had isolated remnants in the muscle layer (5/102 = 5%); the other 3 patients had tumor cells only in a single lymph node (3/102 = 3%). The surrounding stroma showed the highest percentage of TRG1 ( = pCR: 47%). In patients with pretreatment lymph node positivity, the percentage of TRG1 in all lymph nodes was also favorable (52%). Overall regression showed a nonrandom mixed pattern of both concentric regression and regression toward the lumen. After nCRT for esophageal cancer, both the mucosa and the submucosa show frequent residual malignant involvement. The surrounding stroma and the regional lymph nodes show the highest percentage of pCR and the overall regression pattern is most frequently a mixed pattern of both concentric regression and regression toward the lumen. This overall regression pattern lends support to careful testing of a wait-and-see approach in a subgroup of patients with esophageal cancer after nCRT.

Complementação por coagulação com plasma de argônio após a ressecção endoscópica completa pela técnica de fatiamento para grandes adenomas colorretais

To evaluate the efficacy of complement by argon plasma coagulation to reduce the rate of residual or recurrent tumor after complete endoscopic piecemeal resection of large sessile colorectal adenomas. patients with large sessile colorectal adenomas (e" 20 mm), without morphological signs of deep infiltration, submitted to complete endoscopic piecemeal resection studied with chromoendoscopy and magnification of images. Patients were randomized into two groups: group 1 - no additional procedure, and group 2 - complementation by argon plasma coagulation. follow-up colonoscopy was performed at three, six and 12 months postoperatively. We evaluated the rate of local recurrence or residual malignancy. The study included 21 patients, eleven in group 1 and ten in group 2. There were two local recurrences or residual tumors in each group, detected at three months follow-up. Complementation by argon plasma coagulation after apparent complete endoscopic piecemeal resection of large sessile colorectal adenomas does not seem to reduce the occurrence of residual adenomatous lesions or local recurrence.

Incorporating the Prediction of Residual Tumor Location Into Prospective Dose Painting for Locally-Advanced Non-Small Cell Lung Cancer

We hypothesize that a treatment planning technique which prospectively incorporates the prediction of residual tumor location after radiation therapy for locally advanced non-small-cell lung cancer (NSCLC) into plan optimization could allow dose escalation to the radio-resistant portion of the tumor and improve tumor control without increasing normal tissue toxicities.

Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer

Intramucosal undifferentiated early gastric cancer (EGC) up to 2 cm in size without ulceration has been treated by endoscopic submucosal dissection (ESD) because the incidence of lymph node metastasis is negligible. The aim of this retrospective study was to clarify the short-term and long-term outcomes of ESD carried out to treat undifferentiated EGC. Between January 1999 and September 2011, 113 patients with poorly differentiated adenocarcinoma or signet ring cell carcinoma on preoperative biopsy underwent ESD. In 16 patients differentiated EGC had been diagnosed after the ESD and these patients were excluded from the study. Short-term outcomes were evaluated in the remaining 97 patients with undifferentiated EGC, and long-term outcomes analyzed in the 79 patients with undifferentiated EGC who had undergone ESD between 1999 and 2008. En bloc and R0 resection were achieved in 99.0 % and 90.7 % of patients, respectively. Median procedure time was 45 minutes. Postoperative bleeding, perforation during the procedure, and delayed perforation were noted in 4.1 %, 3.1 %, and 1.0 % respectively. Curative resection was achieved in 63.9 %. Additional surgery was performed in 21 of 35 patients in whom resection was noncurative: one (4.8 %) had local residual tumor and two (9.5 %) had lymph node metastases. Of the 46 /79 patients in the long-term outcome group who had curative resection, none had local recurrence or lymph node or distant metastasis during a median follow-up of 76.4 months. The 5-year overall mortality rate after curative resection was 7.0 %, and no patient died of gastric cancer. ESD for undifferentiated EGC can achieve curative resection with an excellent 5-year mortality rate.

Clinical value of FDG PET/CT in predicting local failure in patients with esophageal cancer.

e15197 Background: Local failure, including local residual tumor and local recurrence, is the most common failure patterns for patients with esophageal cancer (EC) treated with radiotherapy. The purpose of this study was to evaluate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for predicting local failure in patients with EC. Methods: Twenty-two patients with biopsy-proven EC treated definitively with RT with or without chemotherapy were enrolled from June 2010 to August 2012. Dose of 60.4 - 70.2 Gy with 1.8 - 2.0Gy /fraction were delivered with three-dimensional conformal radiation therapy (CRT). All patients underwent FDG PET/CT scan prior to therapy. The patients were followed up every 3 months after treatment completion. Patients who developed local failure were confirmed with histological evidence or follow-up. Results: The follow up time was in the range of 5-30 months. Of 22 patients, 3 patients had local residual tumor, 2 patients experienced local recurrence. The mean SUVmax for patients with local failure was higher than that for patients without local failure (15.688±3.115 vs. 14.137± 4.397, p = 0.54). The local failure regions were mostly the regions with higher metabolic activity before radiotherapy. Conclusions: Patients with higher FDG-uptake may have higher risk to experienced local failure. The local failure regions were localized mostly in the higher FDG uptake regions of pre-therapeutically FGD PET/CT scans of the patients with EC.

Critical Appraisal of Extent of Resection of Clival Lesions Using the Expanded Endoscopic Endonasal Approach

Objectives To present a critical evaluation of our experience using an expanded endoscopic endonasal approach (EEEA) to clival lesions and evaluate, based on the location of residual tumor, what the anatomic limitations to the approach are. Design A retrospective review of all endoscopic endonasal operations performed at our institution identified 19 patients with lesions involving the clivus. Extent of resection was determined by preoperative and postoperative tumor volumes. Results Three patients underwent planned subtotal resections. Of the remaining patients, gross total resection was achieved in 8/16 (50%), > 95% in 5/16 (31%), and < 95% in 3/16 (19%). Residual tumor occurred, most commonly with extension posterior and lateral to the internal carotid artery, with inferior, lateral invasion of the occipital condyle and with deep inferior extension to the midportion of the dens. Conclusions The EEEA represents a safe and effective technique for the resection of clival lesions. Despite excellent overall visualization of this region we found that adequate exposure of the most lateral and inferior portions of large tumors is often difficult. Knowledge of these limitations allows us to determine which tumors are best suited for an EEEA and which may be more appropriate for an open skull base or combined technique.

Feasibility of endoscopic mucosal resection as salvage treatment for patients with local failure after definitive chemoradiotherapy for stage IB, II, and III esophageal squamous cell cancer

Local failure after definitive chemoradiotherapy (CRT) for stage IB, II, and III esophageal cancer is one of the causes of poor outcome. Endoscopic mucosal resection (EMR) is an effective treatment for superficial esophageal cancer. However, its feasibility as a salvage treatment for local recurrent or residual tumors after definitive CRT for stage IB, II, and III esophageal cancer remains unclear. Between January 2000 and February 2008, 274 patients with stage IB, II, and III esophageal squamous cell cancer excluding T4 received definitive CRT at the National Cancer Center Hospital, Japan. Of these patients, nine patients with local recurrence after achieving complete response and two patients with residual tumor underwent salvage EMR. The technique of salvage EMR involved a strip biopsy method. We retrospectively reviewed the 11 patients (13 lesions). Characteristics of all 11 patients were as follows: median age of 69 (range: 45-78); male/female: 10/1; baseline clinical stage (Union for International Cancer Control 7th) IB/IIA/IIB/III: 1/3/7/0. The depth of resected tumor was limited to the mucosal layer in seven lesions and submucosal in six lesions. En bloc resection was performed on six lesions (46%). The vertical margin was free of cancer cells in 11 lesions (84.6%). No major complications, such as hemorrhage requiring blood transfusion and perforation, were experienced. At a median follow-up period of 38.9 months (range: 5.3-94 months) after salvage EMR, no recurrence was detected in six patients (54%). Local recurrence was detected in five patients (27%). Of these patients, two had lung metastasis simultaneously, and one was also detected lung metastasis 2 months after the detection of local recurrence. The 5-year survival rate after salvage EMR was 41.6%. Salvage EMR is a feasible treatment option for local recurrent or residual lesions after definitive chemotherapy and/or radiotherapy for stage IB, II, and III esophageal squamous cell cancer.

The role of dynamic contrast-enhanced MRI in differentiation of local recurrence and residual soft-tissue tumor versus post-treatment changes

To evaluate the reliability of dynamic contrast-enhanced MRI in the diagnosis of local recurrence of malignant soft-tissue tumors after receiving treatment. From March 2002 till December 2009 we performed dynamic contrast enhanced MRI in 95 patients with soft-tissue tumor after receiving treatment (surgery, radiotherapy, chemotherapy). Patients were classified according to five types of TIC. The recurrent disease was suspected in 47 patients and the biopsy was recommended. In 8 cases (TIC II), the biopsy was performed due to long-term post-treatment changes. Histological results proved STT recurrence in 45 patients; in 10 patients (8 with TIC II), biopsy revealed hypervascular granulation tissue, florid inflammation and reactive changes. The sensitivity for dynamic contrast-enhanced MR examination was 100 %, specificity 80 %, positive predictive value (PPV) 95.7 % and negative predictive value (NPV) 100 %. Our results indicate that TICs III, IV and V raise high suspicion of local tumor recurrence and require percutaneous imaging-guided biopsy. TIC of type II usually represents a pseudomass and the biopsy should be performed only in selected cases with increased risk of recurrent disease based on multidisciplinary approach. On the basis of literature review as well as our experiences we created a reliable algorithm proposed for diagnosing the residual or recurrent soft-tissue tumors (Tab. 2, Fig. 6, Ref. 20).

Tu1616 The Efficacy of Salvage Endoscopic Submucosal Dissection in Patients With Recurrent or Residual Tumor After Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

Local recurrent or residual tumor after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma remains an important problem. Although salvage esophagectomy after CRT is the only curative possibility, it carries a higher mortality and morbidity rate than primary surgery. If the carcinoma is a superficial lesion that is limited to the superficial submucosal layer, endoscopic mucosal resection (EMR) may be effective as salvage treatment. However, salvage EMR has problems: lifting is not easy because of submucosal fibrosis; it has a low complete en bloc resection rate; and a positive vertical margin can occur in submucosal invasive cancer.