Median Maximum Tumor Diameter Research Articles

The quantitative analysis of MR dynamic contrast-enhangced imaging on efficacy and prognosis of transcatheter arterial chemoembolization on hepatocellular carcinoma

Objective: To investigate the prognostic value of quantitative parameters of dynamic contrast-enhangced MR (DCE-MR) on short-term efficacy of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma(HCC). Methods: 79 patients with HCC underwent non-enhanced MR imaging and DCE on a 3.0T MR scanner before and one month after TACE. The quantitative parameters were measured on the maximal tumor region, including maximal tumor diameter(MTD), ADC, K(trans,) K(ep) and V(e) value before and after TACE. All patients were divided into stable group (36 patients) and progressive group (43 patients) based on follow-up. The quantitative data of the two groups before and after TACE was collected for analysis. Results: Among the 79 lesions in 79 patients, 21 were located in the left lobe of the liver, 53 in the right lobe of the liver and 5 in the junction area of the hepatic lobe. The maximum tumor diameter (MTD) was 2.2-9.9 cm, the median MTD was 5.1 cm. There were significant differences between progressive group and the stable group in MTD, K(trans,) K(ep) values of the tumor before TACE (P<0.05). One month after TACE, the MTD, K(trans,) K(ep,)ΔMTD, ΔK(trans) and ΔK(ep) values of the tumor in progressive group were statistically different with the stable group (P<0.05, respectively). For all the patients, the pre-TACE MTD, AFP, K(trans) and K(ep) values of tumors were statistically different with the post-TACE values (P<0.05). Conclusion: The quantitative parameters (K(trans,) K(ep,)ΔK(trans) and ΔK(ep) values) of the DCE-MR could predict and evaluate the short-term efficacy of TACE on HCC.

The extended, transnasal, transsphenoidal approach for anterior skull base meningioma: considerations in patient selection.

In this study, we set out to define our institutional criteria for patient eligibility for transsphenoidal resection of parasellar meningiomas, and to report our experience with extended transnasal approaches for these lesions. We aimed to discuss the important considerations of patient selection and risk stratification to optimize outcomes for patients with these difficult lesions, and also include considerations that should be reviewed during surgical approach selection. Medical records from Brigham and Women's Hospital were retrospectively reviewed for all patients who underwent transsphenoidal surgery for pituitary disease with the senior author from April 2008 to March 2017 (938 procedures). Patients undergoing surgery for anterior skull base meningioma were identified and patient data were collected. Seven patients (four women, three men) underwent transsphenoidal resection (five endoscopic, one microscopic, and one hybrid endoscopic/microscopic) of pathologically-confirmed anterior skull base meningiomas during the study period. Five patients presented with visual field deficits, three presented with headache, two presented with hypopituitarism, and one woman presented with infertility. The median maximum tumor diameter was 1.7cm (range 1.4-4.2cm). Six patients underwent subtotal resection, and one underwent gross total resection. The median MIB-1 index was 2.3 (range 1.0-7.6). Complications included two readmissions (one on POD11 for small bowel obstruction, one on POD48 for epistaxis), and the development of new onset thyroid deficiency and transient diabetes insipidus in one patient. Two patients had reoperations by craniotomy for tumor recurrence after 5 and 6 years, respectively. Although more commonly treated transcranially, anterior skull base meningiomas are sometimes amenable to resection transphenoidally. Patient selection is critical, and multiple factors, including tumor size, consistency, and location, patient and surgeon preference, and presenting symptoms each affect the optimum surgical approach. We have developed criteria for patient selection so that transsphenoidal surgery can be used to resect or debulk anterior skull base meningiomas safely and with favorable outcomes.

A nonrandomized confirmatory phase III study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L).

8561 Background: The optimal mode of surgery for peripheral ground glass opacity (GGO) dominant lung cancer (LC) defined with thoracic thin-section computed tomography (TSCT) remains unknown. Methods: We conducted multi-institutional confirmatory phase III trial to evaluate the efficacy and safety of sublobar resection for peripheral GGO dominant LC. Mode of surgery is basically wedge resection, and segmentectomy is allowed when surgical margin is insufficient ( &lt; 5 mm) or histological invasiveness. LC with maximum tumor diameter (MTD) ≤ 2.0 cm and with consolidation tumor ratio ≤ 0.25 based on TSCT were registered. The primary endpoint was 5-year relapse-free survival (RFS). The planned sample size was 330, with the expected 5-year RFS of 98%, threshold of 95%, one-sided α of 5% and power of 90%. Survival analyses were performed using the Kaplan-Meier method and their confidence intervals were estimated by Greenwood’s formula. Results: Between May 2009 and April 2011, 333 pts were enrolled from 51 institutions. The primary endpoint, RFS was estimated on 314 pts who underwent sublobar resection. Median age was 62 (range 24 - 79) and 104 were smokers. Median MTD on lung window was 1.20 cm (0.53 - 2.00). Median MTD of consolidation was 0 (0.00 - 0.48). Operative modes were 258 wedge resection and 56 segmentectomy. Histological diagnosis were 310 adenocarcinomas, 27 precancerous lesions, and 14 non-neoplastic lesions. Median pathological surgical margin was 15 mm (0 - 55). Grade 2 or higher postoperative complications based on CTCAE v3.0 were observed in 119 (37.9%), and Grade 3 in 17 (5.4%), without any Grade 4 or 5. The 5-year RFS was 99.7% (95% CI, 97.7 - 100.0%), which met the primary endpoint. There was no local relapse. The ratio of FEV1.0 change between preoperative and one year after surgery over preoperative value ranged -37% to +49% with a median of -5%. Conclusions: Sublobar resection, mainly wedge resection, offered sufficient local control and RFS for peripheral GGO dominant LC on TSCT. Sublobar resection should be the first choice of mode of surgery if surgical margin is enough preserved. Clinical trial information: 000002008.

Clinical Features, Radiologic Findings, and Surgical Outcomes of 65 Intracranial Psammomatous Meningiomas.

Intracranial psammomatous meningiomas (PMs) are rarely reported due to their extremely low incidence. Knowledge about intracranial PMs is therefore poor. This study aimed to analyze the incidence, clinical features, radiologic findings, and surgical outcomes of intracranial PMs. Approximately 5651 intracranial meningiomas were surgically treated at Beijing Tiantan Hospital between November 2011 and December 2015. The authors identified all cases in which patients underwent resection of an intracranial tumor that was found to be a PM on pathologic examination and analyzed the data from these cases. PMs accounted for 1.15% of the entire series of intracranial meningiomas. Sixty-two (95.4%) of these 65 intracranial PMs were female. The median maximal tumor diameter was 2.8 cm (range, 1.4-8.4 cm). On computed tomography scan, all PMs (23/23) showed various calcification. Gross total resection was achieved in 56 cases, near total resection in 5, subtotal resection in 3, and partial resection in 1. Seventeen (26.2%) of the patients experienced new or exacerbated deficits immediately after operation. Three patients (17.6%, 3/17) got alleviation when assessed at last follow-up. Eleven patients (16.9%) experienced additional surgical complications. At the time of discharge, Karnofsky Performance Scale (KPS) score and neurologic function showed improvement in 50 cases (76.9%) and worsening in 15cases (23.1%). At a median follow-up of 37 months (range, 7-56 months), 1 patient had experienced tumor regrowth 50 months after surgery and the 4-year progression-free survival rates were 100.0%. No patient died of recurrence. At the latest follow-up, the KPS score showed improvement in 56 cases (86.2%) and worsening in 9 cases (13.8%). Tumor located in the skull base is significantly associated with an increased risk of worsened long-term outcomes. Preoperative KPS score <90, peritumoral brain edema (PTBE), and hypointensity on T2-weighted imaging had a statistically significant effect on the extent of tumor resection. Intracranial PM is a rare subtype of meningioma with marked female predominance and low tendency toward growth and recurrence. Most intracranial PMs exhibit highly calcified imaging characteristics, particularly as seen by computed tomography. Microsurgical treatment of skull base PM remains a formidable challenge due to the hard tumor consistency and critical neurovascular structure encasement. It is unnecessary for radical tumor resection at the cost of severe neurologic deficits.

Clinical Features, Management Considerations and Outcomes in Case Series of Patients with Parasellar Intracranial Aneurysms Undergoing Anterior Skull Base Surgery.

The coincidence of parasellar aneurysms (IAs) and anterior skull base (ASB) lesions, while rare, presents a management challenge. IAs embedded within, or adjacent to, ASB lesions are at risk in the perioperative period and may have unique presentations, natural histories, and outcomes. The objective of this study was to outline management options and nuances in patients with coexisting IAs and ASB lesions. We retrospectively evaluated all patients who presented for management of IAs and ASB lesions from January 2006 to January 2014. Medical charts and imaging were reviewed for patient, tumor and IA characteristics, pathology, operative findings, complications, and outcomes. Of 13 patients included in the study, 11 had histologically proven or presumed pituitary macroadenomas. The majority of cases presented with visual and endocrine deficits, and the median maximal tumor diameter was 3.1 cm. There were 17 IAs, all located in the parasellar area. Endovascular treatment of the IA was performed before tumor resection in 2 cases. Transsphenoidal resection was performed before IA occlusion in 1 case, and intraoperative vascular injury occurred in 2 cases. The median follow-up was 36 months. Management decisions for patients with coincident IA and ASB lesions require careful, individualized treatment plans. Coil embolization is well tolerated and does not delay surgery, except in cases requiring stent placement. Inadvertent intraoperative rupture of an adjacent IA during anterior skull base surgery may be treated with emergent coil embolization, flow diversion, or carotid sacrifice, but adequate preoperative planning can reduce this risk.

Single Institutional Experience With Observing 564 Vestibular Schwannomas: Factors Associated With Tumor Growth.

To characterize the risk and predictors of growth during observation of vestibular schwannomas (VS). Retrospective case series. Single academic, tertiary care center. Five hundred sixty-four consecutive VS patients who underwent at least two magnetic resonance imaging (MRI) studies before intervention. Serial MRI studies. Tumor growth, defined as a ≥2 mm increase in the maximum tumor diameter between consecutive MRI studies, or between the first and last study. A total of 1296 patients (1995-2015) with VS were identified. Of those, 564 patients (median age 59.2 years; 53.5% female) were initially observed and underwent multiple MRI studies (median follow-up 22.9 months, interquartile range [IQR] 11.7-42.7). The median maximum tumor diameter at presentation was 1.00 cm (IQR 0.6-1.51 cm). In all, 40.8% of tumors demonstrated growth and 32.1% underwent intervention (21.5% microsurgery, 10.5% radiation) during the surveillance period. Multivariable Cox regression analysis showed that for each tumor, the risk of growth or intervention was significantly increased for larger initial VS diameters (HR = 2.22; 95% CI: 1.90-2.61) and when disequilibrium was a presenting symptom (HR = 1.70; 95% CI: 1.30-2.23). Patient age, sex, aspirin use, and presenting symptoms of asymmetric hearing loss, tinnitus, and vertigo were not associated with tumor growth. To date, this is the largest series of observed VS reported in the literature. Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium.IRB:: 151481. No cohort with this sample size has assessed vestibular schwannoma growth rates in conjunction with this number of variables. To characterize vestibular schwannoma growth rates and predictors of growth.

Selective marginal resections in the management of aggressive angiomyxomas

Aggressive angiomyxomas (AA) are rare tumors, most commonly presenting in the pelvis of women of childbearing age. This study presents the results of selective marginal resection of this disease in patients managed at a single institution. Patients diagnosed with AA from July 2001 to July 2015 were identified from a prospectively maintained histopathology database. Seventeen patients were diagnosed with AA in the study period. The median age at diagnosis was 48 years. Females were more commonly affected with a M:F of 1:8.5. The most common differential diagnoses were an ischiorectal abscess or Bartholin's cyst. Fifteen cases occurred in the pelvis, with two cases at other sites. Median maximum tumor diameter was 10 cm. Of the pelvic cases, 12 were managed operatively via perineal, abdominal, or abdominoperineal approaches. Excision was performed in a marginal fashion with minimal morbidity. Local recurrence developed in 58.3% with a median local recurrence free survival of 25 months. No patients developed metastatic disease or died from disease. AA are rare tumors with a propensity for local recurrence. Atypical presentations of other perineal pathologies should prompt further investigation. Surgery should be reserved for symptomatic patients and is associated with low rates of morbidity. J. Surg. Oncol. 2016;114:828-832. © 2016 2016 Wiley Periodicals, Inc.

Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors.

PurposePrognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC.Materials and MethodsBetween June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively.ResultsThe median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy.ConclusionThere is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.

American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95% confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. We evaluated 1501 laparoscopic (98%) or robotic (2%) PNs. Median age: 58years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20min and 200cc. 81% of the lesions were malignant, with clear cell histology being 65% of the total. Median maximum tumor diameter is 2.7cm, positive margin is 8.2%, and median hospitalization is 3days. One or more postoperative complication was recorded in 19.8% of the patients: Clavien 1: 5.6%; Clavien 2: 8.4%; Clavien 3A: 1.5%; Clavien 3B: 3.2%; Clavien 4A: 1%; Clavien 4B: 0.1%; Clavien 5: 0%. Bleeding was the main cause of a reoperation (5.5%), conversion to radical nephrectomy (3%) or open partial nephrectomy (6%). Transfusion rate is 10%. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95% CI 1.02-1.2; p=0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37years. The 5-year progression or kidney cancer mortality-free rate was 94% (95% CI 90, 97). Positive margins (HR 4.98; 95% CI 1.3-19; p=0.02) and females (HR 5.6; 95% CI 1.7-19; p=0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

Integration and analysis of associated data in surgical treatment of gastric cancer based on multicenter, high volume databases

To elucidate the current diagnosis and treatment status of gastric cancer in the Chinese population based on three high volume databases. Clinical and pathological data of patients who underwent gastric cancer resection with complete follow-up information between January 2000 and December 2012 from Sun Yat-sen University Cancer Center, The First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital were retrospectively analyzed. The overall survival rate was calculated by Kaplan-Meier method. The prognostic risk factors were analyzed by using Cox proportional hazards model. A total of 8 338 cases were enrolled into the study, including 2 977 cases (35.7%) from Sun Yat-sen University Cancer Center, 3 043 cases (36.5%) from The First Affiliated Hospital of China Medical University and 2 318 cases (27.8%) from Tianjin Medical University Cancer Hospital. There were 5 852 male cases and 2 486 female cases with a ratio of 2.4 to 1.0. The age of patients was from 15 to 89 years old (median 59 years old). The ratio of early gastric cancer (T1NanyM0) was 11.5% (956/8 338). There were 2 226 gastric cancer cases (26.7%) originating from the fundus and cardiac region, 1 637 cases (19.6%) from the body, 3739 (44.9%) cases from the antrum, and 736 cases (8.8%) from the whole stomach. The median maximal tumor diameter was (4.5 ± 2.8) cm. Based on the Lauren classification, 3 448 cases (41.4%) were intestinal type and 4 890 cases (58.6%) diffuse type. A total of 1 975 cases (23.7%) and 6 363 cases (76.3%) underwent complete and subtotal gastrectomy respectively. The majority of patients (7 707 cases, 92.4%) underwent radical gastric resection, while 631 cases (7.6%) palliative resection. According to AJCC/UICC seventh edition of gastric cancer TNM staging system, 802 patients (9.6%) were stage I(A, 735 patients (8.8%) stage I(B, 695 patients (8.3%) stage II(A, 1 507 patients (18.1%) stage II(B, 1 247 patients (15.0%) stage III(A, 1 342 patients (16.1%) stage III(B, 1 583 patients (19.0%) stage III (C and 427 patients (5.1%) stage IIII(. The average number of retrieved lymph node was 21.0 ± 13.1, in which 5 761 patients (69.1%) had more than 15 retrieved lymph nodes. The overall 1-, 3-, 5- and 10-year survival rates were 83.0%, 56.8%, 49.1% and 43.0% respectively. For patients receiving radical resection, the 1-, 3-, 5- and 10-year survival rates were 84.9%, 59.5%, 51.7% and 45.3% respectively. The overall 5-year survival rates for different stages were as follows: stage I(A 93.8%, stage I(B 80.8%, stage II(A 70.8%, stage II(B 59.6%, stage III(A 44.4%, stage III(B 32.9%, stage III(C 18.9% and stage IIII( 10.2%. Cox regression model showed that age, tumor site, tumor size, Lauren type, T staging, N staging, M staging and number of retrieved lymph nodes were independent factors affecting the prognosis of gastric cancer patients (P=0.000). Retrospective study on these domestic three high volume databases demonstrates the clinical and pathological characteristics of gastric cancer based on Chinese population, which is expected to stand as a ground of basic data for future clinical research.

Angiotensin receptor blockers improve survival outcomes after radiofrequency ablation in hepatocarcinoma patients.

Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. The aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. Data on 153 patients were reviewed. The study population was classified into three groups: 73 (47.8%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 49 (32%) patients treated with angiotensin-converting enzyme inhibitors (group 2), and 31 (20.2%) patients treated with sartans (group 3). Survival outcomes were analysed by means of Kaplan-Meier analysis and compared with log-rank test. In the whole study population, 85.6% of patients were in Child-Pugh A class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10-40) and alpha fetoprotein was 25 (1.1-2100) UI/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (95% confidence interval: 31-58) in group 1, 72 months (49-89) in group 2, and 84 months (58-92) in group 3 (P = 0.02). Median time to recurrence was 26 (15-42), 44 (33-72), and 69 (44-74) months in the three groups, respectively (P = 0.02). Sartan therapy was a significant predictor of longer overall survival and delayed time to recurrence on multivariate analysis. Sartans significantly improved overall survival and time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients.

Multiparametric Magnetic Resonance Imaging Predicts Postoperative Pathology but Misses Aggressive Prostate Cancers as Assessed by Cell Cycle Progression Score

We identified prognostic biomarkers in prostate cancer by a radiogenomics strategy that integrates gene expression using the cell cycle progression score and medical images. We obtained institutional review board approval and written informed consent from 106 men with prostate cancer, including 60% at low risk, who underwent multiparametric magnetic resonance imaging before radical prostatectomy was done and a cell cycle progression score was determined. The correlation between the results of multiparametric magnetic resonance imaging and Gleason grade or cell cycle progression score was assessed by logistic regression. Patients with primary Gleason grade greater than 3 had a longer median maximal tumor diameter (13 vs 10 mm) and a lower median apparent diffusion coefficient (0.745 vs 0.88×10(-3) mm2 per second, each p=0.0001) than those with primary Gleason grade 3 or less. Maximal diameter 10 mm or greater (OR 4.9, 95% CI 1.7 to 14.0, p=0.0012) and apparent diffusion coefficient 0.80×10(-3) mm2 per second or less (OR 7.5, 95% CI 3.0 to 18.7, p<0.0001) were significantly associated with primary Gleason grade greater than 3. The combined measure of maximal diameter less than 10 mm and apparent diffusion coefficient greater than 0.80×10(-3) mm2 per second identified only index lesions harboring primary Gleason grade 3. However, 7 of those lesions showed a molecular pattern of high risk lethal prostate cancer (cell cycle progression score greater than 0). Multiparametric magnetic resonance imaging is able to predict low and high risk Gleason scores in the tumor. However, the cell cycle progression score did not completely match the imaging result. These findings suggest that management of early stages prostate cancer could strongly benefit by performing magnetic resonance imaging targeted biopsy coupled with molecular analysis.

Phase II multicenter study of adjuvant S-1 for colorectal liver metastasis: survival analysis of N-SOG 01 trial

We previously showed that S-1 after curative resection of colorectal liver metastasis had acceptable toxicity and a high rate of completion of therapy in a prospective phase II trial. We here reported the primary endpoint of disease-free survival (DFS). Between October 2008 and August 2010, 60 patients were eligible for this study and received S-1 for 28days followed by a 2-week rest period. Treatment was started within 8weeks after surgery and repeated for eight cycles. Median follow-up was 41months. Among 60 patients, 45 had solitary metastasis, and the median maximum tumor diameter was 2.6cm. The 3-year DFS and overall survival were 47.4 and 80.0%, respectively. Recurrences developed in 31 patients, with the remnant liver the most common site (19 patients). Multivariate analysis showed that positive lymph node metastasis around the primary site (p=0.013) and early liver metastasis (synchronous disease or metachronous disease within 12months) (p=0.041) were independent poor prognostic factors for DFS. Patients having both risk factors had a significantly worse DFS than those without these risk factors (p<0.001). Early liver metastasis was an independent indicator of early recurrence within 1year. S-1 after curative liver resection yielded promising survival in patients with a low tumor burden. Outcome in patients having both positive lymph node metastasis around the primary site and early liver metastasis was much worse than in patients without these conditions; therefore, they might warrant more aggressive therapy.

Percutaneous Cryoablation of Clinical T2 (> 7 cm) Renal Masses: Technical Considerations, Complications, and Short-Term Outcomes

PurposeTo determine the technical success, safety, and preliminary clinical outcome of percutaneous cryoablation of large (> 7 cm) renal masses. Materials and MethodsTwelve patients underwent percutaneous cryoablation for treatment of renal tumors measuring greater than 7 cm (clinical stage II, T2aN0M0) between 2004 and 2013. Median patient age was 75 years (range, 46–84 y), median Charlson comorbidity index was 5 (range, 4–9), and median maximal tumor diameter was 8.4 cm (range, 7.2–9.7 cm). Seven of the 12 patients underwent superselective intraarterial tumor embolization before cryoablation. Technical success, procedural complications, renal function, and oncologic and survival outcomes were evaluated for each patient. ResultsAll cryoablation procedures were technically successful in a single treatment session, with no mortalities at 30 days. Two patients (17%) experienced major complications related to postprocedural hemorrhage. Median change in estimated glomerular filtration rate within 7 days following cryoablation treatment was 11 mL/min (range, 7–14 mL/min). One patient with baseline stage IV chronic kidney disease and a major bleeding complication required temporary dialysis in the periprocedural period. In 11 patients (92%) who had follow-up beyond 3 months after the procedure (mean, 19 mo; range, 4–49 mo), recurrence-free survival and overall survival rates at 2 years were 100% and 91%, respectively. ConclusionsPercutaneous cryoablation of large (> 7 cm) renal masses was technically successful, with effective preliminary clinical outcomes. However, major complications are more common with cryoablation of stage T2 tumors than is typically encountered with treatment of smaller stage T1 tumors.

Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort

ObjectiveConcurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT.MethodsWe retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models.ResultsOf the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes.ConclusionNew treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.

Comparison of clinical manifestation and multi-slice computed tomography characteristics in pancreas solid pseudopapillary tumor between male and female patients

Objective To retrospectively analyze imaging features of multi-slica computed tomography (MSCT) and clinical characteristics of male patients with pancreas solid pseudopapillary tumor (SPT) and compare with that of female patients.Methods From November 2000 to October 2012,clinical data of 18 male patients and 94 female patients underwent MSCT examination and pathological diagnosed as SPT were retrospectively analyzed.Clinical characteristics and imaging features of MSCT of male and female patients with SPT were analyzed,which included lesion location,size,shape,encapsulation,calcification,internal composition,density and enhancement pattern of tumors.Rank sum test or x2 test was performed for statistical analysis.Results The median age of male patients with SPT was significantly older than that of female patients (39.0 (15.0,67.0) years vs 27.5 (11.0,63.0) years; U=2.865,P =0.005).There were no significant differences in clinical manifestation,lesion location and composition ratio of benign and malignant tumors between male and female patients with SPT (all P＞0.05).Imaging of MSCT indicated that the median maximum tumor diameter of male patients with SPT was significantly shorter than that of female patients (5.1 (1.0,11.6) cm vs 7.9 (2.5,18.7) cm; U=3.161,P=0.002).Solid tumors were more common in male patients compared with female patients (9/18 vs 5.3％ (5/94) ; x2 =30.606,P＜0.01).Conclusions The imaging features of male patients with SPT are different with those of females.For pancreas lesion in males,if imaging of MSCT shows more solid composition,small lesion and with typical enhancement patterns of SPT,the possibility of SPT should be considered. Key words: Pancreatic neoplasms; Tomography, X-ray computed; Solid pseudopapillary tumor of the pancreas; Male

Technique and Outcomes of Robot-assisted Retroperitoneoscopic Partial Nephrectomy: A Multicenter Study

BackgroundRobot-assisted retroperitoneoscopic partial nephrectomy (RARPN) may be used for posterior renal masses or with prior abdominal surgery; however, there is relatively less familiarity with RARPN. ObjectiveTo demonstrate RARPN technique and outcomes. Design, setting, and participantsA retrospective multicenter study of 227 consecutive RARPNs was performed at the Swedish Medical Center, the University of Michigan, and the University of California, Los Angeles, from 2006 to 2013. Surgical procedureRARPN. Outcome measurements and statistical analysisWe assessed positive margins and cancer recurrence. Stepwise regression was used to examine factors associated with complications, estimated blood loss (EBL), warm ischemia time (WIT), operative time (OT), and length of stay (LOS). Results and limitationsThe median age was 60 yr (interquartile range [IQR]: 52–66), and the median body mass index (BMI) was 28.2kg/m2 (IQR: 25.6–32.6). Median maximum tumor diameter was 2.3cm (IQR: 1.7–3.1). Median OT and WIT were 165min (IQR: 134–200) and 19min (IQR: 16–24), respectively; median EBL was 75ml (IQR: 50–150), and median LOS was 2 d (IQR: 1–3). Twenty-eight subjects (12.3%) experienced complications, three (1.3%) had urine leaks, and three (1.3%) had pseudoaneurysms that required reintervention. There was one conversion to radical nephrectomy and three transfusions. Overall, 143 clear cell carcinomas (62.6%) composed most of the histology with eight positive margins (3.5%) and two recurrences (0.9%) with a median follow-up of 2.7 yr. In adjusted analyses, intersurgeon variation was associated with complications (odds ratio [OR]: 3.66; 95% confidence interval, 1.31–10.27; p=0.014) and WIT (parameter estimate [PE; plus or minus standard error]: 4.84±2.14; p=0.025). Higher surgeon volume was associated with shorter WIT (PE: −0.06±0.02; p=0.002). Higher BMI was associated with longer OT (PE: 2.09±0.56; p<0.001). Longer OT was associated with longer LOS (PE: 0.01±0.01; p=0.002). Finally, there was a trend for intersurgeon variation in OT (PE: 18.5±10.3; p=0.075). ConclusionsRARPN has acceptable morbidity and oncologic outcomes, despite intersurgeon variation in WIT and complications. Greater experience is associated with shorter WIT. Patient summaryRobot-assisted retroperitoneoscopic partial nephrectomy has acceptable morbidity and oncologic outcomes, and there is intersurgeon variation in warm ischemia time and complications.

Larger Maximum Tumor Diameter at Radical Prostatectomy Is Associated With Increased Biochemical Failure, Metastasis, and Death From Prostate Cancer After Salvage Radiation for Prostate Cancer

To investigate the maximum tumor diameter (MTD) of the dominant prostate cancer nodule in the radical prostatectomy specimen as a prognostic factor for outcome in patients treated with salvage external beam radiation therapy (SRT) for a rising prostate-specific antigen (PSA) value after radical prostatectomy. From an institutional cohort of 575 patients treated with SRT, data on MTD were retrospectively collected. The impact of MTD on biochemical failure (BF), metastasis, and prostate cancer-specific mortality (PCSM) was assessed on univariate and multivariate analysis using Kaplan-Meier and Cox proportional hazards models. In the 173 patients with MTD data available, median follow-up was 77 months (interquartile range, 47-104 months) after SRT, and median MTD was 18 mm (interquartile range, 13-22 mm). Increasing MTD correlated with increasing pT stage, Gleason score, presence of seminal vesicle invasion, and lymph node invasion. Receiver operating characteristic curve analysis identified MTD of >14 mm to be the optimal cut-point. On univariate analysis, MTD >14 mm was associated with an increased risk of BF (P=.02, hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.2-2.8), metastasis (P=.002, HR 4.0, 95% CI 2.1-7.5), and PCSM (P=.02, HR 8.0, 95% CI 2.9-21.8). On multivariate analysis MTD >14 mm remained associated with increased BF (P=.02, HR 1.9, 95% CI 1.1-3.2), metastasis (P=.02, HR 3.4, 95% CI 1.2-9.2), and PCSM (P=.05, HR 9.7, 95% CI 1.0-92.4), independent of extracapsular extension, seminal vesicle invasion, positive surgical margins, pre-RT PSA value, Gleason score, and pre-RT PSA doubling time. For patients treated with SRT for a rising PSA value after prostatectomy, MTD at time of radical prostatectomy is independently associated with BF, metastasis, and PCSM. Maximum tumor diameter should be incorporated into clinical decision making and future clinical risk assessment tools for those patients receiving SRT.

Definitive High-Dose Photon/Proton Radiotherapy for Unresected Mobile Spine and Sacral Chordomas

A retrospective review. The purpose of this study is to report the results of high-dose proton based definitive radiotherapy for unresected spinal chordomas. Spine chordoma is treated primarily by surgical resection. However, local recurrence rate is high. Adjuvant radiotherapy improves local control. In certain locations, such as high sacrum, resection may result in significant neurological dysfunction. We retrospectively reviewed 24 patients with newly diagnosed, previously untreated spinal chordomas (core biopsy only; no prior incision or resection) treated with high-dose definitive radiotherapy alone using protons and photons at our center from 1988 to 2009. Reasons for radiotherapy alone included medical inoperability (3) and concern for neurological dysfunction based on spine level (21). Median age was 69.5 years. Tumor locations included cervical (2), thoracic (1), lumbar (2), S1-S2 (17), and S3 or below (2). Median maximal tumor diameter was 6.6 cm (1.4-25.5), and median tumor volume was 198.3 cm (4.65-2061). Median total dose was 77.4 GyRBE (proton dose unit, gray relative biological effectiveness). Analysis at median follow-up of 56 months showed overall survival of 91.7% and 78.1%, chordoma specific survival of 95.7% and 81.5%, local progression free survival of 90.4% and 79.8% and metastases free survival of 86.5% and 76.3%, at 3 and 5 years respectively. Tumor volume more than 500 cm was correlated with worse overall survival. Long-term side effects included 8 sacral insufficiency fractures (none required surgical stabilization), 1 secondary malignancy, 1 foot drop, 1 erectile dysfunction, 1 perineal numbness, 2 worsening urinary/fecal incontinence, and 4 grade-2 rectal bleeding. None required new colostomy. All surviving patients remained ambulatory. These results support the use of high-dose definitive radiotherapy for patients with medically inoperable or otherwise unresected, mobile spine or sacrococcygeal chordomas.

Maximum tumor diameter as a predictor for outcome following salvage radiation for prostate cancer.

78 Background: While maximum tumor diameter (MTD), as identified on radical prostatectomy (RP) specimens, has been associated with prostate cancer recurrence, the prognostic significance of this variable is unknown in the context of salvage external beam radiation therapy (EBRT) following a rising PSA after RP. Here, we investigate associations between MTD and outcomes in this setting. Methods: From an IRB approved retrospective single-institutional cohort, 575 patients treated with salvage radiation therapy (SRT) were identified, with MTD data available on 173. ANOVA and chi-square were utilized to compare prognostic variables with MTD. The impact of MTD on biochemical failure (BF), metastasis (Mets), prostate cancer-specific mortality (PCSM) and overall survival (OS) was assessed on univariate and multivariate analysis using Kaplan-Meier and Cox-proportional hazards regression. Results: Median follow up was 76.5 months (IQR, 46.5-104.0) and median MTD was 18 mm (IQR, 13-22). Median RT dose was 68.4 Gy (IQR, 64.8-68.4). MTD size correlated with pT-stage, Gleason score, and presence of seminal vesicle invasion or lymph node invasion. Receiver operator characteristic (ROC) curve analysis was used to correlate MTD with clinical end-points and identified 14 mm as the most prognostic cut-point. A MTD &gt;14 mm was associated with a 1.8, 4.0 and 8-fold increase in the risk of BF (p&lt;0.02), Mets (p&lt;0.002), and PCSM (p&lt;0.02), respectively. As a continuous variable, on multivariate analysis, MTD was shown to be a marginally significant predictor of OS (p=0.056, HR [95%] 1.6 [1.0-2.5]), and a significant predictor of PCSM (p&lt;0.03, HR [95%] 2.0 [1.1-3.8]) and Mets (p=0.01, HR [95%] 1.7 [1.1-2.6) but not BF. In this model, for every 10 mm increase in MTD, there is a 1.7, 2.0, and 1.6 fold risk of metastasis, prostate cancer death and overall death, respectively. Conclusions: As a categorical and continuous variable, MTD is a significant predictor of prostate cancer outcomes following SRT and should be used in clinical decision making in this population and in future clinical risk assessment tools.