Non-oncological Causes Research Articles

Sustained complete response to chemotherapy in a patient with advanced merkel cell carcinoma: A case report

Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer. Over the last decade immune checkpoint inhibitors (ICIs) replaced chemotherapy as the recommended first-line therapy option. Across nonrandomized studies chemotherapy showed an overall response rate (ORR) ranged from 50% to 60%, a complete response (CR) rate from 3% to 30% and a progression free survival (PFS) of 3-4 months. We report a clinical case regarding a 72-year-old woman with MCC with right gluteus cutaneous lesion and inguinal and iliac lymph-adenopathies at diagnosis. The initial treatment was based on systemic chemotherapy with carboplatin + etoposide followed by lymphadenectomy. A pancreatic recurrence occurred after thirteen months, histologically confirmed. Systemic chemotherapy with the same regimen yielded a CR without a further progression for the subsequent eight years. The patient died due to nononcological causes, MCC-free, 11 years after the diagnosis.

Analysis of prognostic factors of failure in perineal urethrostomy.

To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. A total of 115 PU were performed. Median age was 61years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71months. In the last 8years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.

Quality Indicators Compliance and Survival Outcomes in Breast Cancer according to Age in a Certified Center

Age as a breast cancer (BC) prognostic factor remains debatable. Several studies have investigated clinicopathological features at different ages, but few make an age group direct comparison. The European Society of Breast Cancer Specialists quality indicators (EUSOMA-QIs) allow a standardized quality assurance of BC diagnosis, treatment, and follow-up. Our objective was to compare clinicopathological features, compliance to EUSOMA-QIs and BC outcomes in three age groups (≤45 years, 46-69 years, and ≥70 years). Data from 1580 patients with staged 0-IV BC from 2015 to 2019 were analyzed. The minimum standard and desirable target on 19 mandatory and 7 recommended QIs were studied. The 5-year relapse rate, overall survival (OS), and BC-specific survival (BCSS) were also evaluated. No meaningful differences in TNM staging and molecular subtyping classification between age groups were found. On the contrary, disparities in QIs compliance were observed: 73.1% in ≤45 years and 46-69 years women vs. 54% in older patients. No differences in loco-regional or distant progression were observed between age groups. Nevertheless, lower OS was found in older patients due to concurrent non-oncological causes. After survival curves adjustment, we underscored evidence of undertreatment impacting BCSS in ≥70 years women. Despite a unique exception-more invasive G3 tumors in younger patients-no age-specific differences in BC biology impacting outcome were found. Although increased noncompliance in older women, no outcome correlation was observed with QIs noncompliance in any age group. Clinicopathological features and differences in multimodal treatment (not the chronological age) are predictors of lower BCSS.

Survivorship, complications, and outcomes following distal femoral arthroplasty for non-neoplastic indications.

AimsEndoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.MethodsWe performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months’ follow-up were excluded. We collected patient demographic data, complications, and reoperations. Reoperation for implant failure was used to calculate implant survivorship.ResultsOverall one- and five-year implant survivorship was 87% and 76%, respectively. By indication for DFA, mechanical failure had one- and five-year implant survivorship of 92% and 68%, PJI of 91% and 72%, and distal femur fracture/nonunion of 78% and 70% (p = 0.618). A total of 37 patients (49%) experienced complications and 27 patients (36%) required one or more reoperation. PJI (n = 16, 21%), aseptic loosening (n = 9, 12%), and wound complications (n = 8, 11%) were the most common complications. Component revision (n = 10, 13.3%) and single-stage exchange for PJI (n = 9, 12.0 %) were the most common reoperations. Only younger age was significantly associated with increased complications (mean 67 years (SD 9.1)) with complication vs 71 years (SD 9.9) without complication; p = 0.048).ConclusionDFA is a viable option for distal femoral bone loss from a range of non-oncological causes, demonstrating acceptable short-term survivorship but with high overall complication rates.Cite this article: Bone Jt Open 2022;3(3):173–181.

Post-operative hypofractionated radiotherapy for prostate cancer: a mono-institutional analysis of toxicity and clinical outcomes.

As the use of hypofractionation has spread in the setting of curative prostate radiotherapy, few data are available in the post-operative scenario. This study reports a mono-institutional experience of moderate post-operative hypofractionated radiotherapy for prostate cancer. In February 2021, we retrospectively assessed the outcomes of 129 patients who received between April 2013 and May 2020 hypofractionated post-operative radiotherapy using Helical Tomotherapy. Toxicity was assessed using CTCAE criteria v4.0. Survival endpoints were calculated with Kaplan-Meier method. Median age and follow-up were, respectively, 67years and 43months. Adjuvant and salvage treatment were delivered to 63.5% and 36.4% of patients to a median total dose of 63.8Gy (61.6-65.25Gy) in 29 fractions (2.12-2.25Gy/fraction). Pelvic lymph-nodes irradiation was performed in 67.4% of cases. ADT was added in 50%. Acute toxicity was: G1 and G2 GU events in 36% and 9.3% of cases; G1 and G2 GI events in 29.4% and 13.9%. Late GU toxicity occurred in 12.4% of cases: 3.1% G1, 7.7% G2 and 1.5% G3 events; GI toxicity consisted of 1.5% G1 and 7.7% G2 events. Biochemical relapse occurred in 26.3% of cases, recording no significant differences between adjuvant and salvage (p = 0.67), with 4- and 5-years bRFS rates of 78.7% and 75.6%. Two patients died of progressive disease and eight for non-oncological causes resulting in 3-years overall survival and cancer-specific survival rates of 98% and 98.4%. Our experience supports the use of moderate hypofractionation for prostate bed radiotherapy, with minimal toxicity and promising results in terms of clinical outcomes.

Peripheral blood cell ratios as prognostic factors in canine diffuse large B-cell lymphoma treated with CHOP protocol.

Diffuse large B-cell lymphoma (DLBCL) is the most common haematopoietic tumour in dogs and recognized as clinical model for its human counterpart. Recently, neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte (LMR) ratios have been shown to predict time-to-progression (TTP) and lymphoma-specific survival (LSS) in dogs with DLBCL treated with CHOP-based chemotherapy. We retrospectively evaluated in 59 dogs diagnosed with DLBCL the prognostic value of haematological parameters and derived ratios: NLR, LMR, platelet-to-lymphocyte (PLR) and platelet-to-neutrophil (PNR) ratios for TTP, LSS and associated secondary end-points (time-to-progression-rate [TTPR] and lymphoma-specific survival-rate [LSSR]) as rates at 180 and 365 days. PNR is an independent prognostic marker (p ≤ .001) for TTPR/180 and 365 days, dogs with a PNR above 0.032 were more likely to progress before 180 days (sensitivity 46.5%, specificity 87.5%, p=.004). On univariate analysis, NLR showed a prognostic significance for LSSR/180 (p=.006) and LSSR/365 (p=.009). A baseline NLR value below 7.45 was positively associated with survival at 180 days (sensitivity 52%, specificity 85.3%, p=.025). The presence of substage b, was associated with early progression and decreased survival at 180 days (p=.031). Anaemia significantly reduced LSSR at 365 days (p=.028). This is the first study evaluating PLR and PNR in canine DLBCL and demonstrates that PNR could be a predictor of early lymphoma progression. Since peripheral blood cell composition can be affected by several non-oncological causes, the development of larger multicenter studies with homogeneous inclusion criteria could help to better determine the true predictive values of blood cell ratios in dogs' DLBCL treated with CHOP chemotherapy.

Keystone design perforator island flaps for coverage of non-oncological periarticular defects surrounded by the zone of injury

ObjectivePeriarticular defect coverage remains challenging because multi-vector tension forces affect wound tensile strength. This study presents our experience with keystone design perforator island flap (KDPIF) reconstruction of non-oncological periarticular defects surrounded by the zone of injury and describes the expanding versatility of KDPIF reconstruction for periarticular defects.MethodsFrom June 2017 to July 2019, 12 patients aged 8 to 84 years underwent KDPIF reconstruction to cover periarticular defects. All defects resulted from non-oncological causes and were surrounded by the zone of injury. We reviewed the patients’ medical records and clinical photographs to collect and analyze clinical and operative data.ResultsThe defect size ranged from 0.8 × 1.2 to 7 × 10 cm2. The flap size ranged from 1.5 × 3 to 15 × 18 cm2. All flaps survived completely. All patients showed favorable functional outcomes without significant limitation in joint range of motion during the follow-up period (range, 4–12 months). The mean observer scar assessment scale summary score and patient scar assessment scale total score were 17.667 ± 5.921 and 20.167 ± 6.478, respectively.ConclusionKDPIF reconstruction is a simple and effective surgical option for coverage of non-oncological periarticular defects surrounded by the zone of injury.

Place of death of people with conditions needing palliative care in the different regions of Spain

Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

Renal function up to the 5th decade of life after nephrectomy in childhood: A literature review.

The aim of the present study was to find out if in children ablation of 50% of renal mass may be associated with a progressive renal damage (Brenner's hypothesis). We collected 1035 adult or adolescent survivors who underwent nephrectomy for unilateral oncological or non-oncological causes during childhood. Stratification of all survivors for age revealed that the number of subjects with blood hypertension and/or renal dysfunction (glomerular filtration rate < 90 mL/min per 1.73 m2 ) to be significantly higher in survivors ≥30 years old in comparison with younger patients. Available data on long-term renal function after nephrectomy during childhood support the Brenner's hypothesis.

Chronic pelvic pain in benign and functional urological conditions: A review and comparison of the UK and European guidelines

We aim to provide a general overview of the available UK and European guidelines on non-oncological causes of chronic pelvic pain, and highlight any differences in practice. We have reviewed the current guidelines on chronic pelvic pain syndrome (defined as chronic pelvic pain with no identified underlying cause and/or the pain is non-specific or involves more than one organ) and other specific organ pain syndromes particularly relevant to urological clinical practice, including prostate pain syndrome, bladder pain syndrome and gynaecological causes of chronic pelvic pain. We have identified a relative paucity of UK guidelines, and accept that the European Association of Urology provides a comprehensive and current evidence based reference and guide which is utilised and regarded by most urologists as the ‘gold standard’ in UK practice.

Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline

Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.

Keystone-Designed Perforator Island Flaps for the Coverage of Traumatic Pretibial Defects in Patients With Comorbidities.

Reconstruction of pretibial skin and soft-tissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Here, we present a retrospective review of our experience with pretibial reconstruction using the keystone-designed perforator island flap (KDPIF) in patients with comorbidities. All defects resulted from nononcological causes. We describe the expanding versatility of KDPIF reconstruction for pretibial defects and suggest a simple algorithmic approach. The medical records of 9 patients who underwent reconstruction with a KDPIF to cover a pretibial defect between May 2016 and June 2017 were reviewed. Clinical and operative data were collected. All 9 KDPIFs fully survived. The defect size varied from 3 × 2 cm2 to 8 × 6 cm2. The flap size varied from 5 × 3 to 20 × 10 cm2. The mean operative time was 90.4 minutes (range = 37-127 minutes). No postoperative complications occurred. The cosmetic results were favorable, and all patients were satisfied with the final outcomes. Thus, the KDPIF is a good reconstruction modality with few complications and provides an alternative to free flaps for pretibial defect reconstruction in patients with comorbidities.

Oesophageal perforation - therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009-2015).

Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.

Close surgical margin after conservative parotidectomy in early stage low-/intermediate-grade parotid carcinoma: Outcome of watch and wait policy

The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma. Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1mm), but close (≤5mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3mm (in 27 cases it was 1mm, in 3 cases - 2mm and in 2 cases - 3mm), average 1.2mm. The patients underwent further clinical-histological analysis. 3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104months. One patient died 72months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3mm, respectively. There were no other distinctive features. The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.

Clinical and treatment factors determining long-term outcomes for adult survivors of childhood low-grade glioma: A population-based study.

The determinants of outcomes for adult survivors of pediatric low-grade glioma (PLGG) are largely unknown. This study collected population-based follow-up information for all PLGG patients diagnosed in Ontario, Canada from 1985 to 2012 (n = 1202) and determined factors affecting survival. The impact of upfront radiation treatment on overall survival (OS) was determined for a cohort of Ontario patients and an independent reference cohort from the Surveillance, Epidemiology, and End Results database. At a median follow-up of 12.73 years (range, 0.02-33 years), only 93 deaths (7.7%) were recorded, and the 20-year OS rate was 90.1% ± 1.1%. Children with neurofibromatosis type 1 had excellent survival and no tumor-related deaths during adulthood. Adverse risk factors included pleomorphic xanthoastrocytoma (P < .001) and a thalamic location (P < .001). For patients with unresectable tumors surviving more than 5 years after the diagnosis, upfront radiotherapy was associated with an approximately 3-fold increased risk of overall late deaths (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6-6.6; P = .001) and an approximately 4-fold increased risk of tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P = .013). In a multivariate analysis, radiotherapy was the most significant factor associated with late all-cause deaths (HR, 3.0; 95% CI, 1.3-7.0; P = .012) and tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P = 0.014). A similar association between radiotherapy and late deaths was observed in the independent reference cohort (P < .001). In contrast to early deaths, late mortality was associated not with PLGG progression but rather with tumor transformation and non-oncological causes. The course of PLGG is associated with excellent long-term survival, but this is hampered by increased delayed mortality in patients receiving upfront radiotherapy. These observations should be considered when treatment options are being weighed for these patients.

Spindle cell carcinoma of the head and neck region: treatment and outcomes of 15 patients.

IntroductionSpindle cell carcinoma of the head and neck is a rare entity and the evidence of optimal management is lacking. The objective of our study was to report the treatment and outcomes of 15 patients treated in a single institution over a seven year period.Materials and MethodsA total of 15 patients (12 males and 3 females) with spindle cell carcinoma of the head and neck were treated between July 2007 to June 2014. In six patients the disease developed after previous radiotherapy. Of the 15 patients, five patients had their primary in the tongue, four in the paranasal sinuses, two in the hypopharynx, two in the vocal cords, and one each in the soft palate and the floor of mouth. Eleven patients were treated with radical intent (seven patients required surgery only and four were treated with combined modality). The remaining four patients were treated with palliative intent.ResultsAmong 11 patients treated with radical intent eight are alive or died of non-oncological causes. The disease recurred locally in three patients and they died of the disease (two patients with locally advanced disease in the tongue and one patient with T1N0 tumour in the hypopharynx). Median overall survival (OS) was 18 months.ConclusionSurgery or surgery combined with radiotherapy has a real impact on the natural cause of spindle cell carcinoma of the head and neck region. Even locally advanced tumours can be controlled with aggressive treatment. The worst outcome is seen with the tongue as the primary site because of a high local recurrence rate.

LG-03 * RADIATION THERAPY IS ASSOCIATED WITH INCREASED LATE MORTALITY IN LONG-TERM ADULT SURVIVORS OF CHILDHOOD LOW GRADE GLIOMA: A POPULATION BASED STUDY

PURPOSE: To uncover clinical risk factors and the impact of radiotherapy on children and adult survivors of childhood low grade glioma (PLGG). METHODS: We collected long-term follow-up information for all PLGG patients diagnosed in all Ontario, Canada from 1985–2012 (n = 1202) and determined factors affecting long-term survival. The impact of upfront (first line) radiation treatment on overall survival was determined in a discovery cohort of clinically relevant (incompletely resected) Ontario PLGG patients and an independent population based validation cohort from the Surveillance, Epidemiology and End Results (SEER) database (n = 2402). RESULTS: At a median follow-up of 12.73 (0.02-33) years; only 93 deaths (7.7%) were recorded with 20 years overall survival (OS) of 90.1% + 1.1%. Children with NF1 had excellent survival and no tumor-related deaths during adulthood. Adverse risk factors included pleomorphic xanthoastrocytoma tumor type (p 5 years post-diagnosis, upfront radiotherapy was associated with three-fold increased risk of overall late deaths (p = 0.001) and four-fold increased risk of tumor-related deaths (p = 0.013). On multivariate analysis radiation therapy was the most significant factor associated with late all deaths and tumor-related deaths (HR 3 [1.3–7.0; p = 0.012] and HR 4.4 [1.3–14.6; p = 0.014] respectively). Similar association of radiotherapy and late deaths was observed in the validation cohort (p < 0.001). In contrast to early deaths, late mortality was not associated with PLGG progression but rather tumor transformation (54%), secondary malignancy (11%) and other non-oncological causes (35%). CONCLUSION: The chronic clinical course of PLGG is associated with excellent long-term survival and is hampered by increased delayed mortality in patients receiving upfront radiotherapy. These observations should be considered while deciding treatment options for these patients.

Histopathological audit of 373 nononcological hysterectomies in a teaching hospital.

Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45 ± 9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.

Nowotwory złośliwe krtani pochodzenia mezenchymalnego w materiale własnym

Although laryngeal malignancies of mesenchymal origin (laryngeal sarcomas, LS) are extremely rare (1% of all laryngeal malignancies), the histological manifestations are very diverse. LS sign as a solid tumor covered with an intact mucosa. was to evaluate retrospective data referring: epidemiology, clinical manifestations, treatment and early follow-up; based on medical record made in ORL, HNS Surgery Dpt of Holy Cross Cancer Centre in Kielce during 9-years period 2001-2009. The retrospective analysis of the group of 12 patients with LS was made. Studied characteristics were: age, sex, primary focus, histological outcome, treatment options and early follow-up. Age of the group of 12 studied patients (10 M, 2 F) ranged from 48 to 84 (mean 69.8). LS accounted 1.2% (12/935) for all of laryngeal malignancies. The focus of origin were: glottis (6), epiglottis (5); subglottis (1). The most common histological types of LS at studied group were: neurosarcoma (2), fibrosarcoma (2), plasmocytoma (2), chondrosarcoma (1), malignant fibrous histiocytoma (1), sarcoma low grade (1), lymphoma malignum (1), liposarcoma (1) and haemangioendothelioma epithelioides vel plasmocytoma (1). Methods of treatment were: surgery (6); radiotherapy (1); chemotherapy (1); chemo- and radiotherapy (3); symptomatic treatment (1). The clinical results of treatment are: 9 patients are still alive (5 pts more than 5 years, 3 pts less than 5 years, 1 pts less than 2.5 years with residual disease); 3 patient died: 2 pts in 1st year from diagnosis, 1 pts after 3 years of treatment died of non-oncological causes. 1. LS are extremely rare and diversed histologically. 2. Immunochemical analyses are very important procedures used in diagnostics of these malignancies. 3. An individual approach is needed in diagnostic and therapeutic procedures of LS.

P-5-533 - Study of clinical stages and CSRCI scheme of cerebral gliomas

The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma.Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1 mm), but close (≤5 mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3 mm (in 27 cases it was 1 mm, in 3 cases – 2 mm and in 2 cases – 3 mm), average 1.2 mm. The patients underwent further clinical-histological analysis.3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56 months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104 months. One patient died 72 months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3 mm, respectively. There were no other distinctive features.The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.