Organ-preserving Surgery Research Articles

Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radiotherapy.

Laryngeal cancer treatment options include radical surgery, "organ preservation surgery", radiotherapy and chemotherapy. There is no proven evidence of a significant increase in late toxicity with adjuvant radiotherapy after conservative surgery. The aim of this retrospective study was to evaluate the toxicity, local-regional control and overall survival of adjuvant radiotherapy after conservative surgery. A total of 36 patients was treated with radiotherapy after partial laryngectomy at the Radiotherapy Department of the Institute for Cancer Treatment and Research (IRCC) of Candiolo and of the Mauriziano Hospital in Turin, between 1994 and 2007. The postoperative treatment doses ranged from 45 to 70.2 Gy with conventional fractionation. The Kaplan-Meier method was applied for statistical analysis. The RTOG-EORTC scale was used to evaluate late and acute toxicity. Overall 5- and 10-year survival was 93% and 47%, respectively. Local control was 93.5% at 5 and was unchanged at 10 years. Grade 2 acute cutaneous and mucous toxicity was 41% and 62%, and grade 3, 6.9% and 3.5%, respectively. Only one patient required percutaneous endoscopic gastrostomy due to severe dysphagia and one patient required temporary tracheostomy for severe acute laryngeal edema (grade 3). Two patients experienced late toxicity greater than grade 3. The median dose to the residual larynx was 59.5 Gy (range, 45-70.2), and the median dose to the neck was 50.4 Gy (range, 39.6 -55.8). The results of our study showed a dose-dependent increase in the late toxicity trend at doses over and above 60 Gy, which is higher than the cutoff dose reported in the literature. There was no indication from our data that adjuvant postoperative radiotherapy means additional toxicity. The use of highly conformal techniques can further reduce toxicity of the radiotherapy.

Treatment of early stage Supraglottic squamous cell carcinoma: meta-analysis comparing primary surgery versus primary radiotherapy

ObjectivesFor early stage supraglottic squamous cell carcinoma (SCC), single modality treatment either in the form of primary organ preservation surgery alone or radiation alone is recommended. Thus, a definite treatment strategy for early stage supraglottic SCC remains undefined. The primary objective of this study was to conduct a systematic review and meta-analysis comparing the oncologic outcomes of surgery and radiotherapy in early stage (Stage I and II) T1 N0 and T2 N0 supraglottic SCC.MethodsSystematic methods were used to identify published and unpublished data. Two reviewers independently screened all titles, abstracts and articles for relevance using predefined criteria. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.ResultsFive studies met the inclusion criteria for disease specific mortality with a total of 2864 pooled patients. 5-year disease specific mortality was lower in the surgery group (ORs 0.43, 95% CI 0.31–0.60). Four studies met the inclusion criteria for 5-year overall mortality with a total of 2790 pooled patients. Five-year overall mortality was lower in surgery group (ORs 0.40, 95% CI 0.29–0.55).ConclusionsThis is the first study to examine the management of early stage supraglottic SCC using meta-analytic methodology. Our results suggest that primary surgery may result in decreased disease specific and overall mortality compared to primary radiotherapy.

СРАВНИТЕЛЬНАЯ ОЦЕНКА КАЧЕСТВА ЖИЗНИ БОЛЬНЫХ РАКОМ ПОЧКИ ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

In the study using the questionnaire EORTC-QLQ C30 there was done a comparative analysis of the quality of life of 35 patients with renal cancer (stage T1-2N0M0) who underwent organ-preserving surgery or open access radical nephrectomy. The initial parameters of quality of life of patients with kidney cancer were higher under organ-preserving surgery; important advantages covered general health status, role and social functions, fatigue and reduced appetite and sleep disorders. In the postoperative period in patients after organ-preserving surgery there remained higher general health status, physical and emotional functions, while the use of open access lowered the quality of life in both groups in functional scales due to the severity of pain and the reduction of social functions. The widespread introduction of endoscopic organ-preserving surgery for kidney cancer can improve the quality of life and contributes to rapid rehabilitation.

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.

Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .

P097 - Organ-preserving surgery for localized renal cell carcinoma: A modern approach

P097 - Organ-preserving surgery for localized renal cell carcinoma: A modern approach

Organ-preserving surgery for rectal cancer

Organ-preserving surgery for rectal cancer

Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer

IntroductionEarly rectal cancer (ERC) assessment should include prediction of the potential excision plane to safely remove lesions with clear deep margins and feasibility of organ preservation.MethodMRI accuracy for differentiating ≤T1sm2...

Organ-preserving surgery for localized renal cell carcinoma: Current approaches.

e16077 Background: Introduction of modern organ-preservingapproaches in surgical treatment of kidney cancer is limited by the duration of warm ischemia used during the partial nephrectomy (PN), including surgery for elective indications. Some resection procedures require prolonged warm ischemia time resulting in acute kidney injury and development of renal failure in the postoperative period. The purpose of the study was to analyze the effectiveness of a new organ-preserving surgery method for kidney cancer. Methods: 46 patients with clinically localized renal cancer, R.E.N.A.L. score 6-10, underwent PN for elective indications. Patients were divided into two groups: the first group – 20 patients (8 patients – laparoscopic PN (LPN), 12 – open PN (OPN)) with bilateral perirenal procaine blockade (BPPB) before the resection. The second group included 26 patients (19- LPN, 7– OPN) receiving surgery without BPPB. BPPB was performed under US-control. 50 ml of 0.25% procaine solution was successively injected to the perinephric fat in upper, middle and lower kidney segments at both sides. Acute kidney injury (AKI) was diagnosed by serum creatinine level increase by 50% of the initial level and higher. Results: Patients in both groups were comparable by age – 58.35±7.5 (44–70) and 58.7±5.6 (50–65) years, and resection difficulty by R.E.N.A.L. score – 7.35±1.1 (6–10) and 7.15±1.2 (6–10), respectively. Median warm ischemia time did not differ significantly in both groups and was 20.0±2.99 (15–25) and 18.42±2.93 (15–25) min., respectively. Morphologically, all patients were diagnosed with renal cancer, surgical margins were negative. 9 (34.6%) patients of the second group developed AKI, while no AKI was registered in the first group. Urinary fistula and delayed bleeding were not observed. Conclusions: The results suppose renal protective effect of BPPB during partial nephrectomy for kidney cancer with warm ischemia time of 15-25-minutes.

Trans-oral miniature X-ray radiation delivery system with endoscopic optical feedback

PurposeSurgery, chemo- and/or external radiation therapy are the standard therapy options for the treatment of laryngeal cancer. Trans-oral access for the surgery reduces traumata and hospitalization time. A new trend in treatment is organ-preserving surgery. To avoid regrowth of cancer, this type of surgery can be combined with radiation therapy. Since external radiation includes healthy tissue surrounding the cancerous zone, a local and direct intraoral radiation delivery would be beneficial.MethodsA general concept for a trans-oral radiation system was designed, based on clinical need identification with a medical user. A miniaturized X-ray tube was used as the radiation source for the intraoperative radiation delivery. To reduce dose distribution on healthy areas, the X-ray source was collimated by a newly designed adjustable shielding system as part of the housing. For direct optical visualization of the radiation zone, a miniature flexible endoscope was integrated into the system. The endoscopic light cone and the field of view were aligned with the zone of the collimated radiation. The intraoperative radiation system was mounted on a semi-automatic medical holder that was combined with a frontal actuator for rotational and translational movement using piezoelectric motors to provide precise placement.ResultsThe entire technical set-up was tested in a simulated environment. The shielding of the X-ray source was verified by performing conventional detector-based dose measurements. The delivered dose was estimated by an ionization chamber. The adjustment of the radiation zone was performed by a manual controlling mechanism integrated into the hand piece of the device. An endoscopic fibre was also added to offer visualization and illumination of the radiation zone. The combination of the radiation system with the semi-automatic holder and actuator offered precise and stable positioning of the device in range of micrometres and will allow for future combination with a radiation planning system.ConclusionsThe presented system was designed for radiation therapy of the oral cavity and the larynx. This first set-up tried to cover all clinical aspects that are necessary for a later use in surgery. The miniaturized X-ray tube offers the size and the power for intraoperative radiation therapy. The adjustable shielding system in combination with the holder and actuator provides a precise placement. The visualization of radiation zone allows a targeting and observation of the radiation zone.

Outcome of watch and wait strategy or organ preservation for rectal cancer following neoadjuvant chemoradiotherapy: report of 35 cases from a single cancer center

To investigate the safety and efficacy of organ preservation surgery or "watch and wait" strategy for rectal cancer patients who are evaluated as clinical complete response(cCR) or near-cCR following neoadjuvant chemoradiotherapy (nCRT). From March 2011 to June 2016, 35 patients with mid-low rectal cancers who were diagnosed as cCR or near-cCR following nCRT underwent organ preservation surgery with local excision or surveillance following "watch and wait" strategy in the Peking University Cancer Hospital. All the patients received re-evaluation and re-staging 6-12 weeks after the completion of nCRT, according to Habr-Gama and MSKCC criteria for the diagnosis of cCR or near-cCR. The near-cCR patients who received local excision and were pathologically diagnosed as T0Nx were also regarded as cCR. The end-points of this study included organ-preservation rate (OPR), sphincter-preservation rate (SPR), non-re-growth disease-free survival (NR-DFS), stoma-free survival, cancer-specific survival (CSS) and overall survival(OS). Kaplan-Meier curve was used to estimate the survival data at 3 years. A total of 35 cases were analyzed including 24 males (68.6%) and 11 females (31.4%). The median age was 60 (range 37-79) years and the median distance from tumor to anal edge was 4(2-8) cm. Thirty-three patients received 50.6 Gy/22f IMRT with capecitabine and two patients received 50 Gy/25f RT with capecitabine. The cCR and near-cCR rates were 74.3%(26/35) and 25.7%(9/35) respectively. Excision biopsy was performed in 4 near-cCR cases to confirm the diagnosis of cCR. The non-re-growth DFS rate was 14.3%(5/35) and the median time of tumor re-growth was 6.7 (4.7-37.4) months. In five patients with tumor re-growth, four were salvaged by radical rectal resections and one received local excision. The distant metastasis rate was 5.7%(2/35), one patient presented resectable liver metastasis and received radical resection, another patient presented multiple bone metastases and was still alive. The median follow-up time was 43.7(6.1-71.4) months. At three years, the organ-preservation rate was 88.6%(31/35), the sphincter-preservation rate was 97.1% (34/35). No local recurrence was observed in five patients who received salvage surgery. The non-re-growth DFS was 94.0%. Three patients died of non-rectal cancer related events. The cancer-specific survival was 100%, the overall survival was 92.7% and the stoma-free survival rate was 90.0%. Organ preservation surgery or "watch and wait" strategy for cCR or near-cCR patients is feasible and achieves good outcomes. This strategy can be an alternative to standard care, improve patient's quality of life and facilitate tailored treatment for mid-low rectal cancer following nCRT, however, it should be cautiously applied in near-cCR patients before local excision biopsy.

EXPERIENCE OF ENDOPROSTHETICS OF PATIENTS WITH PELVIC TUMORS

This study presents an analysis of the effectiveness of organ-preserving surgeries using various endoprostheses in patients with malignant tumors of the pelvic bones. Nine patients (male - 3, female - 7) with malignant tumors of the pelvic bones (chondrosarcoma - 7, osteosarcoma - 1, me-tastases - 2) underwent organ-preserving surgeries with endo-prosthetics of the postresection defect. The average age of the patients was 38 years (15-67 years). During the operation two patients were equipped with individual prostheses of Waldemar Link, one patient - a combined prosthesis with an individual pelvic component (from Biomedical) and a modular femoral component. In 7 patients modular structures of Implant-Сast were used. The pelvic component was cementless, femoral -more often (7 cases) on a cement basis. Patients were assessed by oncological, surgical and functional results. Anatomically-functional status was assessed on the MSTS scale. As a conclusion good functional and oncological results can be obtained even with the resection of three segments of the pelvic bones if the ileal bone volume is sufficient for a good fixation of the endoprosthesis. To achieve the most durable fixation of the femoral component of the endoprosthesis it is better to use bone cement.

Buschke-Lowenstein tumors

Agiant condyloma acuminatum which shows destructive growth but lacking invasion is designated as aBuschke-Lowenstein tumor (BLT). Classification of the BLT and therapeutic guidelines are provided. AMEDLINE literature search from 2006-2016 was performed. Induction through low-risk mucosotropic human papillomavirus (HPV) infection separates BLT from verrucous carcinoma. In the last 10years, slightly more than 100new cases have been described. Invasion as atrue sign of malignancy was described in 12% of cases. HIV infection was observed in 14%. As invasion often occurs only focally and may only be detected after complete resection, BLT must be treated and considered as alow grade in situ epithelial cancer that evolves from condylomata acuminata. Diagnosis is confirmed by HPV detection and typical histology. CT scans are recommended to rule out deeper invasion. Organ preservation surgery remains the recommended therapy. Buschke-Lowenstein tumors represent low grade epithelial in situ carcinomas which evolved from condylomata acuminata. Focal invasion is frequent but metastases occur only rarely. Organ preservation surgery is recommended.

Organ-preserving surgery for locally advanced duodenal gastrointestinal stromal tumor after neoadjuvant treatment.

This report aims to investigate the feasibility and outcomes of neoadjuvant imatinib mesylate (IM) administration followed by organ-preserving surgery (OPS) for patients with locally advanced duodenal gastrointestinal stromal tumor (GIST). Between 2012 and 2015, 10 consecutive patients with locally advanced duodenal GISTs were treated in Peking University Cancer Hospital. Multidisciplinary assessment was implemented, and pancreaticoduodenectomy (PD) was initially indicated as the most probable surgical procedure for all 10 patients. To attempt to create opportunities of less-invasive OPS for patients, neoadjuvant IM was administered followed by radical resection. All data were prospectively collected, and the short- and long-term outcomes of the treatment strategy were analyzed. The median treatment duration of neoadjuvant IM administration was 5 mo (range 2-18 mo). Significant tumor shrinkage (from 9.2 to 5.9 cm on average) was observed in all patients, and partial response was achieved in eight patients (80.0%) according to the Response Evaluation Criteria in Solid Tumors 1.1. No tumor perforation occurred, and nine patients (90.0%) underwent successful OPS with four different operation types. Postoperative morbidity rate of OPS was 55.6% (5/9), and no mortality occurred. After a median follow-up of 36 mo, one patient developed multiple distant metastases, but no local recurrence was observed. For long-term follow-up, patients who underwent OPS did not show any degradation in quality of life, whereas the patient who underwent PD suffered weight loss of ~10 kg. In conclusion, in patients with locally advanced duodenal GISTs, neoadjuvant IM administration followed by OPS is a feasible treatment strategy which leads to favorable short- and long-term outcomes.

喉頭温存手術が可能であった輪状軟骨原発軟骨肉腫の1例

喉頭温存手術が可能であった輪状軟骨原発軟骨肉腫の1例

Problems of diagnostics and treatment of the epithelial and non-epithelial breast tumors

Study objective. To improve diagnostics quality and surgical treatment efficiency in patients with non-epithelial and fibroepithelial malignant breast tumors. Materials and methods. The non-randomized study included 87 patients, among them 16 patients with breast sarcomas and 71 patients with phyllodes tumors of the breast. Primary diagnosis was made based on mammography, ultrasound scan (including contrast-enhanced ultrasound), and sonoelastography data. Organ-preserving surgeries were performed in 48 (67.6 %) patients with phyllodes tumors and 2 (13 %) patients with sarcomas, mastectomy and breast amputations were performed in 23 (32.4 %) patients with phyllodes tumors and 14 (87 %) patients with sarcomas. Follow-up duration varied between 3 and 132 months. Results and discussion. During routine examination of patients with phyllodes tumors and sarcomas diagnostic errors were made in 62 and 20 % of cases, respectively. Sonoelastography and contrast-enhanced ultrasound allowed to make a correct diagnosis in the majority of patients (70 %). Long-term treatment results correlated with tumor type. Over all survival for benign phyllodes tumors was significantly higher (97.6 %) than overall survival for its malignant type (57 %) and breast sarcomas (60 %). Sparing tumor removal (tumorectomy) was associated with high incidence of local recurrences for all types of non-epithelial and fibroepithelial tumors (between 31 % and 100 %). Segmental resection was also associated with high incidence of local recurrences, especially for the malignant type of phyllodes tumor (83 %). Conclusion. Primary diagnostics of breast diseases should involve sonoelastography and a contrast-enhanced ultrasound scan. Surgical treatment for malignant phyllodes tumors and sarcomas should include breast amputation or mastectomy.

Multilocular cystic renal neoplasm of low malignant potential: experience of N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology

Introduction. Multilocular cystic renal cell neoplasm of low malignant potential (MCRCNLMP) or multilocular cystic renal cell carcinoma (MCRCC) is classified as a distinct nosological unit. Currently, in literature there are no results of studies based on a large number of observations. Objectives: to systemize clinical and pathomorphological characteristics of MCRCNLMP. Materials and methods . In the period from January 2011 to December 2015 in the clinic of the N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, 32 cases of MCRCNLMP were diagnosed among 588 patients. We have studied clinical and morphological characteristics of this disease, surgical approaches to its treatment, and long-term results, which we present in this article. Results. MCRCNLMP comprised 5.44 % of all histological cases of RCC. The majority (75 %) of patients didn’t have clinical manifestations of the disease. Т1а tumor stage corresponded to 65.6 % of tumors, Т1b stage to 28.1 %, and Т2 stage only to 6.2 %. In all cases neoplasm was characterized by moderate and mild differentiation (G1–2) per the grading system of the International Society of Urological Pathology (ISUP). Only 25 % of patients had normal body mass index. In 31 of 32 patients, long-term outcomes were observed. Median follow-up duration was 29 (14–66) months. Progression of the disease wasn’t observed in any of the patients. Conclusion. Patients with MCRCNLMP have the best oncological prognosis among patients with RCC. The necessity of classification of this tumor in accordance with the TNM system is currently dubious. Only organ-preserving surgeries should be used in treatment of the disease. For cases of MCRCNLMP, it is recommended to increase periods of control examinations proposed for patients with RCC, and diagnostic manipulations should be minimal.

A Case of Recurrent Localized Laryngeal Amyloidosis

Herein, we report a case of recurrent localized laryngeal amyloidosis in a patient who had been followed up for 15 years after the first treatment. A 63-year-old male was referred to our department with the chief complaints of hoarseness and dyspnea. Several examinations showed submucosal swelling of the subglottic area bilaterally. A biopsy specimen obtained by laryngomicrosurgery showed submucosal deposition of amyloid. Debulking surgery was performed via an opening of the trachea. However, 9 months after the first surgery, the patient presented to us again complaining of dyspnea. We performed revision surgery for a repeat debulking of the lesion via a laryngofissure. His postoperative course was good and his dyspnea improved. However, 13 years after the revision surgery, the patient presented yet again with dyspnea. Therefore, we performed a third surgery using the same procedure as in the previous operation. Despite the repeated recurrences, we performed debulking of the lesion, and not total resection. Since amyloidosis is a benign disorder, and the larynx has important functions, organ-preserving surgery is recommended in cases of laryngeal amyloidosis.

COMPARATIVE ANALYSIS OF DIFFERENT NEOADJUVANT CHEMOTHERAPY REGIMENS FOR TRIPLE-NEGATIVE BREAST CANCER

Background. Breast cancer is a heterogeneous disease with a variety of phenotypic forms. Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes characterized by high sensitivity to chemotherapy and early recurrence. Due to the lack of efficiency of standard therapeutic approaches, it appears extremely important to search for new regimens of neoadjuvant polychemotherapy (NAPCT). Objective: to assess the efficiency of different NAPCT regimens for treatment of stages T1N1–3 and T2–4N0–3 locally advanced TNBC and to compare the efficiency of eribulin and paclitaxel in NAPCT of TNBC. Materials and methods. A randomized prospective study to evaluate the efficacy of TNBC treatment is being conducted in the N.N. Petrov National Medical Research Center of Oncology since October, 2015. The study included 61 patients with a median age of 45 years (range 31–76 years). Study participants were treated with 2 different NAPCT regimens: patients in the 1 st group received eribulin at a dose of 1.1 mg/m 2 on the days 1 and 8 of a 21-day cycle in combination with carboplatin AUC6, patients in the 2 nd group received paclitaxel at a dose of 80 mg/m 2 on the days 1 and 8 of a 21-day cycle in combination with carboplatin AUC6. Then all patients underwent surgery in different volume (radical mastectomy, organ-preserving surgery, reconstructive plastic surgery) with subsequent FAC adjuvant chemotherapy. Results. So far, 61 patients have been randomized (further calculations are based on the number of operated patients: 24 in the 1 st group and 27 in the 2 nd group). During the preoperative stage, complete clinical regression was achieved in 11 patients from the 1 st group and 15 patients from the 2 nd group; partial clinical regression was observed in 13 and 12 patients in groups 1 and 2 respectively. We found that the therapeutic regimen with paclitaxel + carboplatin induced a higher rate of pathologic complete responses (ypCR). After NAPCT, 51 out of 61 patients (84 %) underwent surgical treatment. Pathomorphological examination showed that the frequency of pathologic complete response was 33 % (8 cases) in the 1 st group compared to 60 % (16 cases) in the 2 nd group. Five patients treated with eribulin + carboplatin developed distant metastases in bones, lungs, brain, postoperative scar and lymph nodes in the neck on average 4 months after surgery. Conclusions. Higher rate of ypCR was observed in patients received paclitaxel + carboplatin.

ADJUVANT CHEMOTHERAPY OF PRIMARY OPERABLE LUMINAL B BREAST CANCER WITHOUT OVEREXPRESSION OF HER2/NEU IN POSTMENOPAUSAL WOMEN: YES OR NO?

Background. Luminal tumors account for 65 % of all breast cancer (BC) cases; however, within this group, there are multiple subtypes with various clinical and morphological characteristics, disease course and prognosis. Choosing an optimal strategy for adjuvant chemotherapy (ACT) in postmenopausal women with primary operable luminal BC B subtype without overexpression of HER2/neu appears to be the most challenging. Objective: to evaluate treatment outcomes in postmenopausal women with primary operable luminal BC without overexpression of HER2/neu depending on the ACT used. Materials and methods. We analyzed treatment outcomes in 190 postmenopausal women with stages T1–2N0–1M0 primary operable luminal BC without overexpression of HER2/neu. Of them, 105 patients had luminal BC A subtype, whereas 50 patients were diagnosed with luminal BC B subtype. All patients underwent radical mastectomy or organ-preserving surgery + external beam radiotherapy + adjuvant hormonal therapy with tamoxifen or aromatase inhibitors; 35 patients with luminal BC B subtype additionally had 6 cycles of FAC ACT. Results. We observed no significant differences in overall and relapse-free survival (assessed using the Kaplan–Meier method) across the groups during 37 months of follow-up (p >0.05). Conclusions. Luminal BC B subtype without overexpression of HER2/neu is an extremely heterogeneous group in terms of planning ACT, especially in postmenopausal women. Our results encourage to pay particular attention to finding additional biological characteristics of the tumor, which will ensure more individual approach to treatment of these patients.

Current status and challenges in sentinel node navigation surgery for early gastric cancer.

Although a number of feasibility studies for sentinel node (SN) concepts in gastric cancer have been conducted since 2000, there remains a debate regarding detailed detection techniques and oncological safety. Two important multicenter phase II clinical trials were performed in Japan that used different methods and reached different conclusions; one confirmed acceptable results with a false-negative rate of 7%, and the other showed an unacceptably high false-negative rate of 46.4%. The Sentinel Node Oriented Tailored Approach (SENORITA) trial is a multicenter randomized controlled phase III trial being performed in Korea. Patient enrollment is now complete and the long-term results are currently awaited. Recently, an image-guided SN mapping technique using infrared ray/fluorescence was introduced. This method might be a promising technology because it allows the clear visualization of SNs. With regard to the primary tumor, the non-exposed endoscopic wall-inversion surgery technique and non-exposure endolaparoscopic full-thickness resection with simple suturing technique have been reported. These methods prevent abdominal infection and tumor seeding and can be good alternatives to conventional laparoscopic gastric wedge resection. For indications, SN navigation surgery can be extended to patients who underwent non-curative endoscopic resection. Although a few studies have been performed on these patients, sentinel concepts may be beneficial to patients as they omit the need for additional gastrectomy. SN navigation surgery can lead to actual organ-preserving surgery and plays a key role in improving the quality of life of patients with early gastric cancer in the future.