Radical Treatment Group Research Articles

The Effect of Conservative vs. Radical Treatment of Ameloblastoma on Recurrence Rate and Quality of Life: An Umbrella Review.

Ameloblastoma is a rare, benign, but locally aggressive odontogenic tumor that originates from the epithelial cells involved in tooth development. The surgical approach to treating an ameloblastoma depends on the type, size, location, and extent of the tumor, as well as the patient's age and overall health. This umbrella review's aim is to summarize the findings from systematic reviews (SRs) and meta-analyses on the effect of radical or conservative treatment of ameloblastoma on the recurrence rate and quality of life, to evaluate the methodological quality of the included SRs and discuss the clinical management. Three electronic databases (PubMed, Scopus, The Cochrane Library) were checked. The primary outcome was the recurrence rate after surgical treatment, while the secondary outcomes were the post-operative complications, quality of life, esthetic, and functional impairment. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Eighteen SRs were included. The quality of the included reviews ranged from critically low (three studies) to high (eight studies). Four studies were included in meta-analysis, and they revealed that the recurrence rate is about three-times more likely in the conservative treatment group compared to the radical treatment group, and this result is statistically significant. Despite the high recurrence rate, the latter was more appropriate in the case of smaller lesions and younger patients, due to better post-operative quality of life and reduced functional and esthetic impairments. Based on the results of this overview, conservative treatment may be recommended as the first-line approach for intraosseous ameloblastoma not involving soft tissue. However, given the expectation of a higher recurrence rate, it is advisable to reduce the interval between follow-up visits. However, further prospective studies are needed to establish the best treatment choice and follow-up period.

Impact of the COVID-19 Infection on Head and Neck Cancer Treatment During Hospitalization.

Objective The after-effects of coronavirus disease 2019 (COVID-19) infection are still unknown; therefore, we investigate the possibility that COVID-19 may interrupt cancer treatment and impact prognosis. Methods We examined the characteristics, prognosis, and changes in treatment options before and after COVID-19 in 11 head and neck cancer patients who were infected with COVID-19 after admission for cancer treatment at Gifu University Hospital. These patients were compared to 110 patients unaffected by COVID-19 during the same period. To identify the effects of COVID-19 on the cancer treatment sequence, we examined the rates of overall survival, progression-free survival, and completion, as well as radiation dosage in radiotherapy and cisplatin dosage in chemoradiotherapy. Results All 11 patients with COVID-19 had their planned cancer treatment postponed or interrupted. There was no significant difference in overall or progression-free survival compared to patients without COVID-19. Notably, only 3/6 of the COVID-19-affected patients completed radiotherapy compared to 42/46 unaffected patients. The ratio of actual radiation dose to planned dose was significantly impaired in COVID-19 affected patients group (98.3% vs. 88.6%). Cisplatin dosage in chemoradiation was not significantly different in either the radical (100 mg/m2, every three weeks) or adjuvant (40 mg/m2, every one week) treatment groups. Conclusion COVID-19 infection in head and neck cancer patients had no apparent impact on cancer prognosis. However, when restricted to irradiation, the treatment completion rate and the ratio of planned to actual dose decreased significantly, underscoring the impact of COVID-19 infection on cancer treatment. The difference in irradiation may affect the success of patients' treatment going forward, and it should be explored whether irradiation can be continued without delay.

Comparison of the efficacy of different surgical strategies in the treatment of patients with initially resectable gastric cancer liver metastases

Objective: To examine the impact of varied surgical treatment strategies on the prognosis of patients with initial resectable gastric cancer liver metastases (IR-GCLM). Methods: This is a retrospective cohort study. Employing a retrospective cohort design, the study selected clinicopathological data from the national multi-center retrospective cohort study database, focusing on 282 patients with IR-GCLM who underwent surgical intervention between January 2010 and December 2019. There were 231 males and 51 males, aging (M(IQR)) 61 (14) years (range: 27 to 80 years). These patients were stratified into radical and palliative treatment groups based on treatment decisions. Survival curves were generated using the Kaplan-Meier method and distinctions in survival rates were assessed using the Log-rank test. The Cox risk regression model evaluated HR for various factors, controlling for confounders through multivariate analysis to comprehensively evaluate the influence of surgery on the prognosis of IR-GCLM patients. A restricted cubic spline Cox proportional hazard model assessed and delineated intricate associations between measured variables and prognosis. At the same time, the X-tile served as an auxiliary tool to identify critical thresholds in the survival analysis for IR-GCLM patients. Subgroup analysis was then conducted to identify potential beneficiary populations in different surgical treatments. Results: (1) The radical group comprised 118 patients, all undergoing R0 resection or local physical therapy of primary and metastatic lesions. The palliative group comprised 164 patients, with 52 cases undergoing palliative resections for gastric primary tumors and liver metastases, 56 cases undergoing radical resections for gastric primary tumors only, 45 cases undergoing palliative resections for gastric primary tumors, and 11 cases receiving palliative treatments for liver metastases. A statistically significant distinction was observed between the groups regarding the site and the number of liver metastases (both P<0.05). (2) The median overall survival (OS) of the 282 patients was 22.7 months (95%CI: 17.8 to 27.6 months), with 1-year and 3-year OS rates were 65.4% and 35.6%, respectively. The 1-year OS rates for patients in the radical surgical group and palliative surgical group were 68.3% and 63.1%, while the corresponding 3-year OS rates were 42.2% and 29.9%, respectively. A comparison of OS between the two groups showed no statistically significant difference (P=0.254). Further analysis indicated that patients undergoing palliative gastric cancer resection alone had a significantly worse prognosis compared to other surgical options (HR=1.98, 95%CI: 1.21 to 3.24, P=0.006). (3) The size of the primary gastric tumor significantly influenced the patients' prognosis (HR=2.01, 95%CI: 1.45 to 2.79, P<0.01), with HR showing a progressively increasing trend as tumor size increased. (4) Subgroup analysis indicates that radical treatment may be more effective compared to palliative treatment in the following specific cases: well/moderately differentiated tumors (HR=2.84, 95%CI 1.49 to 5.41, P=0.001), and patients with liver metastases located in the left lobe of the liver (HR=2.06, 95%CI 1.19 to 3.57, P=0.010). Conclusions: In patients with IR-GCLM, radical surgery did not produce a significant improvement in the overall prognosis compared to palliative surgery. However, within specific patient subgroups (well/moderately differentiated tumors, and patients with liver metastases located in the left lobe of the liver), radical treatment can significantly improve prognosis compared to palliative approaches.

GTV Based Automatic Delineation of Clinical Target Volume for Cervical Cancer

The delineation of gross tumor volume (GTV) and clinical target volume (CTV) are two critical steps in the radiotherapy planning for cervical cancer. GTV defines the primary treatment region for the gross tumor, while CTV is the area surrounding GTV that includes a certain probability (5% to 10%) of subclinical lesions. In contrast to GTV, CTV delineation relies on predefined and judgment-based boundaries, and the high variability among users makes this task particularly challenging. In this study, we evaluated the potential relationship between GTV and CTV and developed an automatic CTV delineation algorithm for cervical cancer based on the fusion of GTV information. We introduced position and shape constraints of GTV to improve the accuracy of CTV delineation. The GTV-Net deep learning method was used to segment the CTV images of cervical cancer. The method aimed to use the delineation results of the GTV region for one-hot coding and add human anatomy experience in the clinical field to guide the CTV segmentation. This retrospective study included 545 cervical cancer patients who received radiation therapy from June 2017 to May 2019, including postoperative and radical treatment groups. The CTV and GTV regions were manually delineated by human experts. Numerous experiments were conducted to evaluate the performance of the network. First, compared with different network architectures, the Dice similarity coefficient (DSC) and 95% Hausdorff distance (95HD) of GTV-Net were both improved. Then, we compared the GTV-Net method with two resident physicians. Our GTV-Net method outperformed both resident physicians. In the postoperative group, our method improved the DSC by 4% compared to 3D-UNet, reaching 76.55%, and increased by about 2.57% compared to V-Net's 73.98%, with an improvement of approximately 1.23% compared to the two resident physicians. In the radical treatment group, compared to 3D-UNet's 78.76%, our method increased the DSC by about 3.25%, reaching 82%, and increased by approximately 2.08% compared to V-Net's 79.92%, with an improvement of about 1.35% compared to the two resident physicians. Compared with 3D-UNet, the average 95HD in the postoperative group decreased from 1.489 to 1.457, and in the radical treatment group, it decreased from 1.454 to 1.433. The results of 95HD also showed some improvement compared to V-Net. This study is the first to introduce GTV information for automatic segmentation of the clinical target area for cervical cancer. In this experiment, we observed a positive gain in CTV target automatic delineation guided by GTV information compared to solely performing CTV segmentation, with an improvement in Dice similarity of more than 4% and Hausdorff distance of more than 6% in the experimental dataset. In addition, GTV-guided CTV automatic delineation has also shown promising results on multicenter data, which will better serve the clinical field.

Clinical Outcomes in cN+M0 Bladder Cancer Patients: Can Bladder be Spared?

<h3>Purpose/Objective(s)</h3> Optimum management of patients initially presenting with clinically node positive non-metastatic (cN+M0) bladder cancer is a topic of debate with significant variation in practice worldwide. In the UK, fit patients are offered – after platinum-based chemotherapy - either radical cystectomy (RC) or radical radiotherapy (RadRT) – a bladder preserving treatment. There is a paucity of evidence to guide clinician and patient decision making on choice of treatment. A multi-center UK retrospective analysis was undertaken to assess clinical outcomes for cN+M0 bladder cancer. <h3>Materials/Methods</h3> A multicenter retrospective analysis was conducted on patients from four large UK Oncology Centers. Patients initially presenting with cN+M0 bladder cancer between 2012 and 2021 were identified. Data was collected on treatment received, clinical outcomes and patient and tumor factors. Overall survival (OS) was calculated as time from initial diagnosis of bladder cancer. Univariable and multivariable analysis was performed on patients receiving radical treatment using the variables; age, performance status (PS), T and N stage, primary chemotherapy and radical treatment received. <h3>Results</h3> 288/292 patients with cN+M0 bladder cancer identified had survival data available for analysis. Median OS of the whole analyzed cohort (n=288) was 1.54 years (95% CI 1.35-1.82). 163/288 patients received a treatment with radical intent. OS was significantly higher in the radical vs palliative treatment group (log-rank test, p<0.0001). Median OS in the radical and palliative groups were 2.41 years (95% CI,1.92-2.78) and 0.89 year (95% CI, 0.68-1.07) respectively. Patients treated radically received either RC (n=76) or RadRT (n=87) with no difference is OS between the two groups (log-rank test p=0.5). Median OS for those receiving RadRT was 2.53 years (95% CI, 2.02-3.44) vs 2.09 years (95% CI, 1.79-3.13) for RC. In a univariable analysis of patients receiving radical treatment, improved OS was positively associated with lower PS (HR 0.61 (95% CI 0.41-0.91) p=0.02), lower T stage (HR 0.59 (95% CI 0.37-0.95) p=0.03) and receiving primary chemotherapy (HR 0.6 (95% CI 0.4-0.9) p=0.01). No variables retained significance on multivariable analysis. <h3>Conclusion</h3> This multi-center retrospective analysis of survival outcomes gives real-world data on a large cohort of patients with cN+M0 bladder cancer. A limitation of our data is the risk of confounders when comparing retrospective cohorts. Overall survival unfortunately remains poor in this cohort but was significantly longer in patients who received radical-intent treatment. There was no difference in overall survival between patients receiving RC and RadRT. Given the equivalent survival outcomes in these patients whose overall prognosis remains poor, our data would support wider use of radiotherapy to avoid risks from major surgery in node-positive patients.

Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer.

BACKGROUNDThe incidence and mortality rate of breast cancer in China rank 120th and 163rd, worldwide, respectively. The incidence of breast cancer is on the rise; the risk increases with age but is slightly reduced after menopause. Early screening, diagnosis, and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIMTo evaluate the clinical value of magnetic resonance imaging (MRI) combined with digital breast tomosynthesis (DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODSThis study was divided into two parts. Firstly, 110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group, respectively. Both groups underwent DBT and MRI examination, and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer. Secondly, according to the operation method, 110 patients with breast cancer were divided into either a breast-conserving group (69 patients) or a modified radical mastectomy group (41 patients). The surgical effect, cosmetic effect, and quality of life of the two groups were compared.RESULTSAmong the 110 cases of breast cancer, 66 were of invasive ductal carcinoma (60.00%), and 22 were of ductal carcinoma in situ (20.00%). Among the 110 cases of benign breast tumors, 55 were of breast fibromas (50.00%), and 27 were of breast adenosis (24.55%). The sensitivity, specificity, and area under the curve (AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%, 84.55%, and 0.791, respectively. The sensitivity, specificity, and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%, 85.45%, and 0.850, respectively. The sensitivity, specificity, and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%, 93.64%, and 0.955, respectively. The blood loss, operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group, and the difference was statistically significant (P < 0.05). After 3 mo of observation, the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group, and the difference was statistically significant (P < 0.05). Before surgery, the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ (P > 0.05). Three months after surgery, the quality-of-life scores in both groups were higher than those before surgery (P < 0.05), and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group (P < 0.05). In the observation of tumor recurrence rate two years after the operation, four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence. There was no significant difference in the recurrence rate between the two groups (χ2 = 0.668, P = 0.414 > 0.05).CONCLUSIONMRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone. Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

The first patient-reported outcomes from the Utrecht Prostate Cohort (UPC): the first platform facilitating ‘trials within cohorts’ (TwiCs) for the evaluation of interventions for prostate cancer

PurposeTo describe the development and first outcomes of the Utrecht Prostate Cohort (UPC): the first ‘trials within cohorts’ (TwiCs) platform for prostate cancer (PCa).MethodsAll non-metastasized, histologically proven PCa patients who are planned to receive standard of care are eligible for inclusion in UPC. Patients provide informed consent for the collection of clinical and technical patient data, physician-reported outcomes, and patient-reported outcomes (PROs) up to 10 years post-treatment. Additionally, patients may provide broad consent for future randomization for experimental-intervention trials (TwiCs). Changes in PROs (EPIC-26 questionnaire domains) of the participants who received standard of care were analyzed using Wilcoxon signed-rank tests.ResultsIn two years, 626 patients were enrolled, 503 (80.4%) of whom provided broad consent for future randomization. Among these, 293 (46.8%) patients underwent magnetic resonance-guided adaptive radiotherapy (MRgRT), 116 (18.5%) CT-guided external beam radiation therapy (EBRT), 109 (17.4%) robot-assisted radical prostatectomy (RARP), and 65 (10.4%) patients opted for active surveillance. Patients treated with MRgRT and CT-guided EBRT showed a transient but significant decline in urinary irritative/obstructive and bowel domain scores at 1-month follow-up. RARP patients showed a significant deterioration of urinary incontinence domain scores between baseline and all follow-up moments and significant improvement of urinary irritative/obstructive domain scores between baseline and 9- and 12-month follow-up. All radical treatment groups showed a significant decline in sexual domain scores during follow-up. Active surveillance patients showed no significant deterioration over time in all domains.ConclusionThe first results from the UPC study show distinct differences in PROs between treatment options for PCa.Registration No.: NCT04228211.

Effect of radiographic &amp; histopathologic variants in management of ameloblastoma

Introduction: Ameloblastoma is a rare, benign odontogenic tumor that accounts for 1% of all tumors of the jaws. We aim to compare the ameloblastoma recurrence rate according to the type of treatment: radical or conservative and as per the radiographic, histologic features. Material and methods: we conducted a retrospective study and collected the data based on the radiological, and histological and the type of treatment: conservative or radical and to compare the recurrence rate according to the type of treatment. Results: Thirty Patients were included, managed by conservative treatment (CT) in 26 cases and radical treatment (RT) in 14 cases. The recurrence rate was 90.9% in the CT group and 9.1% in the RT group (P = 0.025) with a mean follow-up of 56.2 months. Conclusion: The recurrence rate after conservative treatment was higher than that after radical treatment. The choice of treatment must be adapted to the macroscopic and histological characteristics of each tumor and to the patient.

Assessment of early symptoms of surgical menopause in patients with borderline ovarian tumors

Aim: to make a comparative evaluation of women with borderline ovarian tumors (BOTs) and surgical menopause (early symptoms) and explore their level of anxiety and depression depending on the age and volume of surgery.Materials and methods. The prospective comparative study included 117 patients, aged 44.3 ± 6.5 years, after surgical treatment of BOTs: 62 women at reproductive age with surgical menopause after radical treatment (group IА), 24 women at reproductive age after organ-preserving surgery (group IВ), 31 women at perimenopausal age after radical treatment (group II). The severity of menopausal syndrome (modified menopausal Kupperman–Uvarova index), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) were determined 29–59 (36.4 ± 5.6) days after surgery.Results. Early symptoms of surgical menopause are found in 98.3 % of patients with BOTs. Reproductive age patients after radical surgery (group IA) had moderate neurovegetative (21.7 ± 4.0 points), mild metabolic (5.8 ± 1.8 points), and moderate psychoemotional disorders (8.9 ± 1.4 points). Young women who underwent organ-saving operations with preservation of at least one ovary (group IB), had normal range the indicators of neurovegetative disorders (8.2 ± 3.1 points), metabolic and psychoemotional disorders were regarded as moderate (2.6 ± 1.6 and 5.9 ± 2.3 points, respectively). Disorders due to surgical menopause (early symptoms) at perimenopausal age females (group II) corresponded to a mild degree: neurovegetative – 15.3 ± 2.7 points; metabolic – 6.0 ± 2.2 points; psychoemotional – 5.7 ± 1.5 points. Our data indicate that patients of group IA had moderate surgical menopause (early symptoms) – 36.4 ± 5.4 points, while in groups IB and II the total values were 16.8 ± 5.4 and 27.0 ± 4.3 points, which corresponds to mild severity. Patients with BOTs (one month after antitumor therapy) had early symptoms of surgical menopause (postovariectomy syndrome). The most typical clinical picture was observed among young women after removal of both ovaries.Conclusion. Surgical menopause affects by somatic and psychological health negatively. This leads to a significant decrease in the quality of life and an increase in the level of disability among patients with gynecological cancer. Therefore, even at the planning treatment, it is necessary to include pre-rehabilitation measures to minimize the negative consequences of cancer therapy.

Comparative performance and external validation of the multivariable PREDICT Prostate tool for non-metastatic prostate cancer: a study in 69,206 men from Prostate Cancer data Base Sweden (PCBaSe)

BackgroundPREDICT Prostate is an endorsed prognostic model that provides individualised long-term prostate cancer-specific and overall survival estimates. The model, derived from UK data, estimates potential treatment benefit on overall survival. In this study, we externally validated the model in a large independent dataset and compared performance to existing models and within treatment groups.MethodsMen with non-metastatic prostate cancer and prostate-specific antigen (PSA) < 100 ng/ml diagnosed between 2000 and 2010 in the nationwide population-based Prostate Cancer data Base Sweden (PCBaSe) were included. Data on age, PSA, clinical stage, grade group, biopsy involvement, primary treatment and comorbidity were retrieved. Sixty-nine thousand two hundred six men were included with 13.9 years of median follow-up. Fifteen-year survival estimates were calculated using PREDICT Prostate for prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM). Discrimination was assessed using Harrell’s concordance (c)-index in R. Calibration was evaluated using cumulative available follow-up in Stata (TX, USA).ResultsOverall discrimination of PREDICT Prostate was good with c-indices of 0.85 (95% CI 0.85–0.86) for PCSM and 0.79 (95% CI 0.79–0.80) for ACM. Overall calibration of the model was excellent with 25,925 deaths predicted and 25,849 deaths observed. Within the conservative management and radical treatment groups, c-indices for 15-year PCSM were 0.81 and 0.78, respectively. Calibration also remained good within treatment groups. The discrimination of PREDICT Prostate significantly outperformed the EAU, NCCN and CAPRA scores for both PCSM and ACM within this cohort overall.A key limitation is the use of retrospective cohort data.ConclusionsThis large external validation demonstrates that PREDICT Prostate is a robust and generalisable model to aid clinical decision-making.

A comparative analysis of radical and non-radical surgical treatment of hydatid liver echinococcosis: a single-center analysis

The aim of this study was to compare the postoperative outcome and long-term results after management of liver hydatid cyst by radical and non-radical surgeries. From January 2015 to December 2017, 86 patients were treated with various surgical interventions for liver hydatid cyst. These patients were retrospectively divided into two groups according to the surgical method for treatment: radical methods (e.g., liver resection and pericystectomy) and non-radical methods (e.g., echinococcectomy). Of the 86 patients, 50 (58%) underwent radical treatment and 36 (42%) underwent non-radical treatment. Clinical data and outcomes were retrospectively analyzed. Eighty (93%) patients were considered to have been completely cured of their hydatid disease. Surgery duration in the non-radical treatment group was significantly shorter than in the radical treatment group (p < 0.01). There were no cases of biliary leakage in the liver resection patients during the postoperative period. In contrast, among the echinococcectomy patients, biliary leakage occurred in 6 (16.7%), which was significantly higher than with other modalities (p < 0.05). Recurrence occurred at a median of 32 months after surgery. Recurrent liver hydatid disease occurred in 6 cases (7%): radical group, 1 (2%); non-radical group, 5 (13.9%). There were no mortalities in either group in the postoperative period. Postoperative hospital stay was significantly shorter in the liver resection patients than in the other patients (p < 0.01). Radical surgical treatment of liver hydatid cyst is more effective than non-radical surgery, resulting in a reduced recurrence rate, reduced postoperative complication rate, and early recovery of patients.

Costs and Complications After a Diagnosis of Prostate Cancer Treated With Time-Efficient Modalities: An Analysis of National Medicare Data

PurposeRecent trends in payer and patient preferences increasingly incentivize time-efficient (≤2-week treatment time) prostate cancer treatments. Methods and MaterialsNational Medicare claims from January 1, 2011, through December 31, 2014, were analyzed to identify newly diagnosed prostate cancers. Three “radical treatment” cohorts were identified (prostatectomy, brachytherapy, and stereotactic body radiation therapy [SBRT]) and matched to an active surveillance (AS) cohort by using inverse probability treatment weighting via propensity score. Total costs at 1 year after biopsy were calculated for each cohort, and treatment-specific costs were estimated by subtracting total 1-year costs in each radical treatment group from those in the AS group. ResultsMean 1-year adjusted costs were highest among patients receiving SBRT ($26,895), lower for prostatectomy ($23,632), and lowest for brachytherapy ($19,980), whereas those for AS were $9687. Costs of radical modalities varied significantly by region, with the Mid-Atlantic and New England regions having the highest cost ranges (>$10,000) and the West South Central and Mountain regions the lowest range in costs (<$2000). Quantification of toxic effects showed that prostatectomy was associated with higher genitourinary incontinence (hazard ratio [HR] = 10.8 compared with AS) and sexual dysfunction (HR = 3.5), whereas the radiation modalities were associated with higher genitourinary irritation/bleeding (brachytherapy HR = 1.7; SBRT HR = 1.5) and gastrointestinal ulcer/stricture/fistula (brachytherapy HR = 2.7; SBRT HR = 3.0). Overall mean toxicity costs were highest among patients treated with prostatectomy ($3500) followed by brachytherapy ($1847), SBRT ($1327), and AS ($1303). ConclusionsTime-efficient treatment techniques exhibit substantial variability in toxicity and costs. Furthermore, geographic location substantially influenced treatment costs.

Effects of radical treatment of Helicobacter pylori on endoscopic diagnosis of early gastric cancer

Objective To investigate the effects of Helicobacter pylori (HP) radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy (WLE), chromoendoscopy of indigo carmine dye added to acetic acid, and magnifying endoscopy with narrow band imaging (ME-NBI). Methods Between January 2013 and March 2018, patients without HP (successful cured before six months) or with HP (no radical treatment for HP in recent 6 months), who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital, People′s Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital, Tongji Medical College Huazhong University of Science and Technology were enrolled in the study. Endoscopy examinations were performed according to the order of conventional WLE, chromoendoscopy using indigo carmine dye added to acetic acid, and ME-NBI. Among the patients finally diagnosed as early gastric cancer by histopathology, 120 patients without HP and 120 patients with HP were continuously collected, and included in the radical treatment group and the non-radical treatment group, respectively. Diagnostic reliabilities of WLE, chromoendoscopy, and ME-NBI for early gastric cancer between the two groups were statistically analyzed. Results There were no statistical differences between the two groups in terms of hospital source (χ2=2.637, P=0.104), gender composition (χ2=0.074, P=0.785), mean age (t=0.582, P=0.561), and lesion morphology (χ2=0.179, P=0.914). The detection rates of early gastric cancer in the radical treatment group using WLE [75.0% (80/120) VS 81.7% (98/120), χ2=7.046, P=0.008], chromoendoscopy [57.5% (69/120) VS 93.3% (112/120), χ2=41.554, P<0.001], and ME-NBI [90.0% (108/120) VS 98.3% (118/120), χ2=7.585, P=0.006] were significantly lower than those in the non-radical treatment group. In the radical treatment group, chromoendoscopy had the lowest detection rate of early gastric cancer, followed by WLE (χ2=2.142, P=0.143) and ME-NBI (χ2=32.736, P<0.001), while ME-NBI had the highest detection rate of early gastric cancer, which higher than that of WLE (χ2= 19.247, P<0.001). Conclusion The diagnosis of early gastric cancer by WLE, chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP. Among the above three endoscopic methods, ME-NBI has the highest diagnostic efficacy, and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP. Key words: Helicobacter pylori; Early gastric cancer; White light endoscopy; Chromoendoscopy; Magnifying endoscopy with narrow band imaging

Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received

BackgroundThe ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. ObjectiveTo determine report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participantsThis study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. InterventionTwo cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment. Outcome measurements and statistical analysisHealth-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitationsAccording to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p=0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p=0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6mo) and urinary incontinence (55% at 6mo) after surgery, and of sexual dysfunction (88% at 6mo) and bowel dysfunction (5% at 6mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa. ConclusionsAnalyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summaryMore than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common.

Management of elderly patients with head and neck carcinoma: analysis of outcomes for radical versus palliative treatment.

There are no universally accepted treatment recommendations for elderly patients with head and neck carcinomas. This study investigated whether radical treatment in elderly patients resulted in better survival compared with palliative treatment. We retrospectively reviewed the medical records of 724 patients aged > 60years who underwent treatment for primary head and neck carcinomas at Hamamatsu University Hospital. We evaluated the impact of the following: age, sex, the clinical stage, smoking history, alcohol use history, primary tumor site, performance status, and Osaka Head and Neck Comorbidity Index score on overall survival using a Cox proportional hazards model. The 5-year overall survival rate was significantly greater for the 646 patients initially treated with radical (curative) therapy than for the 78 patients treated with palliative therapy (p < 0.01). Patients who received palliative treatment in all age groups were more likely to die than were those in the radical treatment group, after controlling for age, sex, and clinical stage of the cancer. Information on the survival status of patients was obtained after a mean follow-up period of 46months (range 6-205months). In the absence of contraindications associated with comorbidities, radical treatment protocols should be recommended for elderly patients with head and neck carcinomas because they confer better survival.

Conservative management and radical treatment in localised prostate cancer: A systematic review with meta-analysis and trial sequential analysis

Background: Several randomised control trials comparing conservative management (watchful waiting/observation/active monitoring) and radical treatments (radical prostatectomy/radiotherapy) for localised prostate cancer with at least more than 10 years of follow-up (median) have been published with conflicting findings. The primary aim of this study was to determine all-cause mortality and prostate cancer-related mortality between conservative management and radical treatment for localised prostate cancer. Methods: All randomised clinical trials were searched in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until September 2018. Results: Four trials were eligible ( n = 3211) for inclusion in the data synthesis. In patients who had radical treatment, the incidence of all-cause mortality and prostate cancer-related mortality (three trials, 3069 patients) were reduced (with odds ratio, i.e. 95% confidence interval (CI)), of 1.37 (1.14–1.64), ρ &lt; 0.001, low quality of evidence and odd ratio (95% CI) of 1.74 (1.31–2.30), ρ &lt; 0.001, low quality of evidence, respectively). The radical treatment group was associated with reduced incidence of distant metastases, the odds ratio (95% CI) being 1.87 (1.48–2.36), ρ &lt; 0.001, low quality of evidence. However, patients who were randomised to radical treatment had a significantly higher incidence of erectile dysfunction (the odds ratio (95% CI) being 0.62 (0.39–0.98), ρ = 0.04, very low quality of evidence) and urinary incontinence (odds ratio (95% CI) of 0.42 (0.21–0.86), ρ = 0.02, very low quality of evidence). Conclusions: In summary, radical treatments reduce all-cause mortality, and prostate cancer-related and distant metastases, at the expense of higher incidence of erectile dysfunction and urinary incontinence. The general quality of evidence ranged from very low to low. Level of evidence: 1a PROSPERO Registration Number: CRD42017072687

Survival impact of aggressive treatment on patients with oligometastatic non-small cell lung cancer (NSCLC).

e20669 Background: The new 2016lung cancer classification differentiates oligometastatic (M1b) better prognostic from plurimetastatic (M1c) disease. A prospective study presented at 2016 ASCO showed improved PFS in patients with oligometastatic brain disease treated aggressively compared to a more palliative treatment but OS data is pending. Methods: This study is a single-center retrospective study including 643 patients with metastatic lung cancer diagnosed in an University center (CHUM) from 2005-2015 and followed more than 6 months (median follow up 13.3mo) . Only 67 patients (10.4%) were found to have synchronous oligometastatic disease at diagnosis. Results: Amongst the 67 patients, the localization of metastatic disease was as follows: 74% brain (n = 50), 9% adrenal gland (n = 6), 7% contralateral pulmonary lobe (n = 5), 6% bone (n = 4) and 3% liver (n = 2). 29 patients received radical treatment to primary and metastatic site (group A) and 36 patients received non-aggressive treatments (group B). There was no statistically significant difference between the two groups in terms of demographic and histological characteristics. The radical treatment group A had a mOS of 26mo and a mPFS of 12.8m compared to mOS of 5mo (p = 0.0001) and mPFS of 4.8mo (p = 0.010) for group B. This difference was observed when stratifying according to stage of primary lung disease (stage I mOS 42mo vs 16mo, stage II mOS 34mo vs 6mo and stage III mOS 22mo vs 4mo) and according to to oligometastatic site. Interestingly, addressing aggressively the primary lung cancer improved median survival even when the oligometastasis was not resected (26mo v and 24mo respectively), but not when oligometastasis only was resected and primary was treated palliatively (5mo vs 3 mo). Adjuvant chemotherapy given after radical treatment did not improve mPFS or mOS (12.83 vs12.47 months, p = 0.860). Conclusions: Radical treatment of oligometastatic NSCLC in this unselected population improved mPFS and mOS compared to other treatment strategies. As overall survival data of the prospective trial presented at 2016 ASCO meeting is pending, the more radical approach should be emphasized when patients present with oligometastatic lung cancer disease.

Ameloblastoma of the jaws: Management and recurrence rate

IntroductionAmeloblastoma is a rare, benign odontogenic tumour associated with a high recurrence rate. It accounts for 1% of all tumours of the jaws. The purpose of this study was to compare the ameloblastoma recurrence rate according to the type of treatment: radical or conservative. Patients and methodsAll patients with a diagnosis of ameloblastoma between 1991 and 2013 were retrospectively identified in order to extract topographic, radiological, and histological data and the type of treatment: conservative (marsupialization, enucleation, curettage) or radical (segmental resection) and to compare the recurrence rate according to the type of treatment. ResultsTwenty-seven patients were included, managed by conservative treatment (CT) in 22 cases and radical treatment (RT) in 14 cases. The recurrence rate was 90.9% in the CT group and 9.1% in the RT group (P=0.025) with a mean follow-up of 56.2 months. DiscussionThe recurrence rate after conservative treatment was higher than that after radical treatment. These results are similar to those reported in the literature. The choice of treatment must be adapted to the macroscopic and histological characteristics of each tumour and to the patient.

Clinical outcomes of adenoid cystic carcinoma of the head and neck: a single institution 20-year experience.

This study reports the clinical outcomes of head and neck adenoid cystic carcinoma treatment over a 20-year period. The treatment outcome of 51 head and neck adenoid cystic carcinoma patients treated between 1992 and 2013 were analysed. Patients were stratified into radical treatment and disease control groups. A total of 40 patients underwent surgery and post-operative radiotherapy. The 10-year disease-specific survival rate was 93 per cent. Eleven patients had tumour recurrence: of these, nine were pulmonary metastases. The 11 patients in the disease control group had a median follow up of 21 months (range, 2-172 months); 5 underwent radical radiotherapy with palliative intent. There was late tumour recurrence in over 25 per cent of patients. Adenoid cystic carcinoma has a high tendency to relapse even after radical excision and adjuvant therapy. However, definitive radiotherapy should still be considered on an individual basis because it may provide local control and prolong patient survival.

A clinical analysis on 23 patients with advanced gallbladder carcinoma

Objective To summarize the clinical features and surgical treatment experience of primary galildadder carcinoma,and to explore the effects of different procedures on the prognosis and analyze the prognostic factors.Methods The clinical data on 23 patients with gallbladder carcinoma who had been treated in our hospital from June 2006 to June 2010 were reviewed.The association of prognosis with tumor stages and surgical procedures was analyzed.Results 21 patients were followed up.The 6-month survival rate,1 -year survival rate,and 3-year survival rate were 80.95 ％,52.38％,and 28.57％.The three different survival rates were markedly increased in the radical treatment group ( 100.00％,71.48％,and 42.85％ ),as compared with the non-radical group ( P＜ 0.05 ).Conclusions Standard radical surgery for advanced gallbladder carcinoma can significantly improve survival rate. Key words: Primary gallbladder carcinoma; Diagnosis; Treatment