Recurrent Pelvic Tumors Research Articles

Robotic versus open and laparoscopic pelvic exenterations for pelvic cancer: a multicenter propensity-matched analysis in Japan.

Pelvic exenteration (PE) is the last resort for achieving a complete cure for pelvic cancer; however, it is burdensome for patients. Minimally invasive surgeries, including robot-assisted surgery, have been widely used to treat malignant tumors and have also recently been used in PE. This study aimed to evaluate the safety and efficacy of robot-assisted PE (RPE) by comparing the outcomes of open PE (OPE) with those of conventional laparoscopic PE (LPE) for treating pelvic tumors. Following the ethics committee approval, a multicenter retrospective analysis of patients who underwent pelvic exenteration between January 2012 and October 2022 was conducted. Data on patient demographics, tumor characteristics, and perioperative outcomes were collected. A 1:1 propensity score-matched analysis was performed to minimize group selection bias. In total, 261 patients met the study criteria, of whom 61 underwent RPE, 90 underwent OPE, and 110 underwent LPE. After propensity score matching, 50 pairs were created for RPE and OPE and 59 for RPE and LPE. RPE was associated with significantly less blood loss (RPE vs. OPE: 408mL vs. 2385ml, p < 0.001), lower transfusion rate (RPE vs. OPE: 32% vs. 82%, p < 0.001), and lower rate of complications over Clavien-Dindo grade II (RPE vs. OPE: 48% vs. 74%, p = 0.013; RPE vs. LPE: 48% vs. 76%, p = 0.002). This multicenter study suggests that RPE reduces blood loss and transfusion compared with OPE and has a lower rate of complications compared with OPE and LPE in patients with locally advanced and recurrent pelvic tumors.

Retrospective study of combined pelvic exenteration in the treatment of primary and recurrent pelvic malignant tumors.

Pelvic malignant tumors often originate in the rectum, bladder, uterus, and other organs. In patients with locally advanced tumours in the presence of direct invasion of one or more organs, negative tumor resection margin (R0) resection can be very beneficial to patient survival if it can be performed. As a multidisciplinary and high-risk surgical method, the pelvic exenteration (PE) procedure has only been reported in a few medical centres internationally. We retrospectively analyzed the clinical data of patients who had undergone PE surgery in our hospital, in order to provide ideas for the best treatment of patients with pelvic malignant tumors. A retrospective analysis was conducted of 59 patients with pelvic malignant tumors admitted to the Affiliated Cancer Hospital of Zhengzhou University from January 2015 to July 2021, all of whom received PE surgery. They were divided into two groups according to the location of the disease: the rectal cancer group (n=40) and the cervical cancer group (n=19). Statistical analysis was performed on the baseline and follow-up data of the two groups of patients. (I) Patient baseline data. Compared to the rectal cancer group, more patients in the cervical cancer group received preoperative radiotherapy and chemotherapy (P=0.013), and had a lower R0 resection rate (P=0.037). Postoperative complications in patients with rectal cancer and cervical cancer were 27.5% and 47.3%, respectively. (II) Patient survival analysis after PE surgery. The 5-year survival rate was 36.6% in the rectal cancer group and 25.3% in the cervical cancer group. In the rectal cancer group, for the primary tumor, if there was no lymph node metastasis or no postoperative complications in the postoperative pathology, the patient had a good survival prognosis. Univariate analysis showed that recurrent rectal cancer, postoperative lymph node metastasis, postoperative complications, and microsatellite stability (MSS) were significant predictors of poor survival outcomes. Multivariate analysis showed that lymph node metastasis and postoperative complications were independent prognostic factors for patient survival. PE is a viable option for pelvic malignancies; aggressive radical resection of lesions and reduced postoperative complications can effectively improve patient outcomes.

Surgical tactics in the treatment of patients with recurrent tumors of the pelvic organs

Introduction. Despite the wide introduction of the principles of total mesorectumectomy and effective schemes of neoadjuvant chemoradiotherapy, the development of local recurrences of tumors of the rectum and female reproductive system remains a complex and unsolved surgical problem. The lack of a unified classification and algorithms for choosing the optimal volume of surgery are one of the reasons for unsatisfactory results of treatment of this group of diseases.The aim. To standardize the choice of surgery volume based on the proposed unified classification.Materials and Methods. The experience of surgical treatment of 108 patients with pelvic organ tumor recurrence (pOTR) is summarized in the article. Inclusion criteria: age 18 years and older, confirmation of the diagnosis of tumor recurrence of rectum, uterine body, cervix, ovaries by radiation methods of examination and histologically if the tumor was available for biopsy, the primary tumor was surgically removed with achievement of negative peripheral resection margin (R0), signed informed consent. Inclusion criteria: health status according to the Eastern Cooperative Oncology group (ECOg) 2 or more; distant visceral metastases and/or carcinomatosis of the peritoneum and pleura were diagnosed; complicated course of the tumor process was detected, which did not allow performing a planned surgical intervention.Results. According to the location of the primary tumor, the distribution was as follows: 66 patients with rectal cancer, 12 with cervical, 9 with uterine body and 21 with ovarian cancer. The sex distribution was as follows: 38 (35.1 %) – males and 70 (64.8 %) females. The median age was 63.0 (53.0; 70.0) years. The ECOg overall status was: 0 points in 44 (66.7 %) patients and 1 point in 64 (59.3 %) patients. The median duration of relapse-free period was 15.25 (6.2; 19.6) months. On the basis of the analysis of the nature and type of local tumor spreading, a classification was developed, distinguishing 8 types of recurrence: anterior-upper, anterior-lower, central, lower, posterior-upper, posterior-lower, lateral-left and lateral-right. The characteristics of the entire cohort of patients were analyzed to determine the extent of surgery appropriate for a particular type of recurrence or their combinations.

Retrospective study of combined pelvic organ resection in the treatment of primary and recurrent pelvic malignant tumors.

e15635 Background: For locally advanced or recurrent pelvic malignancies, combined pelvic organ resection has been used to treat rectal, bladder, gynecological and other related malignancies. As an interdisciplinary and high-risk operation, the perioperative safety and future information are often very limited. We retrospectively analyzed the efficacy of PE surgery in our institution. Methods: In this retrospective study, 59 patients with pelvic malignant tumors received PE surgery from July 2015 to July 2021. They were divided into two groups according to the location of the disease: rectal tumor group (n = 40) and cervical cancer group (n = 19). The baseline data, gene detection reports, pathological reports, perioperative conditions and prognosis were analyzed. The two groups were compared by independent sample t-test; Comparison between groups χ2 test, the survival curve was drawn by Kaplan-Meier method and compared by log rank test. Results: Among these 59 patients treated with PE, the rectal tumor group and the cervical cancer group did not differ significantly in terms of demographics, operative time, hospital stay, intraoperative blood loss, and rates of use of preoperative and intraoperative radiotherapy. Compared with the two groups, the overall incidence of postoperative complications was 37% in the group with rectal tumours and 26% in the group with perineal wound infection being the most common, cervical cancer 46% and urinary tract infection being the most common. Comparing the postoperative survival OS between patients in the rectal tumor group and those in the cervical cancer group, the former was better, with 5-year overall survival rates of 37% in the rectal tumor group and 28% in the cervical cancer group. Within the group of rectal tumours, however, there are differences in survival between patients with primary (LARC) and recurrent (lrrc) rectal tumours; Patients with LARC have shown a significant survival benefit postoperatively, with 5-year overall survival rates of 40% for patients with LARC and 27% for patients with lrrc. OS was significantly better in patients with well differentiated tumors, N0 stage, and high microsatellite instability (MSI). On the basis of univariate analysis, poorly differentiated tumor, regional lymph node dissemination, MSI, and no chemotherapy received perioperatively were significant predictors of poor survival (P &lt; 0.05). Conclusions: PE is currently an effective treatment for pelvic malignancies with aggressive radical resection of lesions, which can effectively improve their cure rate, improve quality of life, and careful patient selection can optimize outcomes.

Recognition of empty pelvic syndrome and its prevention and treatment

With the development of existing surgical techniques, equipment and treatment concepts, more and more medical centers begin to carry out extensive resection for recurrent pelvic malignant tumors or those with multivisceral invasion. Exenteration may facilitate curative resection and improve the outcome of the patients. Therefore, pelvic exenteration has gradually become the standard of care for locally advanced pelvic malignancies. At present, pelvic exenteration leads to high intraoperative and postoperative complications and mortality, and therefore compromise the safety and long-term quality of life. Cumulating evidences suggest remnant cavity after exenteration might trigger the pathophysiological process and cause downstream complications which can be defined as empty pelvis syndrome. The literature related to empty pelvic syndrome was summarized, the possible cause of empty pelvic syndrome was analyzed. After the pelvic exenteration, the closed pelvic residual cavity formed continuous negative pressure with the gradual absorption of air in the cavity, bacterial propagation, and accumulation of fluid, which had an impact on the distribution of organs in the abdominal and pelvic cavity. At the same time, whether physical processes also play a role in the occurrence of empty pelvic syndrome remains to be explored. It is concluded that the diagnosis is mainly based on the patient's medical history, clinical manifestations and radiological findings, and the history of pelvic exenteration is the most important indicator in the diagnosis. In terms of prevention measures, we should identify the high-risk groups of the occurrence of empty pelvic syndrome, and then take accurate and individualized preventive measures. Various new biomaterials have more advantages in preventive pelvic cavity filling than traditional human tissue filling. Mesentery plays an important role in the morphology, peristalsis and arrangement of the small intestine. More attention should be paid to reducing the ectopic placement of the small intestine into the pelvic cavity by protecting the mesentery structure and restoring or rebuilding the mesentery morphology. In terms of treatment measures, there is still a lack of standard treatment pathway for empty pelvic syndrome.

Clinical algorithm for the management of advanced pelvic tumours involving the aortoiliac axis

Pelvic exenteration offers potentially curative treatment for locally advanced and recurrent pelvic tumours. Laterally infiltrating tumours involving the pelvic sidewall have historically been considered unresectable. Highly specialised exenteration units have accumulated experience with en bloc resection of part or all of the iliac vascular system for tumours with major vessel involvement. These approaches involve complex vascular dissection and reconstructive techniques requiring collaboration with the vascular surgery unit. Adding to the complexity is the paucity of evidence on oncovascular techniques in the pelvis given its developing nature. An algorithm for the workup to determine resectability and the vascular reconstruction approach for advanced pelvic tumours involving the aortoiliac axis is suggested based on current literature and personal experience from the authors’ unit.

Application of augmented reality technology in the surgical treatment of patients with primary and recurrent pelvic tumors

Surgical treatment of locally spread tumors of pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to a successful and safe surgical intervention is careful planning and intraoperative navigation, including the use of augmented reality technology. The study presents the experience in the clinical testing of augmented reality technology in the surgical treatment of 11 patients. The paper also described the main stages of the algorithm. Radical operations with intraoperative application of augmented reality technology were performed in eight patients with favorable outcomes. One patient underwent palliative intervention, and two patients did not undergo surgery. In the eight patients who underwent surgery, the median operation time was 202.5 (117.5282.5) min, the median volume of blood loss was 300 (187.5625) mL, and the median duration of hospital stay was 21 (17.7527.75) days. Three patients (37.55%) developed complications, namely, necrosis of the perineal edges of the wound, ascending pyelonephritis, and intrahospital pneumonia. No hospital fatality has been registered. In the postoperative morphological examination, a negative peripheral resection boundary (R0 resection) was achieved in all patients. Subsequently, these patients were referred for dynamic monitoring and systemic antitumor therapy. The application of an augmented reality algorithm in the surgical treatment of primary and recurrent pelvic tumors is feasible and reproducible in clinical practice. Augmented reality technology, with its innovative nature and obvious advantages, opens up certain prospects for improving the results of multivisceral resections of pelvic organs; however, further study and implementation in clinical practice are necessary.

Robotic-assisted soft-tissue pelvic exenteration for primary and recurrent pelvic tumours: IDEAL stage 2a evaluation.

Robotic-assisted soft-tissue pelvic exenteration for primary and recurrent pelvic tumours: IDEAL stage 2a evaluation.

Mioma cervical: anatomía y abordaje quirúrgico de alta complejidad

Uterine fibroids are the most recurrent pelvic tumor in women, these are derived from myometrial smooth muscle cells and can be located in any of the three main uterine components: fundus, body and neck (cervix). However, they represent only 5% of all uterine fibroids. A case of a cervical uterine fibroid is presented with the purpose of reviewing the clinical manifestations, and its therapeutic management, with a health history, who attends the gynecology service due to an increase in the volume of the abdomen, progressive, approximately three years of evolution, accompanied by genital bleeding and voiding difficulty. A tumor dependent on the uterus (cervix) is diagnosed and in the transoperative period a large tumor with loss in the pelvic anatomy is confirmed. The ligation of hypogastric arteries in large cervical and giant fibroids is an effective therapeutic resource to minimize bleeding and its complications. Myomatous tumor of the cervix should be taken into account in the differential diagnosis of abdominopelvic masses. From the anatomical point of view, hemorrhagic complications are frequent, so total abdominal hysterectomy with ligation of the hypogastric arteries is a good resource to apply.

Specific characteristics of the magnetic resonance imaging for transarterial chemoembolization with drug-saturated microspheres in oncogynecology

Background: Magnetic resonance imaging (MRI) is used for the staging and assessment of treatment results of female pelvic tumors. The inclusion of transarterial chemoembolization (TACE) with drug-saturated microspheres into the treatment regimen puts a question to the radiologist: what TACE characteristics should be taken into account for the correct interpretation of the treatment results? Aim: To determine the main MRI parameters that characterize the results of TACE in the treatment of women with primary and recurrent pelvic tumors. Materials and methods: We performed a retrospective observational study of 80 patients with primary tumors (group 1) and 20 patients with recurrent tumors (group 2) of the small pelvis, complicated by tumor bleeding, who underwent 121 TACE procedures from 01.09.2015 to 01.12.2021 and were followed up to May 31, 2022. The study inclusion criteria were as follows: compliance with the approved protocol and time points for pelvic MRI. TACE results were evaluated according to RECIST 1.1. Results: In 100% of the cases in the groups 1 and 2, bleeding was controlled within 24 hours. In group 1, partial response was achieved in 48% (n = 38), complete response in 15% (n = 12), stabilization in 37% (n = 30), without any progression in all patients. In group 2, partial response was achieved in 27% (n = 5), complete response in 11% (n = 2), stabilization in 62% (n = 13), without any progression, as well. When comparing the mass volumes, recurrent tumors were significantly more responsive to TACE. The type of tumor growth was infiltrative (n = 25), expansive (n = 55), and mixed (n = 20). No significant differences in volume changes depending on the type of tumor growth were found. Eight women had undergone non-targeted ovarian embolization related to the type of blood supply. There were no cases of non-targeted embolization of the abdominal organs and the bladder, even with existing abnormal collateral vasculature. Conclusion: According to this data, the results of TACE for primary and recurrent pelvic tumors are characterized with the following MRI parameters: 1) hemostatic and cytostatic effects of TACE are manifested independently of each other; 2) tumor volume reflects changes after TACE to a greater extent than changes in linear dimensions; 3) there are cases of non-targeted ovarian embolization.

Transarterial chemoembolization in the treatment of primary and recurrent pelvic tumors with peritoneal involvement: what results can be expected?

Transarterial chemoembolization (TACE) with drug-saturated microspheres is used in the treatment of women with pelvic tumors complicated by bleeding. Another serious problem is peritoneal carcinomatosis. However, it has not been studied whether TACE affects peritoneal lesions, is there a difference in peritoneal lesions with primary and recurrent tumors? The purpose of this article is to analyze the results of TACE in women with peritoneal lesions with primary and recurrent pelvis tumors. This is an analysis of 80 patients with primary tumors (group 1) and 20 patients with recurrent tumors of pelvis (group 2). 8 women in group 1 and 11 women in group 2 had an implantation lesion of peritoneum near the main focus, 3 women in group 1 and 4 women in group 2 had a peritoneum lesion at a distance from the main focus. Angiography revealed differences in blood supply of implantation metastases in the group of primary and recurrent tumors, as well as the blood supply of distant peritoneal metastases. These facts should be taken into account in order to reduce the number of errors in assessing the effectiveness of therapy, to obtain a good clinical result, and to avoid discrediting TACE due to unreasonable requirements for it.

A new technique for performing interstitial implants for gynecologic malignancies using transvaginal ultrasound guidance

ObjectivesThis study concerns a new technique that aims to achieve precise interstitial brachytherapy of pelvic recurrent tumors under transvaginal ultrasound (US) guidance, enhance the conformity index of the brachytherapy (BT), and improve the curative effect of radiotherapy for gynecological oncology patients with pelvic relapse.MethodsA real-time transvaginal US-guided interstitial implant device was developed to assist in implant BT. Prior to implant brachytherapy, the size and location of the tumor in the pelvis and the interrelationship with adjacent organs were first assessed with intracavitary ultrasound. The transvaginal US-guided interstitial implant device was then placed on the endoluminal ultrasound probe, the probe was oriented intravaginally to determine a safe needle path, the implant needle was placed into the needle passage of the device, and the implant needle was inserted into the tumor tissue in the direction guided by the ultrasound puncture guide line. After the implant needle was placed in place, the cover of the transvaginal US-guided interstitial implant device was opened perpendicular to the ultrasound probe, and the needle was separated from the ultrasound probe smoothly, and then the cover was re-covered for subsequent implantation.ResultsIn this study, 56 patients who underwent real-time transvaginal ultrasound-guided implantation for gynecologic oncology were enrolled, and insertion of 736 implant needles was completed. Among them, 13 patients had recurrent pelvic tumors after cervical cancer surgery and 6 patients had recurrent pelvic tumors after endometrial cancer surgery. Thirty-two patients who underwent radical radiation therapy for cervical cancer did not have adequate regression of parametrial invaded tissue after completion of standard EBRT treatment; and 5 patients had recurrent tumors in the radiation field after previous standard course of pelvic radiotherapy. The accuracy of the implant therapy was improved. The radiotherapy dose for recurrent pelvic masses was successfully increased, and the cumulative dose of external irradiation combined with BT was augmented to 80–100 Gy. The use of a new device for transvaginal implant for recurrent masses located in the lateral wall of the pelvic cavity was successful.ConclusionThis intravascular US-guided interstitial implant device can realize interstitial implant with the shortest path under transvaginal US guidance. With convenient operation, high precision, and good security, the device not only improves the accuracy of implant therapy, but it also reduces the risks of anesthesia and organ injury, so it is suitable for widespread promotion and use.

Quality of life after extended pelvic exenterations

BackgroundThe aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration (PE) and extended pelvic exenteration (EPE). EPEs were defined as extensive procedures including, in addition to standard PE extent, the resection of internal, external, or common iliac vessels; pelvic side-wall muscles; large pelvic nerves (sciatic or femoral); and/or pelvic bones. MethodsData from 74 patients who underwent PE (42) or EPE (32) between 2004 and 2019 at a single tertiary gynae-oncology centre in Prague were analysed. QoL assessment was performed using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaires specifically developed for patients after (E)PE. ResultsNo significant differences in survival were observed between the groups (P > 0.999), with median overall and disease-specific survival in the whole cohort of 45 and 49 months, respectively. Thirty-one survivors participated in the QoL surveys (20 PE, 11 EPE). No significant differences were observed in global health status (P = 0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P = 0.502), and both expressed similar, high willingness to undergo treatment again if they were to decide again (P = 0.317). ConclusionsEPEs had post-treatment QoL and oncological outcome comparable to traditional PE. These procedures offer a potentially curative treatment option for patients with persistent or recurrent pelvic tumour invading into pelvic wall structures without further compromise of patients´ QoL.

Clinical application of computed tomographic angiography in predicting the vascular pedicle length of the proximally-based anterolateral thigh flap

To explore the reliability and effectiveness of prediction of the pedicle length of the proximally-based anterolateral thigh (pALT) flap which was used to repair the defects following the resection of various malignant tumors using computed tomographic angiography (CTA). The clinical data of 12 patients who met the selection criteria by using pALT flap to repair wounds left after malignant tumor resection between June 2015 and December 2020 were retrospectively analyzed. There were 5 males and 7 females; the age ranged from 16 to 80 years, with an average age of 54.4 years. After tumor resection, the soft tissue defect ranged from 15 cm×5 cm to 30 cm×12 cm; defect sites included 4 cases of lower abdomen, 3 cases of groin, 2 cases of thigh, and 3 cases of buttocks. Preoperative CTA was used to obtain the location information of the descending branch of the lateral femoral circumflex artery and its perforators by maximum density projection, and the length of the pedicle of pALT flap was estimated. Fasciocutaneous flap (5 cases) or myocutaneous flap (7 cases) were cut during operation to repair the defect, and the size of flap ranged from 20 cm×7 cm to 30 cm×12 cm. The donor site of thigh was directly sutured (11 cases) or repaired with skin graft (1 case). Bland-Altman analysis was used to detect the consistency between the pALT flap vascular pedicle length estimated by CTA and the pALT flap vascular pedicle length actually obtained during operation. One case had distal blood supply disturbance of the flap and was repaired with skin graft after debridement; the remaining 11 flaps survived. All donor and recipient incisions healed by first intention. All 12 cases were followed up 1-12 months, with an average of 4.3 months. One patient died of pelvic tumor recurrence at 6 months after operation, and no tumor recurrence was found in the other patients. Preoperative CTA estimated that the length of pALT flap vascular pedicle was 9.3-24.7 cm, with an average of 14.7 cm; the actual length of pALT flap vascular pedicle was 9.5-25.0 cm, with an average of 14.8 cm. Bland-Altman analysis showed that there was no significant difference between the pALT flap vascular pedicle length estimated by CTA before operation and the pALT flap vascular pedicle length actually obtained during operation, and the average difference was 0.1 (95% consistency limit: -0.89, 0.74), indicating that they had good consistency. CTA can be accurately used to localize the perforator and predict the possible pedicle length of the pALT flap. When performing a pALT flap surgery, preoperative CTA is helpful for surgeons to make a preliminary assessment of the difficult of the operation. The time for exploration of perforators and dissection of the vascular pedicle, and complications can be reduced, and the safety of the operation can be improved.

Preoperative planning of arterial chemoembolization with drug-saturated microspheres for women with recurrent pelvic tumors complicated by bleeding

Arterial chemoembolization is an X-ray surgical method that is used for recurrent pelvic tumors complicated by bleeding. It combines occlusion of tumor vessels and local chemotherapy, for which a cytostatic and drug-saturated microspheres are used. To obtain a result, two conditions must be met: carefully close all tumor afferents, treat the maximum tumor volume with saturated microspheres.The aim of the work: to define the key points of preoperative planning for recurrent pelvic tumors in women in order to achieve reliable hemostasis and cytoreduction.An analysis of 17 women with recurrent tumors complicated by tumor bleeding is presented. The first group consisted of 7 patients in whom the uterus was not removed, the second group consisted of 10 patients with removed uterus. For preoperative planning, magnetic resonance imaging of pelvis and selective angiography of the branches of the anterior and posterior trunk of the internal iliac artery were used. The sources of blood supply to the tumor were different and depended on the localization of the process in the upper, middle, and lower levels of pelvis. Multidisciplinary planning made it possible to achieve reliable hemostasis in all cases, to prevent complications from the pelvic organs.

Image Navigation Surgery With the Fluorescent Ureteral Catheter of Recurrent Tumors in the Pelvic Cavity.

Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors. The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum. All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter. Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.

Malignant Ectomesenchymoma of Pelvis in an Infant

Malignant ectomesenchymoma is a rare pediatric soft tissue tumor that contains both neuroectodermal and mesenchymal components. It is frequently found in the pelvis, paratesticular soft tissue, external genitalia and the head-neck region. We present a 12-month-old boy with a recurrent pelvic tumor excised 5 months ago and diagnosed as neuroblastoma. Histological consultation of the initial tumor tissue revealed a biphasic pattern with rhabdomyosarcomatous and neural components. The mesenchymal component was embryonal rhabdomyosarcoma showing desmin, myogenin, and Myo-D1 positivity. The neuroectodermal component was mainly Schwannian stroma stained with S100 antibody and scattered synaptophysin and chromogranin positive ganglion cells were also present. The patient was diagnosed with malignant ectomesenchymoma. A chemotherapy regime was started and surgical approach to the recurrent tumor was planned. We present here a pediatric case of malignant ectomesenchymoma because of its rarity and it is important that this entity should be considered in the differential diagnosis for appropriate clinical management.

Therapeutic effects and prognostic factors of 125I brachytherapy for pelvic recurrence after early cervical cancer surgery

To investigate the efficacy of 125I seed implantation in the treatment regimen of pelvic recurrence after early cervical cancer surgery and to analyse prognostic factors. To evaluate efficacy and analyse prognostic factors of 125I seed implantation for pelvic recurrence after early cervical cancer surgery. A prospective study was conducted on 62 patients who experienced pelvic recurrence after early cervical cancer surgery between August 2005 and September 2015. The 62 patients were treated and assessed in 2 groups (n = 30). All 62 patients were randomized into two groups that received two different treatment regimens: the treatment group (n = 30), which received 125I particle implantation therapy, and the control group (n = 32), which received whole-pelvic irradiation using the anteroposterior/posteroanterior field and cisplatin-based concurrent chemoradiation therapy. The efficacy/efficiency of 125I seed implantation and prognostic factors were analysed by logistic regression. Overall survival was determined by Kaplan–Meier analysis. Multivariate analysis results were obtained by the Cox proportional hazards regression model. The effective control rates at 1, 3, 6 and 12 months were 76.7%, 80.0%, 83.3%, and 86.7% in the 125I particle implantation group. The total effective control rates at 1, 3, 6 and 12 months were 65.6%, 65.5%, 62.5%, and 71.9% in the chemoradiotherapy group. Significant differences were observed between the two groups. The overall survival rates at 1, 2, 3, 4, and 5 years and the median overall were 96.7%, 93.3%, 86.7%, 71.9%, 65.6% and 4.34 years, respectively, in the 125I seed implantation group and 81.3%, 71.9%, 62.5%, 56.3%, 53.1% and 3.59 years, respectively, in the control group. There were statistically significant differences in survival rates depending on the diameter of the largest recurrent pelvic tumour (χ2 = 6.611, P = 0.010). The multivariate analysis showed that the survival rates were related to the diameter of the largest recurrent pelvic tumour (χ2 = 4.538, P = 0.033). 125I implantation is an effective, safe, and promising method for the treatment of pelvic recurrence after early cervical cancer surgery. The diameter of the recurrent pelvic tumour was identified as a significant independent prognostic factor in patients who received 125I implantation.

Stereotactic body radiotherapy for pelvic boost in gynecological cancer patients with local recurrence or unsuitable for intracavitary brachytherapy

ObjectiveTo evaluate efficacy of stereotactic body radiotherapy (SBRT) for pelvic boost irradiation in gynecological cancer patients with pelvic recurrence or with intact uterus unsuitable for brachytherapy. Materials and methodsWe retrospectively reviewed the medical records of 25 gynecological cancer patients who received SBRT boost for pelvic recurrence (salvage group, n = 14), or for local dose escalation instead of intracavitary brachytherapy due to unfavorable medical condition (definitive group, n = 11). The pelvis was irradiated with a median dose of 54 Gy in six weeks, and then SBRT was prescribed with a range of 10–25Gy in two to five fractions. The cumulative radiobiological equivalent dose in 2-Gy fractions (EQD2) to the tumors ranged from 62.5 to 89.5 Gy10 (median, 80.7). Overall survival (OS) and in-field relapse-free survival (IFRFS) were calculated using the Kaplan–Meier method. ResultsAt the initial assessment, eighteen (72%) patients achieved complete or partial remission, and seven (28%) had stable or progressive disease. With a median follow duration of 12 months, the 1-year IFRFS for salvage and definitive group were 64.5% and 90.0%, whereas the 1-year OS for the two groups were 80.8% and 49.1%, respectively. One patient developed entero-vaginal fistula and one had sigmoid perforation. No patient experienced ≧ grade 3 genitourinary complications. ConclusionIn gynecological cancer patients with recurrent pelvic tumors or intact uterus unsuitable for brachytherapy, local dose escalation with SBRT resulted in an initial response rate of 72% with acceptable early toxicities. A long-term follow-up is required to assess the impact on local control or survival.

35 лет после аварии на Чернобыльской АЭС: методы ретроспективной дозиметрии в оценке последствий крупномасштабных неконтролируемых радиационных воздействий, их последующее развитие и применение в онкорадиологии (опыт МРНЦ им. А.Ф. Цыба)

Individual retrospective dosimetry was developed at A. Tsyb Medical Radiological Research Centre (A. Tsyb MRRC) after the Chernobyl accident for assessment and analysis of radiation effects on people lived in radioactively contaminated settlements in the Kaluga and Bryansk regions. The method was also used in radiation epidemiology case-control studies within frames of international pilot projects. The ob-tained data demonstrated reliable dose-response relationship for thyroid cancer in patients with diag-nosed thyroid cancer, who were children and adolescents at the time of the accident and resided in radi-oactively contaminated areas in the Bryansk region. The dose-response relationship for diagnosed inva-sive breast cancer was found in women, resided in radioactively contaminated settlements since the acci-dent till the first diagnosis of cancer that was established within the period from October 2008 to February 2013. Their age at diagnosis was under 55 years. At the same time, no dose-response relationship for leu-kaemia was found in children under 5 years old at the time of the accident. The individual retrospective dosimetry method has been updated and used in pilot studies for verifying conservative estimates of radi-ation doses to the population exposed to radiation as a result of nuclear tests at the Semipalatinsk nuclear test site, as well as for verifying estimates of external radiation doses to people affected by the accident at the Fukushima Daiichi NPP. The method was also used for estimating individual doses from residual radi-oactivity for the survivors of the Hiroshima and Nagasaki atomic bombings. The long-term collaboration continues under bilateral International Collaboration Agreements between the National Medical Research Radiological Centre and leading research centres in the Republic of Kazakhstan and Japan. Since 2016 researchers and physicians of A. Tsyb MRRC have modi-fied method of stimulated luminescence of natural and synthetic materials and developed innovative technology in vivo dosimetry that has been put into clinical practice for estimating spatial radiation doses distribution in internal organs at risk during the brachytherapy of prostate cancer, gynecologic and recur-rent pelvic tumors, as well as for estimating local radiation dose to the skin of the breast gland with the tumor. The 35-year experience in the development and application of methods for individual retrospective dosimetry after the Chernobyl accident formed the basis for identifying future-pointing trends for the de-velopment of novel applications of stimulated luminescence techniques. Radiation-induced stimulated luminescence dosimetry can be applicable in uncontrolled radiation events; retrospective dosimetry method applicable for neutron beam radiation therapy is under development. The method of in vivo do-simetry is useful in radiation oncology. Now assembled thermoluminiscent micro-sized dosimeters are used for arterial radioembolization. At present, feasibility of using items of clothing and special inserts (buttons, fastenings, etc.), parts of wearable electronic devices as natural dosimeters, as well as the feasi-bility of using luminescent microdosimeters, made of different materials, after exposure to high LET radiation ranged from a fraction of mGy to the dose greater than 60 Gy have been examined. Development of flexible planar microdosimeter assemblies in order to obtain more detailed information about possible discrepancy in distribution of planned and actual radia-tion doses to patients during radiotherapy is considered.