Resection Of Recurrence Research Articles

Multiplatform Molecular Profiling of Vestibular Schwannoma Reveals Immune Enrichment after Radiosurgery and a Methylation-Based Predictor of Recurrence

Vestibular schwannomas (VS) can cause significant morbidity from cranial nerve deficits and mass effect. Broad molecular differences have been described for intracranial versus spinal axis schwannomas, but little is known about the molecular heterogeneity of VS or predictors of VS recurrence. The objective of this study was to understand VS biology and identify molecular predictors of VS recurrence. Sixty-six sporadic VS from 59 consecutive patients with available tissue who underwent initial resection (44), resection for recurrence after prior surgery (5), resection for recurrence after prior stereotactic radiosurgery (SRS) (11), or resection after both prior surgery and prior SRS (6) at a single institution from 2003-2017 were profiled using Illumina 850K DNA methylation arrays (median follow-up: 4.2 years, median volumetric resection: 91%). Twenty-four VS were further characterized using RNA sequencing (RNA-seq), and 7 were analyzed by single nuclei RNA-seq. Molecular subtyping was performed by hierarchical clustering of differentially-methylated DNA probes and validated using transcriptomic data. In vitro functional experiments were performed using human VS cells. Clustering of genome-wide DNA methylation probes revealed that VS are comprised of 2 subgroups that are delineated by enrichment of neural crest or immune genes. Fifteen of 35 immune-enriched VS (43%) had prior SRS, while only 2 of 31 neural crest-enriched VS (6%) had prior SRS (p<0.001). Analysis of 6 patients with matched primary and recurrent VS samples revealed that all recurrent VS after prior SRS exhibited similar methylation profiles and were enriched in immune genes. In contrast, the methylation profile of VS that recurred after prior surgery did not deviate from the primary tumor. Hypomethylation of G protein-coupled estrogen receptor 1 (GPER) promoter was prognostic for local failure in multivariate regression irrespective of primary treatment modality (p<0.0001). Radiation of VS cells in vitro recapitulated gene expression of immune-enriched VS. VS are comprised of 2 molecular subgroups characterized by differential enrichment of neural crest or immune genes. VS with prior SRS are associated with immune-enrichment. GPER promoter hypomethylation is prognostic for VS recurrence. These data illuminate the biology of VS and shed light on potential molecular therapies.

Systemic Therapy in Local Recurrence of Breast Cancer, Report of a case and Decision Making in MDT Meeting

Background: Locoregional recurrence of breast cancer has significantly decreased over the last decades, particularly due to effective systemic therapy. While there is little controversy regarding local management of locoregional recurrences, in light of previous systemic treatment, additional chemotherapy regimens and their benefit to the patient are still subject to debate in tumors boards.Case Presentation: A 45-year-old woman was referred to our tertiary care center with a local recurrence of breast cancer 9 years after modified radical mastectomy for a ypT2N2a invasive ductal carcinoma. She received neoadjuvant treatment consisting of FEC-D (5-FU-epirubicin-cyclophosphamide, followed by docetaxel) for hormone receptor positive, HER-2-neu negative cancer in 2009, as well as adjuvant radiotherapy and tamoxifen for 9 years. After R0 resection of the hormone receptor positive, HER-2-neu negative recurrence in 2019, adjuvant therapy with ovarian suppression and an aromatase inhibitor was undertaken. A multigene assay identified a recurrence score at 37 and benefit from chemotherapy &gt; 15%.Question: What would the ideal chemotherapy regimen consist of for this patient with an R0 resection of late recurrence of breast cancer?Conclusion: After reviewing history, imaging and pathology, members of the multidisciplinary team recommended treatment with Taxotere and cyclophosphamide (TC) x 4 for our patient.

Clinical value of QST classification in the treatment of children with craniopharyngioma

Objective To explore the clinical manifestation of children with different QST classification of craniopharyngioma (CP) and its role in prognosis. Methods We retrospectively analyzed 149 children with CP who underwent surgery at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 1998 to December 2015. Of those, 70 (47.0%) children underwent operation through frontal base approach, 46 (30.9%) through pterional approach and 33 (22.1%) through transsphenoidal approach for tumor removal. All patients underwent clinical follow-up after surgery, including MRI review of the sellar region to determine the tumor resection and recurrence, and measurement of relevant indicators to assess the prognosis. All 149 children were classified according to the QST classification criteria, and the differences in clinical characteristics of different types of children were analyzed. Furthermore, multivariate logistic regression analysis was used to determine the clinical factors affecting the prognosis of children. Results All children in this series underwent successful operation and 138 (92.6%) out of those had total resection and 11 (7.4%) had subtotal resection. The median follow-up duration of 149 patients was 87 months (range: 11-236 months). Good outcomes were reported in 134 patients and poor outcome in 15. In this study, 91 patients were type Q (Q-group), 14 were type S (S-group) and 44 were type T (T-group) according to the QST classification criteria. There were no significant differences in age, gender, maximum diameter, tumor calcification degree, degree of tumor resection and tumor recurrence between the 3 groups (all P>0.05), while the clinical symptoms, incidence of hydrocephalus, pre- and post-operative pituitary function, operation approach and pathological types were significantly different in patients with different QST classifications among 149 children with CP (all P<0.05). The T-type was more often associated with hydrocephalus, the Q-type was more prone to have abnormal pituitary function, and the S-type was more likely to have vision and visual field damage. Multivariate logistic regression analysis showed that QST classification(OR=5.984, 95%CI: 1.529-23.417, P=0.037) and degree of tumor resection(OR=8.220, 95%CI: 2.158-31.318, P=0.002) were independent prognostic factor in children with CP. Conclusions The clinical characteristics of children with different QST classification of craniopharyngioma are different, and QST classification is one of the independent risk factors affecting the prognosis of children with craniopharyngioma. Key words: Craniopharyngioma; Child; Prognosis; Disease attributes; QST typing

Multiplatform Molecular Profiling of Vestibular Schwannoma Reveals 2 Subgroups of Tumors With Distinct Radiographic Features and a Methylation-Based Predictor of Local Recurrence

Abstract INTRODUCTION Vestibular schwannomas (VS) can cause significant morbidity from cranial neuropathies and mass effect. Broad molecular differences have been described for intracranial versus spinal axis schwannomas, but little is known about the molecular heterogeneity of VS or predictors of recurrence. METHODS A total of 66 sporadic VS from 59 consecutive patients with available tissue who underwent initial resection (44), resection for recurrence after prior surgery (5), resection for recurrence after prior stereotactic radiosurgery (SRS) (11), or resection after both prior surgery and prior SRS (6) at a single institution from 2003 to 2017 were profiled using 850 K DNA methylation arrays (median follow-up: 4.2 yr, median volumetric resection: 91%). A total of 24 VS were further characterized using RNA sequencing. Molecular subtyping was performed using differential-DNA methylation analysis and validated using transcriptomic data. Preoperative magnetic resonance imaging (MRI) studies were centrally reviewed by a board-certified neuro-radiologist. RESULTS NA methylation profiling revealed 2 novel subgroups of VS, delineated by enrichment of neural crest genes (31 tumors) or immune genes (35 tumors). Neural crest-enriched VS were more likely to show reduced diffusion on MRI (P &lt; .01), while immune-enriched VS were more likely to show cystic changes (P &lt; .05), mass effect (P &lt; .01), and edema (P &lt; .05). Immune-enriched VS were significantly more likely to be adherent to the brainstem and left as residual at the time of resection. A total of 15 immune-enriched VS (43%) had prior SRS, while only 2 neural crest-enriched VS (6%) had prior SRS (P &lt; .001). Hypomethylation of G protein-coupled estrogen receptor 1 (GPER) promoter was prognostic for local failure in multivariate regression irrespective of primary treatment modality (P &lt; .0001). CONCLUSION VS are comprised of 2 molecular subgroups characterized by differential enrichment of neural crest or immune genes. VS treated with prior SRS are associated with immune-enrichment. GPER promoter hypomethylation is prognostic for VS recurrence. These data illuminate the biology of VS and shed light on potential molecular therapies.

Comprehensive Profiling of Gene Copy Number Alterations Predicts Patient Prognosis in Resected Stages I-III Lung Adenocarcinoma.

Background: Lung adenocarcinoma (LUAD) possesses a poor prognosis with a low 5-year survival rate even for stages I-III resected patients, it is thus critical to understand the determinants that affect the survival and discover new potentially prognostic biomarkers. Somatic copy number alterations (CNAs) are major source of genomic variations driving tumor evolution, CNAs screening may identify prognostic biomarkers.Methods: Oncoscan MIP array was used to analyze the patterns of CNAs on formalin fixed paraffin embedded(FFPE) tumor specimens from 163 consecutive stage I-III resected LUAD patients, 145 out of which received platinum-based adjuvant chemotherapy.Results: Of the 163 patients, 91(55.8%) were recurred within 3 years after surgery. The most common aberrations in our cohort were 1q, 5p, 5q, 7p, 8q, 14p, 16p, 17q, 20q for copy number gains and 8p, 9p, 13p, 16q, 18q for losses. The GISTIC2 analysis produced 45 amplification peaks and 40 deletion peaks, involving some reported genes TERT, EGFR, MYC, CCND1, CDK4, MDM2, ERBB2, NKX2-1, CCNE1, and CDKN2A, most of which were consistent with TCGA database. The amplifications of 12p12.1 (CMAS, GOLT1B, YS2, LDHB, RECQL, ETNK1, IAPP, PYROXD1, KRAS) and KDM5A were correlated with worse prognosis in our cohort, this result was further validated in 506 LUAD patients from TCGA. In addition, 163 patients could be well-classified into five groups, and the clinical outcomes were significantly different based on threshold copy number at reoccurring alteration peaks. Among the 145 patients who received adjuvant chemotherapy, focal amplification of ERBB2 and deletion of 4q34.3 were found to be specific in relapsed patients, this result was validated in an independent group of Imielinski et al., demonstrating these two CNAs may contribute to resected LUAD recurrence after adjuvant chemotherapy.Conclusion: This study suggests that CNAs profiling may be a potential prognostic classifier in resected LAUD patients. Amplifications of 12p12.1 and KDM5A might be prognostic biomarkers for LUAD, and amplification of ERBB2 and deletion of 4q34.3 predicted early relapse after adjuvant chemotherapy. These novel findings may provide implication for better implementation of precision therapy for lung cancer patients.

Oncologic and Functional Outcomes After Primary and Salvage Laryngopharyngoesophagectomy With Gastric Pull-Up Reconstruction for Locally Advanced Hypopharyngeal Squamous Cell Carcinoma.

Background/Purpose: Hypopharyngeal squamous cell carcinomas (SCC) are generally diagnosed in an advanced disease stage. A total laryngopharyngoesophagectomy with gastric pull-up reconstruction is a time tested surgical treatment in our centre for resectable failures or recurrences after primary treatment with organ preservation protocols (radiotherapy or chemoradiation), or as a primary surgical treatment for very advanced hypopharyngeal tumors. We present the results of our approach in terms of success rate, postoperative complications and functional and oncologic outcomes.Methods: We retrospectively reviewed the charts of all patients with hypopharyngeal SCC, who underwent laryngopharyngoesophagectomy with gastric pull-up reconstruction during the period 1989–2015.Results: The cohort included 60 patients. Mean follow-up was 32 months. Stage III and stage IV disease was present in 35 and 60% of patients, respectively. Successful reconstruction by intended gastric transposition was possible in 98.3% of cases. The in-hospital mortality rate was 8.3%. Two-year and five-year actuarial overall survival were 39.5 and 21.1%, respectively. Two-year and five-year actuarial disease specific survival were 58.5 and 46.6%, respectively. Two-year and five-year actuarial locoregional recurrence free survival were both 49.5%. A significantly lower locoregional recurrence free survival was observed in patients with pN+ disease compared to pN0 (Log rank, p <0.05). Complete oral intake was achieved in 82.7% of patients. Speech rehabilitation by means of Provox® puncture or electrolarynx was achieved in 66% of patients.Discussion/Conclusion: Total laryngopharyngoesophagectomy with gastric pull-up reconstruction for advanced stage hypopharyngeal SCC combines relatively good oncologic and functional outcomes in a prognostically unfavorable patient group.

Outcomes of Non-B Non-C Hepatocellular Carcinoma with Reference to Patients with Interferon-Induced Hepatitis C Virus Eradication

PurposeThis study aimed to evaluate survival outcomes in patients with non-B non-C hepatocellular carcinoma (NBNC-HCC) with reference to patients with HCC achieving sustained virological response (SVR) by preoperative interferon (IFN) treatment for chronic hepatitis C. MethodsWe examined 781 patients who underwent hepatic resection for HCC. They were classified into NBNC-HCC, SVR-HCC, and non-SVR HCC groups. ResultsMultivariate analysis for recurrence-free survival (RFS) and overall survival (OS) revealed that the adjusted hazard ratios (HR) of NBNC-HCC and non-SVR HCC groups with reference to the SVR-HCC group were 1.46 (p = 0.10) and 2.10 (p < 0.001), respectively, for RFS, and 1.69 (p = 0.024) and 2.11 (p < 0.001), respectively, for OS. Worsening of Child–Pugh grade at recurrence was confirmed in 21 patients (17.1%) with NBNC-HCC but not in those with SVR-HCC (p = 0.017, SVR vs. NBNC). In the NBNC-HCC group, hepatic resection for intrahepatic recurrence was adopted in 17.4% of patients without worsening of Child–Pugh grade at recurrence, whereas hepatic resection was not adopted in those with grade worsening. Among patients with alcoholic hepatitis, Child–Pugh grade worsening at recurrence was more frequently observed in patients with sobriety than those without sobriety (14.3% vs. 46.2%, p = 0.049). ConclusionsNBNC-HCC patients had an increased risk for overall death as compared with those with SVR-HCC. Worsening of background liver function may reduce the chances of re-hepatic resection for recurrence and increase the risk for overall death in NBNC-HCC patients. For alcoholic hepatitis patients, sobriety may prevent deterioration of liver function after surgery.

Uniportal video-assisted sleeve resections: how to deal with specific challenges.

Concerns about incomplete resection and future recurrence, combined with the fact that a parenchyma sparing procedure is more technically demanding than that of a pneumonectomy, have traditionally reserved sleeve pulmonary resection (SL) procedures for patients diagnosed with central lung tumors who cannot tolerate a pneumonectomy.

Intraoperative Frozen Section Analysis for the Excision of Nonmelanoma Skin Cancer: A Single-center Experience

INTRODUCTION: Recurrence rates for nonmelanoma skin cancers (NMSCs) following Mohs’ micrographic surgery (MMS) are consistently lower than standard surgical excision. However, variations in the availability of MMS, waiting times, and costs continue to affect patient preference between treatment modalities. Furthermore, MMS commonly requires delayed reconstruction leading to additional surgeries that increases the risk of adverse outcomes. To achieve curative resection while ensuring optimal cosmetic outcomes, plastic surgeons may utilize intraoperative frozen section-guided excision to forego extensive or delayed reconstruction. METHODS: Patients presenting with NMSCs undergoing wide local excision using intraoperative frozen section margin analysis (IFSA) at our institution from October 2008 to November 2016 were retrospectively reviewed. Analyzed data included IFSA results, final permanent section histopathology, number of resections required for clear margins, and recurrence rates. Excisions were performed by 1 of 3 plastic surgeons and analyzed by 1 of 8 pathologists. RESULTS: A total of 171 patients and 204 lesions were included in the study. Mean patient age was 72 years. Operative reports demonstrated that 79.9% of margins were clear after one excision. The remaining 20.1% of cases with residual positive margins after primary excision were identified using IFSA and were re-excised until negative margins were achieved. Of the 20.1%, a total of 11.8% required a second excision and 8.3% required ≥3 excisions. Intraoperative frozen section results revealed 1 false-positive case representing a rate of 0.49% and 5 false-negative results leading to a rate of 2.45%. Fifteen patients had local recurrence; a rate of 7.35%. Frozen section sensitivity was 89.79% and specificity was 99.35%. The positive predictive value was 97.78% with a negative predictive value of 96.85%. Patients had a mean follow-up of 39 months. CONCLUSION: The resection results and recurrence rate of NMSCs excised at our institution are comparable to national trends using standard surgical excision. The findings suggest that standard surgical excision using intraoperative frozen section analysis is a safe and effective alternative to MMS.

The role of salvage surgery with interstitial brachytherapy for the Management of Regionally Recurrent Head and Neck Cancers

BackgroundThe optimal treatment for regional lymphatic recurrences from head and neck cancer has not been fully established. In order to explore the therapeutic benefit of surgical resection and adjuvant brachytherapy, the authors reviewed their experience utilizing interstitial brachytherapy (IBT) at the M. D. Anderson Cancer Center.MethodsA retrospective chart review of the 51 patients who received salvage surgical resection of lymphatic recurrences and adjuvant IBT between 1993 and 2012 at the M. D. Anderson Cancer Center was undertaken. All patients underwent neck dissection with complete resection and intraoperative placement of afterloading brachytherapy catheters. Soft tissue reconstruction was performed as necessary. The technical aspects of IBT were reviewed, and the overall and disease free survival rates and the recurrence rates were determined.ResultsAll patients had received external beam radiation (EBRT) as part of their initial treatment to a median dose of 66 Gy; 40 and 68% of the patients also had a neck dissection or chemotherapy, respectively. The cumulative regional recurrence probability is 28 and 38% at 5 years and 10 years. All of the patients underwent salvage neck dissection and IBT, with 81% also undergoing soft tissue reconstruction. The median dose delivered to the tumor bed was 60 Gy over a median duration of 4.5 days. There were 21 early adverse events, 8 of which were severe, and 19 late adverse events, 6 of which were severe. The most common early and late adverse events due to surgery and brachytherapy were dysphagia (7.1%) and true vocal cord paralysis (17.9%), respectively. There were no perioperative deaths or carotid hemorrhages. Nineteen patients developed recurrence including regional recurrence and distinct metastasis. The median time to recurrence is 130 months using Kaplan-Meier product limit method. The 2-year disease-free survival rate was 58%. The 2-year, 5-year, and 10-year overall survival rates were 69, 56, and 46%, respectively.ConclusionsRegional recurrences in previously irradiated tissues after the definitive treatment of primary head and neck cancers represent a challenging problem. We demonstrated that salvage neck dissection with IBT provided encouraging regional control and survival rates, while maintaining relatively low acute and long-term toxicity rates.

Surgery for Recurrent Pancreatic Cancer: Is It Effective?

Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3–152) after resection of the primary tumor, and 26.0 months (range 0–112) after surgery for recurrent disease. The disease-free interval after the resection of recurrences was 14.2 months (range 4–29). Although data analysis was performed on a heterogeneous and limited number of patients, some of these may benefit from surgery for isolated recurrence of pancreatic adenocarcinoma. Further studies are needed to identify these cases.

Feasibility of Using Hydrogel Spacers for Borderline-Resectable and Locally Advanced Pancreatic Tumors

Feasibility of Using Hydrogel Spacers for Borderline-Resectable and Locally Advanced Pancreatic Tumors

Brown Tumors Secondary to Parathyroid Carcinoma Masquerading as Skeletal Metastases on 18F-FDG PET/CT: A Case Report

Brown tumors develop as skeletal manifestations of hyperparathyroidism. Increased osteoclast activity leads to accumulation of highly active giant cells and to excess cortical bone resorption, producing fibrous cysts. Though most often reported in patients with parathyroid adenomas, brown tumors secondary to parathyroid carcinoma create a clinical dilemma. Increased signal uptake on 2-deoxy-2-(fluorine-18)fluoro-D-glucose positron emission tomography (18F-FDG PET)/computed tomography (CT) seen within brown tumors may be indistinguishable from bone metastases. We report a case of parathyroid carcinoma in a 38-year-old man presenting with osteolytic bone lesions on 18F-FDG PET/CT that were diagnosed as brown tumors by biopsy. We describe the patient history, presentation, diagnostic studies, and treatment. We report a case of a 38-year-old man diagnosed with parathyroid carcinoma with associated hypercalcemia and elevated parathyroid hormone levels who had undergone 3 surgical resections for local recurrences and had persistent hypercalcemia. He was found to have multiple osteolytic lesions throughout his skeleton on 18F-FDG PET/CT imaging 2 months after diagnosis. Biopsy of a right scapula lesion confirmed a brown tumor. The role of 18F-FDG PET/CT in management of parathyroid carcinoma has not been systematically evaluated. Skeletal manifestations of parathyroid carcinoma may be present in this imaging modality. Clinicians should consider the possibility of brown tumors in patients with parathyroid carcinoma who undergo 18F-FDG PET/CT imaging.

Resection of pancreatic neuroendocrine tumors: defining patterns and time course of recurrence

BackgroundTo define recurrence patterns and time course, as well as risk factors associated with recurrence following curative resection of pNETs. MethodPatients who underwent curative-intent resection for pNET between 1997 and 2016 were identified from the US Neuroendocrine Tumor Study Group. Data on baseline and tumor-specific characteristics, overall survival (OS), timing and first-site of recurrence, predictors and recurrence management were analyzed. ResultsAmong 1020 patients, 154 (15.1%) patients developed recurrence. Among patients who experienced recurrence, 76 (49.4%) had liver-only recurrence, while 35 (22.7%) had pancreas-only recurrence. The proportion of liver-only recurrence increased from 54.3% within one-year after surgery to 61.5% from four-to-six years after surgery; whereas the proportion of pancreas-only recurrence decreased from 26.1% to 7.7% over these time periods. While liver-only recurrence was associated with tumor characteristics, pancreas-only recurrence was only associated with surgical margin status. Patients undergoing curative resection of recurrence had comparable OS with patients who had no recurrence (median OS, pancreas-only recurrence, 133.9 months; liver-only recurrence, not attained; no recurrence, 143.0 months, p = 0.499) ConclusionsDifferent recurrence patterns and timing course, as well as risk factors suggest biological heterogeneity of pNET recurrence. A personalized approach to postoperative surveillance and treatment of recurrence disease should be considered.

Experience in Simultaneous Endoscopic Submucosal Dissection Treating Synchronous Multiple Primary Early Esophageal Cancers.

Objective: Synchronous multiple primary early esophageal cancers (SMPEEC) are rare and aggressive. Early detection of esophageal cancer can improve survival rate. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment of early esophageal cancers. However, ESD for SMPEEC is little known. We aimed to clarify the clinical outcomes of simultaneous ESD treating SMPEEC. Methods: We retrospectively reviewed the medical data of 34 patients, who underwent ESD for SMPEEC at Endoscopy Center of Zhongshan Hospital, Fudan University, between May 2013 and December 2014. The data of lesion size, histopathology, en bloc resection, curative resection, complication, and tumor local recurrence were analyzed. Results: Among 34 patients, 67 lesions were removed simultaneously in 33 cases; 2 lesions were removed in 2 operations for 1 case. For the simultaneous resection, the en bloc rate was 97.01% (65/67) and the curative resection rate was 92.54% (62/67). Postoperative stricture occurred in two cases and delayed bleeding occurred in one case. There was one local recurrence, no metastasis or procedure-related death. Conclusions: Simultaneous ESD as a treatment for SMPEEC is technically feasible, benefited from reducing hospitalization time and medical expenses. For the cases with risk factors of complications, simultaneous ESD needs to be avoided.

Recurrent ovarian immature teratoma in a 12-year-old girl: Implications for management

Immature teratomas (IT) are rare and recurrences uncommon. A 12-year-old female with grade 3 (high-grade) ovarian IT underwent surgical resection but experienced early recurrences; the first was treated with surgery but the second was metastatic and managed with chemotherapy, resulting in growing-teratoma-syndrome and need for further surgery. She now remains well in uneventful clinical follow-up. We believe chemotherapy could be reserved for very carefully selected recurrent IT cases, which may alter the natural history of disease.

Management of isolated recurrence after surgery for pancreatic adenocarcinoma.

Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83·6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27·2 per cent), distant multifocal in 251 (18·6 per cent), distant isolated in 188 (14·0 per cent), locoregional plus distant in 153 (11·4 per cent) and peritoneal seeding in 388 (28·8 per cent). Of the 1346 patients with recurrence, 197 (14·6 per cent) had isolated recurrence; of these, 48 (24·4 per cent of all isolated recurrences; 3·6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14·7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23·5 versus 12·0 months; P= 0·014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33·3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28·0 versus 12·0 months, P= 0·010) and lung (median 36·5 versus 9·5 months; P= 0·010) than in those who did not undergo resection. Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

Chest wall resection for locoregional recurrence of breast cancer: a feasible and effective

Chest wall resection for locoregional recurrence of breast cancer: a feasible and effective

Mo1226 THE EFFECT OF ENDOSCOPIC MUCOSAL RESECTION (EMR) VS ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) TECHNIQUE ON HISTOLOGIC MARGINS FOR ENDOSCOPICALLY TREATED EARLY ESOPHAGEAL ADENOCARCINOMA

Both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques are used for the treatment of early esophageal cancers. ESD has potential advantages including higher en bloc and R0 resection rates, which have been demonstrated for squamous cell carcinomas (ESCC) but data for esophageal adenocarcinoma (EAC) is more limited. Histologic determination of the horizontal and vertical margins is important to determine the completeness of resection and risk of recurrence. Larger tumors, especially those that spread laterally may exceed with limits of en bloc resectability using standard EMR techniques.

Comparative genomic analysis of driver mutations in matched primary and recurrent meningiomas.

A significant proportion of low-grade WHO grade I and higher-grade WHO grade II or III meningiomas are at risk to develop post-resection recurrence. Though recent studies investigated genomic alterations within histological subtypes of meningiomas, few have compared genomic profiles of primary meningiomas matched to their recurrences. The present study aimed to identify oncogenic driver mutations that may indicate risk of meningioma recurrence and aggressive clinical course. Seventeen patients treated for low-grade (n = 8) or high-grade (n = 9) meningioma and underwent both primary and recurrent resection between 2007–2017 were reviewed. Tumor specimens (n = 38) underwent genomic sequencing of known oncogenic driver mutations. Primary and recurrent tumors were compared using matched-pair analyses for mutational associations with clinical outcomes including functional status, progression-free survival (PFS) and overall survival (OS). Most common driver mutations included POLE and NF2. There was no enrichment for any driver mutation from primary to recurrent tumor specimen. NF2 mutant meningiomas were associated with larger tumor size (8-fold increase), presence of vasogenic edema, and higher mitotic proliferation on univariate and independently on multivariate regression (p’s < 0.05) after controlling for preoperative and tumor features. Tumors with POLE driver mutations were associated with decreased functional status at last postoperative follow-up (p = 0.022) relative to presentation. Mutation status was not associated with PFS or OS on multivariate Cox regression, but rather with grade of resection (p = 0.046) for PFS. While primary and recurrent tumors exhibited similar driver mutations within patients, the identification of driver mutations associated with clinical outcomes is crucial for guiding potential targeted treatments in recurrent meningiomas.