Suspicion Of Local Recurrence Research Articles

Hysterectomy in Local Recurrent Carcinoma Cervix following Concurrent Chemoradiaton

Concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer. However, residual or subsequent local recurrence is 10 to 30%. Several studies have reported the usefulness of salvage simple total hysterectomy, and efforts have been made to reduce complications. This is a case report of 64 years para 5 postmenopausal lady diagnosed as squamous cell carcinoma of cervix stage II B, had received concurrent chemoradiation. After 6 weeks of its completion, MRI revealed no residual disease. However, 6 months of no residual, USG and MRI revealed cervical lesion. With the suspicion of local recurrence, patient underwent total abdominal hysterectomy with bilateral salpingo-ophorectomy. She developed wound infection and per rectal bleeding which were treated. During her subsequent follow up visit, vault smear was negative and enhanced CT scan revealed no recurrence.

Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia

IntroductionTransperineal Prostate biopsies (TPBx) are usually performed under general anesthesia without image fusion. This study aimed to evaluate prostate cancer (Pca) detection rates (CDR), pain, and adverse events using a novel, free-hand TPBx technique, based on elastic fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) under local anesthesia. Materials and methodsThis multicenter retrospective study included all consecutive patients scheduled for a TPBx. All had clinical suspicion of Pca, active surveillance scheduled for a re-biopsy, or suspicion of local recurrence after previous treatment. Bi-parametric or multiparametric MRI was performed in all patients and classified as positive in the case of Prostate Imaging-Reporting and Data System (PIRADS) suspicion ≥3. At least 1 targeted TPBx was realized from each PIRADS ≥3 index lesion. Six to 12 systematic random TPBx were done in patients with negative MRI. All biopsies were performed under local anesthesia in an outpatient clinic with MRI-TRUS fusion and the 3D navigation system Trinity Perine (Koelis, France). Any- and clinically significant Pca (csPca) (ISUP gr. ≥2) was recorded. Biopsy-related pain and adverse events were reported according to a visual analogue score of 0–10. ResultsIn total, 377 patients were included for analyses. The mean age was 67 years (95% Confidence Interval: 66–68) and the median prostate-specific antigen was 7.2 ng/ml (interquartile range [IQR] 4.8–11.0). MRI was negative in 6% and positive in 94%. The median MRI prostate volume was 43 ml (IQR 31–60) and the median MRI index tumor volume was 0.9 ml (IQR 0.5–2.1). The median number of TPBx was 4 (IQR 3–4). The overall detection of any- and csPca was 64% and 52%, respectively. The overall CDR according to PIRADS 3, 4, and 5 was 30%, 70%, and 94%, respectively. In patients with negative MRI, any- and csPca was detected in 23% and 9%, respectively. The median visual analogue score score was 2 (IQR 1–3, range 0–7). Two patients (0.5%) developed postbiopsy infection, of which one developed urosepsis. Treatment requiring haematuria or urinary retention did not occur. ConclusionFree-hand MRI/TRUS fusion-guided and systematic random TPBx in LA is a feasible, safe, and well-tolerated technique for diagnosing Pca.

Feasibility Study Shows Multicenter, Observational Case-Control Study Is Practicable to Determine Risk of Secondary Breast Cancer in Females With Differentiated Thyroid Carcinoma Given Radioiodine Therapy in Their Childhood or Adolescence; Findings Also Suggest Possible Fertility Impairment in Such Patients.

Objective: This single-center, observational case-control feasibility study sought to test key elements of a protocol for an eventual long-term international observational case-control study of a larger patient cohort, to evaluate the risk of breast cancer as a second primary malignancy in females with differentiated thyroid cancer (DTC) given radioiodine therapy (RAI) during childhood or adolescence.Patients: Females developing DTC after the Chernobyl accident in Belarus and ≤19 years old at the time of thyroid surgery were enrolled: patients given RAI (n = 111) and controls of similar age not given RAI (n = 90).Results: One case of breast cancer was newly diagnosed among the RAI patients, but none in controls. Patients given RAI significantly less frequently needed 2nd surgeries than did controls (23%, 26/111 vs. 39%, 35/90, P < 0.05); the main indication for such procedures usually is suspicion of local recurrence. RAI patients appeared to have had more frequent reproductive difficulties than did controls: 78% (87/111) of the former vs. 93% (84/90) of the latter had a history of pregnancy (P < 0.01), and the mean number of pregnancies was 1.5 ± 1.2 in RAI patients vs. 1.9±1.1 in controls (P < 0.05). Most notably, infertility was observed in 23% (26/111) of RAI patients vs. 4% (4/90) of controls (P < 0.01). In conclusion, a international observational case-control study on breast cancer after DTC in patients given RAI vs. not given RAI appears to be feasible. Additional research and everyday clinical attention should be devoted to reproductive function after RAI in young females.

Functional imaging in soft tissue sarcomas: Update of the indications for 18F-FDG-PET/CT

Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumors when conventional image does not establish benignity with certainty and this determines the approach, in biopsy guiding in selected cases, in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumors, in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.

Imagen funcional en sarcomas de partes blandas: actualización de las indicaciones de la 18F-FDG-PET/TC

Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.

Imaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors.

SummaryBackgroundTumors of the developmental age are an important problem in clinical practice. Primary bone tumors constitute 1–1.5% of all tumors, and 7% of all tumors diagnosed in the developmental age. The aim of the study was to assess the capabilities of imaging methods in diagnosing complications of limb endoprostheses in children with osteoarticular tumors.Material/MethodsWe included 155 patients with limb endoprostheses, aged 7–26 years. There were 113 patients with knee prostheses, 1 patient with bilateral knee prostheses, 16 patients with shoulder prostheses, 14 patients with hip prostheses, 11 patients with hip and knee prostheses, and 1 patient with a femoral prosthesis. All patients underwent plain radiography and an ultrasound study.ResultsComplications were found in 50 patients (32% of all patients). The following complications were seen – inflammatory changes in soft tissues and bones (12 patients, 7.7%), stump fractures (11 patients, 7%), lack of elongation effect or shortening of the prosthesis (7 patients, 4.5%), prosthesis fractures (4 patients, 2.5%), crural fractures (4 patients, 2.5%), loosening of the prosthesis (3 patients, 1.9%), joint dislocation (2 patients, 1.3%), stump and prosthesis fracture (1 patient, 0.6%) and local recurrence (6 patients, 3.9%). Prostheses were exchanged for the following reasons – fractures (5 patients, 3.2%), inflammation (2 patients with 3 exchanges, 1.9%). Local recurrence and inflammation were confirmed by a biopsy.ConclusionsRadiography and ultrasonography are of crucial importance in monitoring patients after implantation of limb endoprostheses. The findings did not require confirmation in additional studies: CT and MRI. Suspicion of local recurrence and inflammation required a biopsy confirmation.

Follow-up after initial surgical treatment of soft tissue sarcomas in the extremities and trunk wall

Background/objectives: Evaluation of our surveillance program for soft tissue sarcomas (STS) and borderline tumors (BT) for identification of local recurrence and lung metastases the first 2 years postoperatively.Methods: We retrospectively assessed the medical files of all patients (n = 232) with STS and BT of the extremities and trunk wall who underwent surgery from 2010 to 2013. Two-hundred-and-thirty-two patients were included in the local recurrence study and 116 patients in the lung metastasis study. We extracted information on how local recurrence and lung metastases were detected. Kaplan–Meier survival analysis and 2 × 2-contingency table with Chi-square test were used. Local recurrence and lung metastases were analyzed separately.Results: Twenty-five of 232 patients experienced local recurrence and 19 of 116 patients experienced lung metastases. Compared to clinical examination, local imaging led to a larger amount of local recurrence suspicions (37/560 vs. 8/706). Suspicions occurring on local imaging were more accurate than on clinical examination (17/37 vs. 0/8 affirmed). Local imaging identified a larger amount of local recurrence than clinical examination (17/560 vs. 0/706). Thirty-three patients suspected local recurrence themselves, 8 were affirmed. Compared to x-ray, computerized tomography (CT) led to a larger amount of lung metastasis suspicions (22/284 vs. 6/276). Suspicions occurring on CT seemed more accurate than on x-ray (15/22 vs. 2/6 affirmed). CT found a larger amount of lung metastases than x-ray (15/284 vs. 2/276). Three patients suspected lung metastases themselves, 1 was affirmed.Conclusion: Bi-annual local imaging and CT the first 2 years after surgery of STS detect local recurrence and lung metastases better than clinical examination and x-ray. Clinical examination and x-ray between these examinations is unnecessary. Patients’ own suspicion of local recurrence and lung metastases is still important.

591 LOW DOSE BRACHYTHERAPY WITH I125 IN PATIENTS WITH LOCAL PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2010591 LOW DOSE BRACHYTHERAPY WITH I125 IN PATIENTS WITH LOCAL PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY F.G. Gómez Veiga, A. Marino, I. Gómez, L.A. Castelo, J. Gonzalez Dacal, S. Breijo, D. Lopez, J. Ponce, A. Candal, and V. Chantada F.G. Gómez VeigaF.G. Gómez Veiga More articles by this author , A. MarinoA. Marino More articles by this author , I. GómezI. Gómez More articles by this author , L.A. CasteloL.A. Castelo More articles by this author , J. Gonzalez DacalJ. Gonzalez Dacal More articles by this author , S. BreijoS. Breijo More articles by this author , D. LopezD. Lopez More articles by this author , J. PonceJ. Ponce More articles by this author , A. CandalA. Candal More articles by this author , and V. ChantadaV. Chantada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.863AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment for patients with biochemical progression after radical prostatectomy (RP) and suspicion of local recurrence usually consists of external beam radiotherapy. This a valid option, but not exempt from complications, and is demanding in terms of dose adjustment and definition of target volumes. Low dose- brachytherapy (LDB) is an alternative option for patients with localized prostate cancer. The aim of this prospective study was to analyze the capacity of LDB to treat patients with local progression after RP in terms of toxicity and oncologic control METHODS 42 patients were treated for local prostate cancer relapse from April 2004 to July 2009. Median age was 69.2 years(54-76). The pathologic staging after at RP was 1(2.4%) pT0, 5(11.9%) pT2a, 7(16.7%), pT2b, 14(33.3%)pT2c, 11(26.2%) pT3a and 4(9.5%) pT3b. Local progression in all cases was confirmed by positive biopsy. The Gleason score (GS) on control biopsy ranged from 6-9, 20(47.1%) GS 6, 18(42.9%) GS 7 and 4 (9.5%) GS ≥8. Only patients with more than 6 months follow-up were included n=35. The median follow-up was 29.5 months (6-60.5), and median time to biochemical progression 26 months. Median PSA before LDB was 1.9 ng/mL(range 0.24-6.8). Real-time implant was realized using Variseed 7.2 program and Rapid Strand ®seeds were used. Treatment dose planning was for 144 Gy to cover the anastomotic area. Median volume prescription was 10cc (3.1-23), seeds activity 0.48mci, seeds per session 44.4, and median prostate and urethra d90 174Gy and 121G respectively. All patients were assessed for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity as defined by RTOG. Biochemical failure was defined using the Phoenix definition. All cases were hormone naive prior to LDB. RESULTS Median hospital stay was 21h. There were no major perioperative complications. All patients were discharged without urethral catheter. Acute GI and GU complications grade 1 and 2 were 2(5.7%), 1(2.9%) and 14(40%) and 3(8.6%) respectively.Mild previous incontinence improved in 3 patients (8.6%). Late GI and GU complications grade 1 or 2 were 3 (8.8%), 1 (2.9%), and 3 (8.6%) and 1 (2.9%) respectively. With a median follow up of 29.5 months, biochemical relapsed-free survival was 88.6%, 4 patients had biochemical failure and one patient died, related to prostate cancer the cancer- free survival was 97%. CONCLUSIONS Although longer follow up is needed, these promising results, with minimal morbidity and excellent biochemical response, lead us to believe that LDB is a valid salvage option or patients with local relapse after RP A Coruna, Spain© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e232 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information F.G. Gómez Veiga More articles by this author A. Marino More articles by this author I. Gómez More articles by this author L.A. Castelo More articles by this author J. Gonzalez Dacal More articles by this author S. Breijo More articles by this author D. Lopez More articles by this author J. Ponce More articles by this author A. Candal More articles by this author V. Chantada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report

IntroductionPatients with resection of stomach and especially with Billroth II reconstruction (gastro jejunal anastomosis), are more likely to develop afferent loop syndrome which is a rare complication. When the afferent part is obstructed, biliary and pancreatic secretions accumulate and cause the distention of this part. In the case of a complete obstruction (rare), there is a high risk developing necrosis and perforation. This complication has been reported once in the literature.Case presentationA 54-year-old Greek male had undergone a pancreato-duodenectomy (Whipple procedure) one year earlier due to a pancreatic adenocarcinoma. Approximately 10 months after the initial operation, the patient started having episodes of cholangitis (fever, jaundice) and abdominal pain. This condition progressively worsened and the suspicion of local recurrence or stenosis of the biliary-jejunal anastomosis was discussed. A few days before his admission the patient developed signs of septic cholangitis.ConclusionOur case demonstrates a rare complication with serious clinical manifestation of the afferent loop syndrome. This advanced form of afferent loop syndrome led to the development of huge enterobiliary reflux, which had a serious clinical manifestation as cholangitis and systemic sepsis, due to bacterial overgrowth, which usually present in the afferent loop. The diagnosis is difficult and the interventional radiology gives all the details to support the therapeutic decision making. A variety of factors can contribute to its development including adhesions, kinking and angulation of the loop, stenosis of gastro-jejunal anastomosis and internal herniation. In order to decompress the afferent loop dilatation due to adhesions, a lateral-lateral jejunal anastomosis was performed between the afferent loop and a small bowel loop.

Diagnosis of Mandibular Osteomyelitis in Probable Coexisting Tumor Recurrence: Role of Tc-99m Ciprofloxacin Imaging

We demonstrate the use of Tc-99m ciprofloxacin imaging in a follow-up case of squamous cell carcinoma of the tongue post hemi-mandibulectomy with clinical suspicion of local recurrence of osteomyelitis. On Tc-99m ciprofloxacin scan, we observed a focus of sharply increasing radiotracer concentration in the left side of the mandible after 24 hours, indicating active bacterial infection. Histopathologic analysis revealed no evidence of local recurrence, whereas the culture examination showed bacterial growth sensitive to ciprofloxacin. A follow-up Tc-99m ciprofloxacin scan after debridement and 8 weeks of antibiotic treatment showed no focus of tracer concentration in the region of the mandible.

11C-coline-positron emission tomography/computerized tomography (C-PET/CT) for tumor localization of locally recurrent prostate cancer after radiation therapy

15519 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized PCA. C-PET/CT is an innovative imaging technique for the evaluation of PCA. It was the purpose of our study to assess the sensitivity of C-PET/CT to predict local intra- and extraglandular extent of PCA and the presence of lymph node involvement. Methods: 45 patients with biopsy-proven locally recurrent PCA scheduled for sRPE underwent preoperative C-PET/CT. All patients underwent retropubic sRPE with extended pelvic lymphadenectomy. The prostatectomy specimens were processed according to the Stanford protocol and pathohistological results were compared to C-PET/CT findings. Intraglandular location of cancer nodules = 5mm was correlated with PET/CT findings. Results: A total of 45 patients underwent sRPE; mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. C-PET/CT identified 1, 2, 3 or more than 3 intraprostatic cancer nodules in 23 (51.1%), 13 (28.9%) and 9 (20%) patients, respectively. Correlation of prostate biopsy findings with PET/CT findings demonstrated a sensitivity of 90% for PET/CT. There was a low sensitivity for PET/CT detecting lymph node metastases. A positive uptake was identified in 14 (31.1%) patients; pathohistology revealed positive lymph nodes in 9 patients with only 4 patients exhibiting positive 11C-choline uptake and 5 patients having demonstrated a negative preoperative PET/CT scan. Conclusions: C-PET/CT is a valuable imaging modality for the detection of locally recurrent prostate cancer after radiation therapy. Due to its high sensitivity it might replace prostate biopsy prior to sRPE and it might be of additional value in patients with a negative biopsy but a high suspicion of local recurrence. The value of PET/CT for the identification pN1 disease is of modest value and not reliable. No significant financial relationships to disclose.

Fusion Image of Positron Emission Tomography and Computed Tomography for the Diagnosis of Local Recurrence of Rectal Cancer

The aim of this study was to evaluate the clinical and therapeutic value of digital fusion image (FI) of positron emission tomography (PET) using (18)F-fluorodeoxy glucose and computed tomography (CT) in patients who were suspected of having a local recurrence of rectal cancer. Forty-two patients (32 men and 10 women; mean age, 61.4 years, range, 40-79 years) with a suspicion of local recurrence after curative resection of rectal cancer were prospectively recruited and underwent (18)F-fluorodeoxy glucose-PET and CT. The FI was reconstructed with a commercially available digital software program, T-B Fusion. Wilcoxon signed rank test was used to compare FI with CT alone or PET alone. FI yielded a correct diagnosis in 39 (93%) of 42 patients, whereas CT alone and PET alone did so in 33 (79%) and 37 (88%) patients, respectively. FI had better diagnostic accuracy than CT alone (P = .0138) and PET alone (P = .0156). Overall, FI altered patient management in 11 (26.2%) patients on the basis of additional information, including differentiation of the tumor from the postoperative scar in 6 patients, exact anatomical location in 3 patients, and both in 2 patients. FI has a potential clinical value in the treatment of suspected local recurrence of rectal cancer.

Added value of cea scintigraphy in the detection of recurrence of rectal carcinoma

Purpose: To explore the diagnostic value of immunoscintigraphy compared to CT and/or MR imaging in the diagnosis of local recurrence (LR) of rectal cancer. Material and Methods: Forty-six patients suspected of having LR of rectal cancer were retrospectively studied. Carcinoembryonic antigen (CEA) scintigraphy findings were compared to CT and/or MR in all patients, and with data from surgery and morphology (31 patients), biopsy (7 cases) and follow-up (8 patients). Results: CEA scintigraphy was not complementary to CT and/or MR in the detection of LR. Two false-positive and 14 false-negative diagnoses of LR occurred with CEA scintigraphy. Distant metastases including metastatic lymph nodes were found by this method in only 7 of 27 patients with proven metastases. CT/MR were able to demonstrate these metastases in 21 of 27 patients. Conclusion: Accuracy and sensitivity of CEA scintigraphy in the detection of LR and distant metastases is lower than that of CT and/or MR. However, CEA scintigraphy seems to have a high specificity and could therefore be used in patients with a strong clinical suspicion of LR but negative CT/MR investigations. Available diagnostic methods have limitations in differentiating between benign, post-treatment changes and LR of rectal cancer and in staging of malignant disease.