Terms Of Local Recurrence Rate Research Articles

Lateral lymph node dissection can increase overall survival and 5‑year survival rate of rectal cancer patients: A meta‑analysis.

Rectal cancer is one of the most malignant tumors, and postoperative recurrence and metastasis are the main reasons for treatment failure. Lymph node metastasis is the main metastatic pathway of rectal cancer. The present study aimed to investigate the role of lateral lymph node dissection (LLND) in patients with rectal cancer using a meta-analysis. Articles in Chinese and English related to the application of LLND in patients with rectal cancer were retrieved and eligible studies were selected for data analysis. Evaluation indicators included the 5-year survival rate, recurrence rate, urinary system function and operation time. The random-effects model was utilized for the analysis. A total of 10 studies that met the eligibility criteria were selected, comprising 2,272 patients, including 1,101 cases in the LLND group and 1,171 cases in the non-LLND group. No significant difference was found between the two groups in terms of local recurrence rate, 5-year disease-free survival (DFS) rate, and DFS rate at the follow-up. It is noteworthy that cases in the LLND group had no significantly longer overall survival, but had a higher 5-year survival rate. However, cases in the LLND group had a longer operation time and worse urinary dysfunction. The results remained consistent throughout separate analyses for different research quality sources. The present meta-analysis showed that LLND provided a specific advantage in prolonging survival time. However, it was associated with prolonged operation time and an increased incidence of urinary dysfunction.

Surgical margins for borderline and malignant phyllodes tumours.

Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.

Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature.

Denosumab is a human monoclonal antibody (mAb) that specifically inhibits tumor-associated bone lysis through the RANKL pathway and has been used as neoadjuvant therapy for giant-cell tumor of bone (GCTB) in surgical as well as non-surgical cases. The purpose of this systematic review of the literature, therefore, is to investigate: (1) demographic characteristics of patients affected by GCTBs treated with denosumab and the clinical impact, as well as, possible complications associated with its use (2) oncological outcomes in terms of local recurrence rate (LRR) and development of lung metastasis, and (3) characteristics of its treatment effect in terms of clinical, radiological, and histological response. A systematic review of the literature was conducted using PubMed, EMBASE, and COCHRANE search including the following terms and Boolean operators: "Denosumab" AND "primary bone tumor", "denosumab" AND "giant cell tumor", "denosumab" AND "treatment", and finally, "denosumab" AND "giant cell tumor" AND "treatment" since 2000. After applying inclusion and exclusion criteria, a total of 19 articles were included. The quality of the included studies was assessed using STROBE for the assessment of observational studies. A total of 1095 patients were included across all 19 studies. Across all the studies included, there were 615 females and 480 males. The mean patient age was 33.7 ± 8.3years when starting the denosumab treatment. The pooled weighted local recurrence rate was 9% (95% CI 6-12%) and the pooled weighted metastases rate was 3% (95% CI 1-7%). The most common adverse event was fatigue and muscular pain. Radiologic response was estimated to occur in 66-100% of the patients. A significant reduction in pain under denosumab treatment was reported in seven studies and additional improvement in function and mobility was reported by several authors. Only two studies reported musculoskeletal tumor society (MSTS) scores which were better after denosumab treatment. The use of denosumab as an adjuvant treatment of GCTB has shown a positive but variable histological response with consistent radiological changes and several types of adverse effects. There is a positive clinical response in terms of pain relief with decrease on the morbidity of surgical procedures to be performed. Finally, oncological outcomes are disparate with neither effect on metastatic disease nor local recurrence rates. IV.

Are older patients with solitary spinal metastases fit for total en-bloc surgery?

ObjectiveDue to radical resection, total en-bloc spondylectomy (TES) is associated with significant levels of surgical injury and spinal instability, particularly in elderly patients with solitary spinal metastases (SM), whether the possible benefits outweigh the risk requires intense consideration. Our aim was to compare and analyze the impact of age on patient prognosis. Patients and MethodsThis study investigated TES in 78 consecutive patients with solitary SM, who were divided into Group A (>65 years, n = 32) and group B (<60 years of age, n = 46). Surgical outcomes were assessed according to survival time, local recurrence, neurological function, pain, and quality of life before and after surgery. Differences between groups were statistically compared using analysis of variance (ANOVA) or chi-square tests. ResultsThere was no significant difference between the two groups in terms of surgery duration, blood loss, blood transfusion or the duration of hospital stay (p > 0.05). Furthermore, there was no significant difference in the median survival time between the two groups (p > 0.05). However, the perioperative complication rate in group A was higher than that in group B (p < 0.05). There was no significant difference in terms of local recurrence rate when compared between group A and group B (p > 0.05), and there were no significant differences in terms of improvements in neurological function, Visual Analogue Scale and Karnofsky scores of patients between the two groups (p > 0.05). ConclusionOlder patients can experience survival and local recurrence rates that were similar to those of younger patients. Although older patients are at increased risk of perioperative complications, this factor does not appear to lead to serious adverse outcomes. Older patients are still good candidates to receive TES to cure solitary SM after careful preparation and strict selection.

Is left upper lobectomy always worthwhile for early stage lung cancer? A comparison between left upper lobectomy, trisegmentectomy, and lingulectomy

Lobectomy is the gold standard treatment for resectable Non-Small Cell Lung Cancer (NSCLC). We compared oncological outcomes of patients undergoing a "multi-segmentectomy" (trisegmentectomy or lingulectomy) and left upper lobectomy for early stage (T1-2, N0) NSCLC of the left upper lobe. We retrospectively analyzed all patients with pathological early stage (T1-T2 N0) NSCLC located in left upper lobe who underwent a lobectomy, a trisegmentectomy, or a lingulectomy between 2006 and 2013, focusing on surgical and oncological outcomes. Among 159 patients, 105 patients underwent a lobectomy and 54 patients a multi-segmentectomy (33 lingulectomy and 21 trisegmentectomy). Actuarial mean Overall Survival was 87 months (95%CI 79-95) and 89 months (95%CI 76-101) for lobectomies and multi-segmentectomies, respectively (P-value: 0.895), while actuarial mean Disease Free Interval was 91 months (95%CI 82-100) and 96 months (95%CI 84-108) respectively (P-value: 0.565). We did not observe any difference in terms of local recurrence rate between the two groups (P = 0.337). Lingulectomy and trisegmentectomy lead to similar oncological outcomes compared to left upper lobectomy for T1 and T2 N0 NSCLC, and they could be used as an alternative to lobectomy even in patients with a good pulmonary function.

Basal cell carcinoma: Epidemiology, clinical and histologic features, and basic science overview

Basal cell carcinoma (BCC) is a quite ubiquitous entity in dermatology and dermatopathology, and, together with cutaneous squamous cell carcinoma (cSCC), constitutes the bulk of the socalled “nonmelanoma skin cancer” (NMSC) cases. Both BCC and cSCC arise in a similar clinical background of chronic sun damage and immunosuppression, among other risk factors. However, it is important to emphasize that BCC represents more of a locally aggressive tumor that rarely metastasizes, compared with cSCC, particularly some subtypes, which may have a higher risk of metastatic spread and even death. BCC can be classified into several variants that demonstrate different clinical behaviors, particularly in terms of local recurrence rates. We review the different facets of BCC to include up to date epidemiologic data, clinical and histopathologic presentations, as well as the latest findings on the molecular alterations driving this entity.

Class II versus Class III radical hysterectomy in early cervical cancer: An observational study in a tertiary center

AimsThe purpose of this observational study was to evaluate disease free survival (DFS), overall survival (OS), and local recurrence rate (LRR) in patients submitted to Class II RH compared with Class III RH in early FIGO stage cervical cancer (ECC). Materials and methodsWe investigated 127 patients with CC admitted to the National Cancer Institute of Milan from June 2001 to October 2011 treated with Class II RH, and compared them with 202 patients operated with Class III RH between March 1980 and March 2001. A total of 329 patients were collected. ResultsMedian follow-up time was 91 months (IQ range:58–196). Five-year OS and DFS estimates were 89.5% (95%CI: 86.0–93.2%) and 85.6% (95%CI: 81.6–89.7%), respectively. Estimates of effect of surgical treatment (Class III RH versus Class II RH) on OS showed a HR of death = 3.38 (95%CI: 1.18–9.63, P = 0.0228), at univariable Cox analysis, and a HR = 3.08 (95%CI: 0.96–9.93; P = 0.0595) at multivariable analysis. For DFS, a HR of relapse = 2.51 (95%CI 1.10–5.72; P = 0.0290) comparing Class III vs Class II was found at multivariable analysis. Overall recurrence rate was 12.8%, whilst it was 16.3% for Class III and 7.1% for Class II respectively. ConclusionsThe present data suggest that the outcomes of Class II RH are comparable in terms of LRR and OS to those of Class III RH, according to literature data. The opportunity of extending the indication to all women with ECC needs further investigations. Clearer data are warranted by prospective controlled studies.

Locally advanced rectal cancer: the importance of a multidisciplinary approach.

Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.

Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience

The authors present their experience with rectal adenomas managed by transanal endoscopic microsurgery (TEM). The goals of this study were to examine our institution's experience by evaluating surgical morbidity, mortality, and local recurrence rate. This retrospective study investigated 402 patients who underwent TEM a for preoperative diagnosis of adenoma from January 1993 to October 2008. The mean age was 65 years (range = 22-92 years). All patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. No 30-day perioperative mortality occurred. No conversion to laparoscopic or open procedures was reported. Minor complications occurred in 28 (7%) patients, whereas major complications were found only in 2 (0.5%) patients. Definitive histology confirmed adenomas in 366 cases (91%). At a mean follow-up of 84 months (range = 1-190 months), 16 (4%) adenomas recurred and were successfully retreated by TEM [14 cases (87.5%)] and by conventional surgery [2 patients (12.5%)]. No further recurrences were observed at subsequent follow-up. The findings warrant the conclusion that TEM is a safe, effective treatment for rectal adenomas where endoscopic removal is not applicable and has low morbidity and no mortality.

Transanal endoscopic microsurgery in rectal adenomas: Experience of six Italian centres

Background/aims Transanal endoscopic microsurgery is a minimally invasive technique that allows the excision of benign and selected malignant tumours. We present a study for evaluating surgical morbidity, mortality and local recurrence rate of patients with rectal adenomas treated with transanal endoscopic microsurgery in six different Italian centres following the same protocol. Methods A total of 882 patients with rectal lesions (adenomas and early stage of carcinomas) underwent transanal endoscopic microsurgery in six different Surgical Departments from January 1993 to October 2004. Five hundred and ninety patients had preoperative diagnosis of adenomas but 588 patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. Results The study involved 588 patients, with a median age of 66 years (25th percentile–75th percentile = 58–71 years). No postoperative mortality was reported. Intraoperative complications were observed in three patients (0.5%). Minor complications occurred in 48 patients (8.2%) whereas major complications were found only in 7 patients (1.2%). Definitive histology confirmed adenomas in 530 cases (90.1%). Two patients (0.3%) were lost to follow-up so were not included in the paper. At median follow-up of 44 months (25th percentile–75th percentile = 15–74 months), 23 (4.3%) adenomas recurred and were successfully retreated by transanal endoscopic microsurgery [20 cases (87%)] and by conventional surgery [3 patients (13%)]. No further recurrences were observed at subsequent follow-up. Thirty-one (5.3%) patients died during follow-up for old age, cardiac disease, etc. Conclusions Transanal endoscopic microsurgery is, in our experience, an effective method for local resection of benign rectal tumours with morbidity of 11.4%, no postoperative mortality and with a percentage of local recurrence of 4.3%.

A Systematic Overview of Radiation Therapy Effects in Breast Cancer

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for breast cancer is based on data from 29 randomized trials, 6 meta-analyses and 5 retrospective studies. In total, 40 scientific articles are included, involving 41 204 patients. The results were compared with those of a similar overview from 1996 including 285 982 patients. The conclusions reached can be summarized as follows: <list id="l1" type="5"> <item>There is strong evidence for a substantial reduction in locoregional recurrence rate following postmastectomy radiation therapy to the chest wall and the regional nodal areas.</item><item>There is strong evidence that postmastectomy radiation therapy increases the disease-free survival rate.</item><item>There are conflicting data regarding the impact of postmastectomy radiotherapy upon overall survival.</item><item>There is strong evidence that breast cancer specific survival is improved by postmastectomy radiotherapy.</item><item>There is strong evidence for a decrease in non-breast cancer specific survival after postmastectomy radiotherapy.</item><item>There is some evidence that overall survival is increased by optimal postmastectomy radiation therapy.</item><item>There is strong evidence that postmastectomy radiotherapy in addition to surgery and systemic therapy in mainly node-positive patients decreases local recurrence rate and improves survival.</item><item>There is moderate evidence that the decrease in non-breast cancer specific survival is attributed to cardiovascular disease in irradiated patients.</item><item>There are conflicting data whether breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of local recurrence rate.</item><item>There is strong evidence that breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of disease-free survival and overall survival.</item><item>There is strong evidence that postoperative radiotherapy to the breast following breast conservation surgery results in a statistically and clinically significant reduction of ipsilateral breast recurrences followed by diminished need for salvage mastectomies.</item><item>There is strong evidence that the omission of postoperative radiotherapy to the breast following breast conservation surgery has no impact on overall survival. In one meta-analysis including three randomized studies a survival advantage is demonstrated by Bayesian statistics.</item><item>There is strong evidence that the addition of a radiation boost after conventional radiotherapy to the tumour bed after breast conservation surgery significantly decreases the risk of ipsilateral breast recurrences but has no impact on overall survival after short follow-up.</item><item>There is strong evidence for the use of postoperative radiotherapy to the breast following breast conservation surgery for DCIS (ductal breast cancer in situ). Radiotherapy leads to a clinically and statistically significant reduction of both non-invasive and invasive ipsilateral breast recurrences.</item><item>There is insufficient evidence to define the optimal integration of systemic adjuvant therapy and postoperative radiotherapy.</item><item>There are limited data on radiotherapy-related morbidity in breast cancer. No conclusions can be drawn.</item></list>

Is radiotherapy needed after breast conservation for small invasive breast cancers?

Aims: The purpose of this study was to determine the rate of local recurrence in patients with small invasive breast cancers (<1cm) who had been treated with breast-conserving surgery either with (group 1) or without (group 2) adjuvant radiotherapy.Methods: This is a retrospective study of 110 patients with an invasive breast cancer less than 1cm in size, treated in our centre by breast-conserving surgery. Parameters examined included age at and mode of presentation, histopathological features, adjuvant therapy, length of follow-up and outcome in terms of local recurrence rate and death.Results: In group 1 there were 59 women of median age 57 (38–80) years. The median tumour size was 9 (1–10) mm and median follow-up was 74 (15–110) months. There were no local recurrences. In group 2 the median age at presentation was 59 (48–81) years. The median tumour size was 7 (2–10) mm and median follow-up was 47 (14–93) months. There were three non-breast-cancer related deaths and three local recurrences (6%).Conclusions: A local recurrence rate of 6% at almost 4 years median follow-up suggests that it may be possible to avoid adjuvant radiotherapy in a subgroup of largely screen-detected, node-negative patients with invasive tumours less than 1cm, in whom adequate local excision is performed. Further follow-up is required to substantiate this.

Surgical Treatment of Penile Carcinoma: Our Experience from 1976 to 1997

Objective: The purpose of this work is to evaluate our experience with the surgical treatment of penile squamous carcinoma, analyzing the therapeutic results in terms of local recurrence rates, survival and mortality rates. Material and Methods: From 1976 to 1997, 47 patients were treated at our institution for carcinoma of penis. Treatment of primary tumor was conservative in 8 patients (17%). Partial penectomy was performed in 30 patients (63.8%); total penectomy in 5 (10.7%) and emasculation in 4 (8.5%). Pathological stage was pTis in 2 cases (4.2%), pT1 in 20 (42.6%), pT2 in 21 (44.7%) and pT3 in 4 (8.5%). The tumor was clinically overstaged in 13 patients (27.7%) and understaged in 4 (8.5%). Bilateral inguinal lymphadenectomy was performed only in 4 patients clinically N+ (pN2) and in 3 clinically N0 (pN0). Results: Local recurrence rate was 43% in the patients with pT1 stage tumor treated conservatively. No local recurrence was observed after penectomy. 19 patients (40.4%) are alive and disease-free; 17 patients (36.2%) died of the tumor and 11 patients (23.4%) died of other causes but disease-free. Mean follow-up is 69.43 months. The overall 5-year survival rate was 34%. Conclusion: Partial penectomy gives better results than conservative treatment in the local management of the T1 stage tumor. Survival and mortality rates are related to both pathological and histological stages. The high mortality rate observed in the pT2 stage tumors in our experience might be related to the fact that in this stage an inguinal lymphadenectomy was not performed as a rule.

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer

Background The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. Methods One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. Results The adjuvant treatment was well tolerated. After an observation time of 4–8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P= 0·01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0·01) and 50 per cent (P = 0·05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0·48 (95 per cent confidence interval 0·28–0·82) and 0–56 (0·33–0·94) respectively. Conclusion The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer

The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Adenoid cystic salivary gland carcinoma: A clinicopathologic correlation

Between 1960 and 1980, 71 cases of adenoid cystic carcinoma (ACC) were reviewed according to treatment modality and clinical course. Histologic review of pathologic slides was performed to classify the tumors into their predominant histologic pattern (tubular, cribriform, solid). The predominant histologic patterns of the tumors were equally divided between tubular and cribriform. Very few were classified as a solid pattern. In the patients receiving the same type of therapy (surgery and irradiation), the cribriform and tubular variants of ACC demonstrated no difference in the rate of distant metastases and overall survival. The cribriform variant demonstrated a significantly worse prognosis in terms of local recurrence rate. The patients who had a solid histologic pattern of ACC appeared to have an overall worse prognosis in terms of distant metastases and long-term survival. The long-term survival of patients with ACC may be related to the development of distant metastases despite local control.