Total Excision Of Tumor Research Articles

Application and evaluation of minimally invasive surgical treatment options for early endometrial cancer.

Laparoscopic and robotic-assisted techniques have gained popularity, and endometrial cancer (EC) remains a significant health problem among women. Minimally invasive surgical (MIS) therapy options for early endometrial cancer will be evaluated for their effectiveness and safety is the aim of this paper. We also investigate the differences in oncologic outcomes between MIS and open surgery (OS) for individuals with early-stage EC. The patient was diagnosed with early-stage EC and treated with laparoscopic surgery and was the focus of a retrospective analysis. 162 patients with early EC were analyzed, with diagnoses occurring between 2002 and 2022. The patients were fragmented into two groups, one for OS and another for laparoscopic procedures. The total tumor excision and recurrence rates were identical across the two methods, indicating similar oncologic results. Rates of complications were likewise comparable across the two groups. The quality of life ratings of patients with robotic-assisted surgery was higher than those with laparoscopic surgery. Sixty-two (62.2%) of the 162 patients in this research had OS, whereas Fifty-six (57.8%) had MIS. The probability of recurrence of EC from stages III to IV was significanitly higher in women who had OS. Minimally invasive procedures were shown to be effective in treating early-stage EC, and while these findings provide support for their usage, larger multicenter randomized controlled studies are required to verify these results and further examine possible long-term advantages. Patients with early-stage EC, regardless of histologic type, had superior survival rates with MIS compared to OS.

Giant Solitary Pulmonary Fibrous Tumor: Case Report

The giant pulmonary solitary fibrous tumor is a mesenchymal tumor of rare fibroblastic differentiation, preferably intrathoracic and intraoral. Not associated with specific risk factors. Non-specific clinical presentation and slow growth. The present case is of a 54-year-old patient with dyspnea on medium exertion with the presence of abolished left vesicular murmur. He developed refractory hypoglycemia leading to Doege Potter syndrome. A total occupying mass was evident in the left chest on computed axial tomography. A modified approach was performed by sternotomy plus left thoracotomy to improve exposure and hemodynamic control with access to the tumor’s nutritional vessels and total tumor excision. Histopathology revealed a heavier tumor reported in the medical literature. Microscopy presence of mesenchymal neoplasia composed of spindle-shaped and oval cells and positive immunohistochemistry of giant solitary pulmonary fibroma.

Primary Spinal PNET: A Rare Case with Aggressive Progression.

PNET of spine are extremely rare, it represent less than 1% of spinal tumors. They are highly invasive and malignant, rapidly growing with grave prognosis. In this case report a 34 yrs lady presented clinically as back ache, urinary symptomps and progressive weakness & spasticty of both lower limbs. After workup patient underwent laminectomy & microscopic gross total excision of tumor, following surgery she improved symptomatically. After confirmation of HPE and IHC she underwent radiotherapy, but she not tolerated chemotherapy and later on tumor recurred and patient succumbed to the disease.

Isolated thoracic intradural extramedullary epidermoid cyst: A technical note.

Congenital, acquired, and iatrogenic spinal epidermoid cysts (EC) are very rare. A 62-year-old female patient presented with a 5-month history of progressive paraparesis leading to paraplegia secondary to a posterior compressive intradural extramedullary lesion at the T7 level. The patient underwent a laminectomy/durotomy for gross total tumor excision. Histopathology confirmed the lesion was an epidermoid cyst. Although her spasticity improved within 5 weeks, she only regained partial lower extremity motion (i.e., 3/5 motor function). Patients presenting with the acute/subacute onset of paraparesis secondary to spinal EC should undergo timely gross total cyst resections to optimize neurological outcomes.

Long-term follow-up of non-myasthenic patients with early-stage thymoma who underwent extended thymectomy or limited resection

BackgroudThe standard resection for early-stage thymoma is total thymectomy and complete tumour excision with or without myasthenia gravis but the optimal surgery mode for patients with early-stage non-myasthenic thymoma is debatable. This study analysed the oncological outcomes for non-myasthenic patients with early-stage thymoma treated by thymectomy or limited resection in the long term. MethodsPatients who had resections of thymic neoplasms at Taipei Veteran General Hospital, Taiwan between December 1997 and March 2013 were recruited, exclusive of those combined clinical evidence of myasthenia gravis were reviewed. A total of 113 patients were retrospectively reviewed with pathologic early stage (Masaoka stage I and II) thymoma who underwent limited resection or extended thymectomy to compare their long-term oncologic and surgical outcomes. ResultsThe median observation time was 134.1 months [interquartile range (IQR) 90.7–176.1 months]. In our cohort, 52 patients underwent extended thymectomy and 61 patients underwent limited resection. Shorter duration of surgery (p < 0.001) and length of stay (p = 0.006) were demonstrated in limited resection group. Six patients experienced thymoma recurrence, two of which had combined myasthenia gravis development after recurrence. There was no significant difference (p = 0.851) in freedom-from-recurrence, with similar 10-year freedom-from-recurrence rates between the limited resection group (96.2 %) and the thymectomy group (93.2 %). Tumour-related survival was also not significantly different between groups (p = 0.726).result ConclusionPatients with early-stage non-myasthenic thymoma who underwent limited resection without complete excision of the thymus achieved similar oncologic outcomes during the long-term follow-up and better peri-operative results compared to those who underwent thymectomy.

Influence of partial resection on survival in glioblastoma: a case report

Glioblastoma, known for its aggressive behavior and poor prognosis, presents a formidable challenge in the realm of neuro-oncology. The conventional treatment paradigm for glioblastoma typically involves maximal safe surgical resection followed by adjuvant chemotherapy and radiation therapy, with the overarching goal of prolonging survival and mitigating symptom burden. Despite the concerted efforts directed towards these therapeutic modalities, the overall prognosis for glioblastoma patients remains dismal, particularly in cases where only partial tumor resection can be achieved. This case study seeks to explore the impact of partial resection on survival outcomes in individuals diagnosed with glioblastoma. A 44-year-old male presented with a constellation of symptoms including impaired speech, recurrent headaches, weekly seizures, and left-sided weakness. Due to the tumor’s location near the motor strip, which posed a significant risk for neurological deficits, a decision was made to pursue partial resection, resulting in the removal of approximately 74 % of the tumor mass. Subsequent to the surgical intervention, the patient underwent a six-week course of chemotherapy utilizing temozolomide (75 mg/m2), albeit without adjunctive radiation therapy. Notably, the patient experienced improvement in symptomatology following the completion of therapy and demonstrated a survival duration of five months post-diagnosis.This case serves to underscore the potential therapeutic utility of partial resection as a viable treatment approach for glioblastoma, particularly in scenarios where achieving total tumor excision is deemed unattainable due to critical anatomical considerations. Furthermore, it underscores the imperative of individualized treatment strategies tailored to each patient’s unique clinical circumstances. Moreover, it emphasizes the critical need for ongoing research endeavors aimed at refining treatment approaches and improving outcomes for glioblastoma patients, particularly those with unfavorable prognostic profiles.

Long-Term Survival after Primary Ewing's Sarcoma of the Skull with Intracranial Extension.

Primary Ewing's sarcoma of the skull is a very rare malignant neoplasm, predominantly occurring in children and adolescents. We describe here the clinical, neuroradiologic, and histopathologic features of a patient with primary Ewing's sarcoma of the skull and discuss the standards of therapy for this type of tumor. This 18-year-old male patient presented with a primary Ewing's sarcoma of the skull, involving the dura of the frontal and parietal lobes of the left cerebral hemisphere. He was treated with gross total surgical excision of tumor, skull reconstruction, chemotherapy, and irradiation. Twelve years after the surgery, the patient has no evidence of local recurrence or distant metastases. Radical surgical excision of the primary tumor with safety margins is thought to play a role in the favorable clinical course. The presented case is the longest surviving patient after treatment of primary Ewing's sarcoma of the skull bone. This rare type of tumor may allow better survival rates under adequate management than sarcoma elsewhere in the body.

Endoscopic Transpterygoid Corridor for Petroclival Tumors: Case Series and Technical Nuances.

The petroclival area is a technically challenging region to operate owing to the proximity of the internal carotid artery (ICA) and the need to obtain gross total excision of tumors in this area as they are often resistant to radiotherapy. We present our experience with the endonasal endoscopic transpterygoid approach in managing tumors of the petroclival region and discuss various operative nuances for safer resection. A retrospective study of all consecutive cases of lesions occupying the petroclival region that were operated via endonasal endoscopic transpterygoid approach at our center between January 2016 and December 2021 was performed. The study included 14 cases of lesions occupying the petroclival region. Gross total resection by intraoperative observation was achieved in 10 patients, near total decompression was performed in two patients, and the remaining two patients underwent marsupialization of lesion. Postoperatively, one patient had right Lower motor neuron (LMN) facial nerve palsy and one patient required surgery for Cerebrospinal fluid (CSF) rhinorrhea on postoperative day 8. The mean duration of follow-up was 13.8 ± 16.6 months (range: 2-59 months). Four of six patients with visual symptoms on presentation reported improvement in vision, and the other two patients had a stable vision on follow-up. Two patients received radiotherapy postsurgery. No mortality was noted. The extended endonasal endoscopic transpterygoid approach can be safely and efficiently used for petroclival lesions. Very sound knowledge of anatomical relationship, use of intraoperative image guidance to avoid injury to ICA, and multilayer reconstruction with a vascularized nasoseptal flap are required to optimize the clinical outcome.

Clinical profile, histopathological, immunohistochemical, and molecular analyses and treatment of pilocytic astrocytoma: an eight year study from a tertiary health care centre in North East India

BackgroundPilocytic astrocytoma (PA) is a central nervous system (CNS) World Health Organization (WHO) grade 1 glial tumor that is highly prevalent in children and young adults. The main aim of the study was to assess the frequency, clinicopathological features, and treatment of PAs along with their immunohistochemical and molecular analyses in patients from Northeast India. About 144 glial tumors were diagnosed in patients from 3 to 75 yrs of age from January 2015 to March 2022. Nine pediatric PA patients were identified and their clinical data were analyzed. Immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), and molecular analysis using the real-time polymerase chain reaction (RT-PCR) were performed. Data analysis was performed using the SPSS software.ResultsThe mean age of the glioma patients was 41.7 yrs ± 18.2 with a male/female ratio of 1.3:1. The most common form of the glial tumor was found to be astrocytoma CNS WHO grade 2 (31.9%). The frequency of PA CNS WHO grade 1 was 6.9%. The pediatric PA cohort had a mean age of 9.2 yrs ± 4.9 with a male/female ratio of 2:1. Glial fibrillary acidic protein (GFAP) positive immunostaining and retention of transcriptional regulator alpha-thalassemia mental retardation X-linked protein (ATRX) expression was seen in all the tested PAs. The KIAA1459-BRAF fusion was detected in four PAs. Surgical intervention with total or radical tumor excision was performed for the PA patients. Eight PA patients exhibited improved condition post-surgery.ConclusionWith the advent of healthcare and newer diagnostic facilities there is an increased incidence of glial tumors in developing countries. A combination of histological, immunohistochemical, and molecular analysis is very important for the diagnosis, accurate treatment, and prognosis of PA patients.

Telovelar versus Transvermian Approach in Management of Patients with Fourth Ventricular Tumors

Background Approaching the fourth ventricle surgically is particularly challenging due to the limited working space provided by the important surrounding cerebrovascular structures. Its close relationship to the surrounding neural structures, including the brainstem and cerebellum, is the major limitation for surgical access. Various surgical routes to the fourth ventricular space will be described in the literature, including the conventional transvermian approach. Recent clinical and anatomical studies have suggested that the telovelar approach will maximize the extent of surgical exposure and working angle while minimizing operative morbidity. Objectives Our primary objective is to evaluate the efficacy and outcome of each approach in handling tumors within different parts of 4th ventricle. Our secondary objective is to analyze approach related complication and limitations of application to find best surgical option for those patients with posterior fossa lesions. Methods The following electronic databases will be searched from 2000 to 2019: PubMed, Google scholar, Cocharne database of systematic reviews, EMBASE and Science direct using Keywords ''Telovelar approach'', ''Transvermian approach'', ''fourth ventricular tumours'', ''Medullary velum''. Studies will be eligible if they contain the target Keywords in title or abstract, addressing our subject. Afterwards the full text of the article will be reviewed to exclude full texts not fulfilling the criteria or deviating from the initial impression taken from the title/abstract reviewing. References\ bibliography of the selected article will be sorted by discussion between study team (Student, Director and Codirectors). Results A total of 130 study were screened for eligibility, 6 studies were included in our systematic review for comparing the Telovelar and Transvermian approach in reaching posterior fossa lesions located within 4th ventricle regarding efficacy, clinical outcome and improvement, safety and complication. It was found that each approach has its own merits and demerits with nearly no difference between them regarding efficacy and safety, however slight superiority was linked to Telovelar approach in minimizing post-operative posterior fossa syndrome and Hydrocephalic changes. Conclusion we concluded that, Both transvermian -without sustained retraction- and telovelar approaches have no significant difference in safety, feasibility of total tumor excision, clinical outcome, postoperative complications and cerebellar mutism. The choice of either approach depends mainly on the surgeon's skills and preference, However the telovelar approach is generally preferred.

Temporal kemiğin dev hücreli tümörü

Giant cell tumor (GCT) arises from undifferentiated mesenchymal cells of the bone marrow. GCT, a benign and locally aggressive tumor, is more commonly seen in the metaphysis of long bones. It may cause local bone destruction, recurrence, and pulmonary metastases (~1%). A 15-year-old male patient was admitted with complaints of swelling on the right face, a headache that has persisted for one year and progressively worsened in the last three months, and hearing loss. Craniotomy and total tumor excision were performed. Histopathological examination revealed a giant cell tumor of the bone. We present a case of temporal bone GCT with its clinical and radiologic features.

Surgical Management of Diffuse Plexiform Neurofibroma in Von's Disease Recklinghausen: About a Case at Mopti Hospital

Introduction: Facial plexiform neurofibromas are considered a rare but disfiguring and devastating complication of facial neurofibromatosis. The objective of this work is to show the difficulties of the surgical management of the facial manifestations of neurofibromatosis. Observation: A 39-year-old woman consulted for a monstrous-looking swelling with an irregular texture on the left hemiface, evolving for 13 years. She underwent external carotid artery ligation, total tumor excision and thin skin grafting. Histology concluded to a facial plexiform neurofibroma. Discussion: Neurofibroma is a benign tumor arising from the connective elements of the Schwann sheath by proliferation of the endoneurial matrix. Complete surgical excision is the treatment of choice for neurofibroma. Conclusion: Facial neurofibromatosis surgery remains a challenge for the surgeon. We must have a critical look at our gestures and indications. In particular, provide for surgery after the age of puberty, ligation of the external carotid artery and reconstructive cosmetic surgery.

Case of Conus Paraganglioma: Case Report with Review

AbstractParagangliomas of spine are rare neuroendocrine tumors. They are World Health Organization grade 1 tumors with common location in cauda equina and filum terminale. We report a case of conus paraganglioma. A 57-year-old lady was admitted with low back pain with radiculopathy without bowel and bladder complaints. Magnetic resonance imaging (MRI) lumbosacral spine showed well-defined round-to-oval extramedullary lesion isointense on T1 and hyperintense on T2-weighted images at the level of L1 vertebra (suggestive of) neurogenic tumor. Intraoperatively reddish-brown capsulated tumor arising from conus with extension to filum and compressing the nerve roots was seen. Gross total excision of tumor was done. Microscopic examination showed well-encapsulated cellular tumor composed of sheets, anastomosing lobules, and nests of small, oval-to-round cells interspersed with blood vessels with mild nuclear atypia and occasional mitosis. Immunohistochemistry analysis was positive for synaptophysin and chromogranin suggestive of paraganglioma. Postoperative period was uneventful. MRI of dorso-lumbar spine showed no residual tumor. Patient was asymptomatic 5 months after surgery. The clinical, radiological, and pathological features of this rare tumor entity is presented.

Primary adrenal Ewing’s sarcoma family of tumors with tumor thrombus of the inferior vena cava: a case report

BackgroundEwing’s sarcoma is a malignant neoplasm that mainly occurs in skeletal tissue but can rarely arise in soft tissues. Recently, small round cell tumors (including Ewing’s sarcoma) caused by chromosomal translocations have been collectively termed Ewing’s sarcoma family of tumors. We report a rare case of primary adrenal Ewing’s sarcoma family of tumors with tumor thrombus.Case presentationA 22-year-old Asian woman was referred to our hospital with a left retroperitoneal tumor 19 cm in diameter. Tumor thrombus was identified from the left adrenal vein to the inferior vena cava, infiltrating the right atrium. Total tumor excision with left adrenalectomy, nephrectomy, and thrombectomy was performed under hypothermic circulatory arrest, followed by seven courses of adjuvant chemotherapy. The patient has shown no signs of recurrence as of 26 months postoperatively.ConclusionRadical surgery combined with systemic chemotherapy may contribute to good prognosis in patients with primary adrenal Ewing’s sarcoma family of tumors.

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

PurposeAfter a full-thickness total wall excision of a rectal tumor, suturing the defect is generally recommended. Recently, due to various contradictory studies, there is a trend to leave the defects open. Therefore, this study aimed to determine whether leaving the defect open is an adequate management strategy compared with suturing it closed based on postoperative outcomes and recurrences.MethodsA retrospective review of our prospectively maintained database was conducted. Adult patients who underwent transanal surgery for rectal neoplasm in our institution from 1997 to 2019 were analyzed. Patients were divided into two groups: sutured (group A) or unsutured (group B) rectal defect. The primary outcomes were morbidity (early and late) and recurrence.ResultsIn total, 404 (239 men) patients were analyzed, 143 (35.4%) from group A and 261 (64.6%) from group B. No differences were observed in tumor size, distance from the anal verge or operation time. The overall incidence of complications was significantly higher in patients from group B, which nearly double the rate of group A. With a mean follow-up of 58 (range, 12–96) months, seven patients presented with a rectal stricture, all of them from group B.ConclusionsWe acknowledge the occasional impossibility of closing the defect in patients who undergo local excision; however, when it is possible, the present data suggest that there may be advantages to suturing the defect closed.

Thoracoabdominal Approach for Giant Tumor Resection in Children

Objective: Surgical exposure has utmost importance in the success of oncological surgery. Traditional incisions may not be adequate for exposure and total excision of the giant tumors. Thoracoabdominal incision favors excision of giant upper abdominal and lower thoracal tumors eliminating telescopic vision and providing excellent exposure of vascular structures. This study is designed to review our institutional experience in upper retroperitoneal tumor excision via thoracoabdominal approach. Material and methods: The records of children who were operated for neuroblastoma, adrenocortical tumor and Wilms tumor with thoracoabdominal incision between 2015 and 2020 are reviewed retrospectively. Results: Eleven children underwent surgery via thoracoabdominal approach for neuroblastoma (n=8), adrenocortical carcinoma (n=2), and Wilms tumor (n=1). The female to male ratio was 1.2. The median age at operation was 58 months (IQR, 18-85). Patients with neuroblastoma had total resection (n=6) and near total resection (n=2). En bloc resection of tumor with adjacent viscera was performed in two patients with adrenocortical carsinoma. These patients had simultaneous ipsilateral pulmonary metastasectomy. Radical nephroureterectomy was performed in one with giant Wilms tumor. All patients had morphine patient–controlled analgesia for the first 2 days, and then paracetamol was used. Prolonged analgesia was not required in any patient. There was no pulmonary morbidity. Postoperative course was uneventful and the patients were discharged in 5 days (IQR, 4-6) The median follow-up time was 12 months (IQR, 10-18). Conclusion: The thoracoabdominal incision for difficult upper abdominal tumor is tolerated well by the patients. The enhanced exposure facilitates resection and improves local control. Simultaneous pulmonary metastasectomy can be performed with this incision.

DISP-02. CENTRAL NERVOUS SYSTEM METASTASES FROM EXOCRINE GLANDS CARCINOMA: CASE MANAGEMENT IN LOW RESOURCE SETTING AND REVIEW OF LITERATURE

Abstract INTRODUCTION Head and neck exocrine gland tumors metastases to central nervous system (CNS) account for less than 1% with median survival of less than 6 months. Unlike brain metastases from lung, breast, melanoma, and colon, there is no established consensus or published clinical guidelines in the management from excorine glands. Filipino patients are manage individually but experienced delays due to limited access to a tertiary level health care and with scarcity of treatment protocols. Methods and RESULTS We present two cases with exocrine glands carcinoma with CNS metastases. First case is a 51/F with a known case of left parotid cystic adenocarcinoma s/p parotidectomy and radiation therapy 2 years prior to the development of neurological deficits and COVID-19 infection, neuroimaging noted extra-axial 7.5 x 5 x 4.5 cm contrast enhancing tumor at bilateral frontal convexity. She underwent bifrontal craniotomy, gross total excision of tumor and anterior sagittal sinus, histopathology results cystic adenocarcinoma. She was discharged GOS 2, planned for chemoradiotherapy but lost to follow up and expired after 2 months post op. Second case is a 28/M known case of lacrimal gland pleomorphic adenocarcinoma OD s/p excision biopsy 2 years prior to the development of multiple right frontal lobe, right orbital wall and right pterion metastases. He underwent gross excision of extracranial and intracranial tumors and a right orbital exenteration. He was discharged GOS 2 and underwent chemoradiation as outpatient with good tumor control and no tumor recurrence after 1 year of treatment. DISCUSSION CNS metastases from exocrine glands are rare and difficult to manage since no approved protocol was established. Patients in low resource setting were then manage on individual basis since molecular and genomic studies are not available. The delays in the management are multifactorial such as geographic disadvantages, COVID-19 pandemic, and government's inadequate support for health system.

Intraoperative Neuromonitoring for Pediatric Pelvic Tumors.

BackgroundTumors of the pre-sacral and sacral spaces are a rare occurrence in children. Total tumor excision is required due to the significant risk of relapse in the event of partial surgery, but the surgical procedure may lead to postoperative problems such as urinary, sexual, and anorectal dysfunctions. Intraoperative neuromonitoring (IONM) has gained popularity in recent years as a strategy for preventing the onset of neurologic impairments by combining several neurophysiological techniques. The aim of our study is to describe the experience of Bambino Gesù Children’s Hospital in the use of IONM in pediatric pelvic surgery.Materials and MethodsThe data of patients treated for pelvic malignancies at Bambino Gesù Children’s Hospital from 2015 to 2019 were retrospectively collected. All patients were assessed from a neurologic and neuro-urologic point of view at different time-points (before and immediately after surgery, after 6 months, and 1-year follow-up). They were all monitored during a surgical procedure using multimodal IONM including transcranial motor evoked potentials (TcMEP), triggered-EMG (t-EMG), pudendal somatosensory evoked potentials (PSSEP), and bulbocavernosus reflex (BCR).ResultsDuring the study period, ten children underwent pelvic tumor removal at our Institution. In all cases, intraoperative neurophysiological recordings were stable and feasible. The preservation of neurophysiological response at the same intensity during surgical procedures correlated with no new deficits for all neurophysiological techniques.DiscussionAlthough the impact of the IONM on surgical strategies and clinical follow-up is unknown, this preliminary experience suggests that the appropriate use of several neurophysiological techniques can influence both the radicality of pelvic tumor removal and the neurological and urological outcome at clinical follow-up. Finally, because of the highly complex anatomy and inter-individual variances, this is especially useful in this type of surgery.

Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region: Review of Surgical Results.

Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV). To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV. Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011-May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots. Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions. Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.

Radiation therapy for pelvic recurrent colorectal or gynecological cancer: is whole pelvic irradiation necessary?

Preoperative whole pelvic radiation therapy (RT) is used commonly for rectal cancer and is the standard field postoperatively in gynecological cancer. However, the ideal field (local vs. whole pelvis) has not been determined for local recurrence of these cancers. We retrospectively reviewed the data for 52 patients who developed local tumor recurrence of rectal or gynecological cancer treated from 2013 to 2021. The initial treatment for all patients was total excision of the primary tumors without radiation therapy. Radiation therapy targets were surgical stumps, perianastomosis sites, and pelvic lymph nodes, classified according to the pelvic nodal volume atlas for radiation therapy. Patients were divided into the local recurrent tumor only radiation therapy group and the whole pelvis radiation therapy group. Whole pelvis radiation therapy included the common iliac lymph nodes or prophylactic lymph nodes below the L5/S1 junction. We recorded second recurrence after RT and the affected site(s) in each group. We also compared disease-specific survival using uni- and multivariate analyses. We found no significant differences between the groups regarding second recurrence or regarding the site(s) of recurrence. We also found no significant differences in disease-specific survival between the two RT groups. However, patients who did not receive chemotherapy after the initial surgery and before RT had significantly longer survival (P=0.015). In patients with locally recurrent rectal or gynecological cancer, we found no significant difference in second recurrence or survival between the local tumor only RT field and the whole pelvic RT field.