Treatment Of Recurrent Tumors Research Articles

Therapy possibilities for locoregional recurrences in breast cancer

In 10–30 % of cases, locoregional recurrence is accompanied by distant metastasis; a further 25 % develop distant metastasis within the year after diagnosis of recurrence. In treatment of recurrent tumor in the thoracic wall, axillary or supraclavicular disease surgery plays a major role. Since – another long-lasting courses occur even in the metastatic situation, recurrence is not an infrequent event, and therapy then needs a multidisciplinary approach. Surgical techniques such as local, myocutaneous or omental flaps and mesh graft transplantation are used to cover large defects after tumor resection. Additional and innovative modalities are combined in the management of this complex problem: locoregional or systemic chemotherapy, topical application of chemotherapy, certain radiation regimens and in otherwise resistant tumors the experimental use of photodynamic laser therapy (PDT). The most important goal hereby is to restore or at least maintain organ function and quality of life.

Primary liver cancers

A review of the recent literature about liver cancers shows the increasing role of hepatitis C as a risk factor for the development of hepatocellular carcinoma. A new discussion has arisen with regard to the association between the use of oral contraceptives and hepatocellular carcinoma. Patients at risk for developing liver cancer can be identified and should undergo thorough follow-up to detect cancer at an early stage. Surgical resection remains the treatment of choice whenever feasible. Because of disappointing results and limited availability of donor organs, liver transplantation must be considered only in selected patients with unresectable tumors. There are also arguments recommending transplantation in early resectable hepatocellular carcinoma in patients with cirrhosis to cure the underlying cancer-bearing disease. Improvement of survival can be expected by promising multimodality treatment protocols that have been started during the past few years. Further studies should also investigate the role of immunosuppression in the treatment of tumor recurrence. For patients excluded from resection and transplantation, the most effective treatment options are transarterial chemoembolization and, in small lesions, percutaneous ethanol injection therapy. In small tumors, combination therapy seems to be even more appropriate.

Cerebellar astrocytoma of childhood: long-term follow-up

Cerebellar astrocytoma of childhood has always been regarded as a benign tumour. Certain issues still attract debate, in particular the role of radiotherapy as an adjuvant to surgery, management of the cyst wall in cystic lesions and treatment of recurrent tumours. To provide some answers to these questions, the experience in Birmingham (United Kingdom) between the years 1959 and 1991 was reviewed. Ninety-seven patients aged 0-14 years had been treated and the histological material was reassessed independently. Detailed statistical and clinical analysis revealed that the main factor of negative prognostic value was the presence of brain stem involvement. In cystic tumours the surgical excision of the cyst wall did not offer significant advantage on survival. Similarly, postoperative radiotherapy did not improve survival, and there is a suggestion that it may actually predispose to malignant transformation. The implications on management are discussed.

Selection bias, survival, and brachytherapy for glioma

Interstitial irradiation is a promising treatment for malignant glioma. Longer than expected survival periods following treatment of recurrent tumor have led to the use of brachytherapy as an adjuvant treatment. The impact of patient selection on survival data was studied among candidates for this therapy. Consecutive, conventionally treated adults with newly diagnosed supratentorial tumors were identified retrospectively at a center where experience with glioma is population-based. Based on imaging and performance status, two surgeons and a radiation oncologist designated each patient as either eligible or ineligible for adjuvant brachytherapy. The survival and prognostic factors in the eligible and ineligible groups were analyzed. Overall, the patients eligible for brachytherapy (32% of the series) lived significantly longer than the ineligible patients (16.57 vs. 9.30 months), were younger, and had larger resections and better function. For glioblastoma, 40% of patients were eligible, and lived much longer than those who were ineligible (13.90 vs. 5.80 months). It is concluded that better outcome following adjuvant brachytherapy for glioma is at least in part the result of patient selection. Randomized trials of comparably selected patients will be necessary to demonstrate conclusively that longer survival is also a result of treatment.

Peritoneal Keratin Granulomas with Carcinomas of Endometrium and Ovary and Atypical Polypoid Adenomyoma of Endometrium A Clinicopathological Analysis of 22 Cases

Twenty-two cases of keratin granulomas of the peritoneum associated with endometrioid adenocarcinoma with squamous differentiation of the endometrium, the ovary, or both, and with an atypical polypoid adenomyoma of the endometrium were reviewed. Follow-up data were available in 18 cases. Twelve patients were well and disease free 13 months to 15.2 years postoperatively; one patient died of unrelated disease 21 years postoperatively; three patients were tumor free with a short duration of follow-up; one patient, who had a stage Ic ovarian tumor, died of pulmonary embolism during the treatment of recurrent tumor 1 year after operation; and a final patient, who had been followed for 3 months after operation for stage IV disease, was alive with residual tumor. At least six patients with stage I carcinomas were treated with postoperative irradiation because the granulomas had raised a suspicion of advanced disease. Follow-up data on the patients in this series suggest that peritoneal keratin granulomas have no prognostic significance and should be distinguished from viable tumor implants on microscopic examination.

Meningiomas

This article reviews the surgical management of meningiomas. Variations in surgical techniques for meningiomas in specific areas are presented. The author also reviews the role of adjunctive radiation therapy, especially in the treatment of recurrent tumors.

Interstitial thermoradiotherapy for recurrent or persistent tumours.

Between 1984 and 1986, 31 sites in 27 patients with biopsy proven tumours were treated with a combination of interstitial microwave hyperthermia (HT) and iridium 192 implants (RT). The 31 sites treated included fifteen (48 per cent) head and neck, six (20 per cent) breast, four (13 per cent) vagina and cervix, and six (20 per cent) others. All patients had prior surgery, RT, or chemotherapy. Of the 31 sites treated, 19 (61 per cent) had complete response (CR) with no recurrence in the volume treated. Additionally, eight patients remained free of tumour from 3 to 24 months. Partial response (PR) was seen in 11 (36 per cent) sites while one (3 per cent) had lesser degree tumour regression. Tumour control rate correlated well with the dose of radiation, p = 0.02, and tumour volume, p = 0.02, but not with thermal dose. Treatment complications of significance occurred in one (3 per cent) site, which developed soft tissue necrosis. This study again has demonstrated the effectiveness of RT-HT combination in treatment of recurrent tumours.

Postoperative recurrence of lung cancer: detection by whole-body gallium scintigraphy.

The records were reviewed of 111 consecutive patients who had lung cancer resected and who were followed with serial postoperative whole-body gallium scans. Scans were obtained preoperatively at intervals of 3-6 months for about 1 year after surgery and subsequently at yearly intervals. The period of follow-up varied from 1 1/2 to 8 years. Of 55 patients who developed tumor recurrence, a gallium scan was the first indicator of recurrence in 11 (20%) and was judged helpful in confirming or localizing a recurrence in another 14 patients (25%). False-positive rates were determined from 175 postoperative scans in the other 56 patients who did not suffer recurrence. Of these 175 scans, 15 (9%) demonstrated abnormalities that were sufficiently suspicious that an additional diagnostic procedure, other than chest radiography, was performed for clarification. However, in no case did the gallium scan result adversely affect the management of the patient. Our data demonstrate that routine postoperative whole-body gallium scanning can facilitate early detection of recurrence in some cases. Judicious use of gallium scanning in cases with clinically suspected recurrence can enable prompt localization, diagnosis, and treatment of recurrent tumor.

Clinical Memoranda: A Flexible Cryoprobe for Cryosurgery

The use of cryosurgery for the treatment of neoplasms of the head and neck, both for cure or palliation, is a proved effective modality.^1-3Whereas most tumors can be reached with a straight cryoprobe or cryospray, some tumors cannot be conveniently frozen by straight probes. These tumor sites include the nasopharynx, lateral pharyngeal wall, cheek, palate, and floor of the mouth. In addition, cryosurgery has been useful in the treatment of recurrent tumor after radical or partial maxillectomy. This article will describe a newly developed flexible cryoprobe that has been found useful in the treatment of tumors that cannot be easily reached by straight cryoprobes. <i>Technique</i>.—The probe, shown in the Figure, consists of a flexible 17-cm-long, coiled copper wire shaft ending in a spherical tip 1 cm in diameter. The probe attaches to a commercially available liquid nitrogen reservoir, which is activated by turning a button on the

Assessment of serial CEA determinations in urine of patients with bladder carcinoma.

Carcinoembryonic antigen (CEA) levels in urine and serum from 294 patients with bladder cancer in varying stages have been clinically evaluated. All urine samples were obtained from patients with intact renal function and without bacterial infection in the bladder. The samples were collected before, during, and at follow-up examination after radiotherapy. They were perchloric acid extracted before being assayed in a double-antibody radioimmunoassay. The geometric mean of urine CEA levels for patients with primary tumors of Stage T1 or T2 was significantly lower than that for those with Stage T3 or T4 disease. The urine CEA levels for patients with tumors of various histologic grades did not differ. The urine CEA levels decreased from before to after radiation treatment of the primary tumor. Patients with recurrence within six months after undergoing primary treatment had higher initial mean urine CEA levels than did those without evidence of recurrence. The prognostic information for recurrence was limited to the more advanced tumors. Differences were also found between the means of samples taken before recurrence and after treatment of recurrent tumors; with regression of the tumor, a lower mean urine CEA level was found; with progression, a higher value. Urine CEA levels before any treatment were higher when the patients had a short survival time. Serum CEA levels were not related to stage or grade of the primary bladder tumor but levels were slightly elevated with metastases. The determination of urine CEA levels seems to be useful in the follow-up of patients with bladder carcinoma because when initially high, it adds to the information of the T classification and predicts early recurrence, and the monitoring of individual patients after primary treatment is useful for detecting recurrence.

Carcinoma of the cervix: II. A critical evaluation of patient follow-up

The value and most desirable frequency and duration of follow-up examinations for a population of consecutively treated patients with primary cervical carcinoma is not well established. In an attempt to judge the value of examinations in terms of improving survival, the survival of patients subjected to follow-up examinations was compared to those not examined and the impact of therapy for recurrence on 5 year survival from primary therapy was determined for 762 consecutively treated patients between 1951 and 1962. The incidence of death and recurrence in patients at risk for intervals up to 15 years after therapy was calculated to determine the most desirable frequency and duration of follow-up examination. Neither the performance of examinations or the treatment of recurrent tumor was effective in significantly improving the 5 year survival from primary therapy. While the incidence of death and recurrence occurring at prolonged intervals following therapy documents the continuing obligation of the physician toward these patients, the optimum frequency of examinations remains speculative.