What is the Role of Surgery for Locally Advanced Disease?

Between November 1978 and March 1990 319 patients with primary carcinoma of the vulva were treated at the Regional Department of Gynaecological Oncology at the Queen Elizabeth Hospital in Gateshead. Twenty-three of these had locally advanced disease which involved the anal and perianal skin, and were treated with radical ano-vulvectomy, bilateral inguinal-femoral lymphadenectomy, and in eight cases pelvic node dissection. Overall the 5-year survival rate was 62.1%. Survival in this group of patients with locally advanced disease was comparable to that reported in other series of similar patients treated with other modalities. Radical ano-vulvectomy has a valuable role to play in the treatment of this difficult problem.

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Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

Urologia Journal ◽

10.1177/03915603211035191 ◽

2021 ◽

pp. 039156032110351

Author(s):

Alessandro Uleri ◽

Rodolfo Hurle ◽

Roberto Contieri ◽

Pietro Diana ◽

Nicolòmaria Buffi ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Advanced Disease ◽

Independent Predictor ◽

Small Sample Size ◽

Statistical Significance ◽

Locally Advanced ◽

Small Sample ◽

Locally Advanced Disease ◽

Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

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Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

Canadian Urological Association Journal ◽

10.5489/cuaj.245 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 699 ◽

Cited By ~ 25

Author(s):

Yannick Cerantola ◽

Massimo Valerio ◽

Aida Kawkabani Marchini ◽

Jean-Yves Meuwly ◽

Patrice Jichlinski

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Advanced Disease ◽

Locally Advanced ◽

Resonance Imaging ◽

Extracapsular Extension ◽

Predictive Values ◽

Locally Advanced Disease ◽

Multiparametric Magnetic Resonance Imaging

Background: Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension.Methods: We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomywere performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference.Results: Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively.Interpretation: This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

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Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?

Annals of Surgical Oncology ◽

10.1245/s10434-015-4734-6 ◽

2015 ◽

Vol 23 (1) ◽

pp. 87-91 ◽

Cited By ~ 45

Author(s):

Anne Warren Peled ◽

Frederick Wang ◽

Robert D. Foster ◽

Michael Alvarado ◽

Cheryl A. Ewing ◽

...

Keyword(s):

Advanced Disease ◽

Locally Advanced ◽

Locally Advanced Disease

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Locally Advanced Disease

Modern Management of Cancer of the Rectum ◽

10.1007/978-1-4471-6609-2_21 ◽

2014 ◽

pp. 311-321

Author(s):

Benjamin Crawshaw ◽

Knut M. Augestad ◽

Harry L. Reynolds ◽

Conor P. Delaney

Keyword(s):

Advanced Disease ◽

Locally Advanced ◽

Locally Advanced Disease

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Irreversible Electroporation: Expanding the Armamentarium against Pancreatic Cancer

Digestive Disease Interventions ◽

10.1055/s-0039-1693226 ◽

2019 ◽

Vol 03 (02) ◽

pp. 138-142

Author(s):

Gray R. Lyons ◽

Brian J. Schiro ◽

Govindarajan Narayanan

Keyword(s):

Pancreatic Cancer ◽

Advanced Disease ◽

Locally Advanced ◽

Irreversible Electroporation ◽

Treatment Algorithm ◽

Advanced Pancreatic Cancer ◽

Invasive Approach ◽

Anticancer Treatment ◽

Minimal Damage

AbstractLocally advanced pancreatic cancer is often refractory to conventional therapy, thus warranting new approaches. Irreversible electroporation is an ablative modality that has the potential to deliver targeted anticancer treatment with minimal damage to surrounding structures. Indications for irreversible electroporation in pancreatic cancer patients include palliation for metastatic disease, downstaging for surgery in locally advanced disease, and treatment of local recurrence following operative resection. Benefits of the modality in pancreatic cancer include a minimally invasive approach, precise delivery that minimizes nontarget ablation, and upregulation of anticancer immune response. Early studies have demonstrated an acceptable safety profile for irreversible electroporation; however, more data are needed to define the role of IRE in the treatment algorithm of pancreatic cancer.

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