scholarly journals Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

2020 ◽  
Author(s):  
Mariline Santos ◽  
Eurico Monteiro
Keyword(s):  
Surgical Treatment ◽  
Tumor Staging ◽  
Treatment Strategies ◽  
Clinical Staging ◽  
Pathological Staging ◽  
Impact On Survival ◽  
Study Population ◽  
Caucasian Patients ◽  
Mean Time ◽  
Level Of Agreement

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen’s Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen’ Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3–4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Surgical treatment strategies for secondary peritonitis: Outcome in 278 patients

2001 ◽  
Vol 120 (5) ◽  
pp. A401-A401
Author(s):  
M BOERMEESTER ◽  
E BELT ◽  
B LAMME ◽  
M LUBBERS ◽  
J KESECIOGLU ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategies ◽  
Secondary Peritonitis

scholarly journals Melanoma in Adolescents and Young Adults: Evaluation of the Characteristics, Treatment Strategies, and Prognostic Factors in a Monocentric Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Paolo Del Fiore ◽  
Irene Russo ◽  
Beatrice Ferrazzi ◽  
Alessandro Dal Monico ◽  
Francesco Cavallin ◽  
...  
Keyword(s):  
Young Adults ◽  
Tnm Classification ◽  
Age Groups ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Adolescents And Young Adults ◽  
Biological Behavior ◽  
Veneto Region ◽  
Common Cancer ◽  
Caucasian Patients

The “Veneto Cancer Registry” records melanoma as the most common cancer diagnosed in males and the third common cancer in females under 50 years of age in the Veneto Region (Italy). While melanoma is rare in children, it has greater incidence in adolescents and young adults (AYA), but literature offers only few studies specifically focused on AYA melanoma. The aim of this study was to describe the characteristics, surgical treatment, and prognosis of a cohort of AYA melanoma in order to contribute to the investigation of this malignancy and provide better patient care. This retrospective cohort study included 2,752 Caucasian patients (702 AYA and 2,050 non-AYA patients) from the Veneto Region who were over 15 years of age at diagnosis, and who received diagnosis and/or treatment from our institutions between 1998 and 2014. Patients were divided in adolescents and youth (15-25 years), young adults (26-39 years) and adults (more than 39 years) for the analysis. We found statistically significant differences in gender, primary site, Breslow thickness, ulceration, pathologic TNM classification (pTNM) stage and tumor subtype among the age groups. Disease-specific survival and disease-free survival were also different among the age groups. Our findings suggest that the biological behavior of melanoma in young people is different to that in adults, but not such as to represent a distinct pathological entity. Additional and larger prospective studies should be performed to better evaluate potential biological and cancer-specific differences between AYAs and the adult melanoma population.

scholarly journals 18F-FDG-PET/CT Plays a Key Role in Formulating Treatment Strategies for Takayasu Arteritis

2020 ◽  
Author(s):  
Qing Han ◽  
Xiang Zhou ◽  
jin ding ◽  
zhaohui zheng ◽  
Fei Kang ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Fdg Pet ◽  
Clinical Remission ◽  
Treatment Strategies ◽  
Pet Ct ◽  
Significant Difference ◽  
Remission Criteria ◽  
Study Population ◽  
Predominantly Female ◽  
Fdg Pet Ct

Abstract Backgroud and Objective: Clinical evaluation alone cannot satisfy the prognosis of TAK. PET-CTmolecular imaging may be a useful tool to supplement the prognosis of TAK. The purpose of this study was to observe whether THE TAK patients who achieved clinical remission also achieved imaging remission with PET-CT. Pet-ct plays an important role in the prognosis of TAK patients and further formulation of treatment strategy.Results: 79% patients with TAK in remission were positive for 18F-FDG-PET /CT. The study population had a mean age of 38.8 years and was predominantly female (90%). Their mean disease duration was 3.5 years and they had a mean disease remission period of 9.4 months. Patients had a mean ESR of 37.3 mm/h and a mean CRP level of 13.5 mg/l at the first dignosis time and 4.9 mm/h/3.7 mg/l at the Courrent time point. There was a statistically significant difference between the two groups (p<0.01). All patients on initial treatment received oral glucocorticoids, 25% received methotrexate, 65% received leflumide, and 45% received cyclophosphamide. Quantitative analysis of the SUV of nineteen patients showed an increasing trend (Baseline SUVmax 2.16±0.46 vs Remission SUVmax 2.08±0.49, p=0.56; Baseline SUVmean 2.34±0.57 vs Remission SUVmean 2.42±0.81, p=0.46). The arterial SUVmax uptake was higher in 15 patients with remission than baseline (2.30 ± 0.62 vs 2.48 ± 0.91, p = 0.54). But it was not statistically significant. Most of the patients (13/19, 68%) had an SUVmax value ≥ 2.0 in visual vasculitis with positive PET/CT before treatment, and 32% ＜2.0. No correlation was found between the type of treatment used, the time that elapsed from remission, or laboratory parameters and the scintigraphic results. Conclusion: TAK's clinical remission criteria are not entirely consistent with actual vascular inflammatory activity. Patients with TAK that achieve clinical remission may not achieve imaging remission with PET-CT, and PET-CT plays an important role in the prognosis of TAK patients and further formulation of treatment strategy.

scholarly journals The chemotherapy and radiation in low-grade myofibroblastic sarcoma: is there a role?

2020 ◽  
Author(s):  
Yao Xu ◽  
Guijun Xu ◽  
Xin Wang ◽  
Min Mao ◽  
Haixiao Wu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Head And Neck ◽  
Radiation Treatment ◽  
Treatment Strategies ◽  
Neck Region ◽  
Low Grade ◽  
Myofibroblastic Sarcoma ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Regression

Abstract Background: Low-grade myofibroblastic sarcoma (LGMS) is a rare entity with a predilection in the head and neck. There are still no optimal treatment strategies for LGMS. We aimed to investigate the role of chemotherapy and radiation treatment for LGMS. Survival estimate was performed and prognostic factors were identified.Methods: Based on the Surveillance, Epidemiology, and End Result (SEER) database, LGMS patients diagnosed between 2001 and 2015 were involved in our study. Kaplan-Meier curves and log-rank tests were used to estimate overall survival. Cox proportional hazard regression model was performed to identify prognostic factors.Results: A total of 96 eligible patients with LGMS were included, among which 86 (89.6%) received surgical treatment. Twenty-eight (29.2%) patients received radiation treatment while chemotherapy was offered to 20 (10.4%) patients. The median age was 55.0 years old with 22 cases occurred in head and neck region. The mean OS was 125.2 (95%CI 106.3-144.2) months while 1-, 3-, 5- and 10-year OS rates were 88%, 77%, 70% and 59%, respectively. Age older than 60 years, positive nodal status and no surgical treatment were independent prognostic factors for patients with LGMS. Chemotherapy and radiation were not independent prognostic factors for LGMS.Conclusions: Several prognostic factors for LGMS were revealed in this study. Surgical resection is the main therapy while chemotherapy and radiation showed limited effects on survival improvement. Thus, chemotherapy and/or radiation should not be routinely performed in LGMS.

Abstract 14134: The Impact of Ablation for Atrial Fibrillation on Dementia Incidence in Patients With and Without Depression

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heidi T May ◽  
Tami L Bair ◽  
Stacey Knight ◽  
Jeffrey L Anderson ◽  
Joseph B Muhlestein ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Strategies ◽  
Brain Perfusion ◽  
Cardiovascular Comorbidities ◽  
Incident Dementia ◽  
History Of ◽  
The Impact ◽  
Mean Time ◽  
History Of Depression

Introduction: Studies have previously shown that atrial fibrillation (AF) is associated with dementia. The mechanisms are likely multifactorial, but may involve treatment strategies that include anticoagulation use and rhythm management, particularly when used early. Patients that have earlier-life depression are at risk of dementia. However, depression diagnosis in AF patients may indicate a patient at higher risk of developing dementia and whether treatments ameliorate that risk is unknown. Methods: A total of 132,703 AF patients without a history of dementia were studied. History of depression was determined at the time of AF diagnosis. Patients were deemed as having a follow-up ablation if it occurred prior to a dementia diagnosis. Patients were stratified into 4 groups based on depression history and follow-up ablation status: no depression, ablation (n=5,960); no depression, no ablation (n=106,986); depression, ablation (n=923); and depression, no ablation (n=18,834). Patients were followed for 5-year incidence of dementia. Results: A total of 14.9% (n=19,757) pts had a history of depression at the time of AF diagnosis. The mean time between depression and AF diagnoses was 4.9±4.8 years. Patients with depression were younger (68±15 vs. 71±14 years), more likely to be female (62% vs. 44%), and had more cardiovascular comorbidities. Mean time to ablation was 1.3±1.4 days (median: 7.7 months) from AF diagnosis. Frequencies of 5-year dementia were: no depression, ablation=1.6%; no depression, no ablation=5.2%; depression, ablation=4.7%; and depression, no ablation=9.7%, p<0.0001. Multivariable comparisons between the groups are shown in the Figure. Conclusion: In AF patients with and without depression, ablation was associated with a lower risk of incident dementia. Rhythm control approaches that improve long-term brain perfusion may represent a means to impact cognitive declines in patients at higher risk because of earlier-life depression.

scholarly journals Time Intervals From Onset of Clinical Manifestations to Treatment in Patients With Cancer at Hospital General San Felipe, Tegucigalpa, Honduras

2019 ◽  
pp. 1-7
Author(s):  
José A. Sánchez ◽  
Mayra G. Handal ◽  
Juan F. Vílchez Rodriguez ◽  
Sinthia I. Mejía ◽  
Annye P. Pagoaga
Keyword(s):  
Clinical Manifestations ◽  
Cross Sectional Study ◽  
Clinical Staging ◽  
Time Interval ◽  
Pathology Report ◽  
Time Intervals ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
The Mean ◽  
Mean Time

PURPOSE In cancer, clinical staging is related to outcomes, and this is linked to the evolution of the disease over time. In Honduras, cancer mortality is high, and time intervals from onset of symptoms to treatment of cancer are not known. We conducted a cross-sectional study to determine these intervals. PATIENTS AND METHODS This investigation was carried out from April 25 to August 30, 2018, and included 202 patients at the main cancer referral center in Honduras. For the purposes of the study, information was obtained from patients, their caregiver, medical records, or treatment cards. Patients older than age 18 years were included after informed consent was signed. RESULTS The mean time interval from onset of symptoms to cancer treatment was 232 days. Different intervals of time were identified, and the mean of these intervals was calculated in days as follows: 68 days from onset of symptoms to first medical evaluation; 146 days from first evaluation to oncologist consultation; 26 days from cancer specialist to the pathology report; and 86 days from the histopathologic diagnosis to the beginning of treatment. Once diagnosis was established, the average elapsed times to chemotherapy, radiotherapy, surgery, and chemoradiotherapy were 88, 102, 76, and 154 days, respectively ( P < .05, when surgery is compared against chemotherapy and radiotherapy). CONCLUSION The mean time interval from symptom presentation to treatment in patients with cancer is more than 7 months. This could explain the advanced stages of disease seen at the time of treatment in Honduras, which decrease chance of cure and increase the mortality rate of cancer). Appropriate intervention to decrease these intervals must be taken to reduce mortality.

scholarly journals Epidemiology of uveal melanoma in Brazil

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Evandro Lucena ◽  
Daniel Cohen Goldemberg ◽  
Luiz Claudio Santos Thuler ◽  
Andreia Cristina de Melo
Keyword(s):  
Sex Education ◽  
Uveal Melanoma ◽  
Healthcare Access ◽  
Regional Distribution ◽  
Age Distribution ◽  
Treatment Strategies ◽  
Distant Metastases ◽  
Cancer Registries ◽  
Clinical Staging ◽  
Continuous Variables

Abstract Purpose To report the prevalence of uveal melanoma in a Hospital database in Brazil over the period of 16 years (2000 to 2016). Design Descriptive epidemiological study evaluating the Brazilian Hospital Based Cancer Registries. Participants/methods Uveal melanomas were identified based on ICD-O-3 codes C69.3 [choroid], C69.4 [ciliary body and iris], and C69.2 [retina]) derived from the Integrator Registry database. Kolmogorov–Smirnov Test was used for evaluation of normality of data, t-test and Chi square were used for categorical and continuous variables respectively using SPSS Software. Main outcome measures Age, sex, education, regional distribution, clinical staging at the diagnosis, time from diagnosis to treatment (≤ 60 days versus > 60 days) and first-course therapy (surgery, chemotherapy, radiotherapy or a combination of such). Results There were 2166 cases of uveal melanoma representing 5.4% of all cases of melanoma. Histological confirmation of uveal melanoma was available in all cases. Higher prevalence of 1139 cases (52.6%) in women than 1027 cases (47.4%) in men was observed. Age distribution revealed 1411 cases (65.1%) in the group between 41 and 69 years old. A total of 429 (19.8%) patients were classified as initial disease and 334 (15.4%) as advanced (regional or distant metastases). Staging as initial disease was more frequent (113–24.8%) in patients with > 8 school years than in patients with < 8 school years (179–17.6%) reflecting disparities in healthcare access between those two populations. No difference was noticed in terms of diagnosis, staging and treatment after the Brazilian “60 days law” (Federal Law 12.732/12) came into effect in 2013 regulating the maximum period that a patient with cancer has to wait until start the treatment. Conclusion Epidemiological data is critical for planning early treatment strategies and allocating medical resources. This study intended to understand the characteristics of uveal melanoma in Brazil.

scholarly journals Clinical and surgical-pathological staging in early non-small cell lung cancer

2013 ◽  
Vol 7 (1) ◽  
pp. 7
Author(s):  
Ioannis Koukis ◽  
Ioannis Gkiozos ◽  
Ioannis Ntanos ◽  
Elias Kainis ◽  
Konstantinos N. Syrigos
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
International Association ◽  
Critical Evaluation ◽  
Small Cell ◽  
Clinical Staging ◽  
Small Cell Lung ◽  
Non Invasive ◽  
Pathological Staging

Staging is of the utmost importance in the evaluation of a patient with non-small cell lung cancer (NSCLC) because it defines the actual extent of the disease. Accurate staging allows multidisciplinary oncology teams to plan the best surgical or medical treatment and to predict patient prognosis. Based on the recommendation of the International Association for the Study of Lung Cancer (IASLC), a tumor, node, and metastases (TNM) staging system is currently used for NSCLC. Clinical staging (c-TNM) is achieved via non-invasive modalities such as examination of case history, clinical assessment and radiological tests. Pathological staging (p-TNM) is based on histological examination of tissue specimens obtained with the aid of invasive techniques, either non-surgical or during the intervention. This review is a critical evaluation of the roles of current pre-operative staging modalities, both invasive and non-invasive. In particular, it focuses on new techniques and their role in providing accurate confirmation of patient TNM status. It also evaluates the surgical-pathological staging modalities used to obtain the true-pathological staging for NSCLC.

scholarly journals Percutaneous Management of Enterocutaneous Fistulae and Abscess–Fistula Complexes

2018 ◽  
Vol 02 (02) ◽  
pp. 131-140 ◽  
Author(s):  
Abigail Erickson ◽  
Chaitanya Ahuja ◽  
Romulo Vea ◽  
Guillermo Sangster ◽  
Horacio D'Agostino ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Percutaneous Drainage ◽  
Treatment Options ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Review Article ◽  
Abdominal Abscesses ◽  
Percutaneous Catheter

AbstractAbscess–fistula complexes and enterocutaneous fistulae are due to postoperative, spontaneous, and inflammatory etiologies. Conservative, percutaneous, endoscopic, and surgical treatment options are available options. Interventional radiologists have an array of different treatment strategies, often starting with percutaneous drainage of associated intra-abdominal abscesses. This review article details different percutaneous management strategies, focusing on percutaneous catheter strategies for abscess-fistula complexes along with tract closures strategies for enterocutaneous fistulae.

scholarly journals Constipation: an overlooked, unmanaged symptom of patients with pheochromocytoma and sympathetic paraganglioma

2015 ◽  
Vol 173 (3) ◽  
pp. 377-387 ◽  
Author(s):  
Sonali Thosani ◽  
Montserrat Ayala-Ramirez ◽  
Alejandro Román-González ◽  
Shouhao Zhou ◽  
Nirav Thosani ◽  
...  
Keyword(s):  
Symptom Improvement ◽  
Control Group ◽  
Primary Tumors ◽  
Impact On Survival ◽  
Study Population ◽  
Md Anderson ◽  
Design And Methods ◽  
And Control ◽  
Sympathetic Paraganglioma

ObjectivePheochromocytomas (PHs) and sympathetic paragangliomas (PGs) are tumors that produce catecholamines, predisposing patients to cardiovascular disease and gastrointestinal effects such as constipation. Objectives: i) determine the prevalence of constipation, its risk factors, and its impact on survival; ii) identify whether a systematic combination of fiber, water, and laxatives was effective for treatment of constipation.Design and methodsWe retrospectively studied 396 patients with PH/PG diagnosed in 2005–2014. The study population was patients with constipation as a presenting symptom; the control group was patients without constipation as a presenting symptom. The MD Anderson Symptom Inventory was used to assess constipation and quality of life.ResultsTwenty-three patients (6%) had constipation. Constipation was associated with headaches, palpitations, diaphoresis, weight loss, and excessive noradrenaline production (P<0.0001). Eighteen of these patients had non-metastatic primary tumors larger than 5 cm and/or extensive metastases. No statistically significant differences in age, sex, and genotype were noted between the study and control groups. In patients without metastases, resection of the primary tumor led to symptom disappearance. A systematic combination of fiber, water, and laxatives was associated with symptom improvement. Two patients who presented unmanaged constipation died because of sepsis from toxic megacolon.ConclusionsConstipation is a rare and potentially lethal complication in patients with PH/PGs. Severe constipation can be prevented by recognizing and treating mild symptoms.

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