scholarly journals Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

2020 ◽  
Author(s):  
Barbara Verro ◽  
Giuseppe Greco ◽  
Enzo Chianetta ◽  
Carmelo Saraniti
Keyword(s):  
Co2 Laser ◽  
Tumor Resection ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Glottic Cancer ◽  
Resection Margins ◽  
Second Look ◽  
Key Points ◽  
The Status

Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points

scholarly journals Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

2018 ◽  
Vol 275 (9) ◽  
pp. 2333-2340 ◽  
Author(s):  
Martine Hendriksma ◽  
Marc W. Montagne ◽  
Ton P. M. Langeveld ◽  
Maud Veselic ◽  
Peter Paul G. van Benthem ◽  
...  
Keyword(s):  
Co2 Laser ◽  
Local Control ◽  
Surgical Margin ◽  
Margin Status ◽  
Glottic Cancer ◽  
Laser Microsurgery ◽  
Early Glottic Cancer

Kehlkopf-Karzinom: Wundbettbiopsien nach TLM-Behandlung sinnvoll

2019 ◽  
Vol 98 (02) ◽  
pp. 71-72
Author(s):  
Peter Jecker
Keyword(s):  
Co2 Laser ◽  
Local Control ◽  
Surgical Margin ◽  
Margin Status ◽  
Glottic Cancer ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Kopf Und Hals

Hendriksma M et al. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275: 2333–2340 Bei Patienten mit primärem Kehlkopf-Plattenepithelkarzinom (Tis-T2) beurteilten niederländische Kopf- und Hals-Chirurgen den Effekt des Resektionsrand-Status auf die lokale Kontrollrate nach Behandlung mit transoraler CO2-Laser-Mikrochirurgie (TLM). Darüber hinaus überprüften die Bedeutung zusätzlicher Wundbettbiopsien.

Six years of experience in citoreductive surgery and the application of HIPEC-oxaliplatin.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14676-e14676
Author(s):  
Srdjan Nikolic ◽  
Milan Zegarac ◽  
Igor Djurisic ◽  
Aleksandar Martinovic ◽  
Milan Kocic ◽  
...  
Keyword(s):  
Peritoneal Cancer Index ◽  
Tumor Resection ◽  
Age Distribution ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Years Of Experience ◽  
Peritoneal Carcinosis ◽  
Peritoneal Cancer ◽  
Statistical Relevance

e14676 Background: In this abstract we present six years of experience in citoreductive surgery and intraperitoneal chemotherapy (HIPEC) as treatment for patients with peritoneal carcinosis of colorectal carcinoma. Methods: In six years time 61 patient has been operated. Age distribution was from 27 to 76 and median age was 55. Male/female distribution was 18.13%/81.87%. All patients have been treated with intraperitoneal Oxaliplatin with dose of 410mg/m2 in 2 liters of perfusions. In 93.44% cases R0 resection was done and R1 in 3.28%. There was no patient with R2 resection. In 13.1% cases there was Grade I postoperative complication Adjuvant chemotherapy has been applied to 67.21% of operated patients and most had FOLFOX protocol. By the end of this research we still follow up 55,74 % of patients as 44.26% had lethal outcome. Results: Median (95% CI )overall survival(OS) was 51 month(22+ months) . Disease free survival (DFS) was 23 months (16+ months ) . One, two and six years OS was 78.6% ,58.7% and 50.5% One , two and six years DFS was 68.3%, 46.7% and 38.1%. The research has shown that factors such as patient age, sex, preoperative symptoms, synchronous and metachronous carcinosis had no statistically relevant influence on OS. There was statistic relevance in DFS for patients who developed peritoneal carcinosis within 12 months after primary tumor resection(p=0.03) Carcinosis node size has no statistical relevance on OS(p=0.24) and DFS(p=0.64). Involving of left subdiaphragmal region significantly reduces OS(p=0.0022) , but has no statistically relevant influence on DFS(p=0.49). Involving of left iliacal region was on boundary of statistical relevance on OS(p=0.05). Involving of right subdiaphragmal regions statistically significantly reduces OS(p=0.04) , and has no influence on DFS. Involving of small intestine has statistical relevance on OS(p=0.01) As the most important prognosis factor we highlight the peritoneal cancer index (PCI). Patients with PCI less then 13 have statistically better OS (p<0.01) and also statistically better DFS (p<0.05). Conclusions: Our results show that citoreductive surgery followed up by HIPEC with Oxaliplatin should always be considered for patients with colorectal cancer carcinosis.

scholarly journals Computer-Assisted Resection and Reconstruction of Pelvic Tumor Sarcoma

Sarcoma ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Pierre-Louis Docquier ◽  
Laurent Paul ◽  
Olivier Cartiaux ◽  
Christian Delloye ◽  
Xavier Banse
Keyword(s):  
Surgical Navigation ◽  
Tumor Resection ◽  
Surgical Margin ◽  
Surgical Oncology ◽  
Tumor Location ◽  
Resection Margins ◽  
Computer Assisted ◽  
Navigation Systems ◽  
First Case ◽  
Saw Blade

Pelvic sarcoma is associated with a relatively poor prognosis, due to the difficulty in obtaining an adequate surgical margin given the complex pelvic anatomy. Magnetic resonance imaging and computerized tomography allow valuable surgical resection planning, but intraoperative localization remains hazardous. Surgical navigation systems could be of great benefit in surgical oncology, especially in difficult tumor location; however, no commercial surgical oncology software is currently available. A customized navigation software was developed and used to perform a synovial sarcoma resection and allograft reconstruction. The software permitted preoperative planning with defined target planes and intraoperative navigation with a free-hand saw blade. The allograft was cut according to the same planes. Histological examination revealed tumor-free resection margins. Allograft fitting to the pelvis of the patient was excellent and allowed stable osteosynthesis. We believe this to be the first case of combined computer-assisted tumor resection and reconstruction with an allograft.

Transoral laser microsurgery outcomes with early glottic cancer: the Dalhousie University experience

2011 ◽  
Vol 125 (5) ◽  
pp. 509-512 ◽  
Author(s):  
S E Lester ◽  
M H Rigby ◽  
S M Taylor
Keyword(s):  
Overall Survival ◽  
Disease Free Survival ◽  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Free Survival ◽  
Early Glottic Cancer ◽  
Kaplan Meier ◽  
Disease Free

AbstractObjective:To report the results of transoral laser microsurgery for the treatment of early glottic cancer at our institution.Design:Cohort study. Retrospective review of charts of patients diagnosed with tumour stage 1 or 2 (early stage; no nodes or metastases), previously untreated, primary glottic cancer, treated with transoral laser microsurgery at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. The minimum follow-up period was two years.Setting:Tertiary care head and neck cancer centre.Participants:Fifty-three patients treated between January 2002 and November 2007.Outcome measure:Kaplan–Meier survival analysis for disease-free survival, overall survival and laryngectomy-free survival, at five years.Results:The group comprised 46 men and seven women, with a mean age of 66 years (range 30–84 years). Mean follow up was 40 months (range 12–89 months). There were four cases of complications (7.5 per cent). Kaplan–Meier survival analysis revealed a five-year disease-free survival (including salvage) of 96.2 per cent, a five-year overall survival (all causes) of 88.8 per cent and a five-year laryngectomy-free survival of 98.1 per cent.Conclusion:Transoral laser microsurgery is a safe and effective initial treatment for early laryngeal cancer, and has high rates of laryngeal preservation and disease-free survival.

scholarly journals Adjuvant Radiation Therapy for Male Breast Cancer—A Rare Indication?

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3645
Author(s):  
Tobias Forster ◽  
Clara Köhler ◽  
Rami El Shafie ◽  
Fabian Weykamp ◽  
Laila König ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Locally Advanced ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Female Breast Cancer ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Disease Free

Due to its rarity, there are no randomized trials investigating the outcome of adjuvant radiotherapy in MBC. This study reports on patient and tumor characteristics of 41 consecutive MBC patients treated between 1990 and 2018 and on clinical outcomes after surgical resection of tumors and adjuvant radiotherapy of the chest wall or breast. Local control (LC), locoregional control (LRC), overall survival (OS), disease-free survival (DFS), and toxicity were evaluated. After a median follow-up of 80 months (95% CI: 14.6–213.8 months) there was only one recurrence, in a patient’s locoregional lymph nodes 17 months after start of radiotherapy, resulting in an LC rate of 100% at 5 years and a 5-year LRC rate of 97.4% (standard deviation (SD): 0.025). Five-year DFS and OS rates were 64.6% (SD: 0.085) and 57.2% (SD: 0.082), respectively. Adjuvant radiotherapy was tolerated well without high-grade (CTCAE grade > II) adverse events. After tumor resection and adjuvant radiotherapy, LC and LRC rates in MBC patients are excellent and comparable to results found for female breast cancer (FBC) patients. However, as patients are often diagnosed with locally advanced, higher-risk tumors, distant recurrences remain the major failure pattern.

scholarly journals Reconstruction With 3D-Printed Prostheses After Sacroiliac Joint Tumor Resection: A Retrospective Case-Control Study

2022 ◽  
Vol 11 ◽  
Author(s):  
Feifei Pu ◽  
Jianxiang Liu ◽  
Deyao Shi ◽  
Xin Huang ◽  
Jingtao Zhang ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Operation Time ◽  
Control Group ◽  
Intraoperative Bleeding ◽  
Free Survival ◽  
3D Printed ◽  
Disease Free

BackgroundSacroiliac joint tumor is rare, and the reconstruction after tumor resection is difficult. We aimed to analyze and compare the clinical effects of three-dimensional (3D) printed prostheses and bone cement combined with screws for bone defect reconstruction after sacroiliac joint tumor resection.MethodsTwelve patients with sacroiliac joint tumors who underwent tumor resection and received 3D-printed prostheses to reconstruct bone defects in our hospital from January 2014 to December 2020 were included in the study group Twelve matched patients who underwent sacroiliac joint tumor resection and reconstruction with bone cement and screws in the same time period were selected as the control group.ResultsIn the 3D-printing group, six cases were extensively excised, and six cases were marginally excised. All patients were followed up for 6–90 months, and the median follow-up time was 21 months. Among them, nine patients had disease-free survival, two survived with tumor recurrence, and one died due to tumor metastasis. The MSTS-93 score of the surviving patients was 24.1 ± 2.8. The operation time was 120.30 ± 14.50 min, and the intraoperative bleeding was 625.50 ± 30.00 ml. In the control group, seven cases were extensively excised, and five cases were marginally excised. All patients were followed up for 6–90 months, with a median follow-up time of 20 months. Among them, nine patients had disease-free survival, one survived with tumor recurrence, and two died due to tumor metastasis. The MSTS-93 score of the patients was 18.9 ± 2.6. The operation time was 165.25 ± 15.00 min, and the intraoperative bleeding was 635.45 ± 32.00 ml. There was no significant difference in survival status, intraoperative blood loss, or complications between the two groups (P&gt;0.05). However, there were statistically significant differences in operative time and postoperative MSTS-93 scores between the two groups (P&lt;0.05).ConclusionsAfter resection of the sacroiliac joint tumor, reconstruction using 3D printed prostheses was shorter and resulted in better movement function.

Oncologic significance of pathologic T2 positive surgical margin in robotic-assisted laparoscopic prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15607-15607
Author(s):  
A. Levinson ◽  
D. S. Berkman ◽  
E. T. Goluboff ◽  
D. B. Samadi
Keyword(s):  
Linear Regression Analysis ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Margin ◽  
Multiple Linear Regression Analysis ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Pathologic Stage

15607 Background: A positive margin (PM) after radical prostatectomy (RP) in organ confined (pT2) prostate cancer (CaP) is considered a surgical error. In addition, capsular incision may occur at a higher frequency with robotic and laparoscopic techniques than with traditional open RP. However, the mechanism and significance of capsular violation may be different between open RP and Robotic Assisted Laparoscopic Prostatectomy (RALP). We sought to determine biochemical disease free survival (BDFS) for patients (pts) who underwent RALP at our institution who had a pT2 PM and compared them to those who did not. Methods: We reviewed our prospective IRB approved database for RALPs performed by a single surgeon. To permit adequate follow-up only cases prior to March 2006 were included. Biochemical failure (BF) strictly defined as any PSA >0.1ng/ml. No pt received adjuvant therapy without a BF. Results: Since Jan 2003, 435 consecutive pts underwent RALP for clinically localized CaP. 211 of these cases were before March 2006, of which 194/211 (92%) had sufficient data for analysis. Mean follow-up was 9.8 mos (range 0.7–41.6). Mean age, preoperative PSA, and path Gleason Score were 60 yrs, 6.6 ng/ml, and 6.9, respectively. Pathologic stages: pT2 77%; pT3a 13%; pT3b 7%, pT4 3%. Overall, 7.2% (14/194) experienced BF at a median of 2.5mos (0.7–15.3). BDFS rates by pathologic stage were pT2 95.3% (142/149), pT3a 91.7% (22/24), pT3b 76.9% (10/13), and pT4 71% (5/7). pT2 pts with a PM had the same rate of BF, (4.4% 1/23), as pT2 pts with negative margins (NM) (4.8% 6/126, p=0.932) and pT3 NM (0% 0/19, p=0.36), but was statistically less than pT3 PM (27.8% 5/18, p=0.035). In multiple linear regression analysis, preoperative PSA >10ng/ml was the most predictive variable of BF even after adjusting for Gleason sum, pathologic stage, and surgical margin status. Conclusions: There may be a different mechanism between a PM in organ confined open RP pts and RALP pts. In our series of RALPs, only one of 23 pT2 PM pts suffered a biochemical recurrence. BDFS for these pts was 95.7%, and did not vary significantly from pT2 NM nor pT3 NM pts. A larger series with longer follow-up will determine whether the oncologic significance of a PM in pT2 RALP pts is different than that of open RP pts. No significant financial relationships to disclose.

scholarly journals Neoadjuvant chemotherapy for brain tumors in infants and young children

2015 ◽  
Vol 15 (5) ◽  
pp. 488-492 ◽  
Author(s):  
Junya Iwama ◽  
Hideki Ogiwara ◽  
Chikako Kiyotani ◽  
Keita Terashima ◽  
Kentaro Matsuoka ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Young Children ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Tumor Diameter ◽  
Second Look ◽  
Initial Surgery ◽  
The Mean ◽  
Infants And Young Children

OBJECT Because of their large size and high vascularity, complete removal of brain tumors in infants and young children is often difficult. In most cases the degree of resection is associated with prognosis. Neoadjuvant chemotherapy may facilitate resection by reducing the vascularity of the tumor. The authors evaluated the effectiveness of neoadjuvant chemotherapy in the management of these tumors. METHODS The authors performed a retrospective review of infants and young children who underwent tumor removal after neoadjuvant chemotherapy. RESULTS Nine consecutive patients underwent resection after neoadjuvant chemotherapy during the period February 2004 to December 2012. The mean age at diagnosis was 18 months (range 2–50 months). The average largest tumor diameter was 71 mm (range 30–130 mm) at initial surgery. Five patients underwent partial resection, and 4 underwent biopsy as the initial surgery. The histopathological diagnoses were ependymoma in 2 patients, anaplastic ependymoma in 1, primitive neuroectodermal tumor (PNET) in 2, choroid plexus carcinoma in 1, atypical teratoid/rhabdoid tumor (AT/RT) in 1, glioblastoma in 1, and embryonal tumor with abundant neuropil and true rosettes in 1. After 2–4 courses of multiagent chemotherapy (mainly with vincristine, cyclophosphamide, etoposide, and cisplatin), the second-look surgery was performed. In 1 patient with a PNET, intratumoral hemorrhage was observed after 2 courses of chemotherapy. The mean interval between the initial and the second-look surgery was 3 months. The tumor volume was reduced to varying degrees in 5 patients (56%) after chemotherapy. Intraoperatively, the vascularity of the tumor was considerably reduced, and the tumor was more circumscribed in all cases. Gross-total resection was achieved in 8 patients (89%) and neartotal resection in 1 (11%). Histopathological examination demonstrated fibrotic tissue circumscribing the tumor in 6 of 9 cases (67%). The average blood loss was 20% of the estimated blood volume, and 3 patients (33%) required a blood transfusion. There was no surgical mortality. One patient had transient dysphasia postoperatively. The mean follow-up period was 28 months. At the last follow-up, 2 patients (22%) had died (1 died of tumor progression and 1 of sepsis), and 4 patients (44%) had no tumor recurrence. CONCLUSIONS Neoadjuvant chemotherapy for brain tumors in infants and young children was effective in reduction of tumor vascularity and clarification of the tumor-brain interface, which significantly facilitated maximal tumor resection.

scholarly journals No Difference in Disease-Free Survival after Oral Cancer Resection with Close Tumor Margins in Patients with and without Postoperative Radiotherapy

2018 ◽  
Vol 97 (9) ◽  
pp. 314-322
Author(s):  
Britta Kaltoft Welinder ◽  
Mads Lawaetz ◽  
Laura M. Dines ◽  
Preben Homøe
Keyword(s):  
Survival Rate ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Surgical Margins ◽  
Tumor Control ◽  
Free Survival ◽  
Significant Difference ◽  
Study Population ◽  
Disease Free

We conducted a retrospective follow-up study to determine if adjunctive radiotherapy (RT) affected disease-free survival in patients with oral squamous cell carcinoma (SCC) who were found to have close surgical margins after tumor resection. Our study population was made up of 110 patients—72 men and 38 women, aged 30 to 94 years (median: 66) at the time of diagnosis. Their follow-up ranged from 12 days to 5.2 years (median: 3.6 yr). Of this group, 40 patients had free margins, 55 patients had close margins, and 15 had involved margins after surgery. Only 31 of these patients received postoperative RT, including 17 who had close margins. We would expect to find better postoperative local tumor control with combined surgery and RT, but we found no statistically significant difference in disease-free survival between the surgery-plus-RT group and the surgery-only group (p = 0.72). We also found no significant difference in disease-free survival between patients with a tumor of the floor of mouth and those with a tumor of the tongue (p = 0.34). In the study population as a whole, the disease-free survival rate was 81.0% and the overall survival rate was 78.2%. Our findings support the trend toward a watch-and-wait approach before initiating postoperative RT for patients with close surgical margins. The decision should be carefully discussed between the surgeon, the oncologic radiotherapist, and the patient.

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