Tissue expander placement and adjuvant radiotherapy after surgical resection of retroperitoneal liposarcoma offers improved local control

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

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Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

Case Reports in Oncology ◽

10.1159/000512061 ◽

2021 ◽

pp. 739-745

Author(s):

Zane Blank ◽

Richard Sleightholm ◽

Beth Neilsen ◽

Michael Baine ◽

Chi Lin

Keyword(s):

Radiation Therapy ◽

Disease Progression ◽

Surgical Resection ◽

Local Control ◽

Benign Neoplasm ◽

Good Prognosis ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Adjuvant Radiation ◽

Nasopharyngeal Angiofibroma ◽

Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

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Adjuvant Radiotherapy after Surgical Excision in Keloids

Medicina ◽

10.3390/medicina57070730 ◽

2021 ◽

Vol 57 (7) ◽

pp. 730

Author(s):

Jeong Won Lee ◽

Ki Ho Seol

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Adjuvant Therapy ◽

Local Control ◽

Adjuvant Radiotherapy ◽

Surgical Excision ◽

Recurrence Rates ◽

High Tendency ◽

Advantages And Disadvantages

Keloids are a benign fibroproliferative disease with a high tendency of recurrence. Keloids cause functional impairment, disfigurement, pruritus, and low quality of life. Many therapeutic options have been used for keloids. However, the high recurrence rates have led to the use of adjuvant therapy after surgical keloid excision. There are different radiotherapy regimens available, and the advantages and disadvantages of each are still unclear. The aim of this review is to explain the appropriate radiotherapy regimen for keloids as well as discuss the recent reports on keloid management with radiotherapy. Adjuvant radiotherapy after surgical excision for keloids yields excellent local control with tolerable side effects. Hypofractionated radiotherapy with a BED of more than 28 Gy (α/β value of 10) after excision is recommended in the light of its biologic background.

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Recurrence and disease-specific survival after 10-year disease-free interval in patients with primary retroperitoneal liposarcoma: Implications for long-term surveillance.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.11546 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 11546-11546

Author(s):

Mark Archer Eckardt ◽

Danielle S. Graham ◽

Brian E. Kadera ◽

Kyle D. Klingbeil ◽

Scott D. Nelson ◽

...

Keyword(s):

Surgical Resection ◽

Surgical Margin ◽

Disease Specific Survival ◽

Risk Of Recurrence ◽

Retroperitoneal Liposarcoma ◽

Initial Surgery ◽

Surveillance Imaging ◽

Disease Specific

11546 Background: Surveillance imaging of patients with retroperitoneal liposarcoma (RP-LPS) following surgical resection is based on a projected risk of locoregional and distant recurrence. The duration of surveillance is not well defined as the long-term natural history of RP-LPS after treatment is poorly understood. We evaluate a cohort of RP-LPS patients—without evidence of disease 10 years following initial resection—to assess the long-term risk of recurrence and disease-specific survival (DSS). Methods: The prospectively maintained UCLA Sarcoma Database was used to identify RP-LPS patients who demonstrated 10-year progression-free survival (10yr-PFS) after initial diagnosis and treatment. Patients in the 10yr-PFS cohort were subsequently evaluated for recurrence and DSS. Time intervals start at date of initial surgical resection. Cox proportional hazards models were used to determine factors associated with recurrence and DSS. Results: From 1972-2010, 76 patients with RP-LPS had at least 10 years of follow-up. Of these, 37 (49%) demonstrated 10yr-PFS. Median follow-up was 15 years (range 10-35 years). Among the 10yr-PFS patients, 43% (16/37) developed a recurrence >10 years after the initial surgery, and 19% (7/37) died of disease. Neither long-term recurrence nor DSS were significantly associated with age, sex, tumor size, LPS subtype, surgical margin, or peri-operative treatment with radiation or chemotherapy (Table). Conclusions: Patients with primary RP-LPS treated with surgical resection +/- multimodality therapy have a long-term risk of recurrence and disease-specific death that is unacknowledged by current surveillance imaging guidelines. Among the patients with a 10yr-PFS, 43% developed a recurrence and 19% died of disease. These findings suggest a need for lifelong surveillance imaging in patients with RP-LPS.[Table: see text]

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Mucosal Melanoma of the Head and Neck: Tata Memorial Hospital Experience

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1028 ◽

2010 ◽

Vol 1 (3) ◽

pp. 141-145 ◽

Cited By ~ 1

Author(s):

Vedang Murthy ◽

Ashwini Budrukkar ◽

Gupta Tejpal ◽

Jai Prakash Agarwal ◽

Suruchi Singh ◽

...

Keyword(s):

Head And Neck ◽

Surgical Resection ◽

Adjuvant Radiotherapy ◽

Disease Free Survival ◽

Mucosal Melanoma ◽

Locoregional Control ◽

Free Survival ◽

Tata Memorial Hospital ◽

Aggressive Tumor ◽

Disease Free

Abstract Background Primary mucosal melanoma of the head and neck (MMHN) is a rare, aggressive tumor of neural-crest origin. Despite universal progress in cancer care, the prognosis of MMHN continues to remain dismal. Aims To analyze and report the outcomes of primary head and neck mucosal melanomas treated at Tata Memorial Hospital. Methods Retrospective chart review of all patients with a diagnosis of nonocular MMHN presenting to the institute between 1995 to 2003. Locoregional control and disease-free survival were used as outcome measures. Results 42 patients presenting within the study period with nonocular MMHN (oral-55%, sinonasal-40%, and pharyngeal-5%) at a median age of 53 years constituted the demographic cohort. 11 (26%) patients not amenable to any active anticancer treatment were treated with best supportive care alone and excluded from outcome analysis. 26 patients underwent surgery with complete resection of tumor. Seven (27%) also received adjuvant radiotherapy due to the adverse histopathologic features. Two patients were treated with radical radiotherapy due to unresectability, two patients received palliative chemotherapy, while one patient was treated with definitive chemoradiotherapy. With a mean follow-up of 11 months (range 1-58 months), the 3-year locoregional control and disease-free survival was 41% and 12% respectively. Age, sex, site of primary, tumor stage, surgical resection, margin status, depth of infiltration, and adjuvant radiotherapy did not affect outcome significantly. Conclusion Primary mucosal melanoma of the head and neck is a rare, but, aggressive tumor with a dismal prognosis. Surgical resection with clear margins offers the best chance of cure for early localized disease. The high incidence of locoregional as well as distant failures after surgical resection supports the use of adjuvant therapy. Deeper insights into the pathobiology of disease can help develop more specific and effective treatment strategies to improve long-term outcomes.

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The radiation therapy options of intracranial hemangiopericytoma: An overview and update on a rare vascular mesenchymal tumor

Oncology Reviews ◽

10.4081/oncol.2018.354 ◽

2018 ◽

Cited By ~ 2

Author(s):

Maria Paola Ciliberti ◽

Rosa D'Agostino ◽

Laura Gabrieli ◽

Anna Nikolaou ◽

Angela Sardaro

Keyword(s):

Surgical Resection ◽

Adjuvant Radiotherapy ◽

Therapeutic Option ◽

Treatment Options ◽

Distant Metastases ◽

Complete Resection ◽

Complete Surgical Resection ◽

Hypervascular Tumor ◽

The Central Nervous System ◽

Radiotherapy Treatment

Hemangiopericytoma (HPC) is an extremely rare hypervascular tumor of mesenchymal lineage. It tends to recur and to develop distant metastases even many years after primary surgical resection. The management of recurrent and metastatic disease is not always so well defined. A complete surgical resection does not eliminate the high risk of local recurrences that occur in the central nervous system, often in the same surgical bed. However, treatment with adjuvant radiotherapy even in cases of complete resection remains controversial. Because of its rarity, there is no standard for treatment. We focused on radiotherapy treatment options, analyzing the literature and making a base on conduct further studies to establish the standard radiation dose to be used for locoregional control of such a complex and extremely rare disease and to help specialists to take the most appropriate therapeutic option.

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Multidisciplinary personalized approach in the management of vulvar cancer – the Vul.Can Team experience

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001465 ◽

2020 ◽

Vol 30 (7) ◽

pp. 932-938

Author(s):

Luca Tagliaferri ◽

Giorgia Garganese ◽

Andrea D'Aviero ◽

Valentina Lancellotta ◽

Simona Maria Fragomeni ◽

...

Keyword(s):

Overall Survival ◽

Cancer Patients ◽

Local Control ◽

Adjuvant Radiotherapy ◽

Vulvar Cancer ◽

Disease Free Survival ◽

Tumor Board ◽

Free Survival ◽

Personalized Approach ◽

Disease Free

IntroductionMultidisciplinary treatment strategy involving adjuvant radiotherapy for advanced vulvar cancer could be useful in offering the best personalized clinical approach. In 2013, the VULvar CANcer Multi-Disciplinary Team (Vul.Can MDT) was set up in our institution, in order to share knowledge and expertise, high-quality diagnosis, and evidence-based decision making in the context of personalized medicine. The aim of this observational study was to report on our series of vulvar cancer patients managed postoperatively with radiotherapy within the framework of a formal multidisciplinary tumor board.MethodsCoupling surgical and oncological international guidelines with “case-by-case” discussions, a multi-specialist consensus was progressively reached and internal recommendations were developed and introduced in the daily routine. Data from vulvar cancer patients who underwent primary surgery and adjuvant radiotherapy throughout a 5-year period were retrospectively collected. Actuarial local control was the primary endpoint, while secondary end-points were acute and late toxicities, disease-free survival, and overall survival. Toxicity was evaluated according to the Common Toxicity Criteria Adverse Event v 4.0 scale.ResultsThe analysis included 35 patients with squamous vulvar cancer treated with adjuvant radiotherapy±chemotherapy, from April 2013 to September 2017. Median age was 70 years (range 18–87), all patients underwent surgery followed by concomitant chemoradiation (45.7%) or radiotherapy alone (54.3%). The median prophylactic dose on lymphatic drainage was 45 Gy, while positive nodes and perineal area received 51.2 Gy and 52.6 Gy, respectively. Chemotherapy involved the cisplatin-based regimen (45.7%)±5-fluorouracil (37.1%). Median follow-up was 32 months (range 6–72): the 24-months local control, disease-free survival, and actuarial overall survival rates were 88.6%, 82.0%, and 91.0%, respectively. Low rates of severe acute (12%) and late (3%) toxicities occurred.DiscussionThe outcomes of this series support the benefit of a multidisciplinary personalized approach in the management of vulvar cancer.

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Resected pancreatic neuroendocrine tumors: Patterns of failure and disease-related outcomes with or without radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.325 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 325-325

Author(s):

T. M. Zagar ◽

R. R. White ◽

C. G. Willett ◽

P. Papavassiliou ◽

D. S. Tyler ◽

...

Keyword(s):

Radiation Therapy ◽

Surgical Resection ◽

Neuroendocrine Tumors ◽

Adjuvant Radiotherapy ◽

Pancreatic Head ◽

Pancreatic Neuroendocrine Tumors ◽

High Power Field ◽

Patterns Of Failure ◽

Curative Intent ◽

Pathologic Features

325 Background: Pancreatic neuroendocrine tumors (NET) are rare with improved prognosis compared to adenocarcinomas. Surgical resection remains the standard of care although many patients present with unresectable/metastatic disease. While many resected patients will fail distantly, little is known regarding the use of adjuvant radiotherapy. To define this and establish specific patterns of failure, an analysis of resected patients from a single institution was performed. Methods: From 1994 to 2009, 33 patients with NET of the pancreatic head underwent resection with curative intent at Duke University. Sixteen patients were treated with surgical resection alone, and an additional 17 underwent resection with adjuvant (n=10) or neoadjuvant (n=7) radiation therapy, usually with concurrent fluoropyrimidine-based chemotherapy (CMT). Median radiation dose was 50.4 Gy and median follow-up 28 months. Results: Patients receiving radiation therapy were more likely to have involved nodes (47% vs 19%, p=0.09), more mitoses per high power field (p=0.10) and involved margins (47% vs 31%, p=0.20) compared to surgery alone patients. Median survival for the whole cohort was 52 months. Two-year survival was 68% for the CMT group and 93% for the surgery alone group (p=0.03). Two-year local control was 85% for the CMT and 90% for the surgery group (p=0.49). Two-year metastasis-free survival was 45% and 69% for the CMT and surgery patients, respectively (p=0.02). Conclusions: Patients receiving CMT were more likely to have adverse pathologic features compared to surgery-alone patients. Survival outcomes were high in both groups, although less so in the CMT group. Distant metastasis development dominated patterns of failure. Local failure following resection of NETs is uncommon, and the role of adjuvant radiotherapy in this setting remains unclear. No significant financial relationships to disclose.

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FDG-PET based dose escalated adjuvant tomotherapy (image-guided intensity-modulated radiotherapy) utilizing 4D-CT planning for high-risk adrenocortical carcinoma (ACC): A case study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e13522 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e13522-e13522

Author(s):

Ujjal Mallick ◽

S Ramamurty ◽

Ruth Elizabeth Carr ◽

Nick Willis ◽

S Ball ◽

...

Keyword(s):

High Risk ◽

Local Control ◽

Dose Escalation ◽

Adrenocortical Carcinoma ◽

Fdg Pet ◽

Adjuvant Radiotherapy ◽

Target Volume ◽

Proliferation Index ◽

4D Ct ◽

Integrated Boost

e13522 Background: ACC is a rare endocrine malignancy with an annual incidence of 0.5-2/million/year. Surgery is the mainstay of treatment but relapse rate is high and the prognosis is dismal (20-50% 5 year survival). Adjuvant Radiotherapy improves local control in cases with high risk of local failure and dose escalation may achieve better results. Dose Escalation with 3-Dimensional computed tomography (CT) based radiotherapy is difficult for ACC due to unacceptable toxicity to several adjacent organs at risk (OARs) e.g., the kidneys, stomach bowel, liver, spinal cord. FDG-PET helps delineation of areas of higher metabolic activity and density of clonogenic cells within the target (Biological Target Volume or BTV) where focal dose escalation could be directed safely for improving local control as in other solid tumours. Tomotherapy (IMRT with daily image guidance) delivers precision radiotherapy with integrated boost to the BTV, lower dose to OARs, improved coverage of the targets, and better dose delivery across the targets which are essential for tumour control. 4-Dimensional CT for planning allows adequate Clinical Target Volume(CTV) coverage despite respiratory movements. Methods: A 63 year old lady had left adrenalectomy for an adrenocortical carcinoma measuring 29 x 18 x 25mm (TNM pT1NXMX) thought to be microscopically incompletely excised (R1) with a proliferation index ( Ki-67) of 40% for which adjuvant radiotherapy was advised. PET-CT, 4D-CT and Tomotherapy were used for planning. A total dose of 50.4Gy to PTV with a simultaneous integrated boost to BTV taking it up to 59.40Gy (1.98Gy/ fraction) in 30 daily fractions was prescribed. Results: Target dose and coverage were very satisfactory. The doses to OARs were well within tolerance despite dose escalation; she completed treatment with only grade- fatigue. She had metastatic disease at 11 months follow-up without local relapse. Conclusions: To our knowledge this is the first report of using FDG –PET based dose escalation, 4D CT and Tomotherapy in high risk ACC to improve local control and needs further study.

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Limb salvage surgery in pediatric and AYA patients with osteosarcoma: The incidence of venous thrombosis (VT).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22505 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22505-e22505

Author(s):

Sarah Jane McKillop ◽

Quincy S. Chu ◽

Karen E. Mulder ◽

Mary E Bauman ◽

Ashley Crosty

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Limb Salvage ◽

Surgical Resection ◽

Local Control ◽

Salvage Surgery ◽

Adolescent And Young Adult ◽

Limb Salvage Surgery ◽

Increased Risk ◽

Prophylactic Anticoagulation

e22505 Background: Pediatric, adolescent and young adult (AYA) patients with a diagnosis of osteosarcoma require surgical resection for local control in addition to adjuvant chemotherapy. Limb salvage surgery (LSS) has long been established as the standard of care. Pediatric and AYA patients with sarcoma are know to have an increased risk of VTE however thromboprophylaxis is not routinely used in the pediatric oncology patients. Here we review our experience over a 5 year period with patients up to 21 years diagnosed with osteosarcoma of the lower extremity treated with LSS, amputation or rotationplasty as local control and the development of VTE. Methods: A retrospective chart review was completed of patients up to 21 years of age treated for osteosarcoma of the lower extremity between January 2011 and December 2016 at our institutions. Those that underwent surgical resection of the tumor were included. Data regarding age, type of surgical procedure, the presence of a venous thrombosis, the time from diagnosis and surgery to detection of VTE and the use of anticoagulants was collected Results: 18 patients were identified: median age 14 year (6-21), 8 patients had LSS, 4 underwent rotationplasty and 6 had an amputation. Seven VTE were identified, 5 occurred in patients receiving LSS, 2 in a patient post rotationplasty and 0 in the amputation group. 6 of the 7 VTE occurred within the upper venous system, associated with the central venous line. Conclusions: In pediatric AYA patients being treated for lower limb osteosarcoma, the incidence of VTE was significantly increased for those undergoing LSS (63%) and rotationplasty (50%) compared to those receiving amputation (0%). While the population reviewed is small, based on these findings, prophylactic anticoagulation for patients with osteosarcoma, especially those patients undergoing LSS and rotationplasty should be considered beyond the immediate perioperative period. Larger prospective studies are needed to determine the risk of VTE and risks and benefits of prophylactic anticoagulation in this patient population.

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