scholarly journals Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

2020 ◽  
pp. bjophthalmol-2020-316293
Author(s):  
Puneet Jain ◽  
Paul T Finger ◽  
Maria Fili ◽  
Bertil Damato ◽  
Sarah E Coupland ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Excision ◽  
External Beam Radiotherapy ◽  
Staging System ◽  
Primary Treatment ◽  
Excision Biopsy ◽  
Conjunctival Melanoma ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Eighth Edition

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates

2019 ◽  
Vol 21 (4) ◽  
pp. 451-459 ◽  
Author(s):  
H. J. S. Jones ◽  
S. Goodbrand ◽  
R. Hompes ◽  
N. Mortensen ◽  
C. Cunningham
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Local Excision ◽  
Recurrence Rates

A prospective randomized trial of adjuvant brachytherapy in the management of low-grade soft tissue sarcomas of the extremity and superficial trunk.

1994 ◽  
Vol 12 (6) ◽  
pp. 1150-1155 ◽  
Author(s):  
P W Pisters ◽  
L B Harrison ◽  
J M Woodruff ◽  
J J Gaynor ◽  
M F Brennan
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Systemic Disease ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
Recurrence Rates ◽  
Tumor Bed ◽  
The Impact

PURPOSE This study was designed to evaluate the impact of adjuvant brachytherapy (BRT) on local and systemic recurrence rates in patients with low-grade sarcoma. PATIENTS AND METHODS Forty-five patients with histologic low-grade, completely resected soft tissue sarcomas of the extremity or superficial trunk were entered onto this trial. Following resection of all gross disease, patients were randomized to the BRT arm (n = 22) or to the no-BRT arm (n = 23). On the fifth or sixth postoperative day, catheters were loaded with iridium 192 to deliver a dose of 45 Gy to the tumor bed over 4 to 6 days. RESULTS The two groups were evenly distributed with respect to the distribution of presentation status (primary v recurrent), tumor site (trunk v extremity, proximal v distal extremity), tumor size (< 5 cm v > or = 5 cm), tumor depth (superficial v deep), and microscopic tumor margins (positive v negative). The predominant histopathologic diagnosis in each group was liposarcoma (BRT, 13 of 22 [59%]; no BRT, 14 of 23 [61%]) with other histopathologic subtypes evenly distributed between the two groups. The median follow-up duration among the ongoing survivors is 67 months. One patient in the BRT group developed systemic disease and died of progressive disease. Local recurrence occurred in five of 23 patients (22%) in the no-BRT group and six of 22 patients (27%) in the BRT group (P = .60). CONCLUSION Adjuvant radiation in the form of BRT does not appear to decrease local recurrence rates following complete resection of low-grade extremity and superficial trunk soft tissue sarcomas. Other adjuvant approaches, such as external-beam radiotherapy, are required to have a significant impact on local recurrence rates in this group of patients.

scholarly journals Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia

2019 ◽  
Author(s):  
Min Kyung Back ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Complete Resection ◽  
Epithelial Dysplasia ◽  
Resection Rate ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Complete Resection Rate ◽  
Increased Risk

Abstract Background : Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods : In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015. Results : The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05). Conclusions : The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.

Risk factors in breast-conservation therapy.

1994 ◽  
Vol 12 (4) ◽  
pp. 653-660 ◽  
Author(s):  
J Borger ◽  
H Kemperman ◽  
A Hart ◽  
H Peterse ◽  
J van Dongen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Predictive Factors ◽  
Vascular Invasion ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Recurrence Rates ◽  
Margin Involvement ◽  
Increased Risk ◽  
Breast Recurrence

PURPOSE To identify clinical and pathologic factors associated with an increased risk of local recurrence following breast-conservation therapy (BCT) to assess the safety of this procedure for all subgroups of patients. PATIENTS AND METHODS The study population consisted of 1,026 patients with clinical stage I and II breast cancer treated between 1979 and 1988 at the Netherlands Cancer Institute. The BCT regimen consisted of local excision and axillary lymph node dissection (ALND) followed by whole-breast irradiation to a total dose of 50 Gy in 2-Gy fractions and boost irradiation (mostly by iridium implant) of 15 to 25 Gy. RESULTS With a median follow-up duration of 66 months, the actuarial breast recurrence rate was 4% at 5 years, counting all breast recurrences. Univariate analysis showed seven factors to be associated with an increased risk of local recurrence; age, residual tumor at reexcision, histologic tumor type, presence of any carcinoma-in-situ component, vascular invasion, microscopic margin involvement, and whole-breast radiation dose. Three factors remained independently significant after proportional hazard regression analysis: age, margin involvement, and the presence of vascular invasion. When the analysis was repeated, but counting only those breast recurrences that occurred before regional or distant failures, only young age and vascular invasion were independent predictive factors. In the third analysis, factors predicting the necessity of local salvage treatment were analyzed. In this analysis, the possible bias in the former analysis caused by censoring actuarial methods was avoided. The results were the same as in the second analysis, showing young age and vascular invasion as the only independent predictive factors. Breast recurrence rates were 6% for patients less than 40 years of age and 8% for patients with tumors showing vascular invasion. In the absence of risk factors, the breast recurrence rate is only 1% at 5 years. CONCLUSION Slightly higher recurrence rates were found in patients less than 40 years of age and in patients with tumors showing vascular invasion. The role of margin involvement is uncertain.

scholarly journals Analysis of factors associated with local recurrence after endoscopic resectionof gastric epithelial dysplasia: A retrospective study

2020 ◽  
Author(s):  
Min Kyung Back ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Complete Resection ◽  
Epithelial Dysplasia ◽  
Resection Rate ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Complete Resection Rate ◽  
Increased Risk

Abstract Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods: In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.Results: The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05).Conclusions: The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.

scholarly journals Treatment after breast cancer recurrence: Conserving surgery or adenomastectomy?

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Antonio Luiz Frasson ◽  
Martina Lichtenfels ◽  
Betina Vollbrecht ◽  
Ana Beatriz Falcone ◽  
Fernanda Barbosa
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Cancer Recurrence ◽  
Radical Mastectomy ◽  
Breast Cancer Recurrence ◽  
Luminal A ◽  
Recurrence Rates ◽  
Oncological Safety ◽  
Aesthetic Result ◽  
Increased Risk

Introduction: Different factors are related with the increased risk of local recurrence, such as tumor grade, surgical margins and age. The recurrence of a tumor shows the aggressiveness of the disease and can be related with progression and worse prognosis. Radical mastectomy is the standard treatment for patients who present local recurrence after conserving surgery (CS); however, different studies have shown oncological safety using a new conserving surgery as an alternative to treat recurrence in selected patients. In the past few years, due to an increasing concern of mastologists with oncological safety, besides the aesthetic result, adenomastectomy (nipple-sparing mastectomy, NSM) became a good therapeutic choice for patients with breast cancer. Several authors have demonstrated similar recurrence and survival rates when compared to NSM techniques and total mastectomy. This study aims at assessing the local recurrence rates and the distance of NSM versus CS for the treatment of breast cancer recurrence. Methods: We assessed data from patients with breast cancer recurrence after conserving surgery who were treated with NSM, 24 patients, or new CS, 22 patients. All surgeries to treat the recurrence were carried out between 2001 and 2017. Results: The mean age of patients submitted to NSM was 52.7 years, and 61.3 years in the CS group. Patients submitted to a new conserving surgery presented 81.8% of tumors smaller than 2 cm; 81.3% grade 1 and 2 tumors; and 43.9% of luminal A tumors. In comparison to these characteristics, the patients who underwent NSM demonstrated lower rates (66.7%) of tumors smaller than 2 cm, higher rates of grade 2 (63.2%) and 3 (36.8%) tumors, and only 26.4% presented luminal A tumors, being the highest percentage (52.6%) of luminal B tumors. After a mean follow-up period of 140 months, the local recurrences were similar for both groups: 20.9% in NSM, and 22.7% in CS. Only 1 (4.2%) patient submitted to NSM presented metastasis, and in the CS group, no patient presented metastasis. Conclusions: By assessing the characteristics of patients submitted to NSM or CS for the treatment of breast cancer recurrence after previous CS, we observed younger patients and more aggressive tumors in the group that underwent NSM. Despite these characteristics, the local recurrence rates were similar in both surgeries. The presented local recurrence rates are high, and show the difficulty to treat the recurrence of previous tumors. No patient in the CS group presented with metastasis, and only one was shown in the group of patients submitted to NSM. These results suggest that NSM can be a surgical option to treat breast cancer recurrence when CS is not possible; however, further studies need to be carried out to elucidate these findings.

scholarly journals Expression of Cancer Testis Antigens in Tumor-Adjacent Normal Liver Is Associated with Post-Resection Recurrence of Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2499
Author(s):  
Lisanne Noordam ◽  
Zhouhong Ge ◽  
Hadiye Özturk ◽  
Michail Doukas ◽  
Shanta Mancham ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Normal Liver ◽  
Occult Metastasis ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Cancer Testis Antigens ◽  
Negative Prognostic Factor ◽  
Increased Risk ◽  
Hcc Recurrence ◽  
Cancer Testis

High recurrence rates after resection of hepatocellular carcinoma (HCC) with curative intent impair clinical outcomes of HCC. Cancer/testis antigens (CTAs) are suitable targets for cancer immunotherapy if selectively expressed in tumor cells. The aims were to identify CTAs that are frequently and selectively expressed in HCC-tumors, and to investigate whether CTAs could serve as biomarkers for occult metastasis. Tumor and paired tumor-free liver (TFL) tissues of HCC-patients and healthy tissues were assessed for mRNA expression of 49 CTAs by RT-qPCR and protein expression of five CTAs by immunohistochemistry. Twelve CTA-mRNAs were expressed in ≥10% of HCC-tumors and not in healthy tissues except testis. In tumors, mRNA and protein of ≥ 1 CTA was expressed in 78% and 71% of HCC-patients, respectively. In TFL, CTA mRNA and protein was found in 45% and 30% of HCC-patients, respectively. Interestingly, CTA-expression in TFL was an independent negative prognostic factor for post-resection HCC-recurrence and survival. We established a panel of 12 testis-restricted CTAs expressed in tumors of most HCC-patients. The increased risk of HCC-recurrence in patients with CTA expression in TFL, suggests that CTA-expressing (pre-)malignant cells may be a source of HCC-recurrence, reflecting the relevance of targeting these to prevent HCC-recurrence.

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