Desmoid Tumor: Prognostic Factors and Outcome After Surgery, Radiation Therapy, or Combined Surgery and Radiation Therapy

1999 ◽  
Vol 17 (1) ◽  
pp. 158-158 ◽  
Author(s):  
Matthew T. Ballo ◽  
Gunar K. Zagars ◽  
Alan Pollack ◽  
Peter W.T. Pisters ◽  
Raphael A. Pollock
Keyword(s):  
Radiation Therapy ◽  
Relapse Rate ◽  
Desmoid Tumor ◽  
Survival Rates ◽  
Adverse Impact ◽  
Adjuvant Radiation ◽  
Desmoid Tumors ◽  
Positive Margins ◽  
Potential Benefits ◽  
Relapse Rates

PURPOSE: To evaluate the therapeutic value of resection and the potential benefits of and indications for adjuvant and definitive radiation therapy for desmoid tumors. MATERIALS AND METHODS: We performed a retrospective review of 189 consecutive cases of desmoid tumor treated with surgical resection, resection and radiation therapy, or radiation therapy alone. Treatment was surgery alone in 122 cases, surgery and radiation therapy in 46, and radiation therapy alone in 21. Median follow-up was 9.4 years. RESULTS: Overall, 5- and 10-year actuarial relapse rates were 30% and 33%, respectively. Uncorrected survival rates were 96%, 92%, and 87% at 5, 10, and 15 years, respectively. For the patients treated with surgery, the actuarial relapse rates were 34% and 38% at 5 and 10 years, respectively. Among 78 patients with negative margins, the 10-year recurrence rate was 27%, whereas 40 margin-positive patients had a 10-year relapse rate of 54% (P = .003). Tumors located in an extremity also had a poorer prognosis than did those in the trunk. For patients treated with radiation therapy for gross disease, the 10-year actuarial relapse rate was 24%. For patients treated with combined resection and radiation therapy, the 10-year actuarial relapse rate was 25%. The addition of radiation therapy offset the adverse impact of positive margins seen in the surgical group. CONCLUSION: Wide local excision with negative pathologic margins is the treatment of choice for most desmoid tumors. Function-sparing resection is appropriate because adjuvant radiation therapy can offset the adverse impact of positive margins. Unresectable disease should be treated with definitive radiation therapy.

scholarly journals Desmoid Tumor of the Popliteal Fossa during Pregnancy

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Wolfram Weschenfelder ◽  
Robert Lindner ◽  
Christian Spiegel ◽  
Gunther Olaf Hofmann ◽  
Matthias Vogt
Keyword(s):  
Hormonal Therapy ◽  
Desmoid Tumor ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
Adjuvant Radiation ◽  
Desmoid Tumors ◽  
Excellent Functional Outcome ◽  
Painless Mass ◽  
The Right ◽  
Lateral Head

Desmoid tumors are fibroblastic neoplasms that have an intermediate behavior with a highly aggressive infiltrative growth arising from deep muscle or aponeurosis. We present the case of a 34-year-old woman that developed a painless mass in the right popliteal fossa during pregnancy after intracytoplasmic sperm injection and hormonal therapy. The MRI scan showed a hyperintense mass of 6,7 cm × 4,7 cm × 3,8 cm surrounding the lateral head of the gastrocnemius muscle. The open biopsy was done one week after delivery, and the histology showed a desmoid tumor. We performed the resection one week later and found the common peroneal nerve completely surrounded by the tumor. The close resection due to the neurolysis was the reason why an adjuvant radiation with 56 Gy was done. The last clinical examination, 18 month later, did not show any signs of recurrence and an excellent functional outcome. This case demonstrates the possible influences of pregnancy and hormonal therapy on the evolution of desmoid tumors.

A population-based study of factors associated with post-prostatectomy radiation therapy utilization.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 182-182
Author(s):  
Matthew J. Maurice ◽  
Hui Zhu ◽  
Robert Abouassaly
Keyword(s):  
Radiation Therapy ◽  
Gleason Score ◽  
Strong Predictor ◽  
Teaching Hospitals ◽  
Time Range ◽  
Adjuvant Radiation ◽  
Cancer Society ◽  
Positive Margins ◽  
Pathologic Features ◽  
To Receive

182 Background: Based on level one evidence, adjuvant radiation therapy (aRT) improves cancer control in post-prostatectomy patients with adverse pathologic features. We sought to evaluate its utilization and to identify factors affecting of its use. Methods: Using the National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified men diagnosed with prostate cancer between 2004 and 2011 who were found to have pT3 disease or pT2 disease with positive margins following prostatectomy. We defined aRT as radiation to the prostate and/or pelvis 6 months or less after prostatectomy. We then used univariate and multivariate logistic regression models to assess potential patient and provider predictors of aRT use. Results: We evaluated 103,092 men who had either pT3 disease (81%) or pT2 with positive margins (19%). Of these, we identified 10,043 men (9.7%) who received aRT. Since 2004, there has been a steady decline in aRT usage with time (range, 11.5% to 7.8%). Compared to 2004, patients diagnosed in 2011 were significantly less likely to receive aRT (odds ratio [OR] 0.78, confidence interval [CI] 0.71-0.85, p<0.0001). Higher Gleason score and T stage were strongly associated with positive aRT utilization (p<0.0001), while increasing age was associated with decreased use (p<0.0001). Another strong predictor of aRT uptake was hospital type. Compared to patients treated at community hospitals, patients treated at comprehensive cancer centers or teaching hospitals were significantly less likely to receive aRT (OR 0.63, 0.58-0.68, p<0.0001 or OR 0.42, CI 0.39-0.46, p<0.0001, respectively). Charlson score and hospital location were significantly but weakly associated with aRT. Other demographic variables were not predictive of aRT. Conclusions: Post-prostatectomy aRT use is declining despite clear proof of its benefit. Consistent with the evidence, patients with risk factors for biochemical relapse (i.e. high Gleason score or T3 disease) and younger patients, who are more likely to benefit, are receiving aRT. Surprisingly, aRT use is lower at teaching hospitals, which may reflect higher usage of salvage radiation.

Redefining the role of adjuvant versus salvage radiation therapy for prostate cancer after radical prostatectomy for T3 disease and/or positive margins.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 367-367
Author(s):  
Barry W. Goy ◽  
In-Lu Amy Liu
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Hormonal Therapy ◽  
Salvage Therapy ◽  
Low Risk ◽  
Adjuvant Radiation ◽  
Positive Margins ◽  
Salvage Radiation Therapy

367 Background: SWOG 8794 recommends adjuvant radiation therapy (ART) after radical prostatectomy (RP) for T3 and/or positive margins. Our purpose was to assess 12-year outcomes on 862 RP patients who had either T3 and/or positive margins who underwent surveillance, salvage radiation therapy (SRT), or hormonal therapy (HT), while categorizing these patients into very low risk (VLR), low risk (LR), high risk (HR), and ultra high risk (UHR) groups. Methods: From 2004 - 2007, 862 RP patients had adverse factors of extracapsular penetration (T3a), seminal vesicle invasion (T3b), positive margins, and/or detectable post-operative PSA. Management included surveillance (54.8%), SRT (36.8%), and HT (8.5%) as first salvage therapy, and 21.5% eventually received hormonal therapy. Twenty patients underwent ART, and were excluded from this analysis. We assessed prognostic factors using multivariable analysis, and 12-year estimates of freedom from biochemical failure (FFBF), freedom from salvage therapy (FFST), distant metastases-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS). VLR were those with Gleason Score (GS) of 6. LR were GS 3+4 with only T3a or positive margins, but an undetectable postoperative PSA <0.1. HR were T3b with GS 7-10, any GS 7-10 with T3a/b and positive margins, but an undetectable PSA. UHR were those with a detectable PSA with a GS 7-10. Results: Median follow-up was 12.1 years. Median age was 61.6 years. Median time to first salvage treatment for VLR, LR, HR, and UHR were 10.8, 11.1, 5.3, and 0.6 years, p<0.001. 12-year estimates of FFBF for VLR, LR, HR, and UHR were 60.2%, 52.9%, 28.4%, and 0%, p<0.0001. For FFST, 70.9%, 68.6%, 40.5%, and 0%, p<0.0001. For DMFS, 99.1%, 97.8%, 88.6%, and 63.6%, p<0.0001. For PCSS, 99.4%, 99.5%, 93.5%, and 78.9%, p<0.0001. For OS, 91.8%, 91.8%, 81.0%, and 69.9%, p<0.0001. Conclusions: Outcomes of T3 and/or positive margins using surveillance or SRT as initial management yields excellent outcomes for VLR and LR groups, in which ART should be avoided. For HR, ART can be considered reasonable, since FFBF is only 28.4%. For VHR, these patients may benefit from combined hormonal therapy and ART.

Analysis of surgical strategy of treating thymomas: A single center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18519-e18519
Author(s):  
Lei Yu ◽  
Shan Ma
Keyword(s):  
Radiation Therapy ◽  
Surgical Treatment ◽  
Survival Rates ◽  
Stage Iv ◽  
Type A ◽  
Clinical Staging ◽  
Adjuvant Radiation ◽  
Thymic Epithelial Tumors ◽  
Adjuvant Radiation Therapy ◽  
Type C

e18519 Background: Thymomas are epithelial thymic tumors, generally considered to have an indolent growth pattern but are malignant. 20-40% of patients with thymomas have paraneoplastic syndromes,including myasthenia gravis(MG). The objective of this study is to evaluate outcome of surgical treatment to thymoma and determine whether the different pathological and clinical characteristics of thymomas influences the prognosis in thymoma patients. Methods: We retrospectively studied data from 228 consecutive patients operated on from1992 to 2007. All thymic epithelial tumors were reclassified according to the WHO histologic classification, and the Masaoka clinical staging system. Patients with type A and stage I thymoma had no adjuvant therapy. Most patients with types AB and B1 thymomas had radiotherapy postoperatively. Patients (stageII, III) were treated with adjuvant mediastinal radiation therapy, and both adjuvant radiation therapy and chemotherapy was administered to stage IV and type C one month after operation. For patients with tumor nodules found on the pleural surface, cytoreductive surgery was performed. After that, patients had both adjuvant radiation therapy and chemotherapy. Results: There were no peri-operative deaths. 19 cases were inoperable. 16.2% patients had postoperative complications: The proportions of type A, AB, B1, B2, B3, and C thymoma in this data were 0%, 22.4%, 26.4%, 30.4%, 20.8%, and 0% respectively in patients with MG. Microthymoma was identified in the paraneoplastic thymus of 3 patients. There were 198 patients followed up. There was no recurrence in patients with type A and a few patients with type AB, B1, B2, B3 and C recurred. The actuarial 5- and 10-year survival rates were 89.6% and 80.5% respectively. Within 5 years postoperatively, 6 of 16 deaths died of myasthenia crisis, 6 were attributable to inoperable tumors (stageIV) and type C thymoma. Conclusions: Surgical treatment to thymoma has a sound prognosis. Multimodality treatment of stage III or IV thymomas may be critical to improve the 5-year survival rate. MG seldom occurs in type A and C thymoma. The main cause of death is myasthenia crisis for thymoma patients with MG and stage IV and /or type C for thymoma patients without MG.

Postoperative irradiation for subtotally resected meningiomas

1994 ◽  
Vol 80 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Brian J. Goldsmith ◽  
William M. Wara ◽  
Charles B. Wilson ◽  
David A. Larson
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Benign Meningioma ◽  
Free Survival ◽  
Cerebral Necrosis

✓ The authors retrospectively analyzed 140 patients treated at the University of California, San Francisco, from 1967 to 1990 to evaluate the results of radiation therapy (median 5400 cGy) given as an adjuvant to subtotal resection of intracranial meningioma. Of the 140 meningiomas, 117 were benign and 23 were malignant. The median follow-up period was 40 months. The overall survival rate at 5 years was 85% for the benign and 58% for the malignant tumor groups (p = 0.02); the 5-year progression-free survival rates were 89% and 48%, respectively (p = 0.001). For patients with benign meningioma, the 10-year overall and progression-free survival rates were 77%. An improved progression-free survival rate in that group was not related to tumor size but was associated with a younger age (p = 0.01) and treatment after 1980 with innovative technologies (p = 0.002); none of those variables affected the progression-free survival rate in the patients with malignant meningioma. Increased progression-free survival in the benign tumor group was also significantly associated with increasing the minimum radiation dose (p = 0.04). The 5-year progression-free survival rate for patients with benign meningioma treated after 1980 (when computerized tomography or magnetic resonance imaging was used for planning therapy) was 98%, as compared with 77% for patients treated before 1980 (p = 0.002). There were no second central nervous system tumors. Morbidity (3.6%) included sudden blindness or cerebral necrosis and death. When total resection of benign meningioma is not feasible, subtotal resection combined with precise treatment planning techniques and adjuvant radiation therapy can achieve results comparable to those of total resection.

scholarly journals INFLUENCE OF RISK FACTORS FOR DISEASE PROGRESSION ON TREATMENT RESULTS IN PATIENTS WITH PROSTATE CANCER

2021 ◽  
Vol 20 (3) ◽  
pp. 48-55
Author(s):  
R. M. Isargapov ◽  
M. O. Vozdvizhensky ◽  
A. L. Gorbachev
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radiation Therapy ◽  
Disease Progression ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Disease Free

The purpose of the study was to optimize treatment of patients with prostate cancer at high risk of disease progression using a quantitative assessment of risk factors and the treatment method.Material and methods. Immediate outcomes were analyzed in 107 patients with pt3a-bn0m0g2–4 prostate cancer, who were treated in samara regional clinical oncological dispensary between 2010 and 2012. All patients were divided into 2 groups. Group i patients underwent surgery alone and group ii patients underwent surgery followed by radiation therapy. All patients were at high risk of disease progression according to the d’amico classification. Onlyone risk factor was identified in 64 patients, two risk factors in 37 patients, and three risk factors in 6 cases. The overall survival, cancer-specific survival and disease-free survival were analyzed.Results. In cases with one and two risk factors, the overall, disease-free and cancer-specific survival rates were statistically higher than in cases with three risk factors in the entire cohort (p<0.05). In the subgroups with one, two, and three risk factors, there were no statistically significant differences in overall and cancer-specific survival rates (p>0.05). Disease-free survival rates in the presence of one factor were not statistically different (p=0.920). In the presence of two and three factors, the relapse-free survival rates were statistically higher in group ii patients (surgical with adjuvant radiation therapy, p=0.049, p=0.025).Conclusion. The presence of three risk factors significantly increased the likelihood of a poor prognosis compared with one or two factors. Adjuvant radiation therapy improved survival rates in prostate cancer patients.

scholarly journals Mesenchymal Chondrosarcoma

2016 ◽  
Vol 3 (2) ◽  
pp. 300-304 ◽  
Author(s):  
William M. Mendenhall ◽  
John D. Reith ◽  
Mark T. Scarborough ◽  
Bruce K. Stechmiller ◽  
Nancy P. Mendenhall
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Survival Rates ◽  
Distant Metastases ◽  
Common Mechanism ◽  
Adjuvant Radiation ◽  
Blue Cell ◽  
Overall Survival Rates

Abstract Purpose: To review the treatment and outcomes of patients with mesenchymal chondrosarcomas (MC). Materials and Methods: Review of the pertinent literature. Results: MC is a rare aggressive small round blue cell malignancy that may arise in either bone or soft tissue. It usually presents in the 2nd or 3rd decade of life and exhibits an approximately equal gender predilection. Patients usually present with pain and swelling. The majority of MCs arise in either the trunk or extremities. Distant metastases are present at diagnosis in about 15% of patients. The most common sites for distant metastases are lung and bone. The optimal treatment is surgery. Although the role of adjuvant chemotherapy is unclear, an anthracycline-based chemotherapy regimen combined with ifosfamide or cisplatin, may be considered. Adjuvant radiation therapy (RT) is employed for patients with close (&lt;5 mm) or positive margins as well as those with incompletely resectable tumors. The most common mechanism of recurrence is hematogenous dissemination. Although most recurrences are observed within 5 years of treatment, late recurrences are not unusual. The likelihood of successful salvage in the event of a recurrence is modest. The overall survival rates for all patients are approximately 50% at 5 years and 40% at 10 years. The overall survival rates for the subset of patients with localized disease that is resected are approximately 70% to 80% at 5 years and 60% at 10 years. Conclusion: Patients with MCs are optimally treated with surgery. The role of adjuvant chemotherapy is uncertain. However, given the relatively high risk of recurrence, adjuvant chemotherapy should be considered in medically fit patients. Radiation therapy should be considered for those with incompletely resectable tumors and those with inadequate margins.

Identification of Factors Predicting Response to Adjuvant Radiation Therapy in Patients With Positive Margins After Radical Prostatectomy

2003 ◽  
Vol 170 (5) ◽  
pp. 1860-1863 ◽  
Author(s):  
ASHISH M. KAMAT ◽  
KARA BABAIAN ◽  
MIN REX CHEUNG ◽  
YOSHIO NAYA ◽  
SAMUEL H. HUANG ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Positive Margins

Surgery and adjuvant therapy in gallbladder cancer: A single-institution experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 405-405
Author(s):  
Nishi Kothari ◽  
Richard D. Kim ◽  
Gregory M. Springett ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Therapy ◽  
Gallbladder Cancer ◽  
Early Stage ◽  
High Rate ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Positive Margins ◽  
Radical Cholecystectomy ◽  
Biomarker Analysis

405 Background: Gallbladder cancer is a highly fatal disease with a high rate of recurrence even when diagnosed at an early stage. Because of its relative rarity, there are currently no established algorithms to guide therapy after cholecystectomy. To explore the value of adjuvant therapy with chemotherapy and radiation, we evaluated patients with resected gallbladder cancer treated at our institution. Methods: Patients diagnosed with gallbladder cancer who underwent cholecystectomy (simple or radical) between 2000 and 2010 were identified using our cancer registry. Retrospective chart review was performed for clinicopathologic data, including age, stage, grade, type of surgery, margin status, and type and duration of adjuvant therapy. The primary endpoint was overall survival (OS). Univariate (UVA) and multivariate (MVA) analysis was performed with Cox logistic regression analyses. Results: We identified 73 patients with a median followup for all patients of 28.2 months. The majority of patients were female (74%) and underwent radical cholecystectomy (64%). Positive margins and adjuvant radiation therapy were documented in 21% and 37%, respectively. The majority of patients did not receive any adjuvant therapy (53.4%). Median OS for all patients was 41.3 months. There was a survival benefit associated with patients undergoing radical cholecystectomy followed by adjuvant radiation (median OS 48.4 months vs. 22.3 months; HR 0.35; 95% CI: 0.13–0.98; p=0.0448) compared to simple cholecystectomy alone. On UVA, increasing age and positive margins were significantly associated with worse OS, while radical cholecystectomy was associated with improved OS. On MVA, increasing age, male gender, poorly differentiated tumor, and positive margins were associated with worse OS, while adjuvant radiation was associated with improved OS (p=0.0113). Conclusions: Our analysis supports the role for adjuvant radiation therapy in resected gallbladder cancer. Multi-institutional prospective studies should be performed to evaluate the optimal treatment strategy. Biomarker analysis might also help determine the subset of patients who would benefit from combined chemoradiation.

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