Pre-operative chemotherapy with epirubicin, cisplatin and 5FU/capecitabine in patients with operable oesophageal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14011-14011
Author(s):  
E. Boleti ◽  
D. Sharland ◽  
D. Weeden ◽  
I. Bailey ◽  
A. Bateman ◽  
...  
Keyword(s):  
Oesophageal Cancer ◽  
Oesophageal Carcinoma ◽  
Tumour Resection ◽  
Who Grade ◽  
Disease Response ◽  
Complete Tumour Resection ◽  
Complete Tumour ◽  
Grade 3 ◽  
Neo Adjuvant Chemotherapy ◽  
The Uk

14011 Background: The MRC OE02 study demonstrated pre-operative chemotherapy in patients with potentially operable oesophageal cancer improved survival. Pre-operative chemotherapy has been widely adopted in the UK. At our institution for the past 5 years patients with operable oesophageal cancer have routinely been given pre-operative chemotherapy with 3 cycles of Epirubicin, Cisplatin and Protracted Venous Infusion (PVI) 5FU (ECF). Recently, PVI 5FU has been replaced by Capecitabine (ECX). Methods: From March 2000 to October 2005, patients with operable oesophageal carcinoma have received 3 cycles of ECF or ECX (Epirubicin 50mg/m2, Cisplatin 60mg/m2, and PVI 5FU 200mg/m2 per day or Capecitabine 625mg/m2 po bd for 21 days). Disease response was assessed by CT scan and surgery was performed 4–6 weeks after completion of chemotherapy. Results: 59 patients received neo-adjuvant chemotherapy (48 received ECF, 11 ECX). Median age was 64. Fifty-three patients (89.8%) completed the planned 3 cycles of chemotherapy. WHO grade 3 or 4 toxicity occurred in 7 patients (11.8%): 6 haematological with 1 toxic death among them (1.7%) and 1 mucositis. Forty-four of 49 patients (89.7%) with dysphagia reported improvement of their symptoms as a result of chemotherapy. Fifty-two patients (88.1%) proceeded to surgery of which 47 (90.3%) underwent complete tumour resection, 4 patients (7.7%) were found to have inoperable/metastatic disease and 1 patient had incomplete excision (1.9%). Median follow-up was 26.8 months with overall median survival of 36.2 months and a 2-year survival of 63.2%. Thirty-four (57.6%) patients remain alive to date of which, 30 are disease-free and 4 are alive with recurrent disease. Conclusions: These encouraging results demonstrate that 3 cycles of preoperative ECF/ECX chemotherapy in patients with operable oesophageal cancer allow surgery to be safely performed in the vast majority of patients and our 2-year survival compare favourably with previously reported series. These results suggest that 3 cycles of pre-operative treatment with ECF/ECX chemotherapy may improve survival in this group of patients and is worthy of further research. No significant financial relationships to disclose.

Early postoperative MRI after resection of brain metastases—complete tumour resection associated with prolonged survival

2019 ◽  
Vol 161 (3) ◽  
pp. 555-565 ◽  
Author(s):  
Ida Christine Olesrud ◽  
Mette Katrine Schulz ◽  
Ljubo Marcovic ◽  
Bjarne Winther Kristensen ◽  
Christian Bonde Pedersen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Prolonged Survival ◽  
Tumour Resection ◽  
Postoperative Mri ◽  
Complete Tumour Resection ◽  
Complete Tumour

scholarly journals Introducing Fluorescence Guided Surgery into Neuro-Oncology Practice and Getting It Right First Time

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv3-iv3
Author(s):  
Babar Vaqas ◽  
Ciaran Hill ◽  
Cathy Qin ◽  
Sophie Glover ◽  
Ruchi Maniar
Keyword(s):  
High Grade Glioma ◽  
Learning Curves ◽  
Neurological Deficits ◽  
Consecutive Series ◽  
Who Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Grade 3 ◽  
Oncology Practice ◽  
The Uk

Abstract Introduction Fluorescence Guided Surgery (FGS) using 5-ALA is recommended for patients undergoing resection of suspected high grade glioma and this type of surgery is increasingly being used in more units throughout the UK. We report on our experience of introducing 5-ALA guided surgery for suspected HGG in a regional neurosciences unit. Methods Consecutive series of the first 24 patients in our unit to receive 5-ALA guided surgery for suspected HGG from June 2017 to October 2018. Data was prospectively collected. Results 5-ALA fluorescence guided surgery was used for a range of histologically confirmed WHO grade III-IV gliomas. All but 1 tumour (GBM) fluoresced with 5-ALA, with strong fluorescence in recurrent GBM and anaplastic foci of grade 3 tumours. EOR varied according to the eloquence of the lesion with 70% of cases achieving gross total resection. 40% of cases used awake mapping or intraoperative neurophysiology. 5 patients (20.8%) had temporary neurological deficits which resolved in all cases. Individual surgeon learning curves resulted in 2 styles of practice- complete FGS with fluorescence used throughout the case, and intermittent use of fluorescence as an adjunct often at the end of debulking under white light. Conclusions Adopting 5-ALA use comes with specific challenges in terms of service organisation, learning curves and complication avoidance. Our experience is that it is useful both to improve EOR and as an adjunct to identify tumour tissue in eloquent region tumours with monitoring of function. This is possible through a day admission pathway in line with GIRFT.

scholarly journals Intralesional and subarachnoid bleeding of a spinal schwannoma presenting with acute cauda equina syndrome

2019 ◽  
Vol 12 (7) ◽  
pp. e229251
Author(s):  
Mauro Dobran ◽  
Davide Nasi ◽  
Martina Della Costanza ◽  
Francesco Formica
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Tumour Resection ◽  
Subarachnoid Bleeding ◽  
Thoracic Spinal ◽  
Complete Tumour Resection ◽  
Complete Tumour ◽  
Full Neurological Recovery ◽  
A Minor ◽  
Spinal Cord Decompression

We present an unusual case of spinal neurinoma with intralesional and subarachnoid bleeding with acute cauda equina syndrome. A 38-year-old man was admitted to our department after a minor thoracic spinal trauma with right lower limb plegia and urinary retention. MRI showed a T11 intradural tumour with intralesional and subarachnoid haemorrhage. The patient was operated of spinal cord decompression and complete tumour resection. The histological examination documented a schwannoma with large haemorrhagic intratumoural areas. A full neurological recovery was documented at 6-month follow-up.

Giant cell sarcoma managed with forelimb amputation in a harbour seal (Phoca vitulina geronimensis)

2019 ◽  
Vol 7 (3) ◽  
pp. e000709
Author(s):  
Molly Martony ◽  
Judy St Leger ◽  
Claire Erlacher-Reid ◽  
Hendrik Nollens ◽  
Todd Schmitt
Keyword(s):  
Giant Cell ◽  
Needle Aspiration ◽  
Phoca Vitulina ◽  
Harbour Seal ◽  
Tumour Resection ◽  
Complete Excision ◽  
Cell Sarcoma ◽  
Complete Tumour Resection ◽  
Complete Tumour ◽  
The Right

A 22-year-old harbour seal (Phoca vitulina geronimensis) presented with a subcutaneous mass on the right dorsal carpus. The mass measured 5 cm by 2 cm and was firmly attached to the underlying tissues. Cytology from fine-needle aspiration was consistent with a soft tissue sarcoma. Surgical resection was attempted, however complete excision was prohibited by extensive local invasion. Histopathology results confirmed a moderately cellular, infiltrative, non-encapsulated giant cell sarcoma. Subsequent surgical amputation of the forelimb was performed successfully, with the animal making a full recovery. No radiographic evidence of reoccurrence was identified three years following the surgical procedure. This is the first described case of forelimb amputation in a pinniped. When complete tumour resection is unattainable, forelimb amputation may serve as an alternative or adjunct to medical management of neoplasia in phocids.

scholarly journals Spinal Nerve Root Haemangioblastoma Associated with Reactive Polycythemia

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Eric K. C. Law ◽  
Ryan K. L. Lee ◽  
James F. Griffith ◽  
Deyond Y. W. Siu ◽  
Ho Keung Ng
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Resected Specimen ◽  
Tumour Resection ◽  
Spinal Nerve Root ◽  
Intramedullary Spinal Cord ◽  
Ct Guided ◽  
Complete Tumour Resection ◽  
Complete Tumour ◽  
Ct Guided Biopsy

Haemangioblastomas are uncommon tumours that usually occur in the cerebellum and, less commonly, in the intramedullary spinal cord. The extramedullary spinal canal is an uncommon location for these tumours. Also haemangioblastoma at this site is not known to be associated with polycythemia. We present the clinical, imaging, and histological findings of an adult patient with extramedullary spinal haemangioblastoma and reactive polycythemia. Radiography and computed tomography (CT) revealed a medium-sized tumour that most likely arose from an extramedullary spinal nerve root. This tumour appeared to be slow growing as evidenced by the accompanying well-defined bony resorption with a sclerotic rim and mild neural foraminal widening. Magnetic resonance imaging revealed prominent flow voids consistent with tumoural hypervascularity. CT-guided biopsy was performed. Although preoperative angiographic embolisation was technically successful, excessive intraoperative tumour bleeding necessitated tumour debulking rather than complete tumour resection. Histology of the resected specimen revealed haemangioblastoma. Seven months postoperatively, the patients back pain and polycythemia have resolved.

VEGF-A and i-NOS expression are prognostic factors in serous epithelial ovarian carcinomas after complete surgical resection

2009 ◽  
Vol 62 (5) ◽  
pp. 448-454 ◽  
Author(s):  
K Engels ◽  
A du Bois ◽  
P Harter ◽  
A Fisseler-Eckhoff ◽  
F Kommoss ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Factors ◽  
Progression Free Survival ◽  
Figo Stage ◽  
Tumour Resection ◽  
Residual Tumour ◽  
Serous Ovarian Cancer ◽  
Free Survival ◽  
Complete Tumour Resection ◽  
Complete Tumour

Aims:Clinical stage at the time of diagnosis and achievement of complete macroscopic resection during initial surgery are key factors determining the outcome of ovarian cancer. However, prediction of outcome lacks accuracy and more reliable prognostic factors are required. Therefore, an analysis and evaluation of key angiogenic factors was carried out to determine their diagnostic and prognostic value in serous ovarian cancer.Methods:Expression levels of vascular endothelial growth factor (VEGF)-A, hypoxia-inducible factor (HIF)1-α and inducible nitric oxide synthase (i-NOS) were analysed by immunohistochemistry in a homogenous group of 112 patients with serous adenocarcinoma of the ovary. Vascular density as an indicator of angiogenesis was assessed using the Chalkley eyepiece method after staining for CD34. The correlation of these data with survival and established prognostic factors such as histological grade, Federation of Gynecology and Obstetrics (FIGO) stage, and residual tumour after surgery, was evaluated. Survival analyses, multivariate analyses and correlation tests were performed.Results:In the patient group with macroscopic complete tumour resection (R0) there was a significant correlation between VEGF-A and i-NOS expression. Kaplan–Meier analysis further revealed improved progression-free survival for R0 patients with VEGF-A-positive and i-NOS-negative tumours. The predictive relevance of VEGF-A regarding progression-free survival was sustained in multivariate analysis using FIGO stage, grading and resection status as fixed variables.Conclusion:VEGF-A and i-NOS are prognostic markers for clinical outcome in serous ovarian cancer patients with macroscopic complete tumour resection (R0). Hence, pre-therapeutic assessment of VEGF-A as predictive factor for an antiangiogenic therapy might be of clinical value.

Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience

2020 ◽  
pp. 1-7
Author(s):  
B. Rajkrishna ◽  
Balakrishnan Rajesh ◽  
Sebastian Patricia ◽  
B. Selvamani
Keyword(s):  
Conformal Radiotherapy ◽  
Target Volume ◽  
Tumour Resection ◽  
Subtotal Resection ◽  
Intracranial Meningioma ◽  
Who Grade ◽  
Time To Recurrence ◽  
Grade 3 ◽  
Patterns Of Recurrence

Abstract Aim: To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma. Materials and methods: Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence. Results: The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm. Conclusion: Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

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