Gastric cancer liver metastasis: Optimal management for oligo-metastatic disease.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Hiromichi Ito ◽  
Nobuyuki Takemura ◽  
Yoshihiro Ono ◽  
Takafumi Sato ◽  
Yoshihiro Mise ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Medical Records ◽  
Optimal Management ◽  
Curative Intent ◽  
Entire Cohort ◽  
Disease Free

136 Background: The role of surgery for gastric cancer liver metastasis (GCLM) has not been established and particularly, the optimal management for liver-isolated, oligo-GCLMs remains controversial. The aims of this study were to review the outcomes for our patients with GCLM who underwent liver resection and to define the optimal selection criteria for resection. Methods: The medical records of patients who underwent liver resection for GCLMs with curative intent at our institution from 1993 through 2018 were reviewed. Our criteria for liver resection included absence of extrahepatic disease, and the limited number of liver metastasis (often 3 or less). Results: Total 101 patients with GCLM (77 men [76%], median age 66 years) were included. Forty-seven patients (46%) had synchronous metastasis and all underwent simultaneous resection with the primary disease. Those with synchronous disease received neoadjuvant therapy more often than those with metachronous disease (63% vs 37%, p = 0.021). Median RFS and OS for the entire cohort were 11 months and 39 months, respectively, and 5-year-OS rate was 41%. Of note, 25 patients achieved survival longer than 5 years without any recurrence thereafter with median follow-up of 137 months. In the multivariate analyses, elevated CEA 50 ng/ml or greater and nodal status of the primary were associated with shorter RFS, while primary T4 disease, liver tumor 5cm or great and elevated CEA were associated with shorter OS (Table 1). Conclusions: For well selected patients with GCLM, liver resection is an effective therapy not only to prolong disease-free time, but also to achieve cure. CEA is useful to select patients with GCLM who unlikely benefit from aggressive surgery. [Table: see text]

Sarcomas of Uterine Cervix: Clinicopathological Features, Treatment, and Outcome

2012 ◽  
Vol 22 (6) ◽  
pp. 1026-1030 ◽  
Author(s):  
Divya Khosla ◽  
Ruchi Gupta ◽  
Radhika Srinivasan ◽  
Firuza D. Patel ◽  
Arvind Rajwanshi
Keyword(s):  
Medical Records ◽  
Vaginal Bleeding ◽  
Combined Modality Treatment ◽  
Optimal Management ◽  
Cervical Mass ◽  
Primary Surgery ◽  
Combined Modality ◽  
Primary Radiotherapy ◽  
Disease Free

ObjectiveSarcomas constitute less than 1% of all cervical malignancies. The objective of this study was to determine the presentation, pathological findings, treatment, and outcome of patients with cervical sarcoma.Methods and MaterialsA retrospective analysis of 8 cases of cervical sarcoma diagnosed over a 4-year period from 2006 to 2009 was carried out. The medical records of all patients were reviewed. All pathologic specimens were reviewed by a single pathologist.ResultsOf 1804 patients with cervical malignancies, 8 cervical sarcomas were identified. All patients presented with vaginal bleeding and discharge. The lesions were clinically staged as IB2 (3), II B (1) and IIIB (4). Three patients had leiomyosarcoma, 4 patients had a diagnosis of undifferentiated endocervical sarcoma, and one had embryonal rhabdomyosarcoma. Of the 8 patients, 3 absconded after diagnosis. Primary surgery was done in 3 patients of which 2 patients received adjuvant radiotherapy and chemotherapy and one patient absconded after surgery. Primary radiotherapy was given in 2 patients. Three of 8 patients treated with combined modality treatment remain alive and disease free at the last follow-up.ConclusionsCervical sarcomas are rare neoplasms and represent a spectrum on histopathology. Most patients present with vaginal bleeding and a bulky cervical mass at the time of diagnosis. The optimal management of these tumors is uncertain owing to its rarity; however, combined modality treatment can result in prolonged survival and cure.

Influence of intra-hepatic chemotherapy on survival of patients with colorectal liver metastasis treated with hepatic resection and systemic chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 379-379
Author(s):  
Mohammed Kanaan ◽  
Mohammad Mozayen ◽  
Sunil Nagpal ◽  
David Wiese ◽  
David S. Eilender ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastasis ◽  
Hepatic Resection ◽  
Colorectal Liver Metastasis ◽  
Systemic Chemotherapy ◽  
Small Sample ◽  
Major Liver Resection ◽  
Major Hepatic Resection

379 Background: The role of intrahepatic pump chemotherapy (HAI) in the treatment of liver metastasis is still controversial. Our study was performed to evaluate the adjunctive role of HAI in patients (pts) with colorectal liver metastasis (CLM) treated with major hepatic resection and systemic chemotherapy (Systemic Rx). Methods: A retrospective analysis was performed on pts with histologically confirmed CLM who had major liver resection and/or radiofrequency ablation and received systemic Rx with HAI and compared with pts without HAI. Primary outcome was overall survival. Exclusion criteria included a second cancer, refusal of chemotherapy, loss of follow-up and minor resection or biopsy alone. Statistical analysis was done using Kaplan-Meyer survival curves. Results: Consecutive 66 pts with CLM were analyzed, of which 13 pts were lost to follow-up. Out of 53 pts undergoing systemic Rx and major liver resection, 37 pts had HAI with 5-fluorouracil (gp A) and 16 pts had no HAI (gp B). Both groups received similar systemic Rx ( Table 1). There was no HAI related mortality in gp A. Pts with minimum follow-up of 3 years were included for survival analysis. The overall 3-year survival of gp A was 36% (12 pts out of 33) compared to 23 % (3 pts out of 13 pts) in gp B. Due to small sample size statistical significance was not achieved. Conclusions: Pts with CLM who undergo systemic Rx with HAI along with major hepatic resection or ablation may survive longer than pts with systemic Rx without HAI. A larger multicenter study is warranted. [Table: see text]

Conditional disease‐free survival after curative‐intent liver resection for neuroendocrine liver metastasis

2019 ◽  
Vol 120 (7) ◽  
pp. 1087-1095 ◽  
Author(s):  
Kota Sahara ◽  
Katiuscha Merath ◽  
Diamantis I. Tsilimigras ◽  
J. Madison Hyer ◽  
Alfredo Guglielmi ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastasis ◽  
Disease Free Survival ◽  
Curative Intent ◽  
Free Survival ◽  
Neuroendocrine Liver Metastasis ◽  
Disease Free

Gastric cancer

2016 ◽  
pp. 388-407
Author(s):  
Hideaki Bando ◽  
Takahiro Kinoshita ◽  
Yasutoshi Kuboki ◽  
Atsushi Ohtsu ◽  
Kohei Shitara
Keyword(s):  
Gastric Cancer ◽  
Metallic Stent ◽  
Curative Surgery ◽  
Curative Intent ◽  
Expandable Metallic Stent ◽  
Pain Medications ◽  
Gastric Stenosis ◽  
Environmental Causes ◽  
Endoscopic Placement

This chapter covers gastric cancers, beginning with epidemiology and molecular biology, including the association between Helicobacter pylori infection and gastric cancer, and other genetic and environmental causes. The role of surgical therapy in the treatment of gastric cancer including staging and resection with curative intent is presented. The medical management of gastric cancer is discussed, including adjuvant therapy after curative surgery and systemic treatment for palliation of metastatic disease, taking into account the differing biology and treatments in the East and West. The use of the first biologics in gastric cancer, trastuzumab and ramucirumab, and their mechanisms of action are described. Various modes of palliation of symptoms in patients with advanced gastric cancer include: gastrojejunostomy, endoscopic placement of a self-expandable metallic stent for gastric stenosis or obstruction, and pain control with pain medications and radiotherapy.

scholarly journals Squamous Cell Carcinoma of the Paranasal Sinuses: A Single Center Experience

2019 ◽  
Vol 81 (06) ◽  
pp. 664-672 ◽  
Author(s):  
Marton König ◽  
Terje Osnes ◽  
Åse Bratland ◽  
Torstein R. Meling
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Paranasal Sinuses ◽  
Adjuvant Radiation ◽  
Curative Intent ◽  
Entire Cohort ◽  
High Stage ◽  
Oncologic Treatment

Abstract Objective Squamous cell carcinoma (SCC) of the paranasal sinuses is usually diagnosed at an advanced stage, making curative therapy difficult. The goal of this study was to evaluate the management and outcomes of patients with SCC treated at our institution. Methods In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for SCC between 1988 and 2017. Results A total of 72 patients were included, follow-up was 100%. Mean follow-up was 57 months for the entire cohort, and 108 months for patients with no evidence of disease. Eighty-two percent of all patients had high-stage (T4) disease. Fifty-seven patients underwent treatment with curative intent; consisting of surgery with or without oncologic treatment in 34, and of oncologic treatment only in 23 cases. Fifteen patients received palliative treatment. The rates of overall survival for the entire cohort were 55% at 2, 41% at 5, and 32% at 10 years, and corresponding disease-specific survival (DSS) rates were 55, 45, and 34%, respectively. DSS rates after surgical treatment with curative intent were 81% at 2, 65% at 5, and 54% at 10 years. Retromaxillary involvement and nonradical surgery were negative prognostic factors. Best survival was achieved with the combination of radical surgery and adjuvant oncologic treatment. Conclusion Surgical resection with a curative intent yielded 65% at 5-year DSS even in this cohort of patients with high-stage SCC and is still considered as the treatment of choice, preferably in combination with adjuvant radiation therapy and chemotherapy.

scholarly journals Radiofrequency ablation versus traditional liver resection and chemotherapy for liver metastases from gastric cancer

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094050
Author(s):  
Kezhong Tang ◽  
Bo Zhang ◽  
Linping Dong ◽  
Lantian Wang ◽  
Zhe Tang
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Statistical Significance ◽  
Local Treatment ◽  
Long Term Outcomes ◽  
Short And Long Term

Objective To compare the short- and long-term outcomes of radiofrequency ablation (RFA) versus liver resection and chemotherapy for liver metastases from gastric cancer. Methods We retrospectively evaluated 50 patients who underwent curative gastrectomy and local treatments for liver metastases (RFA, n = 20; liver resection, n = 20; and chemotherapy, n = 10) from 2008 to 2018. Results The short- and long-term outcomes of each local treatment were evaluated. The median overall survival (OS) after RFA was similar to that after liver resection (20 vs. 20 months, respectively) and longer than that after chemotherapy (20 vs. 10 months, respectively). The 3-year OS and progression-free survival (PFS) rates after RFA were 20% and 10%, respectively, while those in the liver resection group were 23.5% and 23.5%, respectively. The 3-year OS rate after chemotherapy was 10%. The size and number of metastases were prognostic factors for patients with gastric cancer with liver metastasis without statistical significance. Conclusions Among patients with liver metastasis from gastric cancer, OS and PFS were satisfactory and comparable between RFA and liver resection but better than those of chemotherapy. RFA is an appropriate option for patients with gastric cancer who have a solitary liver metastasis measuring ≤3.0 cm.

scholarly journals Radiofrequency Ablation (RFA) as A Cytoreductive Strategy for Hepatic Metastasis from Breast Cancer

2006 ◽  
Vol 88 (7) ◽  
pp. 639-642 ◽  
Author(s):  
D Lawes ◽  
A Chopada ◽  
A Gillams ◽  
W Lees ◽  
I Taylor
Keyword(s):  
Breast Cancer ◽  
Radiofrequency Ablation ◽  
Liver Metastasis ◽  
Hepatic Metastasis ◽  
Primary Breast Cancer ◽  
Hepatic Disease ◽  
Extrahepatic Disease ◽  
Major Morbidity ◽  
Disease Free

INTRODUCTION Patients with liver metastasis from breast cancer have a poor prognosis, although this may be improved by hepatectomy in a selected group with disease confined to the liver. We evaluate the effectiveness of radiofrequency ablation (RFA) as a cytoreductive strategy in the management of liver metastasis from primary breast cancer. PATIENTS AND METHODS Nineteen patients with hepatic metastasis from primary breast cancer underwent RFA of their liver lesions between April 1998 and August 2004. RESULTS The median age of the patients was 52 years (range, 32–69 years), 8 had disease confined to the liver, with 11 having stable extrahepatic disease in addition. Seven patients with disease confined to the liver at presentation are alive, as are 6 with extrahepatic disease, median follow-up after RFA was 15 months (range, 0–77 months). Survival at 30 months was 41.6%. In addition, 7 patients followed up for a median of 14 months (range, 2–29 months) remain alive and disease-free. RFA failed to control hepatic disease in 3 patients. RFA was not associated with any mortality or major morbidity. CONCLUSIONS Control of hepatic metastasis from breast cancer is possible using RFA and may lead to a survival benefit, particularly in those patients with disease confined to the liver.

Retrospective Comparison of Using or Not Using Donor Lymphocyte Transfusion in the Treatment of Hematological Relapse after Allogeneic Stem Cell Transplantation in 489 Adults with Acute Myeloid Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 298-298
Author(s):  
Christoph Schmid ◽  
Myriam Labopin ◽  
Juergen Finke ◽  
Gerhard Ehninger ◽  
Olle Ringden ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
De Novo ◽  
Patient Age ◽  
Entire Cohort ◽  
Post Transplant ◽  
Patient Âgé ◽  
Retrospective Comparison ◽  
De Novo Aml

Abstract Relapsed AML after allogeneic SCT has a poor prognosis. So far, no standard therapy could be defined. Donor lymphocyte transfusion (DLT) has been effective in a minority, however, no data is available to identify patients who will benefit from the procedure. Neither, the outcome of patients treated with or without DLT have been compared. We retrospectively evaluated overall survival (OS) of 489 adults with de novo AML in hematological relapse after SCT, receiving DLT (n=190) or not (n=299). DLT and noDLTgroups were well balanced in terms of patient age (median:37y in both groups), donor age, cytogenetics (good:5vs7%, intermediate:83vs79%, poor:12%vs14%), WBC at diagnosis, donor type (geno-id:71vs72%, MUD:18% both, mismatched:11vs10%), status at transplantation (CR1:38vs41%, CR2:13vs15%, advanced:49vs44%), conditioning, source of stem cells, and time from transplant to relapse (5vs4.5 months). However, DLT patients had a median of 39% BM blasts, as compared to 54% for the noDLT group (p=0.03). Follow-up was 32 and 30 months. Within the DLT group, chemotherapy was additionally given in 130 cases. Nevertheless, only 33% of patients received DLT in CR or aplasia, 67% had measurable disease. AGvHD developed in 41% of patients following DLT. CR and PR were achieved in 31.1% and 4.8% of DLT patients. In a multivariate analysis, younger patient age (<36 years) (HR=1.53,p=0.02) and a longer interval (> 5 months) from transplant to relapse (HR=7.74,p=0.002) were associated with better OS after DLT. When comparing the outcome of patients receiving or not DLT, OS at 2 years was 10±1% for the entire cohort, 18±3% for DLT and 6±1% for noDLT (p<.0001). In a multivariate analysis, use of DLT (HR=2.11,p<0.0001); recipient’s age<36 y (HR=1.69, p<0.001); longer interval (>5 months) from transplant to relapse (HR=2.40, p<0.0001) and number of BM blasts (<48%) at relapse (HR=1.56,p=0.002) were favorable for OS. In this retrospective analysis the results suggest that DLT may be of advantage in the treatment of AML relapse post transplant, at least in younger patients with a longer post transplant remission and relapsing with smaller amounts of blasts in BM. However, patients receiving DLT might represent a positive selection among all relapsed cases, since a considerable number from the noDLT cohort had died too early to proceed to DLT. An intetion-to-treat analysis and further prospective studies should investigate the role of DLT and other approaches, such as second reduced intensity SCT.

Population-based analysis of multimodality treatment of gastric cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 124-124
Author(s):  
P. Cen ◽  
Y. Xing ◽  
C. J. Wray ◽  
M. B. Fallon ◽  
V. I. Machicao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Locally Advanced ◽  
Community Setting ◽  
Multimodality Treatment ◽  
Population Based ◽  
Entire Group ◽  
Perioperative Chemotherapy ◽  
Trimodality Therapy

124 Background: Limited data is available for the role of multimodality management for gastric adenocarcinoma and its outcome in the community. Methods: We retrospectively reviewed the outcomes for 341 patients (pts) who were diagnosed with gastric cancer in a community-based health-care system, including 9 hospitals, from 2000 to 2009. Results: 148/341 pts had undergone surgery and were included in the analysis. Median age at diagnosis was 68 year (range: 32-96), 56% were male, 55% were Caucasian and 25% were black. The stage distribution was as follows: 27% (40 pts) localized, 61% (90 pts) locally advanced and 12% (18 pts) with distant metastasis. 98 pts (66%) received surgery alone, 22 pts (15%) received perioperative chemotherapy, and 28 pts (19%) received perioperative chemo-radiation. After a median follow-up time of 5.2 yrs, the median OS for the entire group was 1.9 years, and 88 deaths had occurred at the last follow up. By stage, the median OS was 7 yrs, 2.3 yrs, and 0.3 yrs for localized stage, regional stage, and metastatic disease, respectively. The 5-yr survival was significantly better in pts who received perioperative chemo-radiation (68%), compared to those who received with surgery alone (33%) or perioperative chemotherapy (0%) (p=0.002). The 5-yr survivals by stage and treatment are shown in the table. Conclusions: Perioperative chemo-radiation was associated with a significantly better OS compared to surgery alone. Trimodality therapy for gastric cancer appears to be underutilized in the community setting described here. The survival advantage of surgery plus chemoradiation compared to surgery plus chemotherapy remains controversial and should be investigated in clinical trials. [Table: see text] No significant financial relationships to disclose.

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