scholarly journals Extremely long survival in six patients despite recurrent and metastatic adrenal carcinoma.

2008 ◽  
Vol 158 (6) ◽  
pp. 911-919 ◽  
Author(s):  
I G C Hermsen ◽  
H Gelderblom ◽  
J Kievit ◽  
J A Romijn ◽  
H R Haak
Keyword(s):  
Local Recurrence ◽  
Liver Metastases ◽  
Lung Metastasis ◽  
High Mortality ◽  
Progressive Disease ◽  
Recurrent Disease ◽  
Adrenal Carcinoma ◽  
Long Survival ◽  
The Third ◽  
Repeated Surgery

ObjectiveAdrenal cortical carcinoma (ACC) is an aggressive tumour with a high mortality. We describe six patients living 12–28 years despite recurrent and/or metastatic ACC.PatientsThe first patient presented in 1979 with an ACC of 8 cm. After resection, she developed seven recurrences for which she was treated with resection and/or mitotane (o,p′-DDD) treatment. The patient is still alive 28 years after diagnosis. The second patient presented with an ACC of 9 cm. After resection, the patient developed liver metastases, which were treated witho,p′-DDD. The patient is still alive 25 years after diagnosis. The third patient presented with an ACC of 12 cm. The tumour was resected followed byo,p′-DDD treatment. She had a local recurrence that was completely resected. She is still alive 18 years after diagnosis. The fourth patient presented with an ACC of 14 cm. After resection, adjuvanto,p′-DDD was started. Subsequently, the patient developed two recurrences, which were resected. He is still alive 17 years after the initial diagnosis. The fifth patient presented with an ACC of 10 cm. After diagnosis, she developed lung metastasis, which were treated witho,p′-DDD and chemotherapy. The patient is still alive with slowly progressive disease 12 years after diagnosis. The sixth patient presented with an ACC of 7 cm. After resection, she developed four recurrences, which were resected. The patient is still alive 28 years after diagnosis.ConclusionSome patients can have an extremely long survival of ACC, despite recurrent disease and metastases. The mainstay of therapy in our patients was repeated surgery ando,p′-DDD.

Features of the course and treatment of glaucoma during pregnancy

2020 ◽  
Vol 98 (3) ◽  
pp. 178-184
Author(s):  
T. V. Chernyakova ◽  
A. Yu. Brezhnev ◽  
I. R. Gazizova ◽  
A. V. Kuroyedov ◽  
A. V. Seleznev
Keyword(s):  
Pregnant Women ◽  
Laser Treatment ◽  
Progressive Disease ◽  
Clinical Course ◽  
The Other ◽  
Third Trimester ◽  
The Third ◽  
Chronic Progressive Disease ◽  
Hypotensive Therapy ◽  
Eye Pressure

In the review we have integrated all up-to-date knowledge concerning clinical course and treatment of glaucoma among pregnant women to help specialists choose a proper policy of treatment for such a complicated group of patients. Glaucoma is a chronic progressive disease. It rarely occurs among childbearing aged women. Nevertheless the probability to manage pregnant patients having glaucoma has been recently increasing. The situation is complicated by the fact that there are no recommendations on how to treat glaucoma among pregnant women. As we know, eye pressure is progressively going down from the first to the third trimester, so we often have to correct hypotensive therapy. Besides, it is necessary to take into account the effect of applied medicines on mother health and evaluate possible teratogenic complications for a fetus. The only medicine against glaucoma which belongs to category B according to FDA classification is brimonidine. Medicines of the other groups should be prescribed with care. Laser treatment or surgery may also be a relevant decision when monitoring patients who are planning pregnancy or just bearing a child. Such treatment should be also accompanied by medicines.

scholarly journals Role of neoadjuvant Radio-Chemotherapy for retroperitoneal Liposarcoma in primary and secondary surgical intervention

2020 ◽  
Author(s):  
Ruth Ladurner ◽  
Jens Strohäcker ◽  
Christian Birkert ◽  
Hans-Georg Kopp ◽  
Alfred Königsrainer ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Recurrent Disease ◽  
Distant Metastases ◽  
Radical Resection ◽  
Soft Tissue Tumors ◽  
High Rate ◽  
Neoadjuvant Radiotherapy ◽  
Time To Recurrence ◽  
Repeated Surgery ◽  
Center Of Expertise

Abstract Background: Approximately 30–40 % of all retroperitoneal soft tissue tumors are sarcomas with liposarcoma prevailing in approximately 50% of these cases. Retroperitoneal liposarcomas typically show a high rate of local recurrence and late distant metastases. The aim of our retrospective analysis was to investigate the efficacy of treatment in our patients with liposarcoma. Methods: Thirty-four consecutive patients underwent surgery in our clinic between October 2004 and November 2017. Liposarcomas arising from the mesenteric or abdominal adipose tissue or the pelvis were excluded. In 2011 we had introduced neo-adjuvant therapy according to IAWS-Guidelines in patients younger than seventy without severe comorbidities to pretreatement. Results: Out of 34 patients, 23 (67,6%) presented with primary and 11 (32,4%) with recurrent disease. In 8 of the 27 patients (30 %), a radical resection (R0) could be achieved, and in 17 patients (63%) resection was marginal (R1). Time to recurrence was not affected by neoadjuvant radiotherapy. Patients that underwent systemic chemotherapy followed by radiotherapy developed earlier recurrences (p = 0.016). Overall survival appeared to be better in the neoadjuvant group but was not significant (0.080) Conclusions: Combining surgical resection with neoadjuvant radiation treatment showed survival benefits in primary but not recurrent disease. Repeated surgery stays a valid approach in carefully selected patients but all patients should be referred to a center of expertise in multimodal treatment approaches for retroperitoneal liposarcomas.

Aphasia and Chorea in General Paralysis

1875 ◽  
Vol 21 (95) ◽  
pp. 421-424 ◽  
Author(s):  
T. S. Clouston
Keyword(s):  
Progressive Disease ◽  
General Paralysis ◽  
The Third ◽  
One Stage ◽  
Short Period

The general progressive disease in the structure of the nervous centres, and the steady deterioration of their functions, that constitute by far the chief part of general paralysis, are attended in their course in some cases by various nervous symptoms that closely imitate many of the neuroses of sensibility and motion; such as neuralgia, amaurosis, locomotor ataxy, glosso-pharyngeal paralysis, hemiplegia, apoplexy and epilepsy. Indeed, it is not uncommon for cases of the disease to be diagnosed as epilepsy and glosso-pharyngeal paralysis. I have lately had three cases of the disease under my care, in two of which the ordinary symptoms of aphasia were present for a short period in one stage of the disease, and in the third the symptoms of unilateral chorea were well marked.

scholarly journals SURG-02. LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN METASTASES: OUTCOMES AND PREDICTORS OF LOCAL RECURRENCE

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i31-i31
Author(s):  
Dhiego Bastos ◽  
Ganesh Rao ◽  
Isabella Glitza ◽  
Jonathan Loree ◽  
Jeffrey S Weinberg2 ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Brain Metastases ◽  
Systemic Therapy ◽  
Protective Factor ◽  
Progressive Disease ◽  
Cox Regression ◽  
Radiation Necrosis ◽  
Newly Diagnosed ◽  
Predicting Factors ◽  
Risk Of Treatment

Abstract BACKGROUND: LITT has been used to treat recurrent brain metastasis after stereotactic radiosurgery (SRS). Little is known about how best to assess the efficacy of treatment, specifically the ability of LITT to control local tumor progression post-SRS. Objectives: Evaluate the predictive factors associated with local recurrence after LITT. METHODS: Retrospective study with consecutive patients with brain metastases treated with LITT. Based on radiological aspects, lesions were divided into progressive disease after SRS (recurrence or radiation necrosis) and new lesions. Primary endpoint was time to local recurrence. RESULTS: 61 consecutive patients with 82 lesions (5 newly diagnosed, 46 recurrence and 31 radiation necrosis). Freedom from local recurrence at 6 months was 69.6%, 59.4% at 12, and 54.7% at 18 and 24 months. Incompletely ablated lesions had a shorter median time for local recurrence (p< 0.001). Larger lesions (>6cc) had shorter time for local recurrence (p=0.03). Dural based lesions showed a shorter time to local recurrence (p=0.01). Tumor recurrence/newly diagnosed had shorter time to local recurrence when compared to RN lesions (p=0.01). Patients receiving systemic therapy after LITT had longer time to local recurrence (p=0.01). In multivariate Cox-regression model the HR for incomplete ablated lesions was 4.88 (p< 0.001), 3.12 (p=0.03) for recurrent tumors, and 2.56 (p=0.02) for patients not receiving systemic therapy after LITT. Complication rate was 26.2%. CONCLUSIONS: Incompletely ablated and recurrent tumoral lesions were associated with higher risk of treatment failure and were the major predicting factors for local recurrence. Systemic therapy after LITT was a protective factor regarding local recurrence.

scholarly journals Urogenitalis lokalizációjú mucosamelanoma primer és áttétes esetei klinikánkon

2019 ◽  
Vol 160 (10) ◽  
pp. 378-385
Author(s):  
Balázs Szabó ◽  
Miklós Szűcs ◽  
András Horváth ◽  
Eszter Székely ◽  
Gitta Pánczél ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Metastatic Melanoma ◽  
Radical Surgery ◽  
Histological Study ◽  
Primary Melanoma ◽  
Amelanotic Melanoma ◽  
Surgical Approaches ◽  
Rapid Progression ◽  
Diagnostic Difficulties ◽  
Repeated Surgery

Abstract: Introduction: Both primary and metastatic cases of mucosal melanoma in urogenital localization are rare tumors. Only 4–5% of all primary melanomas do not arise from the skin. Extracutaneous melanomas have a complex clinical presentation, but these aggressive tumors have a poor prognosis. Materials and method: In our department, we found 7 patients with malignant melanoma of the genitourinary tract in the past few years. The 7 cases were: primary amelanotic melanoma of the female urethra, a primary melanoma of the bladder, two primary melanomas of the penis, a metastatic melanoma of the urethra and another to the testis and a metastatic melanoma of the bladder with melanuria. We retrospectively analyzed the available data to describe the presentation, management, and clinical outcome of the patients. Results: In the three inoperative cases, palliative, urologic surgical procedures and systemic antitumor therapy were performed. Two of the four primary urogenital tumors were localized to the penis. In one case, local recurrence developed after surgical treatment, but with a radical, repeated surgery, the patient has been asymptomatic for a year and a half. In the other, neglected case, the penis melanoma spread through the urethra and the inguinal lymph nodes two years after radical surgery and inguinal block dissection. In the female primary urethral melanoma case, the first histological study reported a primary mesenchymal tumor, and the recurrent tumor that occurred one and a half years later showed melanoma diagnosis. Radical surgery performed because of urethral involvement resulted in a 5-year asymptomatic state, followed by local recurrence and distant metastasis. In the fourth case of a primary bladder melanoma, the rapid progression of the disease and the BRAF positivity of the tumor suggested that not the firstly diagnosed bladder melanoma was the primary tumor. Conclusion: The occurrence of urinary tract melanoma is very rare and its discovery happens often in a disseminated state, so the expected prognosis of the cases is also poor. The most important factors for increasing therapeutic efficacy are early diagnosis and radical surgical intervention. Tumors appearing in different localizations require different urological surgical approaches. The literature recommendations for treatment are not uniform. Their prognosis is worse compared to the cutaneous melanoma, which may be due to clinical and pathological diagnostic difficulties. The latest targeted and immunotherapeutic agents can significantly improve the survival of metastatic patients. Orv Hetil. 2019; 160(10): 378–385.

scholarly journals Stereotactic Body Radiotherapy as an Alternative to Brachytherapy in Gynecologic Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Gregory J. Kubicek ◽  
Jinyu Xue ◽  
Qianyi Xu ◽  
Sucha O. Asbell ◽  
Leslie Hughes ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Stereotactic Body Radiotherapy ◽  
Progressive Disease ◽  
Phase Ii Study ◽  
Gynecologic Cancer ◽  
Late Toxicity ◽  
Alternative Form ◽  
Brachytherapy Boost ◽  
To Receive ◽  
Gynecologic Patients

Introduction. Brachytherapy plays a key role in the treatment of many gynecologic cancers. However, some patients are unable to tolerate brachytherapy for medical or other reasons. For these patients, stereotactic body radiotherapy (SBRT) offers an alternative form of treatment.Methods. Retrospective review of patients prospectively collected on SBRT database is conducted. A total of 11 gynecologic patients who could not have brachytherapy received SBRT for treatment of their malignancies. Five patients have been candidates for interstitial brachytherapy, and six have required tandem and ovoid brachytherapy. Median SBRT dose was 25 Gy in five fractions.Results. At last followup, eight patients were alive, and three patients had died of progressive disease. One patient had a local recurrence. Median followup for surviving patients was 420 days (median followup for all patients was 120 days). Two patients had acute toxicity (G2 dysuria and G2 GI), and one patient had late toxicity (G3 GI, rectal bleeding requiring cauterization).Conclusions. Our data show acceptable toxicity and outcome for gynecologic patients treated with SBRT who were unable to receive a brachytherapy boost. This treatment modality should be further evaluated in a phase II study.

Radiofrequency Ablation of Liver Metastases—Software-Assisted Evaluation of the Ablation Zone in MDCT: Tumor-Free Follow-Up Versus Local Recurrent Disease

2009 ◽  
Vol 33 (2) ◽  
pp. 297-306 ◽  
Author(s):  
Sebastian Keil ◽  
Philipp Bruners ◽  
Katharina Schiffl ◽  
Martin Sedlmair ◽  
Georg Mühlenbruch ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Recurrent Disease ◽  
Ablation Zone

DWIBS (diffusion weighted whole body imaging with background signal suppression) scan for colorectal cancer and its evaluation: Comparison with CT or PET scans

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15140-e15140
Author(s):  
T. Sasatomi ◽  
Y. Ogata
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Local Recurrence ◽  
Lung Metastasis ◽  
Pet Scan ◽  
Whole Body ◽  
Whole Body Imaging ◽  
Body Imaging ◽  
Diffusion Weighted ◽  
Signal Suppression

e15140 Background: The most important clinical point for the colorectal cancer patients after surgery is to find out local recurrence and distant metastasis to liver or lungs in early state. Recently, DWIBS (diffusion weighted whole body imaging with background body signal suppression) scan, one of the diffusion weighted MRI imaging methods, was developed, and it has been become used for diagnosis of lung cancer and bladder cancer instead of PET scan. In this report, we examined whether it was more useful method for the diagnosis of recurrence or distant metastasis of the colorectal cancer after surgery than PET/CT scan or not. Methods: All the 12 primary colorectal carcinomas were resected at the surgical division, Kumamoto Central Hospital, Fukuoka Saisekai Ohmuta Hospital and Kurume University Medical Center from 2000 to 2008. (Table 1) After surgery, 14 recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence) were diagnosed by CT and MRI scans. Then all the cases were performed by DWIBS scan. And also the seven out of 12 cases (three liver metastasis, two lung metastasis and four local recurrence) were performed by PET scan. Conditions set before DWIBS scan were six hours of fasting with no restriction on drinking water and normal oral administration of regularly used drugs. No bowel preparation was carried out in any of the patients. Informed consent was obtained from each patient before DWIBS scan. Results: All the 14 metastatic and recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence ) of 12 recurrent patients were performed by DWIBS, MRI and CT scans. Within the seven out of 12 recurrent patients (three liver metastasis, two lung metastasis and five local recurrence), performed by PET scan, all the liver and lung metastatic regions were detected, on the other hand, three out of four local recurrent regions were diagnosed but the other one was not diagnosed by PET scan. Conclusions: DWIBS is not only useful diagnostic method for local recurrence of colorectal cancer after surgery, but also less invasive method than PET scan. No significant financial relationships to disclose.

The utility of PET scanning in colorectal cancer liver metastases being considered for surgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14519-e14519
Author(s):  
Jeffri R. M. Ismail ◽  
Ciara Marie Kelly ◽  
Marian Hanrick ◽  
Cara Regan Downey ◽  
Lauragh McCarthy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Local Recurrence ◽  
Lymph Nodes ◽  
Liver Metastases ◽  
Preoperative Staging ◽  
Definitive Treatment ◽  
Preoperative Imaging ◽  
Colorectal Cancer Liver Metastases ◽  
Pet Scanning

e14519 Background: Liver resection remains the only potentially curative option for a subset of patients with colorectal cancer liver metastases (CRCLM). Preoperative imaging used to determine resectability includes computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The objective of this study was to determine the utility of PET scanning for potentially resectable CRCLM. Methods: We retrospectively reviewed a prospectively maintained database for all patients considered for resection of CRCLM from July 2010 to July 2012 in two specialist colorectal/hepatobiliary cancer centres. We extracted and analyzed data with respect to preoperative staging imaging and definitive treatment performed on completion of staging. Results: We identified 100 patients who underwent preoperative staging investigations for potentially resectable CRCLM. The imaging techniques performed included: CT (n=99, 99%), MRI liver (n=75, 75%), PET (n= 96, 96%). In 22 (22/96, 23%) patients PET scanning added to the preoperative staging information, identifying local recurrence (n=3, 3.1%), confirming liver metastases following an inconclusive CT/MRI (n=2, 2.1%), outruling liver metastases (n=1, 1%) and identifying extrahepatic sites (EHS) suspicious for disease (n=16, 16.7%). The EHS included either lung (n=6), bone (n=2), peritoneum (n=1) or lymph nodes (n=7). There were 2 false positive results. One patient with FDG-avid mediastinal lymph nodes had no cancer on endobronchial biopsy. One patient with FDG avidity at the primary anastomosis had no evidence of disease at colonoscopy. PET definitively changed the therapeutic strategy in 16 patients (16/96, 16.6%): precluding liver resection in 10 patients (10/96, 10.4%), leading to resection of extrahepatic disease in 4 patients (4/96, 4.1%), resection of local recurrence in 1 patient (1/96, 1%) and resection of hepatic metastases in one patient (1/96, 1%). Conclusions: In this small retrospective cohort the addition of metabolic imaging altered management in 16.6% of patients with potentially resectable CRCLM. There is a need for randomized evidence to support the routine use of PET in addition to cross-sectional imaging in this setting.

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