Results of the surgical treatment of primary skin melanoma depending on the method of tumor excision and options for closing the surgical defect

The aim of the study was to analyze the results of the surgical treatment of patients with primary skin melanoma (SM) according to the location of the primary tumor, the type of incision, and the method of suturing the postoperative defect. Material and methods. Patients with primary SM, treated in 2013 (n = 337) were studied; these patients were randomized into two groups using the method of blind selection to the main (n = 182) comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed). Results. In patients with localized forms of SM, it was found necessary to perform a round incision when the tumor is localized on the trunk and an elliptical incision when localized on the extremities, followed by plastic replacement in all cases. In stage III patients with any tumor localization, the type of incision and suturing of the defect was not of fundamental importance. Discussion. It was revealed that patients with tumor on the trunk after rounded incision and plastic surgery had an advantage in progression-free survival (PFS) at all stages before an elliptical incision without plastic surgery during the entire observation period (123660 months) by 18.8%23%, 8%26.5% (p ˂ 0.050). Patients with localized forms of melanoma from stage 0 to IIc over the entire follow-up period of 123660 months had the greatest benefit in PFS from a round incision with plastic before conventional suturing without plastic surgery: from stage 0 to IIa by 22.0%31.8%32.0%, from stage IIb to IIc by 35.6%28.5%34.8%. In overall survival (OS), only patients with a rounded incision and plastic surgery in the initial stages of the disease stage 0 to IIa up to 36 and 60 months benefited by 24.4% and 29.3%, respectively. Compared with patients who underwent simple excision on the trunk, patients with stage IIbIIc with elliptical incisions and plasty had an advantage in PFS in the long term up to 3660 months of follow-up by 25.7% and in IDS with stages 0-IIa in the period 1236 months by 24.4%. With the localization of the primary tumor on the extremities, a statistical difference was revealed with the best indicators in patients with an elliptical incision and plastic surgery in the OS compared to patients with a rounded incision and plastic surgery in the period of 3660 months by 18.6% and 26.7%, respectively, as well as over patients with a conventional incision without plastic surgery in PFS as a whole in the subgroup at periods up to 36 and 60 months by 26.4% and 29.4% with a tendency to improve this indicator in the long term, as well as better SOS in the long term in these patients with a difference in OS of 19.3% (3660 months of observation). Conclusion. In patients with localized stages (0IIc), with the localization of the primary SM on the trunk, it is necessary to perform a round excision followed by plasty of the defect with displaced tissues; in addition, it is advisable to have an elliptical incision along the axial line for the limbs, followed by plasty of the defect. In patients with stage III, the shape of the incision and the method of suturing do not play a significant role in PFS and OS.

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Influence of plastic surgery for melanoma on progression-free survival in patients with skin melanoma according to the degree of tumor lymphoid infiltration

Russian Journal of Oncology ◽

10.17816/1028-9984-2020-25-4-122-126 ◽

2020 ◽

Vol 25 (4) ◽

pp. 122-126

Author(s):

Sergei A. Yargunin ◽

Ya. N. Shoykhet ◽

A. F. Lazarev

Keyword(s):

Plastic Surgery ◽

Wound Closure ◽

Progression Free Survival ◽

Tumor Infiltration ◽

Skin Melanoma ◽

Lymphoid Tumor ◽

Free Survival ◽

Lymphoid Infiltration

The aim of the study was to analyze the effect of plastic methods for closing the defect after excision of primary skin melanoma according to the degree of lymphoid infiltration of the tumor. Material and methods. Patients with primary skin melanoma (SM) treated in 2013 (n = 337) were studied; these patients were randomized into 2 groups using the method of blind selection to the main (n = 182). In these groups, the tumor removal operation in patients ended with plastic tissue defect and the group comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed). Results. It was found that pronounced lymphoid tumor infiltration in patients with primary skin melanoma as a predictor of a favorable prognosis (in terms of the occurrence of locoregional recurrence) is realized in patients with plastic defect replacement significantly 2 times more often than in patients without plastic surgery in the period from 12 to 60 months of observation. Discussion. The dependence of the occurrence of locoregional relapses in patients on lymphoid infiltration of the tumor and the performance of plastic surgery was revealed. In general, all patients who underwent plastic surgery have an advantage in terms of the occurrence of locoregional relapses in the long term for a period of up to 5 years by 12.5%. In patients with severe lymphoid infiltration and plastic surgery, locoregional relapses occur almost 2 times less often than in patients without plastic surgery, starting from a follow-up period of 1236 months by 20.6% (22.9% and 43.5%, respectively; p = 0.008), and in the period from 36 to 60 months of observation by 24.7% (25.3% and 50.0%, respectively; p = 0.002). Conclusion. The use of plastic techniques for closing a wound defect in patients with skin melanoma with pronounced lymphoid tumor infiltration reduces the risk of gross scarring and halves the risk of locoregional metastasis as compared to linear suturing of the postoperative defect.

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Long-term results of surgical treatment of gastric cancer

Kazan medical journal ◽

10.17816/kazmj65314 ◽

1986 ◽

Vol 67 (2) ◽

pp. 104-106

Author(s):

A. S. Abdullin ◽

F. Sh. Akhmetzyanov ◽

A. A. Samigullin ◽

Z. N. Shemeunova ◽

V. A. Arinin ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Treatment ◽

Stomach Cancer ◽

Stage Iv ◽

Stage Ii ◽

Stage Iii ◽

Disease Stage ◽

Long Term Results ◽

Long Term Outcomes

We analyzed long-term outcomes of the treatment of 217 patients (men - 126, women - 91), who underwent radical operations for stomach cancer in the period of 1972 till 1976. 14 patients were under 39, 52 - from 40 to 49, 50 to 59 - 52, 60 to 69 - 80, over 70 years old - 19. The youngest patient was 28 years old and the oldest - 76 years old. Most patients (185) were operated on at stage III of the disease, stage II was diagnosed in 27 patients, and stage IV - in 5 patients.

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Longer Follow-Up Confirms Relapse-Free Survival Benefit With Adjuvant Dabrafenib Plus Trametinib in Patients With Resected BRAF V600–Mutant Stage III Melanoma

Journal of Clinical Oncology ◽

10.1200/jco.18.01219 ◽

2018 ◽

Vol 36 (35) ◽

pp. 3441-3449 ◽

Cited By ~ 90

Author(s):

Axel Hauschild ◽

Reinhard Dummer ◽

Dirk Schadendorf ◽

Mario Santinami ◽

Victoria Atkinson ◽

...

Keyword(s):

Stage Iii ◽

Disease Stage ◽

Cure Rate ◽

Relapse Free Survival ◽

Free Survival ◽

Distant Metastasis Free Survival ◽

Baseline Factors ◽

Stage Iii Melanoma

Purpose Dabrafenib plus trametinib improved relapse-free survival (RFS) versus placebo (hazard ratio [HR], 0.47; P < .001) in patients with resected BRAF V600–mutant stage III melanoma (BRF115532; COMBI-AD; ClinicalTrials.gov identifier: NCT01682083). We present an updated RFS analysis on the basis of extended study follow-up and a cure-rate model analysis to estimate the fraction of patients expected to remain relapse free long term. Methods In this phase III trial, patients with resected BRAF V600–mutant stage III melanoma were randomly assigned to 12 months of adjuvant dabrafenib plus trametinib versus placebo. We report updated RFS (primary end point) and distant metastasis–free survival. RFS was also analyzed by subgroups defined by baseline disease stage (American Joint Committee on Cancer 7th and 8th editions), nodal metastatic burden, and ulceration status. The fraction of patients who remained relapse free long term was estimated using a Weibull mixture cure-rate model. Results At median follow-up of 44 months (dabrafenib plus trametinib) and 42 months (placebo), 3- and 4-year RFS rates were 59% (95% CI, 55% to 64%) and 54% (95% CI, 49% to 59%) in the dabrafenib plus trametinib arm and 40% (95% CI, 35% to 45%) and 38% (95% CI, 34% to 44%) in the placebo arm, respectively (HR, 0.49; 95% CI, 0.40 to 0.59). Distant metastasis–free survival also favored dabrafenib plus trametinib (HR, 0.53; 95% CI, 0.42 to 0.67). The estimated cure rate was 54% (95% CI, 49% to 59%) in the dabrafenib plus trametinib arm compared with 37% (95% CI, 32% to 42%) in the placebo arm. Subgroup analysis of RFS demonstrated similar treatment benefit regardless of baseline factors, including disease stage, nodal metastatic burden, and ulceration. Conclusion Longer follow-up confirmed RFS benefit with dabrafenib plus trametinib. Subgroup analysis suggested that dabrafenib plus trametinib benefited patients regardless of baseline factors.

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Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study

Blood ◽

10.1182/blood.2019003127 ◽

2020 ◽

Vol 135 (10) ◽

pp. 735-742 ◽

Cited By ~ 9

Author(s):

David J. Straus ◽

Monika Długosz-Danecka ◽

Sergey Alekseev ◽

Árpád Illés ◽

Marco Picardi ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Progression Free Survival ◽

Brentuximab Vedotin ◽

Stage Iii ◽

Disease Stage ◽

Classical Hodgkin Lymphoma ◽

Treatment Intensification ◽

Need For Treatment ◽

Positron Emission

Abstract The phase 3 ECHELON-1 study demonstrated that brentuximab vedotin (A) with doxorubicin, vinblastine, and dacarbazine (AVD; A+AVD) exhibited superior modified progression-free survival (PFS) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for frontline treatment of patients with stage III/IV classical Hodgkin lymphoma (cHL). Maturing positron emission tomography (PET)-adapted trial data highlight potential limitations of PET-adapted approaches, including toxicities with dose intensification and higher-than-expected relapse rates in PET scan after cycle 2 (PET2)-negative (PET2−) patients. We present an update of the ECHELON-1 study, including an exploratory analysis of 3-year PFS per investigator. A total of 1334 patients with stage III or IV cHL were randomized 1:1 to receive 6 cycles of A+AVD (n = 664) or ABVD (n = 670). Interim PET2 was required. At median follow-up of 37 months, 3-year PFS rates were 83.1% with A+AVD and 76.0% with ABVD; 3-year PFS rates in PET2− patients aged <60 years were 87.2% vs 81.0%, respectively. A beneficial trend in PET2+ patients aged <60 years on A+AVD was also observed, with a 3-year PFS rate of 69.2% vs 54.7% with ABVD. The benefit of A+AVD in the intent-to-treat population appeared independent of disease stage and prognostic risk factors. Upon continued follow-up, 78% of patients with peripheral neuropathy on A+AVD had either complete resolution or improvement compared with 83% on ABVD. These data highlight that A+AVD provides a durable efficacy benefit compared with ABVD for frontline stage III/IV cHL, consistent across key subgroups regardless of patient status at PET2, without need for treatment intensification or bleomycin exposure. This trial was registered at www.clinicaltrials.gov as #NCT01712490 (EudraCT no. 2011-005450-60).

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Stage III follicular lymphoma: long-term follow-up and patterns of failure

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(03)00641-2 ◽

2003 ◽

Vol 57 (3) ◽

pp. 748-754 ◽

Cited By ~ 8

Author(s):

Chul S Ha ◽

Joseph S Kong ◽

Peter McLaughlin ◽

Susan L Tucker ◽

Luis E Fayad ◽

...

Keyword(s):

Follicular Lymphoma ◽

Stage Iii ◽

Patterns Of Failure ◽

Long Term Follow Up

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Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00202 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Michael Ryan ◽

Benton Emblom ◽

E. Lyle Cain ◽

Jeffrey Dugas ◽

Marcus Rothermich

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Failure Rate ◽

Osteochondritis Dissecans ◽

Surgical Techniques ◽

The Other ◽

Return To Play ◽

Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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SAT0540 ONE-YEAR OUTCOMES AFTER RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS FROM CHECKPOINT INHIBITORS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4366 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1227.2-1227

Author(s):

E. Berard ◽

T. Barnetche ◽

L. Rouxel ◽

C. Dutriaux ◽

L. Dousset ◽

...

Keyword(s):

Adverse Events ◽

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Progression Free Survival ◽

Symptomatic Treatment ◽

Musculoskeletal Symptoms ◽

Day Range ◽

One Year

Background:Description and initial management of rheumatic immune-related adverse-events (irAEs) from cancer immunotherapies have been reported by several groups but to date, few studies have evaluated the long-term outcomes and management of rheumatic irAEs (1).Objectives:To describe the long-term management and assess the one-year outcomes of patients who experienced rheumatic immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI).Methods:This was a single-centre prospective observational study including patients referred for musculoskeletal symptoms while treated with ICI. After baseline rheumatological evaluation defining the clinical entity presented, follow-up visits were organised according to the type and severity of irAE. At one year, persistence of irAE, ongoing treatment, as well as cancer outcomes were assessed.Results:63 patients were included between September 2015 and June 2018. 24 patients (38%) presented with non-inflammatory musculoskeletal conditions managed with short-term symptomatic treatment and did not require specific follow-up. 39 patients (62%) experienced inflammatory manifestations, mimicking either rheumatoid arthritis (RA, n=19), polymyalgia rheumatica (PMR, n=16), psoriatic arthritis (PsA, n=3) and one flare of a preexisting axial spondyloarthritis. Overall, 32 patients (82%) received systemic glucocorticoids, with a median rheumatic dosage of 15mg/day (range: 5-60mg/day). None of the patients had to permanently discontinue ICI therapy for rheumatic irAE. 20 patients (67%) were still receiving glucocorticoids at one year, with a median dosage of 5mg/day (range: 2-20mg/day). Glucocorticoids were more frequently discontinued for patients with RA-like condition (44%) than PMR-like condition (23%), but no other predictive factor of glucocorticoids withdrawal could be identified. At one year, overall survival and progression-free survival were comparable between patients who were still receiving glucocorticoids for rheumatic irAE and patients who have discontinued. Eight patients required csDMARDs.Conclusion:At one year, a majority of patients required long-term low-dose glucocorticoids for chronic rheumatic irAE, which seems not altering oncological control.References:[1]Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2019 Sep 20.Disclosure of Interests:None declared

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Fractionated Stereotactic Radiotherapy for Pituitary Adenomas

Neurosurgery ◽

10.1227/neu.0000000000001155 ◽

2015 ◽

Vol 79 (3) ◽

pp. 406-417 ◽

Cited By ~ 11

Author(s):

Sean M. Barber ◽

Bin S. Teh ◽

David S. Baskin

Keyword(s):

Stereotactic Radiotherapy ◽

Pituitary Adenomas ◽

Progression Free Survival ◽

Hormonal Control ◽

Fractionated Stereotactic Radiotherapy ◽

Small Series ◽

Early Results ◽

Nonfunctional Pituitary Adenomas

Abstract BACKGROUND Early results of postoperative fractionated stereotactic radiotherapy (FSRT) for functional and nonfunctional pituitary adenomas appear promising, but the majority of available evidence draws from small series with insufficient follow-up data to draw meaningful conclusions. OBJECTIVE To evaluate the long-term outcomes of a large series of patients undergoing FSRT for both functional and nonfunctional pituitary adenomas with the Novalis system (Brain LAB, Heimstetten, Germany). METHODS Chart data for 75 consecutive patients undergoing FSRT for a pituitary tumor (21 functional and 54 nonfunctional adenomas) at our institution between January 2004 and June 2013 were reviewed. RESULTS Radiographic progression-free survival was 100% over a mean of 47.8 months of radiographic follow-up (range, 12.0-131.2 months). Hormonal normalization was seen in 69.2% of patients with functional adenomas after FSRT, whereas 30.8% experienced partial hormonal control. Mild, grade I acute adverse effects were observed during radiotherapy treatment in 36 patients (48%), and objective, persistent worsening of vision occurred in a single patient (1.5%) after FSRT. New hormonal deficits were seen in 28.0% of patients after FSRT. Radiographic responses were inversely related to tumor volume. CONCLUSION FSRT delivers radiographic and functional outcomes similar to those seen with stereotactic radiosurgery and conventional radiotherapy with less resultant toxicity. FSRT is most beneficial for smaller tumors (those <3 cm in diameter).

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