scholarly journals Value Assessment of Atypical Central Neurocytoma Classification and Treatment Options

2021 ◽  
Author(s):  
Zuocheng Yang ◽  
Changxiang Yan ◽  
Zuozhen Yang ◽  
Song Han
Keyword(s):  
Treatment Strategy ◽  
Perioperative Complications ◽  
Postoperative Radiotherapy ◽  
Complete Resection ◽  
Therapeutic Modality ◽  
Incomplete Resection ◽  
Potential Candidate ◽  
Value Assessment ◽  
Resection Group ◽  
Classification And Treatment

Abstract Background The classification and treatment strategy of atypical central neurocytomas (CNs) are still controversial largely, this study aimed to explore the optical treatment strategy and characteristics in transcriptomic profile. Methods This study retrospectively analyzed data from Sixty-one patients with CNs who underwent surgery in single institution. Whole-transcriptome analysis was used to investigate the differences between typical and atypical CNs. Results The five-year OS (P= 0.015) and PFS rates (P= 0.000002) were significantly higher in the complete resection group than in the incomplete resection group. Postoperative radiotherapy did not affect OS (P=0.255) or PFS (P=0.398) in the complete resection group. The five-year PFS rate (P=0.000038) among patients in the complete resection group who did not receive radiotherapy was significantly longer than that among patients in the incomplete resection group who received radiotherapy. The extent of surgical resection and operative approaches were irrelevant to perioperative complications and dsyfunctions at the last follow-up. Compared with caudate control, some of differentially expressed genes may involve cancer. Finally, the overexpression of ten genes (AMOTL1, PIK3R3, TGFBR1, SMO, COL4A6, MGP, SOX4, IGF2, Slit1 and CKS2) in atypical CNs may be associated with malignancy in atypical CNs. Conclusion Complete resection is relatively the best therapeutic modality for atypical CNs, radiotherapy is not necessary for patients after complete resection of the tumor. Although the previous definition of atypical CNs may not have significant prognostic value, the overexpression of ten genes may be involved in malignant behaviors and potential candidate hallmarks for differentiating the atypical CNs. Although the number of cases was relatively small, the findings could be helpful and instructive in the clinical treatment of this disease.

scholarly journals Predictive Factors for Local Recurrence and Incomplete Resection of Early Gastric Cancer Treated by Endoscopic Resection: A Western Experience

2009 ◽  
Vol 23 (5) ◽  
pp. 357-363 ◽  
Author(s):  
Fábio Yuji Hondo ◽  
Fauze Maluf-Filho ◽  
Humberto Setsuo Kishi ◽  
Ricardo Sato Uemura ◽  
Luciano Okawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Local Recurrence ◽  
Endoscopic Resection ◽  
Predictive Factors ◽  
Predictive Factor ◽  
Lesion Size ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Resection Group

BACKGROUND: Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described in up to 6% of cases.OBJECTIVES: To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year.METHODS: From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence).RESULTS: Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were tumour location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% CI 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% CI 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006).CONCLUSIONS: A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.

Ovarialkarzinomrezidiv: Sollte operiert werden oder reicht die medikamentöse Therapie?

2020 ◽  
Vol 7 (4) ◽  
pp. 199-200
Author(s):  
Martin Pölcher
Keyword(s):  
Primary Endpoint ◽  
Cytoreductive Surgery ◽  
Recurrent Ovarian Cancer ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Second Line ◽  
Recent Trial ◽  
Secondary Cytoreductive Surgery ◽  
Initial Surgery ◽  
Ago Score

<b>Background:</b> The role of secondary cytoreductive surgery in recurrent ovarian cancer (ROC) has been under debate for decades. A recent trial in unselected patients (pts) failed to show an OS benefit. <b>Methods:</b> Pts with ROC and 1st relapse after 6+ months (mos) platinum-free interval (TFIp) were eligible if they presented with a positive AGO-score (PS ECOG 0, ascites ≤500 ml, and complete resection at initial surgery) and were prospectively randomized to second-line chemotherapy alone vs. cytoreductive surgery followed by the same chemotherapy; platinum combination therapy was recommended. OS was primary endpoint in this superiority trial. <b>Results:</b> 407pts were randomized 2010–2014. The TFIp exceeded 12 mos in 75% of pts. 206 pts were allocated to the surgery arm of whom finally 187 (91%) were operated. A complete resection was achieved in 75%; almost 90% in both arms received a platinum-containing second-line chemo. Primary endpoint analysis showed median OS of 53.7 mos with and 46.2 mos without surgery (HR 0.76, 95%CI 0.59–0.97, p = 0.03); median PFS was 18.4 and 14 mos (HR: 0.66, 95%CI 0.54–0.82, p &#x3c; 0.001), median time to start of first subsequent therapy (TFST) was 17.9 vs. 13.7 mos in favor of the surgery arm (HR 0.65, 95%CI 0.52–0.81, p &#x3c; 0.001). An analysis according to treatment showed an OS benefit exceeding 12 mos for pts with complete resection (CR) compared to pts without surgery (median 60.7 vs. 46.2 mos); pts with surgery and incomplete resection even did worse (median 28.8 mos). 60 d mortality rates were 0 and 0.5% in the surgery and no-surgery arm. Re-laparotomies were performed in 3.7% of operated pts. Further grade 3/4 adverse events did not differ significantly between arms. <b>Conclusions:</b> This is the first surgical study demonstrating a meaningful survival benefit in OC: Surgery in pts with first relapse and TFIp of 6+ mos and selected by a positive AGO-Score resulted in a significant increase of OS, PFS and TFST with acceptable morbidity and, therefore, should be offered to suitable pts. The benefit was exclusively seen in pts with CR indicating the importance of both the optimal selection of pts (eg. by AGO score) and of centres with expertise and a high chance of achieving a CR. Clinical trial information: NCT01166737.

scholarly journals Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

2015 ◽  
Vol 38 (1) ◽  
pp. E5 ◽  
Author(s):  
Björn Sommer ◽  
Cornelia Wimmer ◽  
Roland Coras ◽  
Ingmar Blumcke ◽  
Bogdan Lorber ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Intraoperative Imaging ◽  
Intractable Epilepsy ◽  
Complete Resection ◽  
Blood Oxygenation ◽  
Seizure Outcome ◽  
Incomplete Resection ◽  
Brain Areas ◽  
Total Resection

OBJECT Cerebral gangliogliomas (GGs) are highly associated with intractable epilepsy. Incomplete resection due to proximity to eloquent brain regions or misinterpretation of the resection amount is a strong negative predictor for local tumor recurrence and persisting seizures. A potential method for dealing with this obstacle could be the application of intraoperative high-field MRI (iopMRI) combined with neuronavigation. METHODS Sixty-nine patients (31 female, 38 male; median age 28.5 ± 15.4 years) suffering from cerebral GGs were included in this retrospective study. Five patients received surgery twice in the observation period. In 48 of the 69 patients, 1.5-T iopMRI combined with neuronavigational guidance was used. Lesions close to eloquent brain areas were resected with the implementation of preoperative diffusion tensor imaging tractography and blood oxygenation level–dependent functional MRI (15 patients). RESULTS Overall, complete resection was accomplished in 60 of 69 surgical procedures (87%). Two patients underwent biopsy only, and in 7 patients, subtotal resection was accomplished because of proximity to critical brain areas. Excluding the 2 biopsies, complete resection using neuronavigation/iopMRI was documented in 33 of 46 cases (72%) by intraoperative imaging. Remnant tumor mass was identified intraoperatively in 13 of 46 patients (28%). After intraoperative second-look surgery, the authors improved the total resection rate by 9 patients (up to 91% [42 of 46]). Of 21 patients undergoing conventional surgery, 14 (67%) had complete resection without the use of iopMRI. Regarding epilepsy outcome, 42 of 60 patients with seizures (70%) became completely seizure free (Engel Class IA) after a median follow-up time of 55.5 ± 36.2 months. Neurological deficits were found temporarily in 1 (1.4%) patient and permanently in 4 (5.8%) patients. CONCLUSIONS Using iopMRI combined with neuronavigation in cerebral GG surgery, the authors raised the rate of complete resection in this series by 19%. Given the fact that total resection is a strong predictor of long-term seizure control, this technique may contribute to improved seizure outcome and reduced neurological morbidity.

Proposed diagnostic criteria, disease severity classification and treatment strategy for TAFRO syndrome, 2015 version

2016 ◽  
Vol 103 (6) ◽  
pp. 686-692 ◽  
Author(s):  
Yasufumi Masaki ◽  
Hiroshi Kawabata ◽  
Kazue Takai ◽  
Masaru Kojima ◽  
Norifumi Tsukamoto ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Disease Severity ◽  
Treatment Strategy ◽  
Tafro Syndrome ◽  
Severity Classification ◽  
Classification And Treatment

scholarly journals Clinical Characteristics and Long-term Surgical Outcome of Spinal Myxopapillary Ependymoma: A French Cohort of 101 Patients

2021 ◽  
Author(s):  
Anne-Sophie Montero ◽  
Suzanne Tran ◽  
Aymeric Amelot ◽  
Félix Berriat ◽  
Guillaume Lot ◽  
...  
Keyword(s):  
Postoperative Radiotherapy ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Incomplete Resection ◽  
Sphincter Function ◽  
Age At Surgery

Abstract Purpose: Myxopapillary ependymoma (MPE) is the most frequent tumor affecting the medullary conus. The surgical therapeutic management is still debated and only few studies have focused on the postoperative clinical outcome of patients. This study aimed to demonstrate long-term postoperative outcome and to assess the predictive factors of recurrence as well as the clinical evolution of these patients.Methods: From 1984 to 2019, in four French centers 101 adult patients diagnosed with MPE were retrospectively included. Results: Median age at surgery was 39 years. Median tumor size was 50mm and lesions were multifocal in 13% of patients. All patients benefited from surgery and one patient received postoperative radiotherapy. Gross total resection was obtained in 75% of cases. Sixteen percent of patients presented recurrence after a median follow-up of 70 months. Progression free survival at 5 and 10 years were respectively estimated at 83% and 79%. After multivariable analysis, sacral localization, and subtotal resection were shown to be independently associated with tumor recurrence. 85% of the patients had a favorable evolution concerning pain. Twelve percent of the patients presented a postoperative deterioration of sphincter function and 4% of motor function. Conclusion: Surgery alone is an acceptable option for MPE patients. Patients with sacral location or incomplete resection are at high risk of recurrence and should be carefully monitored.

Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis

2013 ◽  
Vol 31 (6) ◽  
pp. 752-758 ◽  
Author(s):  
Thorsten Simon ◽  
Beate Häberle ◽  
Barbara Hero ◽  
Dietrich von Schweinitz ◽  
Frank Berthold
Keyword(s):  
Local Control ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Local Control Rate ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Primary Tumor Site ◽  
Free Survival ◽  
Stage 4 ◽  
The Impact

Purpose Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate. Patients and Methods Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome. Results A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression–free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS. Conclusion In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome.

scholarly journals Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience

2019 ◽  
Vol 131 (1) ◽  
pp. 238-244 ◽  
Author(s):  
Gary L. Gallia ◽  
Anthony O. Asemota ◽  
Ari M. Blitz ◽  
Andrew P. Lane ◽  
Wayne Koch ◽  
...  
Keyword(s):  
Frozen Section ◽  
Perioperative Complications ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Malignant Neoplasm ◽  
Olfactory Neuroblastoma ◽  
Histopathological Analysis ◽  
Frozen Section Analysis ◽  
Section Analysis

OBJECTIVEOlfactory neuroblastoma (ONB) is a rare malignant neoplasm of the sinonasal cavity. Surgery has been and remains a mainstay of treatment for patients with this tumor. Open craniofacial resections have been the treatment of choice for many decades. More recently, experience has been growing with endoscopic approaches in the management of patients with ONB. The object of this study is to report the authors’ experience over the past 11 years with ONB patients treated with purely endonasal endoscopic techniques.METHODSThe authors performed a retrospective chart review of 20 consecutive patients with ONB who underwent a completely endonasal endoscopic approach for an oncological tumor resection at their institution between January 2006 and January 2017. Patient demographics, tumor stage, pathological grade, frozen section analysis, permanent margin assessment, perioperative complications, postoperative therapy, length of follow-up, and outcomes at last follow-up were collected and analyzed.RESULTSEighteen patients presented with newly diagnosed disease, with a modified Kadish stage of A in 2 cases, B in 3, C in 11, and D in 2. Two patients presented with recurrent tumors. An average of 25.3 specimens per patient were examined by frozen section analysis. Although analysis of intraoperative frozen section margins was negative in all but 1 case, microscopic foci of tumor were found in 7 cases (35%) on permanent histopathological analysis. Perioperative complications occurred in 7 patients (35%) including 1 patient who developed a cerebrospinal fluid leak; there were no episodes of meningitis. All but 1 patient received postoperative radiotherapy, and 5 patients received postoperative chemotherapy. With a mean follow-up of over 5 years, 19 patients were alive and 1 patient died from an unrelated cause. There were 2 cases of tumor recurrence. The 5-year overall, disease-specific, and recurrence-free survival rates were 92.9%, 100%, and 92.9%, respectively.CONCLUSIONSThe current results provide additional evidence for the continued use of endoscopic procedures in the management of this malignancy.

Combined treatment of patients with incompletely resected invasive thymoma: A retrospective analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18193-18193
Author(s):  
D. M. Kowalski ◽  
A. Janowicz-Zebrowska ◽  
M. J. Krzakowski ◽  
P. Jaskiewicz ◽  
K. Zajda ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Stage ◽  
Combined Treatment ◽  
Radical Resection ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Invasive Thymoma ◽  
Type C ◽  
Single Modality

18193 Background: Although surgery remains the mainstay of therapy for invasive thymoma, complete resection is feasible in only 60% of patients (pts) and adjunctive radiotherapy (RT) or/and chemotherapy (CT) is advocated. Multidisciplinary approach with chemotherapy (CT) and radiotherapy (RT) is an option for unresectable disease. The aim of our study was to evaluate retrospectively the outcome of pts with invasive thymoma submitted to postoperative RT or combined CT and RT. Methods: Pts in our analysis underwent either radical resection followed by RT or they had incomplete resection with subsequent CT and RT. Results: Between March 1996 and September 2005, 32 (18 women; 56.3% and 14 men; 43.7%) pts with invasive thymoma were treated. Median age was 47,8 years (range, 20–75). Clinical stage I, II, III or IVA was diagnosed respectively in 3 (9.4%), 12 (37.5%), 6 (18.7%) and 11 34.4%) pts. Pathologic types of invasive thymoma were as follows: A - 4 pts (12.5%), B - 9 pts (28.1%), AB - 8 pts (25%); pathological type was not specified in 1 pts (3.1%). Type C thymoma was diagnosed in 10 pts (31.3%). Complete resection was performed in 26 pts (81.3%), whereas 1 pt (3.1%) was irradiated only and 5 pts (15.6%) were treated with CT as single modality. Cisplatin-based CT was used in all pts. Twenty pts (62.5%) were irradiated, while RT was not used in 12 pts (37.5%). Median survival time (MST) for all pts was 54.5 months (range: 2–240 months), and median time to progression (MTTP) was 27.5 months (range: 1–221 months). MST for pts on CT was 46.3 months (range: 2–156) in comparison with 54.7 months (range: 2–240) in non-CT group. MTTP for CT group was 35.2 months (range: 2–144) and 51.0 months (range: 2–221) for no CT group. Tolerance of CT was acceptable. Conclusions: Postoperative RT is effective in reducing local recurrence rate and prolonging survival in pts with invasive thymoma. The role of postoperative CT is unclear and deserves further exploration. No significant financial relationships to disclose.

scholarly journals Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Byeong Gu Song ◽  
Gwang Ha Kim ◽  
Bong Eun Lee ◽  
Hye Kyung Jeon ◽  
Dong Hoon Baek ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Partial Gastrectomy ◽  
Remnant Stomach ◽  
Complete Resection ◽  
Incomplete Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Single Center Experience ◽  
Epithelial Neoplasms

Aims. To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods. This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results. The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions. ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

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