scholarly journals Curative intent treatment in recurrent carcinoma cervix, numbers need to increase

2021 ◽  
Vol 5 (1) ◽  
pp. 50-53
Author(s):  
Deep Lamichhane
Keyword(s):  
Pelvic Exenteration ◽  
Cancer Recurrence ◽  
Primary Treatment ◽  
Total Pelvic Exenteration ◽  
Curative Intent ◽  
Surgical Options ◽  
Common Operation ◽  
After Cancer ◽  
Disease Free

Cervical cancer is most common cancer among females in Nepal. Majority of them presents in advanced stage and treated with definitive chemo-radiation. Fifteen to thirty percent recurs and among them 50% are localised in pelvis. The only curative treatment available at this point is surgery in selected patients and total pelvic exenteration is most common operation performed among few other surgical options. First described almost 72 years back, now the morbidity and mortality of this so-called brutal procedure has decreased and this becomes the only hope of survival in these patients. We present a case of a person from remote village of Nepal who had recurrence following primary treatment and underwent total pelvic exenteration. She recovered well and is disease free at 1-year follow up and is treatment free. The aim of this case report is to create awareness among clinicians, patient and other person involved in cancer care that treatment with curative intent is still possible after cancer recurrence. 

scholarly journals Pulmonary Metastasis From Breast Cancer With an 18-Year Disease-Free Interval: Implication of the Role of Surgery

2013 ◽  
Vol 97 (4) ◽  
pp. 281-284 ◽  
Author(s):  
Takaaki Fujii ◽  
Reina Yajima ◽  
Ei Yamaki ◽  
Takayuki Kohsaka ◽  
Satoru Yamaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Pulmonary Metastasis ◽  
Thoracoscopic Surgery ◽  
Primary Lung Cancer ◽  
Cancer Recurrence ◽  
Primary Treatment ◽  
Japanese Woman ◽  
Histologic Diagnosis ◽  
Disease Free

Abstract The appearance of pulmonary metastasis more than 15 years after primary treatment for breast cancer is rare. We herein report the case of a breast cancer patient with solitary pulmonary metastasis, after an 18-year disease-free period, treated with resection. A 66-year-old Japanese woman was found to exhibit an abnormal shadow on a chest X-ray. She had undergone a left mastectomy for breast cancer 18 years previously. The nodule was suspected to be either metastatic or primary lung cancer, and thus thoracoscopic surgery was performed. The histologic diagnosis was metastasis from breast cancer. Pulmonary resection in breast cancer recurrence is an important diagnostic tool that allows for a differential diagnosis with primary lung cancer. The clinical implication of surgery for a solitary pulmonary metastasis from breast cancer is discussed in this report.

Surgical primary treatment of stage IVA cervical cancer: A multicenter retrospective study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15551-e15551
Author(s):  
Patrizio Damiani ◽  
Francesco Plotti ◽  
Marzio Angelo Zullo ◽  
Carlo De Cicco Nardone ◽  
Roberto Montera ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Retrospective Study ◽  
Pelvic Exenteration ◽  
Frozen Section ◽  
Colorectal Anastomosis ◽  
Disease Free Survival ◽  
Primary Treatment ◽  
Total Pelvic Exenteration ◽  
Systematic Lymphadenectomy ◽  
Paraaortic Lymph Nodes

e15551 Background: The aim of the present study is to describe feasibility, surgical technique, perioperative data, early and late complications of anterior and total pelvic exenteration after neoadjuvant chemotherapy as primary treatment for stage IVa cervical cancer. Methods: It is a retrospective study which included 73 consecutive patients affected by stage IVa cervical cancer who required anterior or total pelvic exenteration referred to 3 international gynaecologic oncology centres. The steps of this extirpative surgical procedure were: 1) staging laparotomy; 2) frozen section biopsy of the paraaortic lymph nodes; 3) systematic lymphadenectomy, radical hysterectomy with adnexectomy and total or anterior pelvic exenteration; 4) continent urinary diversions and low colorectal anastomosis if it was possible. Results: The treatment of patients affected by FIGO stage IVA cervical cancer remains one of the most complex procedures gynecologic oncologists are faced with. Our study focused on clinical and operative data , in terms of overall survival (OS) and disease free survival (DFS) at 5 years. 5-year OS of our series was 43%. Conclusions: The surgical treatment of stage IVA cervical cancer appears therefore a suitable and valid alternative. Stage IVA cervical cancer patients in good general condition, with a disease resectable with clear surgical margins, should be considered for primary exenteration in referral centers where the surgical experience to perform this procedure is available.

Radiotherapy with curative intent: an option in selected patients relapsing after chemotherapy for advanced Hodgkin's disease.

1987 ◽  
Vol 5 (4) ◽  
pp. 550-555 ◽  
Author(s):  
M Roach ◽  
D S Kapp ◽  
S A Rosenberg ◽  
R T Hoppe
Keyword(s):  
Radiation Therapy ◽  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Curative Intent ◽  
Major Toxicity ◽  
Disease Free ◽  
Advanced Hodgkin’S Disease

Thirteen patients who had relapsed or failed to obtain a complete remission after combination chemotherapy for the treatment of advanced Hodgkin's disease were treated with subtotal or total lymphoid irradiation with curative intent. Twelve of the 13 patients achieved a complete response (CR). Five of the 12 CRs subsequently relapsed at 3, 9, 9, 12, and 19 months. One patient died of leukemia 11 months following radiotherapy. The actuarial relapse-free survival at 1 year was 60%, and six patients (50%) remain disease-free with a median follow-up of 34 months (range, 10 to 115 months) following the completion of radiotherapy. Patients who failed to obtain a CR to their initial chemotherapy, whose chemotherapy CR was of short duration, or who relapsed initially in extranodal sites, tended to have a worse outcome with radiotherapy. Patients who had long disease-free intervals after initial chemotherapy or relapsed only in nodal sites tended to do relatively well. Radiation therapy was well tolerated with no major toxicity. Potentially curative radiation therapy should be considered an option in the management of selected patients who relapse following combination chemotherapy for advanced Hodgkin's disease.

Long-term results of salvage cryotherapy for prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
A. Williams ◽  
C. Martinez ◽  
V. Chalasani ◽  
C. Lu ◽  
C. Ng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Free Survival ◽  
Salvage Cryotherapy ◽  
Disease Free

108 Background: The optimum treatment of Prostate cancer recurrence following external bean radiation therapy (EBRT) remains a controversial topic. The primary problem with comparing salvage techniques following EBRT is the lack of long term data. We reviewed the long- term overall survival, disease-specific survival and disease free survival of patients who have undergone salvage cryotherapy to the prostate gland. Methods: A retrospective analysis was performed on all patients undergoing salvage cryotherapy for locally recurrent prostate cancer after EBRT by a single surgeon at a single institution from 1995-2004. Patients preoperative, perioperative and postoperative data was reviewed and recorded. Should a patient no longer be followed by the urology service the Patients and the patient's primary care physician or urologist were contacted. Mortality data, PSA results, bone scan results and any details of hormone therapy were recorded for this study. Results: 187 patients were included in the current study from which 176 patients had records available for follow up giving a follow up rate of 94%. Mean follow up was 7.46 years (1-14 years). 52 patients were followed for greater than 10 years. Average time to prostate cancer recurrence in patients who developed recurred was 2.3 years and average time to hormone therapy in these patients was 2.8 years. Overall survival at 10 years was high at 87%. Risk factors for recurrence of tumour identified were presalvage PSA, preradiation and presalvage gleason score. Preradiation gleason score had little impact on survival. PSA nadir of >1.0ng/mL was highly predictive of early recurrence. Disease-free survival rates of between 39 and 64% depending on risk factors. Conclusions: Cryotherapy has a definite role in the management of prostate cancer, representing a minimally invasive salvage treatment with acceptable 10 year disease free survival (DFS) of upwards of 39% and specific groups attaining 10 year DFS of 64%. Presalvage PSA and Gleason score are the best predictors of disease recurrence, whilst preradiation gleason score did not correlate with risk of disease recurrence. A PSA Nadir greater than 1 ng/mL indicates a poor prognosis in which early ADT should be strongly considered. No significant financial relationships to disclose.

Gleason <6 (G6) prostate cancer (PC) at radical prostatectomy (RP): Does a high-risk setting truly exist? A recursive partitioning analysis (RPA).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 132-132
Author(s):  
Mark C Smith ◽  
James Kyle Russo ◽  
Chad Tracy ◽  
Darrion Mitchell ◽  
Sarah Mott ◽  
...  
Keyword(s):  
High Risk ◽  
Recursive Partitioning ◽  
Large Population ◽  
Univariate Analysis ◽  
Positive Margin ◽  
Primary Treatment ◽  
Conditional Inference ◽  
Curative Intent ◽  
Psa Relapse

132 Background: G6PC is associated with low rates of PSA failure (bF) after primary treatment. The present study seeks to determine whether a "high-risk" subpopulation of G6PC with lower PSA relapse-free survival (bRFS) may be identified within a large population of men with mature follow-up who underwent RP for curative-intent. Methods: Patients were retrospectively identified for inclusion by cT1-2 PC with PSA <30 at diagnosis, managed by RP alone, with final pathology demonstrating G6PC. Exclusion criteria were: pT3b or pN1, pre- or post-RP (adjuvant) radiotherapy (RT) or hormone therapy, or PSA follow-up (<12 months). The Kaplan-Meier method was employed for survival probability estimation. RPA by conditional inference analysis was applied to identify variables associated with bF. Results: From 2003-2009, 284 patients were eligible for this analysis. The median age was 60 yrs (range, 44-76), 233 (82%) were T1c, and median PSA was 5.3 (92% <10 ng/dL). The median biopsy to RP interval was 50 days (11-410, with 97% <180 days). Eighty patients (28%) had a positive margin (M+). At a median follow-up of 92.6 months (16.9-160.9, with 45% followed >8 years), 32 patients (11%) had bF, with estimated 5/8yr bRFS rates of 91%/89%. Univariate analysis identified M+, EPE, detectable initial post-RP PSA (at <26wks post-RP), longer biopsy to RP interval, and smaller RP specimen volume as significantly associated with bF, with M+ and longer biopsy to RP interval significant at multivariate analysis. RPA identified only M+ as a stratification factor, with 5/8yr bRFS estimates of 79/74% for M+ vs. 96/95% for M-. No other factors permitted further substratification of risk. Of note, 7 of 12 patients who underwent salvage RT alone remained disease-free at last follow-up, including 7 of 8 whose highest pre-salvage RT PSA was <0.6. Conclusions: G6PC managed by RP alone is generally associated with high rates of bRFS; however, in the M+ setting, irrespective of other clinical factors, early bF rates >20% are observed. Adjuvant RT should be considered in G6PC M+ cases; however, close surveillance with early salvage RT may be a reasonable alternative.

Post neoadjuvant chemo-radiation positive anterior circumferential resection margin in carcinoma rectum: Extended resection of rectum versus total pelvic exenteration—Results from a single centre retrospective study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15156-e15156
Author(s):  
Kamlesh Verma ◽  
Reena Engineer ◽  
Vikas S. Ostwal ◽  
Suman Kumar ◽  
Supreeta Arya ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Pelvic Exenteration ◽  
Total Pelvic Exenteration ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Carcinoma Rectum

e15156 Background: Positive circumferential resection margin has been shown to be powerful predictor of poor prognosis in rectal CA. Radiologically positive anterior CRM (PACRM) after NACT+RT leads to either resection of involved organ alone ie.Extended resection of rectum (ERR) or Total pelvic exenteration (TPE). Purpose of this study is to compare recurrence rate and survival of patients undergoing ERR or TPE for PACRM after NACT+RT. Methods: Retrospective study of patients operated for rectal CA from January 2013 to December 2014. Results: Out of 237 patients with non-metastatic CA rectum, 51 patients (21.5%) had PACRM. After NACT+RT, 22 patients (43.1%) developed systemic metastases, 7 patients (13.8%) were downsized and underwent extra-mesorectal resection (AR/APR), remaining 22 patients (43.1%) had persistent PACRM. 13 patients with PACRM underwent ERR whereas 9 patients underwent TPE. Median duration of hospital stay in TPE group was 13 days (10 - 26) whereas it was 7 days (5 – 21) in ERR group. Negative pathological CRM was achieved in all TPE and 92.3% of ERR patients. After median follow-up of 31.6 months, 5 patients with TPE (55.6%) and 4 patients with ERR (30.7%) developed systemic recurrence. None of the TPE patient, whereas 3 patients with ERR (23.1%) developed local recurrence. Median D.F.S. was 12.3 months in TPE and 18.9 months in ERR whereas mean O.S. was 36.2 and 32.8 respectively. Conclusions: Due to lack of significant difference in O.S./ D.F.S. and low post-operative complication and duration of hospital stay, ERR can be considered acceptable alternative to TPE.

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]

No Supportive Evidence for Clinical Benefit of Routine Follow-Up in Ovarian Cancer: A Dutch Multicenter Study

2011 ◽  
Vol 21 (4) ◽  
pp. 647-653 ◽  
Author(s):  
Sandra M.E. Geurts ◽  
Anne M. van Altena ◽  
Femmie de Vegt ◽  
Vivianne C.G. Tjan-Heijnen ◽  
Leon F.A.G. Massuger ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Tumor Biology ◽  
Recurrent Ovarian Cancer ◽  
Primary Treatment ◽  
Survival Times ◽  
National Guidelines ◽  
Fallopian Tube Cancer ◽  
Curative Intent

Introduction:Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.Methods:All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.Results:The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P= 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P= 0.26).Conclusions:Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.

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