Dermatofibrosarcoma Protuberans and Adjuvant Radiotherapy: A Case Report with Uncertain Surgical Margins in The Breast

Background: Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive superficial soft tissue tumor that can occur in many parts of the body. Surgical resection with a wide margin of safety is the main treatment modality of this rare tumor of the breast. According to the postoperative pathology report, the patient can be followed up or adjuvant radiotherapy (RT) can be added. Case presentation: A 22-year-old woman presented with a mass filling the lower inner quadrant of her right breast. Tru-cut biopsy revealed a mesenchymal tumor, but excision was recommended for definitive diagnosis. A right breast quadrantectomy was performed. The result came as DFSP. Tumor diameter was 10x9x6.5 cm and the tumor was positive in most of the surgical margins. The patient underwent re-resection and a residual tumor with a diameter of 0.2 cm was detected at a distance of 3.3 cm from the surgical margin. Although the surgical margins were negative, the distance of the posterior surgical margin, in particular, could not be assured. Because of the uncertainty of surgical margins, 60 Gy RT was planned. Conclusion: The localization of DFSP in the breast is extremely rare and surgery is the primary treatment. RT should be added as an adjuvant when safe surgical margins cannot be obtained.

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Sarcomas of the Nasal Cavity and Paranasal Sinuses

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300907 ◽

1994 ◽

Vol 103 (9) ◽

pp. 699-704 ◽

Cited By ~ 22

Author(s):

Joel A. Sercarz ◽

Rufus J. Mark ◽

Ian Storper ◽

Luu Tran ◽

Thomas C. Calcaterra

Keyword(s):

Los Angeles ◽

Paranasal Sinuses ◽

Adjuvant Radiotherapy ◽

Combined Modality Therapy ◽

Surgical Margin ◽

Surgical Margins ◽

Low Grade ◽

Positive Surgical Margins ◽

Key Issues ◽

The University

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.

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Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience

Sarcoma ◽

10.1155/2012/290698 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 24

Author(s):

Clement S. Trovik ◽

Sigmund Skjeldal ◽

Henrik Bauer ◽

Anders Rydholm ◽

Nina Jebsen

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Adjuvant Radiotherapy ◽

Surgical Margin ◽

Primary Treatment ◽

Margin Assessment ◽

Treatment Characteristics ◽

Extremity Soft Tissue Sarcoma ◽

Original Classification

Surgery remains the mainstay of soft tissue sarcoma (STS) treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG) Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998–2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS.

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Bladder Cancer in an Inguinoscrotal Vesical Hernia

Case Reports in Oncological Medicine ◽

10.1155/2012/142351 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Lucas Regis ◽

Fernando Lozano ◽

Jacques Planas ◽

Juan Morote

Keyword(s):

Adjuvant Radiotherapy ◽

Bladder Tumor ◽

Resection Margin ◽

Diagnostic Delay ◽

Subsequent Treatment ◽

Pathology Report ◽

Inguinoscrotal Hernia ◽

Bladder Dome ◽

Open Surgical Treatment ◽

Anatomical Pathology

We present the case of a 79-year-old male who, due to hematuria, underwent cystoscopy that showed a lesion in the bladder dome. Transurethral resection was attempted, but access to the tumor by this route was impossible. Given the findings, a body CT scan was performed showing an inguinoscrotal hernia with vesical carcinoma contained. Open surgical treatment of the vesical carcinoma contained within the inguinoscrotal hernia was performed in conjunction with the hernia repair. The anatomical pathology report confirmed a high-grade urothelial carcinoma (stage pT2b) with a free resection margin of <1 mm. Adjuvant radiotherapy was selected for subsequent treatment. The presence of bladder tumor in an inguinoscrotal hernia is an uncommon finding and a diagnostic delay can be assumed. The initial therapeutic plan may need to be changed from the usual approaches due to the atypical presentation.

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Meta-analysis of the influence of surgical margin and adjuvant radiotherapy on local recurrence after resection of sporadic desmoid-type fibromatosis

British Journal of Surgery ◽

10.1002/bjs.10477 ◽

2017 ◽

Vol 104 (4) ◽

pp. 347-357 ◽

Cited By ~ 37

Author(s):

M. L. Janssen ◽

D. L. M. van Broekhoven ◽

J. M. M. Cates ◽

W. M. Bramer ◽

J. J. Nuyttens ◽

...

Keyword(s):

Local Recurrence ◽

Adjuvant Radiotherapy ◽

Meta Analysis ◽

Surgical Margin

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Postoperative Adjuvant Radiotherapy Can Delay the Recurrence of Desmoid Tumors After R0 Resection in Certain Subgroups

Frontiers in Surgery ◽

10.3389/fsurg.2021.697793 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tielong Yang ◽

Haotian Liu ◽

Zhichao Liao ◽

Chao Zhang ◽

Lijie Xiang ◽

...

Keyword(s):

Adjuvant Radiotherapy ◽

Clinical Symptoms ◽

Tumor Resection ◽

Final Analysis ◽

Postoperative Recurrence ◽

R0 Resection ◽

Tumor Diameter ◽

Desmoid Tumors ◽

Entire Cohort ◽

Single Tumor

Background: When patients with desmoid tumors (DTs) present uncontrolled clinical symptoms, surgery is an effective treatment, but the high postoperative recurrence rate is a major problem. The significance of adjuvant radiotherapy has been debated for many years, and the significance of aggressive surgery has not been reported.Methods: Medical records for DT patients were collected. KM analysis and the Mann–Whitney U-test were performed to evaluate the role of radiotherapy and aggressive surgery in the entire cohort and different subgroups.Results: Of 385 DT patients, 267 patients with R0 resection were included in the final analysis. A total of 53 patients (19.85%) experienced recurrence. Although radiotherapy showed no significant effect on recurrence-free survival (RFS) or time to recurrence (TTR) in the entire cohort, radiotherapy delayed recurrence in the age ≤ 30 years old subgroup (TTR = 35 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.014) and the tumor diameter >5 cm subgroup (TTR = 26 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.02) among patients with a single tumor. Aggressive surgery improved RFS in the tumor diameter >5 cm subgroup (p = 0.049) but not the entire cohort.Conclusions: Although radiotherapy cannot improve RFS, it can delay recurrence in the age ≤ 30 years old subgroup and the tumor diameter >5 cm subgroup among patients with a single tumor. For patients with large invasive tumors and multiple involved sites, aggressive surgery could be selected to achieve complete tumor resection to improve RFS.

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Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence

Journal of Neurosurgery ◽

10.3171/jns/2008/108/3/0525 ◽

2008 ◽

Vol 108 (3) ◽

pp. 525-532 ◽

Cited By ~ 131

Author(s):

Marco Losa ◽

Pietro Mortini ◽

Raffaella Barzaghi ◽

Paolo Ribotto ◽

Maria Rosa Terreni ◽

...

Keyword(s):

Tumor Recurrence ◽

Postoperative Radiotherapy ◽

Residual Tumor ◽

Benign Tumors ◽

Surgical Removal ◽

Tumor Diameter ◽

Tumor Removal ◽

Early Results ◽

Results Of Surgery

Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.

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The efficacy and safety of anlotinib in neoadjuvant treatment in locally advanced thyroid cancer: A single-arm phase II clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6069 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6069-6069

Author(s):

Naisi Huang ◽

Guohua Sun ◽

Yulong Wang ◽

Jiaying Chen ◽

Qing Guan ◽

...

Keyword(s):

Clinical Trial ◽

Thyroid Cancer ◽

Adverse Events ◽

Objective Response ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Primary Treatment ◽

Tumor Diameter ◽

Efficacy And Safety ◽

Advanced Thyroid Cancer

6069 Background: Surgery is the primary treatment for locally advanced thyroid cancer (TC). For some locally advanced TC, R0/R1 resection could not be achieved at initial diagnosis and neoadjuvant treatment would be an option. However, there is still little evidence regarding neoadjuvant treatment in locally advanced TC. Methods: This single-arm, phase 2 study investigated the efficacy and safety of Anlotinib (12mg orally daily, for two weeks on/on week off) for 2-6 cycles in patients with locally advanced TC in the neoadjuvant setting. Operable patients received surgery after neoadjuvant treatment. The primary endpoint was objective response rate (ORR). Results: A total of 13 patients were included and received an average of 3.5 cycles (range: 3-6 cycles) of Anlotinib treatment. 12 cases were papillary thyroid cancer, and 1 was follicular thyroid cancer. The ORR of Anlotinib was 76.9% with 10 partial response (PR), 2 stable disease (SD), and 1 progressive disease (PD). 8 PR and 1 SD patients received surgery after neoadjuvant treatment, of whom 8 had R0/1 resections and 1 had R2 resection. 2 PR patients refused to have surgery and the rest 2 patients were not operable. The R0/1 resection rate for intent to treat population was 61.5% and for per-protocol population was 72.7%. The maximum reduction in sum of tumor diameter was an average of 34.8% (range: 30.9%-45.5%) for PR patients. Most adverse events were grade 1 or 2. Common adverse events of all grade were hypertension (76.9%), hypertriglyceridemia (69.2%), proteinuria (53.8%), TSH increase (53.8%), cholesterol elevation (53.8%) and hand-foot syndrome (38.5%). The majority of adverse events discontinued after the neoadjuvant treatment stopped. Conclusions: Anlotinib demonstrated antitumor activity in the neoadjuvant treatment in locally advanced TC and the majority of patients achieved R0/1 resection. Adverse events were consistent with the known Anlotinib adverse event profile. These results suggest that Anlotinib neoadjuvant treatment represents a new option for locally advanced TC. Clinical trial information: NCT04309136.

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A systematic review of surgical margins utilized for removal of cutaneous mast cell tumors in dogs

BMC Veterinary Research ◽

10.1186/s12917-019-2227-8 ◽

2020 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Laura E. Selmic ◽

Audrey Ruple

Keyword(s):

Systematic Review ◽

Tumor Recurrence ◽

The Body ◽

Surgical Margins ◽

Data Abstraction ◽

Local Tumor ◽

Local Tumor Recurrence ◽

Cutaneous Mast Cell ◽

Fascial Plane

Abstract Background Traditionally, wide lateral surgical margins of 3 cm and one fascial plane deep have been recommended for resection of canine cutaneous mast cell tumor (MCT). Several studies have been published assessing surgical margins of less than this traditional recommendation. The objective of this systematic review was to determine if resection MCT with lateral surgical margins < 3 cm results in low rates of incomplete resection and local tumor recurrence. Systematic searches of digital bibliographic databases were performed with two authors (AR & LES) screening abstracts to identify relevant scientific articles. Studies regarding surgical treatment of dogs with cutaneous MCT were reviewed. Data abstraction was performed and the quality of individual studies and the strength of the body of evidence for utilization of surgical margins < 3 cm for removal of MCTs was assessed. Results From the initial 78 citations identified through the database searches, four articles were retained for data abstraction after both relevance screenings were performed. Two studies were retrospective observational studies, one was a prospective case series and one was a prospective clinical trial. Assessment of the quality level of the body of evidence identified using the GRADE system was low. Excision of MCT at 2 cm and 3 cm was associated with comparably low rates of incomplete excision and recurrence. Conclusions Despite the low quality of the overall body of evidence, a recommendation can be made that resection of canine cutaneous MCTs (< 4 cm) of Patnaik grade I and II with 2 cm lateral margins and 1 fascial plane deep results in low rates of incomplete excision and local tumor recurrence.

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Survival impact of extended cycles of second-line chemotherapy in platinum-sensitive relapsed ovarian cancer patients with residual tumor after six cycles

BMC Cancer ◽

10.1186/s12885-020-07658-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Se Ik Kim ◽

Woo Yeon Hwang ◽

Maria Lee ◽

Hee Seung Kim ◽

Kidong Kim ◽

...

Keyword(s):

Residual Tumor ◽

Primary Treatment ◽

Survival Outcomes ◽

Standard Group ◽

Second Line ◽

Second Line Chemotherapy ◽

Platinum Sensitive ◽

Platinum Based Chemotherapy ◽

Extended Group ◽

Line Chemotherapy

Abstract Background To determine if extended chemotherapy improves survival outcomes in patients with platinum-sensitive relapsed epithelial ovarian cancer (EOC) who have residual disease after six cycles of second-line chemotherapy. Methods In this study, 135 EOC patients who experienced platinum-sensitive recurrence after primary treatment between 2008 and 2018, and had a residual tumor ≥0.5 cm (detected on CT scans) after completing six cycles of second-line, platinum-based chemotherapy, were retrospectively reviewed. Based on the number of main therapy cycles (second-line chemotherapy), we divided patients into an extended group (>6 cycles, n = 52) or a standard group (6 cycles, n = 83) and compared patient characteristics and survival outcomes between these groups. Results The extended group had a shorter platinum-free interval after primary treatment than the standard group (median, 11.0 vs. 13.1 months; P = 0.018). Secondary debulking surgery was less frequently performed in the standard group (1.9% vs. 19.3%; P = 0.003). After six chemotherapy cycles, the extended and standard groups showed similar serum CA-125 levels (P = 0.122) and residual tumor sizes (P = 0.232). There was no difference in overall survival (OS) between the groups (P = 0.382), although the extended group had significantly worse progression-free survival (PFS) than the standard group (median, 13.9 vs. 15.1 months; P = 0.012). Multivariate analyses revealed that platinum-free interval was an independent prognostic factor for PFS and OS, but extended chemotherapy was not (PFS: HR, 1.25; 95% CI, 0.84–1.85; P = 0.279; and OS: HR, 1.36; 95% CI, 0.72–2.56; P = 0.342). We observed consistent results in the subset of patients who did not undergo secondary debulking surgery. Conclusions More than six cycles of platinum-based chemotherapy might not improve survival outcomes in patients with platinum-sensitive recurrent EOC who had a residual tumor ≥0.5 cm after six cycles of second-line chemotherapy.

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