scholarly journals A Locally Advanced Endometrioid Adenocarcinoma Arising from Vaginal Endometriosis: Management and Review of the Literature

Reports ◽  
2021 ◽  
Vol 4 (3) ◽  
pp. 29
Author(s):  
Mariangela Costanza ◽  
Fernanda Herrera ◽  
Delfyne Hastir ◽  
Patrice Mathevet ◽  
Apostolos Sarivalasis
Keyword(s):  
Treatment Guidelines ◽  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
Treatment Decision ◽  
Staging System ◽  
Endometrioid Adenocarcinoma ◽  
Local Spread ◽  
Nodal Spread ◽  
Distant Spread

Endometrioid adenocarcinoma associated with endometriosis at extrauterine or extraovarian localization is a rare entity. Often presenting with local spread without nodal and distant metastasis, this entity has no specific staging system nor treatment guidelines. In the case of nodal and distant spread, the treatment decision requires personalization. In this article, we present the diagnosis and surgical and systemic treatment of a 56-year-old woman diagnosed with an endometriosis-associated advanced endometrioid adenocarcinoma of the vagina with nodal involvement. Following an extensive review of the scarce data reported to guide the treatment choices in this rare setting, we proposed a multidisciplinary treatment with laparoscopic surgical cytoreduction, four cycles of adjuvant chemotherapy with carboplatin and paclitaxel, and radiotherapy with brachytherapy. Due to an anaphylactic reaction on the first administration, paclitaxel was replaced with nab-paclitaxel. Despite many negative prognostic factors, the patient is free from relapse after 48 months. We report the case of a locally advanced endometrioid adenocarcinoma associated with endometriosis of the vagina, with pelvic nodal spread, and the relevant literature review of similar cases.

scholarly journals Prognostic Assessment in High-Grade Soft-Tissue Sarcoma Patients: A Comparison of Semantic Image Analysis and Radiomics

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1929
Author(s):  
Jan C. Peeken ◽  
Jan Neumann ◽  
Rebecca Asadpour ◽  
Yannik Leonhardt ◽  
Joao R. Moreira ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Treatment Decision ◽  
Staging System ◽  
Predictive Performance ◽  
Machine Learning Techniques ◽  
Clinical Staging ◽  
Imaging Features ◽  
Prognostic Assessment ◽  
Selection Operator

Background: In patients with soft-tissue sarcomas of the extremities, the treatment decision is currently regularly based on tumor grading and size. The imaging-based analysis may pose an alternative way to stratify patients’ risk. In this work, we compared the value of MRI-based radiomics with expert-derived semantic imaging features for the prediction of overall survival (OS). Methods: Fat-saturated T2-weighted sequences (T2FS) and contrast-enhanced T1-weighted fat-saturated (T1FSGd) sequences were collected from two independent retrospective cohorts (training: 108 patients; testing: 71 patients). After preprocessing, 105 radiomic features were extracted. Semantic imaging features were determined by three independent radiologists. Three machine learning techniques (elastic net regression (ENR), least absolute shrinkage and selection operator, and random survival forest) were compared to predict OS. Results: ENR models achieved the best predictive performance. Histologies and clinical staging differed significantly between both cohorts. The semantic prognostic model achieved a predictive performance with a C-index of 0.58 within the test set. This was worse compared to a clinical staging system (C-index: 0.61) and the radiomic models (C-indices: T1FSGd: 0.64, T2FS: 0.63). Both radiomic models achieved significant patient stratification. Conclusions: T2FS and T1FSGd-based radiomic models outperformed semantic imaging features for prognostic assessment.

scholarly journals Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland

2014 ◽  
Vol 48 (2) ◽  
pp. 210-218 ◽  
Author(s):  
Magdalena Fundowicz ◽  
Miguel Macia ◽  
Susanna Marin ◽  
Marta Bogusz-Czerniewicz ◽  
Ewelina Konstanty ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Quality Control ◽  
Waiting Time ◽  
Preoperative Radiotherapy ◽  
Clinical Audit ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
In Vivo Dosimetry ◽  
Diagnostics And Therapy

Abstract Background. We performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences. Methods. A total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radiochemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment. Results. Several differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines. Conclusions. An independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies.

scholarly journals Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer

2010 ◽  
Vol 1 (3) ◽  
pp. 153-160
Author(s):  
Arif Jamshed ◽  
Raza Hussain ◽  
Sarah Jamshed ◽  
Aamir Ali Syed ◽  
Asif Loya ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Survival Rates ◽  
Staging System ◽  
Nodal Disease ◽  
Free Survival ◽  
Concomitant Chemoradiation ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Introduction Despite the acceptance of concomitant chemoradiation (CRT) as an alternative to total laryngectomy (TL) in locally advanced laryngeal cancer (LALC), laryngeal preservation is sparingly recommended in developing countries. We report on prognostic factors and survival in T3/T4 laryngeal cancer treated with concomitant CRT at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH and RC) to provide comparison with other geographic locations. Material and Methods During the period November 2003-April 2009, 101 patients with biopsy proven untreated LALC underwent concurrent CRT treatment at SKMCH and RC. According to AJCC staging system (6th edition) 41 had T3 and 60 patients had T4 disease. Radiation dose to the larynx was 70 Gy in 35 fractions with concomitant cisplatin. Induction chemotherapy was given to 42 patients. Thirty-one patients required tracheotomy either before or during concomitant CRT. Results Actuarial overall survival and laryngectomy free survival (LFS) for the whole group at 5 years were 54% (95% CI; 48-60) and 47% (95% CI; 42-52) respectively. Median LFS was 4.17 years. On univariate analysis patients with T4 tumors (p = 0.04), positive neck nodal disease (p = 0.02), supraglottic site (p = 0.02) and tracheotomy (0.009) had a significantly inferior LFS. Multivariate analysis showed tracheotomy to be the only factor significantly (p = 0.03) related to a higher risk of failure for LFS. Conclusion Survival rates for LALC treated with concomitant CRT in our institution are acceptable. Our study supports the use of TL in patients with compromised airways that require tracheotomy as outcome with concomitant CRT is poor.

Rectal cancer and systemic therapy of colorectal cancer

2016 ◽  
pp. 408-443
Author(s):  
Regina Beets-Tan ◽  
Bengt Glimelius ◽  
Lars Påhlman
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Treatment Decision ◽  
Well Being ◽  
Risk Groups ◽  
Preoperative Chemoradiotherapy ◽  
Recurrence Rates ◽  
Short Course ◽  
Rectal Cancer Treatment ◽  
Long Course

In rectal cancer treatment, surgery is most important. Dissection outside the mesorectal fascia, total mesorectal excision is required for cure in most cases; a local procedure is possible in the earliest tumours. Appropriate staging is required prior to treatment decision to stratify patients into risk groups. In early tumours surgery alone is sufficient whereas in intermediate cancers local recurrence rates are too high and preoperative radiotherapy is indicated. A short-course schedule is convenient, low toxic, although some prefer long-course chemoradiotherapy. The addition of a fluoropyrimidine enhances the radiotherapy. In locally advanced tumours preoperative chemoradiotherapy is required. The value of adjuvant chemotherapy in rectal cancer is controversial, particularly if preoperative chemoradiotherapy was used. Palliative chemotherapy prolongs life and improves well-being in patients with metastatic disease. Targeted drugs further improves the results to some extent. In some patients, chemotherapy may convert non-readily resectable metastases to resectable, and result in long-term cure.

scholarly journals Staging of Locally Advanced Rectal Cancer Beyond TME

2020 ◽  
Vol 33 (05) ◽  
pp. 258-267
Author(s):  
Deborah S. Keller
Keyword(s):  
Rectal Cancer ◽  
Best Practice ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Advanced Rectal Cancer ◽  
Cancer Staging ◽  
Locally Advanced Rectal Cancer ◽  
Multidisciplinary Teams ◽  
Treatment Decision Making

AbstractThe management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI allows a noninvasive assessment of the tumor site, relationship to surrounding structures, and provides highly accurate rectal cancer staging, which is necessary for determining the appropriate treatment strategy. However, the applications of MRI extend far beyond pretreatment staging. MRI can be used to predict outcomes in locally advanced rectal cancer and guide the surgical or nonsurgical plan, serving as a predictive and prognostic biomarker. With continued MRI hardware improvement and new sequence development, MRI may offer new perspectives in the assessment of treatment response and new innovations that could provide better insight into the staging, restaging, and outcomes with rectal cancer.

Paget Disease of the Breast With Invasion From Nipple Skin Into the Dermis: An Unusual Type of Skin Invasion Not Associated With an Adverse Outcome

2013 ◽  
Vol 137 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Mary Ann Sanders ◽  
Laura Dominici ◽  
Christine Denison ◽  
Mehra Golshan ◽  
Tad Wiecorek ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Staging System ◽  
Li Fraumeni Syndrome ◽  
Paget Disease ◽  
Skin Invasion ◽  
Pathology Reports ◽  
Invasive Carcinomas

Context.—Paget disease is an uncommon skin manifestation of breast cancer, associated with either invasive carcinoma or ductal carcinoma in situ in the underlying breast. In very rare cases, tumor cells within the epidermis invade through the basement membrane of the skin into the dermis. Objectives.—To identify a series of cases of Paget disease with direct dermal invasion and to investigate the clinicopathologic features and outcome. Design.—Cases were identified during a 6-year period from the files of 2 hospitals. The clinical histories, imaging studies, and pathology reports were reviewed. Results.—Seven patients were identified, 5 with microinvasion (<0.1 cm) and 2 with 0.2- or 0.3-cm invasive carcinomas in the dermis. No lymphovascular invasion was seen. Sentinel nodes were negative in 3 patients who underwent biopsy. Five patients were treated with breast conservation with radiation. Three patients were at high risk for breast cancer because of prior breast cancer, Li-Fraumeni syndrome, or radiation for Hodgkin disease. The latter 2 patients underwent bilateral mastectomies. Three patients received hormonal therapy and 1 oophorectomy. No patient received chemotherapy. At follow-ups ranging from 4 to 66 months (median, 20 months), there have been no recurrences. Conclusions.—Patients with direct dermal invasion from Paget disease had a favorable outcome during the available follow-up period. This type of dermal involvement must be distinguished from locally advanced invasive carcinomas with skin invasion classified as T4b in the American Joint Cancer Commission staging system, as cancers with other types of skin invasion are associated with a poor prognosis.

scholarly journals Current status of near-total laryngectomy: review

2012 ◽  
Vol 126 (6) ◽  
pp. 556-562 ◽  
Author(s):  
A K D'Cruz ◽  
S Sharma ◽  
P S Pai
Keyword(s):  
Total Laryngectomy ◽  
Relevant Literature ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Current Status ◽  
Success Rates ◽  
Primary Surgery ◽  
Wide Acceptance ◽  
Accepted Standard ◽  
Surgical Complexity

AbstractConcurrent chemoradiation is currently the accepted ‘standard of care’ for locally advanced laryngeal and hypopharyngeal cancers. However, there is a subset of patients not suitable for chemoradiation, in whom primary surgery is the best option. Speech preservation is of prime importance in these patients. Near-total laryngectomy is a voice-preserving procedure which can be considered as an alternative to total laryngectomy for selected patients with lateralised, locally advanced cancers of the larynx and hypopharynx. Although these patients are left with a permanent tracheostomy, lung-powered speech is maintained by way of a dynamic shunt created from the uninvolved tissues of the larynx. Since its first description in the early 1980s, the procedure has been shown by various authors to be oncologically sound, with high success rates. Unfortunately, the procedure has not gained wide acceptance due to perceived fears of surgical complexity. In this review, we discuss the various issues related to the procedure and we review the relevant literature.

Treatment and Outcomes of Women With Large Locally Advanced Breast Cancer

2020 ◽  
pp. 000313482095633
Author(s):  
Christopher W. Mangieri ◽  
Julia Ruffo ◽  
Akiko Chiba ◽  
Marissa Howard-McNatt
Keyword(s):  
Breast Cancer ◽  
Metastatic Cancer ◽  
Locally Advanced Breast Cancer ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Advanced Breast ◽  
Breast Cancers ◽  
Social Challenges ◽  
Radiation Treatments

Advances in breast cancer research have made breast cancer a treatable disease. However, there is a population of women who present with large, advanced, or sometimes neglected breast cancers who can prove difficult to treat. These women often require multiple modality treatment including chemotherapy, surgery, and radiation. The purpose of our study is to examine the treatment and outcomes on women with large, locally advanced breast cancers (LABCs). We identified 8 individuals who presented with LABCs requiring extensive treatment. Patients with inflammatory or metastatic cancer at the time of presentation were excluded. These patients’ charts were reviewed and analyzed. Patient demographics, hormone receptor status, stage, types of treatment, presence of metastasis, survival, and presence of barriers for seeking treatment sooner were identified. The median age at presentation was 65 years old. The patients were equally African American and Caucasian. All patients presented with T4 or stage 3 tumors involving the skin and/or pectoralis muscle. Half of the patients were found to have triple-negative (estrogen receptor, progesterone receptor, Her-2/neu negative) tumors. 87% of the patients received chemotherapy; 1 refused. All 8 patients, either neoadjuvantly or adjuvantly, underwent a modified radical or radical mastectomy. Skin graft or flap coverage was necessary in half of the patients. Postmastectomy radiation was received in 87% of the patients; 1 patient refused the treatment. Half of the patients developed metastatic disease. Thirty-seven percent of the patients have since died with a median survival of 44 months. Reasons for delay in seeking care were monetary or social barriers. Many of the patients finally sought care via the emergency room due to symptoms they could no longer ignore. Women who present with LABC require complex multidisciplinary treatment consisting of chemotherapy, surgery, and radiation treatments. Many of these patients faced economic and social challenges to accessing care. Better access to care and more prompt connection to breast surgeons are required to assist this patient population.

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