Adjuvant radiotherapy in recurrent pleomorphic leiomyosarcoma of spermatic cord: A case report and literature review

Pleomorphic leiomyosarcoma of spermatic cord is a very rare urologic disease, so there are no clear guidelines. The mainstay of treatment is surgery with wide excision margins. The role of adjuvant treatments, such as Chemotherapy (CHT) or Radiotherapy (RT), is not clear, due to the few data available in the literature. However, adjuvant treatments could be considered in patients with a high risk of local recurrence: R1 status after surgery and highgrade histology. We report the case of 68-year old man affected by recurrent pleomorphic leiomyosarcoma of spermatic cord right, who, in five years, underwent many surgical treatments for local recurrence, and also adjuvant CHT. The last surgery shows positive margins. Therefore, the patient receive adjuvant RT on the surgical bed and right inguinal nodes with a dose of 54 Gy in 27 fractions and VMAT technique. The treatment was well tolerated, the follow-up at 12 months is negative for local recurrence and show absence of toxicity. However a long-term follow-up is necessary to confirm the efficacy of radiotherapy on outcomes and especially on local control. Keywords: pleomorphic leiomyosarcoma; recurrence; positive margins; adjuvant radiotherapy

Download Full-text

Mid-term Outcome Of Surgical Treatment In Pediatric Patients With Ebstein's Anomaly: A Single-center Cohort Study.

10.21203/rs.3.rs-42297/v1 ◽

2020 ◽

Author(s):

Jia-chen Li ◽

Xian-chao Jiang ◽

Si-meng Zhang ◽

Jin-yang Liu ◽

Ya-juan Zhang ◽

...

Keyword(s):

Surgical Treatment ◽

Reoperation Rate ◽

Term Effect ◽

Ebstein’S Anomaly ◽

Biventricular Repair ◽

Ebstein's Anomaly ◽

Long Term Follow Up ◽

Surgical Treatments

Abstract Background: Ebstein’s anomaly is a malformation of the tricuspid valve and myopathy of the right ventricle. Surgery is now the main treatment for the defect. To summarize our surgical results and experience based on patients with Ebstein’s anomaly who were under 7 years of age and treated with different surgical treatments.Materials and Methods: From January 2010 to December 2019, 80 patients under 7 years old who were diagnosed of Ebstein’s anomaly and underwent different surgical treatments were consecutively enrolled and followed up in detail. Results: The median age of the 80 patients at the time of surgery was 3.63 years. Sixty-four (80.00%) patients underwent biventricular repair while 13 (16.25%) underwent 1.5-ventricle repair. With the median follow-up 27.50 months, the long-term survival of the total cohort, 1.5-ventricular repair and biventricular repair was 82.35%, 91.67% and 100%, respectively. The long-term freedom from reoperation rate was 97.50%, 92.31% and 98.44%, respectively. Mild, moderate and severe TR before surgery occurred in 6 (7.50%), 18 (22.50%) and 56 (70.00%), respectively. The early outcomes of 78 patients were 65 (83.33%), 11 (14.11%) and 2 (2.56%); the mid-term outcomes of 72 patients were 49 (68.06%), 19 (26.38%) and 4 (5.56%). Both early and long-term valve regurgitation were significantly decreased (p< 0.001) compared with preoperative condition. No more severe regurgitation occurred (p=0.404), though some early mild regurgitation became acceptable moderate regurgitation during long-term follow-up (p=0.036). Compared with Carpentier procedure, cone procedure had better long-term effect, while the effect of whole-valve technique needed more operation and long-term follow-up.Conclusion: The reoperation rate and mid-term mortality of surgical treatment for Ebstein’s anomaly were both low, tricuspid regurgitation was significantly improved during mid-term follow up. Cone procedure had the best mid-term effect among anatomic repair.

Download Full-text

Lessons from pathological analysis of recurrent early esophageal squamous cell neoplasia after complete endoscopic radiofrequency ablation

Endoscopy ◽

10.1055/s-0044-101352 ◽

2018 ◽

Vol 50 (08) ◽

pp. 743-750 ◽

Cited By ~ 1

Author(s):

Wen-Lun Wang ◽

I-Wei Chang ◽

Chien-Chuan Chen ◽

Chi-Yang Chang ◽

Cheng-Hao Tseng ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Local Recurrence ◽

Endoscopic Resection ◽

Squamous Cell ◽

Complete Response ◽

Primary Treatment ◽

Long Term Follow Up ◽

Endoscopic Radiofrequency Ablation ◽

Lost To Follow Up

Abstract Background Endoscopic radiofrequency ablation (RFA) is a treatment option for early esophageal squamous cell neoplasia (ESCN); however, long-term follow-up studies are lacking. The risks of local recurrence and “buried cancer” are also uncertain. Methods Patients with flat-type ESCN who were treated with balloon-type ± focal-type RFA were consecutively enrolled. Follow-up endoscopy was performed at 1, 3, and 6 months, and then every 6 months thereafter. Endoscopic resection was performed for persistent and recurrent ESCN, and the histopathology of resected specimens was assessed. Results A total of 35 patients were treated with RFA, of whom 30 (86 %) achieved a complete response, three were lost to follow-up, and five (14 %) developed post-RFA stenosis. Two patients had persistent ESCN and received further endoscopic resection, in which the resected specimens all revealed superficial submucosal invasive cancer. Six of the 30 patients with successful RFA (20 %) developed a total of seven episodes of local recurrence (mean size 1.4 cm) during the follow-up period (mean 40.1 months), all of which were successfully resected endoscopically without adverse events. Histological analysis of the resected specimens revealed that six (86 %) had esophageal glandular ductal involvement, all of which extended deeper than the muscularis mucosae layer. Immunohistochemistry staining for P53 and Ki67 suggested a clonal relationship between the ductal involvement and epithelial cells. None of the tumors extended out of the ductal structure; no cases of cancer buried beneath the normal neosquamous epithelium were found. Conclusions Because ductal involvement is not uncommon and may be related to recurrence, the use of RFA should be conservative and may not be the preferred primary treatment for early ESCN.

Download Full-text

Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study.

Journal of Clinical Oncology ◽

10.1200/jco.1990.8.10.1664 ◽

1990 ◽

Vol 8 (10) ◽

pp. 1664-1674 ◽

Cited By ~ 376

Author(s):

M E Nesbit ◽

E A Gehan ◽

E O Burgert ◽

T J Vietti ◽

A Cangir ◽

...

Keyword(s):

Overall Survival ◽

Local Recurrence ◽

Multimodal Therapy ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Patient Characteristics ◽

Group I ◽

Long Term Follow Up

A total of 342 previously untreated eligible children were entered into the first Intergroup Ewing's Sarcoma Study (IESS) between May 1973 and November 1978. In group I institutions, patients were randomized between treatment 1 (radiotherapy to primary lesion plus cyclophosphamide, vincristine, dactinomycin, and Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH] [VAC plus ADR]) or treatment 2 (same as treatment 1 without ADR), and group II institutions randomized patients between treatment 2 or treatment 3 (same as treatment 2 plus bilateral pulmonary radiotherapy [VAC plus BPR]). The percentages of patients relapse-free and surviving (RFS) at 5 years for treatments 1, 2, and 3 were 60%, 24%, and 44%, respectively. There was strong statistical evidence of a significant advantage in RFS for treatment 1 (VAC plus ADR) versus 2 (VAC alone) (P less than .001) and 3 (P less than .05) and also of treatment 3 versus 2 (P less than .001). Similar significant results were observed with respect to overall survival. Patients with disease at pelvic sites have significantly poorer survival at 5 years than those with disease at nonpelvic sites (34% v 57%; P less than .001). Among pelvic cases, there was no evidence of differing survival by treatment (P = .81), but among nonpelvic cases, there was strong evidence of differing survival by treatment (P less than .001). The overall percentage of patients developing metastatic disease was 44%; the percentages by treatments 1, 2, and 3 were 30%, 72%, and 42%, respectively. The overall incidence of local recurrence was 15%, and there was no evidence that local recurrence rate differed by treatment. Patient characteristics related to prognosis, both with respect to RFS and overall survival experience, were primary site (nonpelvic patients were most favorable) and patient age (younger patients were more favorable).

Download Full-text

A rare case of paratesticular leiomyosarcoma

Clinics and Practice ◽

10.4081/cp.2012.e29 ◽

2012 ◽

Vol 2 (1) ◽

pp. 29 ◽

Cited By ~ 6

Author(s):

James Moloney ◽

John Drumm ◽

Deirdre M. Fanning

Keyword(s):

Soft Tissue ◽

Adjuvant Radiotherapy ◽

Spermatic Cord ◽

Soft Tissue Sarcomas ◽

Solid Mass ◽

Urological Malignancies ◽

History Of ◽

To Receive ◽

Groin Swelling

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

Download Full-text

Impact of Screening and Risk Factors for Local Recurrence and Survival After Conservative Surgery and Radiotherapy for Early Breast Cancer: Results From a Large Series With Long-Term Follow-Up

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.08.018 ◽

2012 ◽

Vol 83 (3) ◽

pp. 829-838 ◽

Cited By ~ 17

Author(s):

Ian H. Kunkler ◽

Gillian R. Kerr ◽

Jeremy S. Thomas ◽

Wilma J.L. Jack ◽

John M.S. Bartlett ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Local Recurrence ◽

Early Breast Cancer ◽

Conservative Surgery ◽

Large Series ◽

Long Term Follow Up

Download Full-text

Significance of spermatic cord invasion in radical inguinal orchidectomy: Will a modified subinguinal orchidectomy suffice?

Urologia Journal ◽

10.1177/0391560319840529 ◽

2019 ◽

Vol 87 (2) ◽

pp. 70-74 ◽

Cited By ~ 1

Author(s):

Usman M Haroon ◽

Nikita R Bhatt ◽

Ch Muhammad Akram ◽

Hugh D Flood ◽

Sibhasis K Giri

Keyword(s):

Spermatic Cord ◽

B Cell Lymphoma ◽

Testicular Germ Cell ◽

Testicular Germ Cell Tumours ◽

Oncological Outcomes ◽

Long Term Follow Up ◽

Tumour Histology ◽

Test Feasibility

Introduction and objectives: Radical inguinal orchidectomy with ligation and division of the spermatic cord at the deep inguinal ring is the treatment of choice for testicular mass suspicious of cancer. In the era of organ preserving and minimally invasive surgery, it may be possible to propose a less radical sub-inguinal orchidectomy that may avoid the morbidity associated with opening the inguinal canal. The effect of this approach on oncological margins is not known. The aim of this article was to investigate the presence of spermatic cord involvement after a radical inguinal orchidectomy with a view to test feasibility of a modified sub-inguinal approach for testicular tumour excision. Materials and methods: A retrospective study on all orchidectomies performed for suspected testicular cancer was performed at a single hospital from over an 8-year period from January 2005 to December 2013. Non-cancerous lesions were excluded after histopathological review. All testicular malignancies were included and detailed histopathological review was performed. Results: A total of 121 orchidectomies were performed over the 8-year period. Three patients had spermatic cord involvement. Spermatic cord involvement did not adversely affect the outcome in these patients after a median follow-up of 5 years irrespective of tumour histology. The proximal spermatic cord was not involved in any testicular germ cell tumours on further cord sectioning, the only patient with proximal cord involvement had a B-cell lymphoma. Conclusion: We postulate that a sub-inguinal modified orchidectomy may be a less invasive alternative to radical inguinal orchidectomy, with comparable oncological outcomes based on low risk of spermatic cord involvement, which in itself is not a prognostic factor. We require further long-term follow-up studies on patients who have undergone this approach to validate the oncological outcomes and report the possible advantage of lower post-operative complications with this technique.

Download Full-text