Ocular Melanoma

2010 ◽  
Vol 134 (12) ◽  
pp. 1778-1784
Author(s):  
Nora V. Laver ◽  
Margaret E. McLaughlin ◽  
Jay S. Duker
Keyword(s):  
Metastatic Disease ◽  
Needle Aspiration ◽  
Tumor Location ◽  
Local Tumor Control ◽  
Treatment Modalities ◽  
Tumor Control ◽  
The Novel ◽  
Risk Of Death ◽  
Melanocytic Lesions

Abstract Context—Intraocular melanoma of the ciliary body and choroid is the most common primary ocular malignant tumor in adults and the most common noncutaneous melanoma. Objective—To describe the most salient clinical features, histopathologic findings, and treatment modalities of intraocular melanoma, as well as the novel therapies currently being tested. Data Sources—Clinically, it is important to determine which lesions carry a worse prognosis so as to offer patients the best treatment modalities available. Tumor location, size, histopathology, cytogenetic abnormalities, and tumor profiling are all used in determining the risk of death from metastatic disease of uveal melanocytic lesions. Despite successful local tumor control, up to 50% of patients have metastatic disease within 15 years of diagnosis; there is no effective treatment for metastatic disease. Conclusions—Pathologists should be aware of the importance of tumor gross description, cellular histopathology classification, the use of fine-needle aspiration biopsy coupled with cytogenetics, and the new classification of uveal malignant melanomas that is based on chromosome 3 status.

scholarly journals Spinal intraarterial chemotherapy: interim results of a Phase I clinical trial

2016 ◽  
Vol 24 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Athos Patsalides ◽  
Yoshiya Yamada ◽  
Mark Bilsky ◽  
Eric Lis ◽  
Ilya Laufer ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Radiation Therapy ◽  
Phase I ◽  
Metastatic Disease ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Local Tumor Control ◽  
Phase I Clinical Trial ◽  
Intraarterial Chemotherapy ◽  
Tumor Control

OBJECT Despite advances in therapies using radiation oncology and spinal oncological surgery, there is a subgroup of patients with spinal metastases who suffer from progressive or recurrent epidural disease and remain at risk for neurological compromise. In this paper the authors describe their initial experience with a novel therapeutic approach that consists of intraarterial (IA) infusion of chemotherapy to treat progressive spinal metastatic disease. METHODS The main inclusion criterion was the presence of progressive, metastatic epidural disease to the spine causing spinal canal compromise in patients who were not candidates for the standard treatments of radiation therapy and/or surgery. All tumor histological types were eligible for this trial. Using the transfemoral arterial approach and standard neurointerventional techniques, all patients were treated with IA infusion of melphalan in the arteries supplying the epidural tumor. The protocol allowed for up to 3 procedures repeated at 3- to 6-week intervals. Outcome measures included physiological measures: 1) periprocedural complications according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events; and 2) MRI to assess for tumor response. RESULTS Nine patients with progressive spinal metastatic disease and cord compression were enrolled in a Phase I clinical trial of selective IA chemotherapy. All patients had metastatic disease from solid organs and were not candidates for further radiation therapy or surgery. A total of 19 spinal intraarterial chemotherapy (SIAC) procedures were performed, and the follow-up period ranged from 1 to 7 months (median 3 months). There was 1 serious adverse event (febrile neutropenia). Local tumor control was seen in 8 of 9 patients, whereas tumor progression at the treated level was seen in 1 patient. CONCLUSIONS These preliminary results support the hypothesis that SIAC is feasible and safe.

scholarly journals Photodynamic Therapy in Advanced Tracheobronchial Cancers

1999 ◽  
Vol 5 (4) ◽  
pp. 245-251 ◽  
Author(s):  
Tom G. Sutedja
Keyword(s):  
Photodynamic Therapy ◽  
Tracheobronchial Tree ◽  
Local Tumor Control ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Tissue Necrosis ◽  
Endoscopic Techniques ◽  
Lung Cancer Patients ◽  
Secondary Tissue ◽  
Effectiveness Studies

Photodynamic therapy (PDT) has been introduced in the early eighties for treating patients with malignancies in the tracheobronchial tract. After intravenous injection of the photosensitizers, the tumor area in the tracheobronchial tree is illuminated bronchoscopically using a laser fiber to transmit light of a specific wavelength during the procedure. Secondary tissue necrosis ensues, because of the thrombosis of the tumor vasculature leading to late tissue hypoxia. Ample data have shown that PDT is effective to obtain full depth tissue necrosis with relative sparing of the normal tissue. Local tumor control can be achieved. Competitive endoscopic techniques such as lasers and electrocautery are applicable to debulk tumor in a less selective but more immediate manner. Skin photosensitivity is a potential morbidity of PDT, especially in using the first generation photosensitizers. This limits its palliative potential. More selective and more phototoxic sensitizers in combination with the use of portable diode laser, may improve the clinical usefulness of PDT in the management of lung cancer patients. However, cost-effectiveness studies comparing PDT and other local bronchoscopic treatment modalities such as thermal lasers, electrocautery, cryotherapy, brachytherapy, whether or not in addition to external radiotherapy and chemotherapy, should be conducted to define its definite role in the palliative treatment of advanced obstructive bronchial cancers.

scholarly journals Targeted therapy in advanced desmoid tumors: Current perspectives

2020 ◽  
Vol 11 (3) ◽  
pp. 9-16
Author(s):  
Amrallah A. Mohammed ◽  
Hani EL-Tanni ◽  
Hani M. EL-Khatib
Keyword(s):  
Targeted Therapy ◽  
Treatment Options ◽  
Aggressive Fibromatosis ◽  
Local Tumor Control ◽  
The Body ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Desmoid Tumors ◽  
Treatment Needs ◽  
Medline Search

Abstract Background Desmoid tumors/aggressive fibromatosis (DTs/AF) are cytological bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. The exact cause still remains unknown, however, they may present sporadically or as a manifestation of a hereditary syndrome called familial adenomatous polyposis (FAP). Although they lack the capacity to establish metastases, DTs/AF may be devastated and occasionally fatal. As a result of the heterogeneity of DTs/AF, treatment needs to be individualized to improve local tumor control and maintain patients’ quality of life. Therefore, after a multidisciplinary approach, all treatment options should be discussed with patients. Where systemic chemotherapy has been shown to be unsuccessful with marked side effects in case of advanced DTs/AF, new therapeutic options are needed. Methods A Medline search was conducted and published articles in different studies from 2000 to the present were reviewed. Conclusion More research is needed to illustrate both the prognostic and predictive factors of the targeted therapy and the value of their combinations with or without other treatment modalities to get the best result for the treatment of advanced DTs/AF.

scholarly journals A Concise Review of Pelvic Radiation Therapy (RT) for Rectal Cancer with Synchronous Liver Metastases

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Omer Sager ◽  
Ferrat Dincoglan ◽  
Selcuk Demiral ◽  
Bora Uysal ◽  
Hakan Gamsiz ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Liver Metastases ◽  
Stage Iv ◽  
Local Tumor Control ◽  
Health Concern ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Pelvic Radiation ◽  
Synchronous Liver Metastases

Background and Objective. Colorectal cancer is a major health concern as a very common cancer and a leading cause of cancer-related mortality worldwide. The liver is a very common site of metastatic spread for colorectal cancers, and, while nearly half of the patients develop metastases during the course of their disease, synchronous liver metastases are detected in 15% to 25% of cases. There is no standardized treatment in this setting and no consensus exists on optimal sequencing of multimodality management for rectal cancer with synchronous liver metastases. Methods. Herein, we review the use of pelvic radiation therapy (RT) as part of potentially curative or palliative management of rectal cancer with synchronous liver metastases. Results. There is accumulating evidence on the utility of pelvic RT for facilitating subsequent surgery, improving local tumor control, and achieving palliation of symptoms in patients with stage IV rectal cancer. Introduction of superior imaging capabilities and contemporary RT approaches such as Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) offer improved precision and toxicity profile of radiation delivery in the modern era. Conclusion. Even in the setting of stage IV rectal cancer with synchronous liver metastases, there may be potential for extended survival and cure by aggressive management of primary tumor and metastases in selected patients. Despite lack of consensus on sequencing of treatment modalities, pelvic RT may serve as a critical component of multidisciplinary management. Resectability of primary rectal tumor and liver metastases, patient preferences, comorbidities, symptomatology, and logistical issues should be thoroughly considered in decision making for optimal management of patients.

scholarly journals Laparoscopic Liver Resection versus Percutaneous Radiofrequency Ablation for Small Single Nodular Hepatocellular Carcinoma: Comparison of Treatment Outcomes

Liver Cancer ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 25-37
Author(s):  
Dong Ho Lee ◽  
Jing Woong Kim ◽  
Jeong Min Lee ◽  
Jong Man Kim ◽  
Min Woo Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Treatment Outcomes ◽  
Cumulative Incidence ◽  
Laparoscopic Liver Resection ◽  
Local Tumor Control ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Percutaneous Radiofrequency Ablation ◽  
Local Tumor

<b><i>Background:</i></b> Treatment outcomes of laparoscopic liver resection (LLR) and percutaneous radiofrequency ablation (p-RFA) for small single hepatocellular carcinomas (HCCs) have not yet been fully compared. The aim of this study was to compare LLR and p-RFA as first-line treatment options in patients with single nodular HCCs ≤3 cm. <b><i>Methods:</i></b> From January 2014 to December 2016, a total of 566 patients with single nodular HCC ≤3 cm treated by either LLR (<i>n</i> = 251) or p-RFA (<i>n</i> = 315) were included. The recurrence-free survival (RFS) and cumulative incidence of local tumor progression (LTP) were estimated using Kaplan-Meier methods and compared using the log-rank test. Treatment outcome of 2 treatment modalities was compared in the subgroup of patients according to the tumor location. <b><i>Results:</i></b> There were no significant differences in overall survival between LLR and p-RFA (<i>p</i> = 0.160); however, 3-year RFS was demonstrated to be significantly higher after LLR (74.4%) than after p-RFA (66.0%) (<i>p</i> = 0.013), owing to its significantly lower cumulative incidence of LTP (2.1% at 3 years after LLR vs. 10.0% after p-RFA, <i>p</i> &#x3c; 0.001). The complication rate of p-RFA was significantly lower than that of LLR (5.1 vs. 10.0%, <i>p</i> = 0.026). LLR also provided significantly better local tumor control than p-RFA for subscapular tumors (3-year LTP rates: 1.9 vs. 8.8%, <i>p</i> = 0.012), perivascular tumors (3-year LTP rates: 0.0 vs. 17.2%, <i>p</i> = 0.007), and tumors located in anteroinfero-lateral liver portions (3-year LTP rates: 0.0 vs. 10.7%, <i>p</i> &#x3c; 0.001). However, there were no significant differences in LTP rates between LLR and p-RFA for non-subcapsular and non-perivascular tumors (<i>p</i> = 0.482) and for tumors in postero-superior liver portions (<i>p</i> = 0.380). <b><i>Conclusions:</i></b> LLR can provide significantly better local tumor control than p-RFA for small single HCCs in subcapsular, perivascular, and anteroinferolateral liver portions and thus may be the preferred treatment option for these tumors.

scholarly journals Injectable diblock copolypeptide hydrogel provides platform to maintain high local concentrations of taxol and local tumor control

2019 ◽  
Author(s):  
Matthew C. Garrett ◽  
Timothy M. O’Shea ◽  
Alexander L. Wollenberg ◽  
Alexander M. Bernstein ◽  
Derek Hung ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Xenograft Model ◽  
Tumor Location ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Concentration ◽  
Local Tumor ◽  
Immunodeficient Mice ◽  
Wide Range ◽  
Systemic Side Effects

AbstractIntroductionSurgical resection and systemic chemotherapy with temozolomide remain the mainstay for treatment of glioblastoma. However, many patients are not candidates for surgical resection given inaccessible tumor location or poor health status. Furthermore, despite being first line treatment, temozolomide has only limited efficacy.MethodsThe development of injectable hydrogel-based carrier systems allows for the delivery of a wide range of chemotherapeutics that can achieve high local concentrations, thus potentially avoiding systemic side effects and wide-spread neurotoxicity. To test this modality in a realistic environment, we developed a diblock copolypeptide hydrogel (DCH) capable of carrying and releasing paclitaxel, a compound that we found to be highly potent against primary gliomasphere cells.ResultsThe DCH produced minimal tissue reactivity and was well tolerated in the immune-competent mouse brain. Paclitaxel-loaded hydrogel induced less tissue damage, cellular inflammation and reactive astrocytes than cremaphor-taxol (typical taxol-carrier) or hydrogel alone. In a deep subcortical xenograft model, of glioblastoma in immunodeficient mice, injection of paclitaxel-loaded hydrogel led to a high local concentration of paclitaxel and led to local tumor control and improved survival. However, the tumor cells were highly migratory and were able to eventually escape the area of treatment.ConclusionsThese findings suggest this technology may be ultimately applicable to patients with deep-seated inoperable tumors, but as currently formulated, complete tumor eradication would be highly unlikely. Future studies should focus on targeting the migratory potential of surviving cells.

Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions

2017 ◽  
Vol 10 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Melinda Reyes ◽  
Mark Georgy ◽  
Lorenzo Brook ◽  
Orlando Ortiz ◽  
Allan Brook ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Tumor Location ◽  
Local Tumor Control ◽  
Cement Augmentation ◽  
Tumor Control ◽  
Imaging Evaluation ◽  
Post Contrast ◽  
Visual Analogue Pain ◽  
Metastatic Lesions ◽  
Post Procedure

BackgroundTreatment of spinal metastatic lesions by radiofrequency ablation (RFA) before cementation can potentially help in local tumor control and pain relief. This is often limited by access and tumor location. This study reports multicenter clinical and imaging outcomes following targeted RFA (t-RFA) and cement augmentation in neoplastic lesions of the spine.Material and methodsA retrospective multicenter study of 49 patients with 72 painful vertebral lesions, evaluated for clinical and imaging outcomes following RFA and cement augmentation of spinal metastatic lesions, was undertaken. Visual Analogue Pain score (VAS) and Oswestry Disability Index (ODI) were obtained before and 2–4 weeks after treatment. Pre- and post-procedure imaging examinations including MRI and positron emission tomography (PET) were also evaluated.ResultsMean ablation time was 3.7±2.5 min (range 0.92–15). Mean VAS scores decreased from 7.9±2.5 pre-procedure to 3.5±2.6 post-procedure (p<0.0001). Mean ODI scores improved from 34.9±18.3 to 21.6±13.8 post-procedure (p<0.0001). Post-contrast MRI resulted in a predictable pattern of decreased tumor volume and an enhancing rim. Metabolically active lesions in pre-procedure PET scans (n=10 levels) showed decreased fluorodeoxyglucose activity after ablation.Conclusionst-RFA followed by vertebral augmentation in malignant vertebral lesions resulted in significant pain reduction and functional status improvement, with no major complications. t-RFA permitted access to vertebral lesions and real-time accurate monitoring of the ablation zone temperature. Post-procedure MRI and PET examinations correlated with a favorable tumor response and helped to monitor tumor growth and the timing of adjuvant therapy.

scholarly journals Iris Melanoma: Management and Prognosis

2020 ◽  
Vol 10 (24) ◽  
pp. 8766
Author(s):  
Andrea Russo ◽  
Teresio Avitabile ◽  
Michele Reibaldi ◽  
Vincenza Bonfiglio ◽  
Francesco Pignatelli ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Local Tumor Control ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Pigment Dispersion ◽  
Clinical Complications ◽  
Vitreous Loss ◽  
Efficient Alternative ◽  
Limbal Stem Cell ◽  
Iris Nevus

Iris melanomas represent 2–5% of uveal melanomas. Iris melanomas vary in their size, shape, degree of pigmentation and clinical behavior. The main local clinical complications of iris melanomas are tumor vascularization, ectropion uvea, pupillary distortion, pigment dispersion, sector cataract, chronic uveitis, hyphema and glaucoma with irreversible optic nerve damage. The most effective treatment for iris nevus and melanoma remains debatable; treatment modalities have been proposed depending on the local status as well as the age and general condition of the patient. A melanocytic iris nevus is usually observed until documented progression is identified. In this case, radiotherapy or surgical resection is generally performed. Cataract, glaucoma and limbal stem cell deficiency are usually secondary to radiotherapy, while incomplete tumor excisions, which could lead to recurrence, hemorrhage, vitreous loss, dislocated lens, iridocyclitis, macular edema, retinal detachment, glaucoma and cataract, are related to surgical resection. In some cases, a combination of radiotherapy and surgery is used. Conservative treatment is an efficient alternative to enucleation and allows good local tumor control.

scholarly journals Topographic Distribution of Intracranial Meningioma’s Recurrences: Localized Versus Diffuse-Multicentric

2021 ◽  
Author(s):  
Francesco Maiuri ◽  
Sergio Corvino ◽  
Elia Guadagno ◽  
Marialaura Del Basso De Caro
Keyword(s):  
Brain Tumor ◽  
Tumor Location ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Who Grade ◽  
Initial Surgery ◽  
Slow Progression ◽  
Diffuse Recurrence ◽  
Age And Sex ◽  
Topographic Distribution

Meningiomas recur with a rate of 10–32% at ten years. Several features influence the risk of recurrence. Our aim is to define the pathological and surgical features at risk of diffuse-multicentric versus local-peripheral recurrence. Thirty-three cases of multicentric-diffuse recurrence of intracranial meningiomas were retrospectively analyzed and compared with 50 cases who experienced local-peripheral recurrence. The analyzed factors included age and sex, tumor location and shape, brain-tumor interface, entity of resection, WHO grade, Ki67 MIB1, progesterone receptor (PR) expression, number of reoperations, progression of WHO grade, and outcome. The multicentric-diffuse recurrences were mainly related to flat-shaped and Ki67 Li greater than 4% features at first surgery. Among patients with multicentric-diffuse recurrences, 25 underwent one to three reoperations; among them, 17 are alive with local tumor control or slow progression 2 to 25 years after the initial surgery versus only 2 out of 8 who did not undergo surgery. We conclude that flat-shaped meningiomas and those with Ki67 Li greater than 4% are at higher risk to recur in multicentric-diffuse pattern. Even multiple reoperations over a period of several years may obtain rather long survivals in selected patients with prevalent intradural not anaplastic tumors and not too extensive dural infiltration.

scholarly journals Injectable diblock copolypeptide hydrogel provides platform to maintain high local concentrations of taxol and local tumor control

2019 ◽  
Author(s):  
Matthew C. Garrett ◽  
Timothy M. O’Shea ◽  
Alexander L. Wollenberg ◽  
Alexander M. Bernstein ◽  
Derek Hung ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Xenograft Model ◽  
Tumor Location ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Concentration ◽  
Local Tumor ◽  
Immunodeficient Mice ◽  
Wide Range ◽  
Systemic Side Effects

AbstractIntroductionSurgical resection and systemic chemotherapy with temozolomide remain the mainstay for treatment of glioblastoma. However, many patients are not candidates for surgical resection given inaccessible tumor location or poor health status. Furthermore, despite being first line treatment, temozolomide has only limited efficacy.MethodsThe development of injectable hydrogel-based carrier systems allows for the delivery of a wide range of chemotherapeutics that can achieve high local concentrations, thus potentially avoiding systemic side effects and wide-spread neurotoxicity. To test this modality in a realistic environment, we developed a diblock copolypeptide hydrogel (DCH) capable of carrying and releasing paclitaxel, a compound that we found to be highly potent against primary gliomasphere cells.ResultsThe DCH produced minimal tissue reactivity and was well tolerated in the immune-competent mouse brain. Paclitaxel-loaded hydrogel induced less tissue damage, cellular inflammation and reactive astrocytes than cremaphor-taxol (typical taxol-carrier) or hydrogel alone. In a deep subcortical xenograft model, of glioblastoma in immunodeficient mice, injection of paclitaxel-loaded hydrogel led to a high local concentration of paclitaxel and led to local tumor control and improved survival. However, the tumor cells were highly migratory and were able to eventually escape the area of treatment.ConclusionsThese findings suggest this technology may be ultimately applicable to patients with deep-seated inoperable tumors, but as currently formulated, complete tumor eradication would be highly unlikely. Future studies should focus on targeting the migratory potential of surviving cells.

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