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Somashekhar SP Ramya Y Rohit Kumar C Shabber SZ Vijay A Amit R Poonam P Arun KN Ashwin KR 《中国肿瘤临床》2022,49(24):1268-1272
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《European journal of surgical oncology》2022,48(5):946-955
BackgroundPeritoneal metastases is the second most common colorectal cancer dissemination. The anatomic sites at which colorectal peritoneal metastases are located within the abdomen and pelvis has not been previously determined.MethodsA prospective database has been maintained on patients treated by cytoreductive surgery (CRS) plus perioperative chemotherapy. The patients in this current study all had peritoneal metastases histologically confirmed, and a complete cytoreduction. The patterns of dissemination of the peritoneal metastases recorded after a prior left colon resection or right colon resection at the time of the CRS were analyzed. The major goal was to identify the location of colorectal cancer peritoneal metastases at abdominopelvic anatomic sites.ResultsIn these 77 patients, by the abdominopelvic regions, the highest incidence of histologically documented cancer was the pelvis (85.7%), central region (75.3%), right upper quadrant (50.6%) and right lower (53.2%). Specific anatomic sites free of disease at the time of primary resection at which cancer was documented at the time of CRS was the abdominal incision or laparoscopy port sites at 57.1% and the anatomic site for the primary cancer resection at 76.6%. Right colon cancer had a statistically significant increase in the right flank region 8 (p = 0.0350) and borderline significant increase of left colon cancer in the left lower region 5 (p = 0.0699).ConclusionsWhen data is pooled from many patients, physiology of the peritoneal spaces and tumor cell entrapment contribute to the distribution of disease within the abdomen and pelvis. 相似文献
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Lee SW Russell AH Kinney WK 《International journal of radiation oncology, biology, physics》2003,56(3):788-792
PURPOSE: No standard, universally accepted therapy exists for patients with adenocarcinoma of the endometrium with peritoneal dissemination. We report mature outcomes of selected patients with this uncommon pattern of spread treated with whole abdomen radiotherapy (RT). METHODS AND MATERIALS: A retrospective review was undertaken of all patients with a diagnosis of endometrial cancer referred to the Radiologic Associates of Sacramento Medical Group between January 1, 1988 and October 1, 1999. Eleven patients were identified who had surgically proven peritoneal dissemination (peritoneal seeding) treated with whole abdomen RT as the sole cytotoxic therapy after operative cytoreduction. Ten patients had International Federation of Obstetrics and Gynecology (1988) Stage IV disease at diagnosis, and one had peritoneal dissemination at the time of initial recurrence after hysterectomy for Stage I disease. RT was administered to the whole abdomen using 10-MV photons in fractions of 1.0 or 1.5 Gy. A cumulative dose of 30 Gy was given in all patients, with shielding used to reduce the dose to the liver and kidneys. Partial abdominal volumes (pelvis plus paraaortic nodes) received supplementary dose at 1.5-1.8 Gy/fraction to bring the cumulative dose within the limited volumes to 46.2-54 Gy. RESULTS: Four patients developed progressive cancer within 13 months of completion of whole abdomen RT. One additional patient died of hepatic venoocclusive disease (radiation hepatitis) 15 months after RT without evidence of cancer recurrence. Five patients were alive and clinically cancer free 55, 129, 131, 134, and 178 months after RT completion. One patient died of unrelated causes 79 months after treatment completion. CONCLUSION: Abdominal RT, in doses compatible with the acute and late tolerance of normal tissues, can eradicate small deposits of disseminated, intraperitoneal endometrial cancer. Currently, our patient selection criteria include limited peritoneal dissemination at diagnosis permitting complete surgical clearance (<1 mm residual) of visible and palpable disease, Grade 1 or 2 histologic features, lack of demonstrable extraabdominal metastasis, and absence of major medical contraindications. 相似文献
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Salani R Santillan A Zahurak ML Giuntoli RL Gardner GJ Armstrong DK Bristow RE 《Cancer》2007,109(4):685-691
BACKGROUND: The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to or=12 months between initial diagnosis and recurrence, and or=18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS.: The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval >or=18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months. 相似文献
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Antonio Santillan Ruchi Garg Marianna L Zahurak Ginger J Gardner Robert L Giuntoli Deborah K Armstrong Robert E Bristow 《Journal of clinical oncology》2005,23(36):9338-9343
PURPOSE: To evaluate the risk of epithelial ovarian cancer (EOC) recurrence in patients with rising serum cancer antigen 125 (CA-125) levels that remain below the upper limit of normal (< 35 U/mL). PATIENTS AND METHODS: All patients treated for EOC between September 1997 and March 2003 were identified and screened retrospectively for the following: (1) elevated serum CA-125 at time of diagnosis, (2) complete clinical and radiographic response (CR) to initial treatment with normalization of serum CA-125, (3) at least three serial serum CA-125 determinations that remained within the normal range, and (4) clinical and/or radiographic determination of disease status at the time of last follow-up or recurrence. For statistical analyses, univariate regression models were used to compare absolute and relative changes in CA-125 levels among patients with recurrent disease and those without EOC recurrence. RESULTS: A total of 39 patients satisfied study inclusion criteria; 22 patients manifested EOC recurrence at a median interval from complete response of 11 months. The median follow-up time from complete response to last contact was 32 months for the 17 patients in the no recurrence group. A relative increase in CA-125 of 100% (odds ratio [OR] = 23.7; 95% CI, 2.9 to 192.5; P = .003) was significantly predictive of recurrence. From baseline CA-125 nadir levels, an absolute increase in CA-125 of 5 U/mL (OR = 8.4; 95% CI, 2.2 to 32.6; P = .002) and 10 U/mL (OR = 71.2; 95% CI, 4.8 to > 999.9; P = .002) were also significantly associated with the likelihood of concurrent disease recurrence. CONCLUSION: Among patients with EOC in complete clinical remission, a progressive low-level increase in serum CA-125 levels is strongly predictive of disease recurrence. 相似文献
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《European journal of surgical oncology》2022,48(12):2551-2557
ObjectivesThis study was designed to investigate the response to chemotherapy of supradiaphragmatic disease diagnosed by preoperative imaging. As secondary objectives, oncologic outcomes of patients affected by supradiaphragmatic disease and their pattern of recurrence were also evaluated.MethodsData of consecutive patients with newly diagnosed FIGO stage IV (for supradiaphragmatic disease) epithelial ovarian cancer undergoing either primary debulking surgery or neoadjuvant chemotherapy plus interval debulking surgery between 2004 and 2021, were retrospectively collected. All patients were preoperatively evaluated by chest/abdominal CT scan or 18F-FDG PET/CT preoperatively and at follow-up to evaluate response to chemotherapy. At follow-up visits, site of recurrence diagnosed by imaging techniques was systematically recorded as it occurred. Progression-free and overall survival were measured by using Kaplan-Meier and Cox models.ResultsA total of 130 patients was included in this study with a median (range) follow-up of 32.9 (12.8–176.7) months. Complete or partial response was achieved in most of the patients after 3 cycles (77.7%) and 6 cycles (85.4%) of chemotherapy. At follow-up, recurrence occurred in 96 (73.8%) patients and the main site of recurrence was abdomen only in 64 (66.7%) patients. At multivariate analysis, residual disease after surgery was the only variable influencing survival outcomes.ConclusionsSupradiaphragmatic disease respond to chemotherapy in most patients affected by advanced EOC and recurrence mainly occurs in the abdomen. Results from this study confirms that abdominal optimal cytoreduction is the main surgical goal in the treatment of women affected by FIGO stage IV EOC. 相似文献
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BACKGROUND AND OBJECTIVES: Accurate surgical staging and maximal tumor reduction are the basic management principles of epithelial ovarian cancer (EOC). The purpose of our study is to report on staging practices and the primary surgery of EOC in a region that has no tertiary oncological referral center and no surgical gynecological oncologist. METHODS: Between 1 January 1989 and 30 December 1995, the Valais Cancer Registry had registered 157 patients with ovarian cancer stage I-IV. Hospital case notes were reviewed retrospectively and patients who did not have a surgical abdominal exploration (n = 20), with borderline (n = 12) or non-epithelial tumors (n = 13), operated upon in other regions (n = 8) and without complete medical records (n = 2) were excluded. Therefore 102 patients were evaluated. RESULTS: The interventions have been performed in 7 regional hospitals and 1 private clinic by 24 obstetricians-gynecologists and 8 general surgeons. In early EOC, 9% random peritoneal biopsies and 3% retroperitoneal lymph node samplings have been performed. In advanced EOC, 40% of patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy and 42% had cytoreductive surgery with a residual tumor of =2 cm. CONCLUSIONS: The present study is a population-based study over a 7-year period within a region that has only community hospitals. Patients with early EOC had incomplete staging and patients with advanced EOC an insufficient rate of radical surgery. Women with a suspicion of ovarian cancer should be referred to centers with experienced tumor surgeons. 相似文献
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上尿路肿瘤术后再发膀胱癌的危险因素分析 总被引:1,自引:0,他引:1
目的:探讨上尿路肿瘤术后再发膀胱癌的因素。方法:采用回顾性研究对上尿路肿瘤76例进行总结。结果:术后膀胱癌再发率36%(27/76),70%(19/27)发生于术后2年。多器官性肿瘤者的再发率69%(11/16)高于单发肿瘤者的27%(16/60)。输尿管下段肿瘤者的再发率50%(8/16)高于肾盂输尿管上段者的18%(8/44)。Ⅱ-Ⅲ级、T3者再发率高。未切除患侧输尿管口周围膀胱壁的再发率49%(21/43),高于肾输尿管膀胱部分切除术的18%(6/33)。结论:上尿路肿瘤的部位、多器官性、病理分级、分期是术后膀胱癌再发的危险因素,切除输尿管口周围膀胱壁是防止再发的关键。 相似文献
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Patterns of recurrence in patients treated with photodynamic therapy for intraperitoneal carcinomatosis and sarcomatosis 总被引:3,自引:0,他引:3
Wilson JJ Jones H Burock M Smith D Fraker DL Metz J Glatstein E Hahn SM 《International journal of oncology》2004,24(3):711-717
The purpose of this study was to evaluate the patterns of recurrence in patients treated with Photofrin-mediated intraperitoneal photodynamic therapy (IP PDT). Sixty-six patients with gastrointestinal cancers, ovarian cancers, and sarcomas have been enrolled to date and 51 patients underwent IP PDT. Photofrin, 2.5 mg/kg, was administered intravenously 48 h prior to surgical debulking and intraoperative light treatment. Forty-five, and 49 patients were evaluable for response rates, and patterns of recurrence, respectively. Response to treatment was evaluated by CT or MRI scans of the abdomen and pelvis every 3 months. Patterns of recurrence were determined by evaluating the abdomen as a combination of different treatment regions. Of the 51 patients enrolled and treated with IP PDT two are alive without evidence of recurrence. Eleven of 45 patients showed no evidence of recurrence 3 months after treatment. No evidence of recurrence was noted in 7/17 sarcoma patients, 2 of 13 ovarian cancer patients, and 2 of 15 gastrointestinal cancer patients. The most common site of recurrence as determined by radiographs was the pelvis, which was noted in 19 of 49 (39%) patients. The presence of gross residual disease before light treatment (as determined by the attending surgeon) did not affect the site of recurrence. When studying those patients who had only locoregional recurrence, 9 of 33 evaluated radiographically and 10 of 24 evaluated operatively recurred only in peritoneal areas not previously involved with gross disease. The pelvis was the site with the highest rate of recurrence after IP PDT. A significant minority of patients recurred only in sites not previously involved with gross disease. Patients with gross residual disease before light therapy had similar recurrence rates to those without gross residual disease. Since sites involved with gross residual tumor often received boost doses of light, this could suggest a dose-response relationship for IP PDT. 相似文献
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Tertiary Cytoreduction for Recurrent Epithelial Ovarian Cancer: a Multicenter Study in Turkey
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Macit ArvasYavuz SalihogluVeysel SalTayfun GungorHamdullah SozenIlker KahramanogluSamet TopuzFuat DemirkiranCem IyibozkurtTugan BeseBurcin Salman OzguDogan VatanseverNedim TokgozogluSinan BerkmanHasan TuranErgin BengisuNigar SofiyevaIrem DemiralMutlu Meydanli 《Asian Pacific journal of cancer prevention》2016,17(4):1909-1915
Background: The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and Methods: Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results: Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III–IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery . Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions: Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected. 相似文献
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Lacey JV Chia VM Rush BB Carreon DJ Richesson DA Ioffe OB Ronnett BM Chatterjee N Langholz B Sherman ME Glass AG 《International journal of cancer. Journal international du cancer》2012,131(8):1921-1929
Obesity strongly increases the risk of endometrial cancer and is projected to increase current and future endometrial cancer incidence. In order to fully understand endometrial cancer incidence, one should also examine both hysterectomy, which eliminates future risk of endometrial cancer, and endometrial hyperplasia (EH), a precursor that prompts treatment (including hysterectomy). Hysterectomy and EH are more common than endometrial cancer, but data on simultaneous temporal trends of EH, hysterectomy and endometrial cancer are lacking. We used linked pathology, tumor registry, surgery and administrative datasets at the Kaiser Permanente Northwest Health Plan to calculate age-adjusted and age-specific rates, 1980-2003, of EH only (N = 5,990), EH plus hysterectomy (N = 904), hysterectomy without a diagnosis of EH or cancer (N = 14,926) and endometrial cancer (N = 1,208). Joinpoint regression identified inflection points and quantified annual percentage changes (APCs). The EH APCs were -5.3% (95% confidence interval [CI] = -7.4% to -3.2%) for 1980-1990, -12.9% (95% CI = -15.6% to -10.1%) for 1990-1999 and 2.4% (95% CI = -6.6% to 12.2%) for 1999-2003. The EH-plus-hysterectomy APCs were -8.6% (95% CI = -10.6% to -6.5%) for 1980-2000 and 24.5% (95% CI = -16.5% to 85.7%) for 2000-2003. Hysterectomy rates did not significantly change over time. The endometrial cancer APCs were -6.5% (95% CI = -10.3% to -2.6%) for 1980-1988 and 1.4% (95% CI = -0.2% to 3.0%) for 1988-2003. Hysterectomy rates were unchanged, but increased endometrial cancer incidence after 1988 and the reversal, in 1999, of the longstanding decline in EH incidence could reflect the influence of obesity on endometrial neoplasia. 相似文献