-
Cancer Radiotherapie : Journal de La... 2014Extracranial stereotactic radiotherapy is booming. The development and spread of dedicated accelerators coupled with efficient methods of repositioning can now allow... (Review)
Review
Extracranial stereotactic radiotherapy is booming. The development and spread of dedicated accelerators coupled with efficient methods of repositioning can now allow treatments of mobile lesions with moderate size, with high doses per fraction. Intuitively, except for the prostate, pelvic tumours, often requiring irradiation of regional lymph node drainage, lend little to this type of treatment. However, in some difficult circumstances, such as boost or re-radiation, stereotactic irradiation condition is promising and clinical experiences have already been reported.
Topics: Brachytherapy; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Organs at Risk; Pelvic Neoplasms; Radiosurgery; Radiotherapy Dosage
PubMed: 24792995
DOI: 10.1016/j.canrad.2014.03.011 -
European Journal of Surgical Oncology :... Aug 2023Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical... (Meta-Analysis)
Meta-Analysis Review
Comparing minimally invasive surgical and open approaches to pelvic exenteration for locally advanced or recurrent pelvic malignancies - Systematic review and meta-analysis.
INTRODUCTION
Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical challenges which account for the high risk of morbidity and mortality associated with the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced peri-operative care have facilitated improved long term outcomes. However, the optimum approach to PE remains controversial.
METHODS
A systematic literature search was conducted in accordance with PRISMA guidelines to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus the open approach for patients with locally advanced or recurrent pelvic malignancies. The methodological quality of the included studies was assessed systematically and a meta-analysis was conducted.
RESULTS
11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR] 1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield (Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although MIS had a trend towards improved towards improved survival and recurrence outcomes, this did not reach statistical significance. MIS was associated with prolonged operating times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with less intra-operative blood loss, and a shorter length of post-operative stay (WMD -3.89, 955 CI -6.53, -1.25, p < 0.00001). Readmission rates were higher with MIS (RR 2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased (RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major, or specific morbidity and mortality.
CONCLUSION
MIS approaches are a safe and feasible option for PE, with no differences in survival or recurrence outcomes compared to the open approach. MIS also reduced the length of post-operative stay and decreased blood loss, offset by increased operating time.
Topics: Humans; Pelvic Neoplasms; Pelvic Exenteration; Pelvis; Minimally Invasive Surgical Procedures; Blood Loss, Surgical
PubMed: 37087374
DOI: 10.1016/j.ejso.2023.04.003 -
Colorectal Disease : the Official... Mar 2021This study aims to assess surgical outcomes and survival following first, second and third pelvic exenterations for pelvic malignancy.
AIM
This study aims to assess surgical outcomes and survival following first, second and third pelvic exenterations for pelvic malignancy.
METHOD
Consecutive patients undergoing pelvic exenteration for pelvic malignancy at a quaternary referral centre from January 1994 and December 2017 were included. Demographics and surgical outcomes were compared between patients who underwent first, second and third pelvic exenterations by generalized mixed modelling with repeated measures. Survival was assessed using Cox proportional hazards models and Kaplan-Meier plots.
RESULTS
Of the 642 exenterations reviewed, 29 (4.5%) were second and 6 (0.9%) were third exenterations. Patients selected for repeat exenteration were more likely to have asymptomatic local recurrences detected on routine surveillance (P < 0.001). Postoperative wound complications increased with repeat exenteration (6%, 17%, 33%; P = 0.003, respectively). Additionally, postoperative length of stay increased from 27 to 38 and 48 days, respectively (P = 0.004). Median survival from first exenteration was 4.75, 5.30 and 8.14 years respectively amongst first, second and third exenteration cohorts (P = 0.849). Median survival from the most recent exenteration was 4.75 years after a first exenteration, 2.02 years after a second exenteration and 1.45 years after a third exenteration (P = 0.0546).
CONCLUSION
This study demonstrates that repeat exenteration for recurrent pelvic malignancy is feasible but is associated with increased complication rates and length of admission and reduced likelihood of attaining R0 margin. Moreover, these data indicate that repeat exenteration does not afford a survival advantage compared with patients having a single exenteration. These data suggest that repeat exenteration for recurrent pelvic malignancy may be of questionable therapeutic value.
Topics: Humans; Margins of Excision; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Treatment Outcome
PubMed: 33058495
DOI: 10.1111/codi.15402 -
Journal of Medical Radiation Sciences Jun 2020How can we better understand and improve our practice around the physical and psychological well-being of women treated with radiation therapy for pelvic malignancy? In...
How can we better understand and improve our practice around the physical and psychological well-being of women treated with radiation therapy for pelvic malignancy? In this issue, Summerfield et al report the results of a nationwide survey capturing practices around the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS) across New Zealand. This study highlights the need for oncologists to improve care around a challenging but critically important aspect of women's health beyond a cancer diagnosis.
Topics: Adult; Female; Humans; Pelvic Neoplasms; Quality of Health Care; Quality of Life; Sexual Health; Surveys and Questionnaires
PubMed: 32452091
DOI: 10.1002/jmrs.402 -
Diagnostic and Interventional Radiology... May 2020The incidence of abdominal and pelvic cancer in pregnancy is low, but it is rising as the population of pregnant women gets older. Depending on disease stage,... (Review)
Review
The incidence of abdominal and pelvic cancer in pregnancy is low, but it is rising as the population of pregnant women gets older. Depending on disease stage, gestational age and patient's preference, active surveillance as well as surgery and chemotherapy are feasible options during pregnancy. Correct diagnosis and staging of the tumor is crucial for choosing the best therapeutic approach. Moreover, a reproducible modality to assess the treatment response is requested. Magnetic resonance imaging (MRI) is commonly used with good results for the local staging and treatment response evaluation of most abdominal and pelvic cancers in nonpregnant patients, and it is considered relatively safe during pregnancy. The purpose of this article is to analyze the most relevant topics regarding the use of MRI in pregnant women with abdominal and pelvic cancer. We discuss MRI safety during pregnancy, including the use of gadolinium-based contrast agents (GBCAs), how to prepare the patient for the exam and MRI technique. This will be followed by a brief review on the most common malignancies diagnosed during pregnancy and their MRI appearance.
Topics: Abdomen; Abdominal Neoplasms; Adult; Contrast Media; Female; Gestational Age; Humans; Incidence; Magnetic Resonance Imaging; Neoplasm Staging; Patient Positioning; Patient Preference; Pelvic Neoplasms; Pelvis; Precision Medicine; Pregnancy; Radiologists; Safety; Watchful Waiting
PubMed: 32071031
DOI: 10.5152/dir.2019.19343 -
Journal of Surgical Oncology Sep 2021The treatment of pelvic tumors is widely recognized to be challenging. The purpose of this study was to evaluate the efficacy of personalized three-dimensional (3D)...
BACKGROUND AND OBJECTIVES
The treatment of pelvic tumors is widely recognized to be challenging. The purpose of this study was to evaluate the efficacy of personalized three-dimensional (3D) printing-based limb salvage and reconstruction treatment for pelvic tumors.
METHODS
Twenty-eight pelvic tumor patients were enrolled. 3D printing lesion models and osteotomy templates were prepared for surgery planning, prosthesis design, and osteotomy assistance during surgery. 3D printing-based personalized pelvic prostheses were manufactured and used in all 28 patients. Follow-up of postoperative survival, prosthesis survival, imaging examinations, and Musculoskeletal Tumor Society (MSTS) lower limb functional scores were carried out.
RESULTS
The mean follow-up period was 32.2 months, during which 16 patients had disease-free survival, 3 survived with the disease, and 9 died. The prostheses were stable, and the mean offset of the center of rotation was 5.48 mm. The prosthesis-bone interface showed good integration. For the 19 surviving patients, the mean MSTS lower limb functional score was 23.2. Postoperative complications included superficial infection in six patients and hip dislocation in three patients.
CONCLUSIONS
Personalized 3D printing-based limb salvage and reconstruction was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery.
Topics: Female; Humans; Limb Salvage; Male; Middle Aged; Osteotomy; Pelvic Neoplasms; Precision Medicine; Printing, Three-Dimensional; Prosthesis Design; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 34086993
DOI: 10.1002/jso.26516 -
European Journal of Surgical Oncology :... Nov 2022Advanced pelvic malignancy, regardless of the cancer of origin, is often multivisceral and complex. The management of advanced pelvic malignancy is resource-intensive...
Advanced pelvic malignancy, regardless of the cancer of origin, is often multivisceral and complex. The management of advanced pelvic malignancy is resource-intensive and requires multidisciplinary input. The definition of resectability is evolving with improving multimodal therapy, preoperative staging and optimisation, perioperative care, and advanced surgical techniques. Pelvic exenteration is a highly morbid procedure and has been shown to improve survival and quality of life when performed with a curative intent. Unresectable distant solid organ or lymph node metastases and an inability to achieve a clear resection margin preclude curative pelvic exenteration. Patients with advanced pelvic malignancy who are deemed palliative are mostly managed by non-operative treatment such as chemo-, radio-, immuno-, hormonal therapy, pain management and palliative care, as well as allied health and psychosocial support team. These patients may present with severe and debilitating symptoms including intractable pain, ulcerating/proliferating tumour, pelvic fistula/sepsis/bleeding, urinary and bowel obstruction/incontinence. Interventional radiological and surgical procedures such as percutaneous drainage, nephrostomy, intestinal and urinary diversion, intestinal bypass, and venting gastrostomy have an important role in symptom control and improving quality of life. Palliative pelvic exenteration should be carefully considered along with life expectancy, patient wishes and tumour characteristics. Comprehensive discussion with patient is crucial to achieve realistic expectations. These patients should not only be discussed in a multidisciplinary team meeting with palliative care input, but also be referred for a formal palliative care consultation. Tumour anatomical extent should be considered both for and against pelvic exenteration whether involving the posterior compartment i.e. sacrectomy; lateral compartment incorporating neurovascular bundle and the anterior compartment requiring pubic bone excision as all can be associated with high morbidity rates. Patient recovery may be protracted too if surgery is complicated by perineal wound or flap breakdown in cases necessitating wide perineal skin and soft tissue excision. Furthermore, evidence from quality of life and cost-effectiveness studies do not provide robust data to support pelvic exenteration with palliative intent. Whilst a relatively 'straightforward' central soft tissue pelvic exenteration may offer reasonable symptomatic relief in a patient with an acceptable life expectancy, palliative pelvic exenteration overall should only be considered in highly selected patients.
Topics: Humans; Pelvic Neoplasms; Palliative Care; Quality of Life; Pelvic Exenteration; Urinary Diversion
PubMed: 35123817
DOI: 10.1016/j.ejso.2022.01.019 -
Der Chirurg; Zeitschrift Fur Alle... Feb 2016Due to optimization of surgical techniques in surgical oncology and vascular surgery, the most modern approaches of anesthesia and intensive care medicine and effective... (Review)
Review
Due to optimization of surgical techniques in surgical oncology and vascular surgery, the most modern approaches of anesthesia and intensive care medicine and effective multimodal therapeutic strategies, locally advanced malignant tumors are resected more frequently with a potentially curative intent. In the case of extensive tumors with infiltration of vital vascular structures or of structures which are crucial for extremity preservation, the necessary surgical procedure for complete tumor removal poses a major challenge for the surgeon and incorporates a high risk of perioperative morbidity for the patient. The decision to attempt tumor resection should therefore always be based on a concept considering all aspects of the malignant disease. The treating team should be highly experienced in this complex field of surgery, not only with respect to the surgical approach but also regarding the management of postoperative complications. In this article relevant aspects of decision making, surgical technique and postoperative outcome for malignant tumors involving vascular structures of the retroperitoneum and pelvis are presented.
Topics: Aorta, Abdominal; Combined Modality Therapy; Decision Support Techniques; Hemangiosarcoma; Humans; Leiomyosarcoma; Neoplasm Invasiveness; Pelvic Neoplasms; Retroperitoneal Neoplasms; Sarcoma; Vascular Neoplasms; Vascular Surgical Procedures
PubMed: 26661949
DOI: 10.1007/s00104-015-0123-8 -
Clinical Oncology (Royal College of... Jan 2021Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body...
AIMS
Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis.
MATERIALS AND METHODS
This single institution retrospective study evaluated patients treated with SBRT reirradiation in the pelvis from January 2011 to February 2018. Patients with more than five oligometastatic lesions, >7 cm in size, and recurrence within the prostate were excluded.
RESULTS
In total, 30 patients were treated with SBRT with a median follow-up of 29.4 months. The primary tumour sites were most commonly rectum (30.8%) and prostate (30.8%). The median time interval between irradiation for the primary and SBRT reirradiation was 48 months (3-245). The typical reirradiation treatment was 35 Gy in five fractions, the median gross tumour volume size was 10.2 (0.3-110.5) ml and the most common target was the iliac nodes (40%). There were three (10%) acute grade 3 toxicities and no late grade 3 or more toxicities. At 12/24 months, local relapse-free survival, metastasis-free survival, progression-free survival and overall survival were 67.7%/50.7%, 67%/41.7%, 34.8%/14.9% and 83.2%/62.5%, respectively. On univariate analysis, improved local control was associated with low gross tumour volume (<10 ml) (P = 0.003) and prostate primary (P = 0.02), but was no longer significant on multivariate analysis. The proximity of organ at risk to the target did not significantly correlate with worse toxicity (P = 0.14) or tumour coverage (gross tumour volume: P = 0.8, planning target volume: P = 0.4).
CONCLUSION
SBRT pelvic reirradiation in oligometastatic patients is a safe and effective treatment modality. Careful consideration should be taken with larger tumour size, as it may be associated with worse oncological and toxicity outcome.
Topics: Aged; Female; Humans; Male; Neoplasm Recurrence, Local; Pelvic Neoplasms; Prostatic Neoplasms; Radiosurgery; Re-Irradiation; Rectal Neoplasms; Survival Analysis; Treatment Outcome; Tumor Burden
PubMed: 32641243
DOI: 10.1016/j.clon.2020.06.009 -
Radiographics : a Review Publication of... 2015Pelvic exenteration is a radical surgery that is used in an attempt to cure patients with locally advanced central pelvic malignancies. Exenteration is a salvage... (Review)
Review
Pelvic exenteration is a radical surgery that is used in an attempt to cure patients with locally advanced central pelvic malignancies. Exenteration is a salvage operation that is considered only after other therapies, such as chemoradiation, have been exhausted. The high morbidity from exenteration's multiorgan resection warrants careful patient selection. Preoperative imaging plays a major role in the selection process, allowing the exclusion of patients with unresectable pelvic disease or distant metastases. Imaging is also crucial to surgical planning, providing the surgeon with a map of the distribution and extent of the pelvic disease.
Topics: Female; Humans; Magnetic Resonance Imaging; Middle Aged; Pelvic Exenteration; Pelvic Neoplasms; Preoperative Care; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 26172363
DOI: 10.1148/rg.2015140127