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Current Opinion in Otolaryngology &... Dec 2013To review the body of literature on the treatment options for nontuberculous cervicofacial lymphadenitis in children, focusing on the most recent reports describing... (Review)
Review
PURPOSE OF REVIEW
To review the body of literature on the treatment options for nontuberculous cervicofacial lymphadenitis in children, focusing on the most recent reports describing outcomes utilizing either observation alone, medical therapy or various forms of surgical intervention.
RECENT FINDINGS
Large studies have defined the time course of the disease and the safety and efficacy in treating nontuberculosis cervicofacial lymphadenitis with a wait-and-see approach.
SUMMARY
Nontuberculosis cervicofacial lymphadenitis is a disease with several stages that provides for various treatment options. All treatment regimens--wait-and-see approach, medical therapy, and surgical excision--have their risks and benefits. The current body of literature allows the otolaryngologist an assortment of treatment choices that permits him to tailor the treatment with an individualized approach for each family's preferences.
Topics: Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Face; Female; Humans; Infant; Lymph Node Excision; Lymphadenitis; Macrolides; Male; Mycobacterium Infections, Nontuberculous; Neck; Patient Selection; Watchful Waiting
PubMed: 24152916
DOI: 10.1097/MOO.0000000000000005 -
European Journal of Surgical Oncology :... Mar 2018Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of... (Review)
Review
Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.
Topics: Carcinoma, Papillary; Clinical Trials as Topic; Disease Progression; Humans; Incidence; Population Surveillance; Prognosis; Risk Assessment; Risk Factors; Survival Rate; Thyroid Neoplasms; Thyroidectomy; Watchful Waiting
PubMed: 28343733
DOI: 10.1016/j.ejso.2017.03.004 -
International Journal of Pediatric... Jul 2020Silent sinus syndrome (SSS) is defined as a progressive enophthalmos and hypoglobus associated with maxillary sinus atelectasis. There is extremely limited literature...
INTRODUCTION
Silent sinus syndrome (SSS) is defined as a progressive enophthalmos and hypoglobus associated with maxillary sinus atelectasis. There is extremely limited literature describing SSS in children. The goals of this study are to characterize SSS in children through an IRB approval retrospective chart review of cases identified through a large health system-wide imaging database and to compare the presentation and outcomes of patients who underwent surgery versus those who were observed.
METHODS
A radiology database of over 26 million reports from 2003 to 2017 was searched to identify children aged 1-18 years diagnosed with maxillary sinus hypoplasia or SSS on CT scan. Chart review was performed on the identified children including clinical presentation, eye symptoms, surgical treatment, and outcome.
RESULTS
Eighty-three children were identified to have maxillary sinus hypoplasia. Eighty-one patients had maxillary sinus opacification and 57 patients had hypoglobus or enophthalmos characteristic of SSS. Thirty-two patients (47%) were seen by a specialist and 19 had surgery. The majority of patients (55%) had headache as their presenting symptom. There were no statistically significant differences in the clinical presentation between those who received surgery and those who were observed clinically.
CONCLUSIONS
Silent sinus syndrome can present at any age. The majority of cases of maxillary sinus hypoplasia will have the orbital floor changes characteristic of SSS. Headaches are a common presenting symptom. Close follow up of pediatric patients is advised and early intervention may be favorable to prevent long term orbital changes and complications.
Topics: Adolescent; Child; Child, Preschool; Enophthalmos; Female; Headache; Humans; Infant; Male; Maxillary Sinus; Paranasal Sinus Diseases; Retrospective Studies; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Watchful Waiting
PubMed: 32272375
DOI: 10.1016/j.ijporl.2020.110034 -
Current Opinion in Urology Sep 2022This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC). (Review)
Review
PURPOSE OF REVIEW
This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC).
RECENT FINDINGS
A growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion.
SUMMARY
AS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.
Topics: Carcinoma in Situ; Cystoscopy; Humans; Neoplasm Invasiveness; Urinary Bladder Neoplasms; Watchful Waiting
PubMed: 35869738
DOI: 10.1097/MOU.0000000000001028 -
The British Journal of Surgery Jul 2022Organ preservation as a successful management for rectal cancer is an evolving field. Refinement of neoadjuvant therapies and extended interval to response assessment... (Review)
Review
BACKGROUND
Organ preservation as a successful management for rectal cancer is an evolving field. Refinement of neoadjuvant therapies and extended interval to response assessment has improved tumour downstaging and cCR rates.
METHODS
This was a narrative review of the current evidence for all aspects of organ preservation in rectal cancer management, together with a review of the future direction of this field.
RESULTS
Patients can be selected for organ preservation opportunistically, based on an unexpectedly good tumour response, or selectively, based on baseline tumour characteristics that predict organ preservation as a viable treatment strategy. Escalation in oncological therapy and increasing the time interval from completion of neaodjuvant therapy to tumour assessment may further increase tumour downstaging and complete response rates. The addition of local excision to oncological therapy can further improve organ preservation rates. Cancer outcomes in organ preservation are comparable to those of total mesorectal excision, with low regrowth rates reported in patients who achieve a complete response to neoadjuvant therapy. Successful organ preservation aims to achieve non-inferior oncological outcomes together with improved functionality and survivorship. Future research should establish consensus of follow-up protocols, and define criteria for oncological and functional success to facilitate patient-centred decision-making.
CONCLUSION
Modern neoadjuvant therapy for rectal cancer and increasing the interval to tumour response increases the number of patients who can be managed successfully with organ preservation in rectal cancer, both as an opportunistic event and as a planned treatment strategy.
Topics: Chemoradiotherapy; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Organ Preservation; Rectal Neoplasms; Treatment Outcome; Watchful Waiting
PubMed: 35640118
DOI: 10.1093/bjs/znac140 -
Current Opinion in Urology Nov 2019Significant morbidity is associated with overtreatment of clinically localized prostate cancer (PCa). Risk stratification tools such as novel biomarkers, MRI and risk... (Review)
Review
PURPOSE OF REVIEW
Significant morbidity is associated with overtreatment of clinically localized prostate cancer (PCa). Risk stratification tools such as novel biomarkers, MRI and risk calculators are useful in predicting which patients would benefit from active surveillance. This review examines current risk stratification tools in localized PCa and the safety of active surveillance in these patients.
RECENT FINDINGS
Very low risk, low-risk and favourable intermediate-risk PCa variants may benefit from treatment with active surveillance. These disease categories have been shown (with up to 10-year follow-up) to have survival and cancer-specific complication rates similar to immediate definitive treatment. Novel biomarkers sensitively predict upstaging, recurrence and metastatic progression while multiparametric MRI reliably detects clinically significant PCa and is valuable in the biopsy naïve patient considering active surveillance. Lastly, risk calculators and nomograms are being developed to combine clinical data and provide optimal individualized treatment while minimizing overtreatment in clinically localized disease.
SUMMARY
Although large randomized trials are needed to validate treatment pathways, current data supports active surveillance in certain clinically localized PCa. Many tools exist to define and support active surveillance in this group.
Topics: Early Detection of Cancer; Humans; Magnetic Resonance Imaging; Male; Medical Overuse; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatic Neoplasms; Risk Assessment; Watchful Waiting
PubMed: 31469662
DOI: 10.1097/MOU.0000000000000672 -
World Journal of Gastroenterology Oct 2014Although the prevalence of gastric cancer (GC) progressively decreased during the last decades, due to improved dietary habit, introduction of food refrigeration and... (Review)
Review
Although the prevalence of gastric cancer (GC) progressively decreased during the last decades, due to improved dietary habit, introduction of food refrigeration and recovered socio-economic level, it still accounts for 10% of the total cancer-related deaths. The best strategy to reduce the mortality for GC is to schedule appropriate screening and surveillance programs, that rises many relevant concerns taking into account its worldwide variability, natural history, diagnostic tools, therapeutic strategies, and cost-effectiveness. Intestinal-type, the most frequent GC histotype, develops through a multistep process triggered by Helicobacter pylori (H. pylori) and progressing from gastritis to atrophy, intestinal metaplasia (IM), and dysplasia. However, the majority of patients infected with H. pylori and carrying premalignant lesions do not develop GC. Therefore, it remains unclear who should be screened, when the screening should be started and how the screening should be performed. It seems reasonable that screening programs should target the general population in eastern countries, at high prevalence of GC and the high-risk subjects in western countries, at low prevalence of GC. As far as concern surveillance, currently, we are lacking of standardized international recommendations and many features have to be defined regarding the optimal diagnostic approach, the patients at higher risk, the best timing and the cost-effectiveness. Anyway, patients with corpus atrophic gastritis, extensive incomplete IM and dysplasia should enter a surveillance program. At present, screening and surveillance programs need further studies to draw worldwide reliable recommendations and evaluate the impact on mortality for GC.
Topics: Decision Support Techniques; Early Detection of Cancer; Humans; Precancerous Conditions; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Stomach Neoplasms; Time Factors; Watchful Waiting
PubMed: 25320506
DOI: 10.3748/wjg.v20.i38.13681 -
American Society of Clinical Oncology... 2015Smoldering multiple myeloma (SMM) is an asymptomatic disorder characterized by the presence of at least 3 g/dL of serum M-protein and/or 10% to 60% bone marrow plasma... (Review)
Review
Smoldering multiple myeloma (SMM) is an asymptomatic disorder characterized by the presence of at least 3 g/dL of serum M-protein and/or 10% to 60% bone marrow plasma cell infiltration with no myeloma-defining event. The risk of progression to active multiple myeloma (MM) is not uniform and several markers are useful for identifying patients at high risk of progression. The definition of the disease has recently been revisited and patients with asymptomatic MM at 80% to 90% of progression risk at 2 years are now considered to have MM. Although the current standard of care is not to treat, a randomized trial in patients with high-risk SMM that compared early treatment versus observation demonstrated that early intervention resulted in substantial benefits in terms of time to progression and overall survival (OS). These findings highlight the need to follow a correct diagnosis by an accurate risk stratification to plan an optimized follow-up according to the risk of disease progression.
Topics: Antineoplastic Agents; Bence Jones Protein; Chromosome Aberrations; Diagnosis, Differential; Diagnostic Imaging; Disease Progression; Humans; Immunoglobulin Light Chains; Immunoglobulins; Immunophenotyping; Medical History Taking; Multiple Myeloma; Physical Examination; Plasma Cells; Proteinuria; Risk Factors; Watchful Waiting
PubMed: 25993213
DOI: 10.14694/EdBook_AM.2015.35.e484 -
The Urologic Clinics of North America May 2017Active surveillance for small renal masses (SRMs) is an accepted management strategy for patients with prohibitive surgical risk. Emerging prospectively collected data... (Review)
Review
Active surveillance for small renal masses (SRMs) is an accepted management strategy for patients with prohibitive surgical risk. Emerging prospectively collected data support the concept that a period of initial active surveillance in an adherent patient population with well-defined criteria for delayed intervention is safe. This article summarizes the literature describing growth kinetics of SRMs managed initially with observation and oncologic outcomes for patients managed with active surveillance. Existing clinical tools to determine and contextualize competing risks to mortality are explored. Finally, current prospective clinical trials with defined eligibility criteria, surveillance schema, and triggers for delayed intervention are highlighted.
Topics: Cell Proliferation; Humans; Kidney Neoplasms; Kinetics; Treatment Outcome; Tumor Burden; Watchful Waiting
PubMed: 28411913
DOI: 10.1016/j.ucl.2016.12.007 -
The Journal of Urology Dec 2020
Topics: Benchmarking; Humans; Male; Michigan; Prostatic Neoplasms; Quality Indicators, Health Care; Reimbursement, Incentive; Urology; Watchful Waiting
PubMed: 32717165
DOI: 10.1097/JU.0000000000001308