-
Cancer Radiotherapie : Journal de La... Oct 2016The standard of care for local treatment for extremities soft tissue sarcomas relies on conservative surgery combined with external beam radiotherapy. Brachytherapy can... (Review)
Review
The standard of care for local treatment for extremities soft tissue sarcomas relies on conservative surgery combined with external beam radiotherapy. Brachytherapy can be realized instead of external beam radiotherapy in selected cases, or more often used as a boost dose on a limited volume on the area at major risk of relapse, especially if a microscopic positive resection is expected. Close interaction and communication between radiation oncologists and surgeons are mandatory at the time of implantation to limit the risk of side effects. Long-term results are available for low-dose rate brachytherapy. Nowadays, pulsed dose rate or high-dose-rate brachytherapy are more often used. Brachytherapy for paediatric sarcomas is rare, and has to be managed in reference centres.
Topics: Brachytherapy; Humans; Intraoperative Care; Neoplasm Recurrence, Local; Pelvic Neoplasms; Radiotherapy Dosage; Radiotherapy, Adjuvant; Sarcoma; Soft Tissue Neoplasms
PubMed: 27614500
DOI: 10.1016/j.canrad.2016.07.069 -
Journal of Surgical Oncology 1975The following is a discussion of dyspareunia and its role as an aid to diagnosing pelvic neoplasms. The great majority of cases of dysparenia are psychosomatic in...
The following is a discussion of dyspareunia and its role as an aid to diagnosing pelvic neoplasms. The great majority of cases of dysparenia are psychosomatic in origin, and in a large proportion of the remaining cases, painful coitus is an indicator of benign problems. Nevertheless, painful coitus is a symptom which requires careful pelvic examination to rule out the possibility of pelvic neoplasm and to discover treatable causes of dyspareunia.
Topics: Dyspareunia; Female; Humans; Melanoma; Pain; Pelvic Neoplasms; Uterine Cervical Neoplasms; Vulvar Neoplasms
PubMed: 1152474
DOI: 10.1002/jso.2930070311 -
Expert Review of Clinical Immunology Jun 2014Pelvic gynecological malignancies account for 6% of all cancers. In the relapsed state, classical treatments are limited. There is an urgent need for new and... (Review)
Review
Pelvic gynecological malignancies account for 6% of all cancers. In the relapsed state, classical treatments are limited. There is an urgent need for new and personalized treatment. Wilms' tumor gene 1 (WT1) is the most important tumor-associated antigen. Although highly present in gynecological tumors, active immunotherapy against it is still underexplored. This review gives an insight into the importance of WT1 in pelvic gynecological malignancies and the first taken steps into the world of WT1 immunotherapy.
Topics: Antigens, Neoplasm; Female; Genital Neoplasms, Female; Humans; Immunotherapy; Pelvic Neoplasms; WT1 Proteins
PubMed: 24784346
DOI: 10.1586/1744666X.2014.910119 -
Annals of Surgery Nov 2019To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy.
OBJECTIVE
To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy.
BACKGROUND
The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes.
METHODS
Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality.
RESULTS
One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23-85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma.
CONCLUSION
Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%-59%) reflects the diversity of tumor types.
Topics: Aged; Aged, 80 and over; Cause of Death; Cohort Studies; Databases, Factual; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Exenteration; Pelvic Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Tertiary Care Centers
PubMed: 31634184
DOI: 10.1097/SLA.0000000000003533 -
Radiology Mar 1968
Topics: Barium Sulfate; Cystoscopy; Diagnosis, Differential; Enema; Humans; Lipomatosis; Male; Middle Aged; Pelvic Neoplasms; Sigmoidoscopy; Urography
PubMed: 5642294
DOI: 10.1148/90.3.558 -
Radiographics : a Review Publication of... 2011The complex extraperitoneal anatomy of the pelvis includes various outlets for the transit of organs and neurovascular structures to the rest of the body. These outlets... (Review)
Review
The complex extraperitoneal anatomy of the pelvis includes various outlets for the transit of organs and neurovascular structures to the rest of the body. These outlets include the greater sciatic foramen, lesser sciatic foramen, inguinal canal, femoral triangle, obturator canal, anal and genitourinary hiatuses of the pelvic floor, prevesical space, and iliopsoas compartment. All of these structures serve as conduits for the dissemination of malignant and benign inflammatory diseases from the pelvic cavity and into the soft-tissue structures of the abdominal wall, buttocks, and upper thigh. Knowledge of the pelvic anatomy is crucial to understand these patterns of disease spread. Cross-sectional imaging provides important anatomic information and depicts the extent of disease and its involvement of surrounding extrapelvic structures, information that is important for planning surgery and radiation therapy.
Topics: Humans; Neoplasm Invasiveness; Pelvic Neoplasms; Pelvis; Radiography
PubMed: 21257938
DOI: 10.1148/rg.311105050 -
Tumori Apr 1993The principles of management of all sarcomas that involve the abdominal and pelvic cavity are presented. The anatomic sites for the primary malignancy include... (Review)
Review
The principles of management of all sarcomas that involve the abdominal and pelvic cavity are presented. The anatomic sites for the primary malignancy include retroperitoneal sarcomas, pelvic side-wall sarcomas, sarcomas arising from the abdominal viscera, and sarcomas arising from the pelvic organs. All histologic types of sarcomas may be considered together when therapeutic options are being discussed. This presentation stresses surgical removal with an adequate margin of resection as the principal goal of management. The curative treatment of these cancers places great emphasis on the surgeon's knowledge of anatomy, technical skills, innovation, and surgical courage. Systemic chemotherapy and radiotherapy have not shown reproducible efficacy. Complete resection in the absence of tumor spillage remains the only reliable treatment option. Possible benefits of induction chemotherapy and intraperitoneal chemotherapy using cisplatin and doxorubicin in the early postoperative period are presented.
Topics: Abdominal Neoplasms; Actuarial Analysis; Chemotherapy, Adjuvant; Gastrointestinal Neoplasms; Humans; Leiomyosarcoma; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pelvic Neoplasms; Reoperation; Retroperitoneal Neoplasms; Sarcoma; Time Factors
PubMed: 8346570
DOI: 10.1177/030089169307900201 -
Archives of Internal Medicine Apr 1989Three women had endometriosis that involved the rectosigmoid colon; their clinical presentation suggested primary colonic malignant neoplasm. Intestinal obstruction,...
Three women had endometriosis that involved the rectosigmoid colon; their clinical presentation suggested primary colonic malignant neoplasm. Intestinal obstruction, weight loss, and, in two patients, rectal bleeding with radiologic evidence of a mass lesion that involved the rectosigmoid were present at initial evaluation. All patients eventually underwent colonic resection as definitive therapy. Endometriosis of the pelvic colon may mimic primary intestinal disease, mistakenly suggesting malignant neoplasm. Such symptoms in a young woman should prompt a search for endometriosis, which is a more likely diagnosis. Adequate therapy frequently requires surgical intervention.
Topics: Adult; Colonic Neoplasms; Diagnosis, Differential; Endometriosis; Female; Humans; Pelvic Neoplasms
PubMed: 2705845
DOI: No ID Found -
Seminars in Surgical Oncology 1999Pelvic exenteration is a demanding, yet potentially curative operation, for patients with advanced pelvic cancer. The majority will present with recurrence after prior... (Review)
Review
Pelvic exenteration is a demanding, yet potentially curative operation, for patients with advanced pelvic cancer. The majority will present with recurrence after prior surgery and radiotherapy. After exenteration, 5-year survival is 40% to 60% in patients with gynecologic cancer as compared to 25% to 40% for patients with colorectal cancer. Physiologic age and absence of co-morbidities appear to be more important when selecting patients for exenteration than chronological age. Careful pre-operative staging, including either computed tomography (CT) scan or magnetic resonance imaging (MRI), usually will identify patients with distant metastases, extrapelvic nodal disease, or disease involving the pelvic sidewall (which generally precludes surgery). The recent application of intra-operative radiotherapy or postoperative high-dose brachytherapy for patients with more advanced pelvic disease, which may include sidewall involvement, may expand the standard indications for exenteration. However, the intent of this procedure, with or without radiotherapy, should be resection of all tumor with the aim of cure since the place of palliative exenteration is controversial at best. The operative details of exenteration are presented, as are two surgical approaches to composite resection of pelvic structures in continuity with sacrectomy. Filling the pelvis with large tissue flaps, usually a rectus abdominus flap, has decreased morbidity rates, particularly with small bowel complications. Peri-operative mortality is usually 5% to 10%, and significant morbidity occurs in over 50% of patients. Restorative techniques for both urinary and gastrointestinal tracts can diminish the need for stomas and, along with vaginal reconstruction, can significantly improve quality of life for many patients after exenteration. These advances in surgery and radiotherapy help make the procedure a viable option for patients with otherwise incurable pelvic malignancy.
Topics: Female; Humans; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Quality of Life; Radiotherapy, Adjuvant; Survival Rate
PubMed: 10504662
DOI: 10.1002/(sici)1098-2388(199910/11)17:3<152::aid-ssu3>3.0.co;2-j -
Journal of the College of Physicians... Jun 2018To evaluate the outcomes of patients undergoing radiotherapy for primary local control of pelvic ewing sarcoma (ES).
OBJECTIVE
To evaluate the outcomes of patients undergoing radiotherapy for primary local control of pelvic ewing sarcoma (ES).
STUDY DESIGN
Case series.
PLACE AND DURATION OF STUDY
Shaukat Khanum Memorial Cancer Hospital, Lahore, from January 2010 to October 2015.
METHODOLOGY
Patients with primary pelvic ES were included in the analysis and all other primary disease sites were excluded. All of them were treated with radiotherapy and followed the EuroEwing-99 chemotherapy protocol. Tumor volume, relapse and metastases were noted.
RESULTS
There were 13 patients with pelvic ES. The median age at the time of diagnosis was 15 years with IQR of 7 years (range 2-19 years). Tumor volume was more than 400ml in more than 50% of the patients. Eight patients (61.5%) had local relapses and 5 patients (38.5%) had combined local and distant disease metastases.
CONCLUSION
These results showed poor local control and overall survival in local pelvic ES cases in children and adolescents. Intensity modulated radiotherapy (IMRT) can be used to deliver higher doses of radiation. Compressed cycles of chemotherapy should be evaluated in local setting.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Child; Combined Modality Therapy; Female; Humans; Infant; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pelvic Neoplasms; Retrospective Studies; Sarcoma, Ewing; Survival Rate; Treatment Outcome; Tumor Burden; Young Adult
PubMed: 29848420
DOI: 10.29271/jcpsp.2018.06.445