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Radiographics : a Review Publication of... 2001Invasive cervical cancer is the third most common gynecologic malignancy. The prognosis is based on the stage, size, and histologic grade of the primary tumor and the... (Review)
Review
Invasive cervical cancer is the third most common gynecologic malignancy. The prognosis is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of the stage of disease is important in determining whether the patient may benefit from surgery or will receive radiation therapy. The official clinical staging system of the International Federation of Gynecology and Obstetrics has led to errors of 65%-90% in stage III and IV disease; the result has been unofficial extended staging with cross-sectional imaging modalities such as computed tomography (CT). CT is useful in staging advanced disease and in monitoring patients for recurrence. The primary tumor is heterogeneous and hypoattenuating relative to normal stroma on contrast material-enhanced scans. Obliteration of the periureteral fat plane and a soft-tissue mass are the most reliable signs of parametrial extension. Less than 3 mm separation of the tumor from the pelvic muscles and vascular encasement are signs of pelvic side wall invasion. Lymphatic spread is along the external and internal iliac nodal chains and the presacral route to the paraaortic nodes. Distant metastases are seen with primary or recurrent disease and can involve the liver, lung, and bone.
Topics: Female; Humans; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Neoplasms; Tomography, X-Ray Computed; Uterine Cervical Neoplasms
PubMed: 11553823
DOI: 10.1148/radiographics.21.5.g01se311155 -
International Journal of Hyperthermia :... 2020Patient suitability for magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) ablation of pelvic tumors is initially evaluated clinically for treatment...
BACKGROUND
Patient suitability for magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) ablation of pelvic tumors is initially evaluated clinically for treatment feasibility using referral images, acquired using standard supine diagnostic imaging, followed by MR screening of potential patients lying on the MRgHIFU couch in a 'best-guess' treatment position. Existing evaluation methods result in ≥40% of referred patients being screened out because of tumor non-targetability. We hypothesize that this process could be improved by development of a novel algorithm for predicting tumor coverage from referral imaging.
METHODS
The algorithm was developed from volunteer images and tested with patient data. MR images were acquired for five healthy volunteers and five patients with recurrent gynaecological cancer. Subjects were MR imaged supine and in oblique-supine-decubitus MRgHIFU treatment positions. Body outline and bones were segmented for all subjects, with organs-at-risk and tumors also segmented for patients. Supine images were aligned with treatment images to simulate a treatment dataset. Target coverage (of patient tumors and volunteer intra-pelvic soft tissue), i.e. the volume reachable by the MRgHIFU focus, was quantified. Target coverage predicted from supine imaging was compared to that from treatment imaging.
RESULTS
Mean (±standard deviation) absolute difference between supine-predicted and treatment-predicted coverage for 5 volunteers was 9 ± 6% (range: 2-22%) and for 4 patients, was 12 ± 7% (range: 4-21%), excluding a patient with poor acoustic coupling (coverage difference was 53%).
CONCLUSION
Prediction of MRgHIFU target coverage from referral imaging appears feasible, facilitating further development of automated evaluation of patient suitability for MRgHIFU.
Topics: High-Intensity Focused Ultrasound Ablation; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Neoplasm Recurrence, Local; Pelvic Neoplasms; Referral and Consultation
PubMed: 32873089
DOI: 10.1080/02656736.2020.1812736 -
Ultrastructural Pathology 1991Clear cell sarcoma of kidney (CCSK) is an aggressive childhood renal tumor of unknown histogenesis that has not been reported to occur outside the kidney. The article...
Clear cell sarcoma of kidney (CCSK) is an aggressive childhood renal tumor of unknown histogenesis that has not been reported to occur outside the kidney. The article describes an extrarenal neoplasm arising in the pelvic soft tissues of a 13-year-old boy that was composed predominantly of uniform mesenchymal cells with optically clear cytoplasm supported by an arborizing network of small blood vessels, which was indistinguishable in appearance from CCSK. The electron microscopic findings, although nonspecific, were essentially identical to those of CCSK, with tumor cells displaying fine chromatin, electron-lucent cytoplasm, and intercellular collagen but no evidence of tissue-specific differentiation. Immunocytochemical studies showed positivity for vimentin but negative results for desmin, myoglobin, cytokeratin, epithelial membrane antigen, S-100 protein, neuron-specific enolase and factor VIII-related antigen. Tumor cells were also nonreactive with Ulex lectin. This unusual pelvic tumor and CCSK may both derive from primitive mesenchymal cells and may represent phenotypic but not necessarily histogenetic analogs.
Topics: Adolescent; Diagnosis, Differential; Humans; Immunohistochemistry; Kidney Neoplasms; Male; Microscopy, Electron; Pelvic Neoplasms; Sarcoma; Vimentin
PubMed: 1755102
DOI: 10.3109/01913129109016248 -
Anticancer Research Oct 2015The aim of our study was to evaluate the impact of systemic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer after neoadjuvant...
AIM
The aim of our study was to evaluate the impact of systemic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer after neoadjuvant chemotherapy.
PATIENTS AND METHODS
This multi-centric descriptive study included patients with initially inoperable advanced ovarian cancer, undergoing neoadjuvant chemotherapy followed by cytoreductive surgery with no residual tumor between 1998 and 2012. They were distributed into two groups depending on if they underwent lymphadenectomy or not during the interval surgery.
RESULTS
Among the 101 included patients, 54 underwent lymphadenectomy and 47 did not. The multivariate analysis for overall survival showed no significant difference between the two groups [hazard ratio (HR)=1.88, confidence interval (CI)=0.89-3.94; p=0.08]. The multivariate analysis for progression-free survival showed no significant difference (HR=1.43, 95% CI=0.86-2.39; p=0.17).
CONCLUSION
In patients with advanced ovarian cancer, treated by neoadjuvant chemotherapy and interval surgery with no residual tumor, lymphadenectomy does not seem to improve the survival rate.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Cytoreduction Surgical Procedures; Female; Follow-Up Studies; Humans; Lymph Node Excision; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Neoplasm, Residual; Ovarian Neoplasms; Para-Aortic Bodies; Pelvic Neoplasms; Prognosis; Survival Rate
PubMed: 26408716
DOI: No ID Found -
World Journal of Surgical Oncology Jun 2012In patients with locally advanced or recurrent pelvic malignancies, total pelvic exenteration (TPE) may be necessary for curative treatment. Despite improvements in... (Comparative Study)
Comparative Study
BACKGROUND
In patients with locally advanced or recurrent pelvic malignancies, total pelvic exenteration (TPE) may be necessary for curative treatment. Despite improvements in mortality rates since TPE was first described, morbidity rates remain high due to the extensive resection and the aggressiveness of these tumors. We have studied the outcomes of TPE surgery performed at our institution.
METHODS
Fifty-three patients with various pelvic pathologies underwent TPE between 2004 and 2010. Patients were divided into two groups based on pathology: colorectal (n = 36) versus non-colorectal (n = 17) malignancies. Demographics, operative reports, pathology reports, periprocedural events, and outcomes were analyzed. Comparison of the two groups was performed using student's t-test and Fisher's exact test. Survival curves were constructed using the Kaplan-Meier method and compared using the log rank test.
RESULTS
The colorectal and non-colorectal groups were similar in demographics, operative times, length of stay, estimated blood loss, and rates of preoperative and intraoperative radiation use. Chemotherapy use was increased in the colorectal group compared with the non-colorectal group (55.6% vs. 23.5%, P = 0.04). Complication rates were similar: 86% in the colorectal group and 76% in the non-colorectal group. In the colorectal group, 27.8% of patients developed perineal abscesses, whereas no patients developed these complications in the non-colorectal group (P = 0.02). No survival difference was seen in primary versus recurrent colorectal tumors; however, within the colorectal group there was a survival advantage when comparing R0 resection to R1 and R2 resection combined. Median survival rates were 27.3 months for R0 resection and 10.7 months for R1 and R2 resection combined. The median survival was 21.4 months for the colorectal group and 6.9 months for the non-colorectal group (P = 0.002).
CONCLUSIONS
Patients undergoing TPE for colorectal tumors have improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Within the colorectal group, the extent of resection demonstrated a significant survival benefit of an R0 resection compared with R1 and R2 resections. Despite TPE carrying a high morbidity rate, mortality rates have improved and careful patient selection can optimize outcomes.
Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 22703863
DOI: 10.1186/1477-7819-10-110 -
Annals of Surgical Oncology Feb 2020The oncological role of pelvic exenteration for locally advanced and recurrent pelvic malignancies arising from the anorectum, gynaecological, or urological systems is...
BACKGROUND
The oncological role of pelvic exenteration for locally advanced and recurrent pelvic malignancies arising from the anorectum, gynaecological, or urological systems is now well-established. Despite this, the surgical community has been slow to accept pelvic exenteration, undoubtedly due to concerns about high morbidity and mortality rates. This study assessed the general major complications and predictors of morbidity following extended radical resections for locally advanced and recurrent pelvic malignancies.
METHODS
Data were collected from prospective databases at two high-volume institutions specialising in beyond TME surgery for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary outcome measures were major complications (Clavien-Dindo 3 or above) and predictors for morbidity.
RESULTS
A total of 646 consecutive patients required extended surgery for local advanced pelvic malignancies. The median age was 63 (range 19-89) years, and the majority were female (371; 57.4%). One or more major complications were observed in 106 patients (16.4%). The most common major complications were intra-abdominal collection (43.7%; n = 59/135) and wound infection (14.1%; n = 19/135). The overall inpatient mortality rate was 0.46% (n = 3/646). Independent predictors for major morbidity following surgery for locally advanced or recurrent pelvic malignancies were squamous cell carcinoma of anus, sacrectomy, and blood transfusion requirement.
CONCLUSIONS
This series adds increasing evidence that good outcomes can be achieved for extended radical resections in locally advanced and recurrent pelvic malignancies. A coordinated approach in specialist centres for beyond TME surgery demonstrates that this is a safe and feasible procedure, offering low major complication rates.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Prognosis; Prospective Studies; Retrospective Studies; Surgical Procedures, Operative; Young Adult
PubMed: 31520213
DOI: 10.1245/s10434-019-07816-8 -
Acta Obstetricia Et Gynecologica... 1986Carcinosarcoma of the Müllerian system is an uncommon tumor. We report here a case of extra-uterine carcinosarcoma from pelvic wall, presenting 11 years after...
Carcinosarcoma of the Müllerian system is an uncommon tumor. We report here a case of extra-uterine carcinosarcoma from pelvic wall, presenting 11 years after hysterectomy. Accidental surgical implantation of endometrioid cells is suggested as the pathogenic mechanism in this case.
Topics: Carcinosarcoma; Endometriosis; Female; Humans; Middle Aged; Neoplasm Seeding; Pelvic Neoplasms; Time Factors
PubMed: 3811858
DOI: 10.3109/00016348609161510 -
Urology Aug 2010To review the treatment strategies among patients with Stage IV penile cancer to describe potentially curative or palliative therapy. (Review)
Review
OBJECTIVES
To review the treatment strategies among patients with Stage IV penile cancer to describe potentially curative or palliative therapy.
METHODS
The International Consultation on Urologic Disease for Penile Cancer subcommittee on the treatment of Stage IV penile cancer reviewed reports related to the topics of advanced penile cancer and metastatic penile cancer alone and combined with chemotherapy, radiotherapy, and inguinal lymphadenectomy. The reports were rated as to their level of evidence using the criteria of the Oxford Centre for evidence-based medicine. Treatment recommendations were made by consensus, with the appropriate grades determined from the level of evidence.
RESULTS
The incidence of Stage IV disease using the current or modified TNM or Jackson descriptions was 0%-14%. Cisplatin-containing regimens were the most active, with patients exhibiting an average response and survival rate of 26% (range 15%-32%) and 5.5 months (range 4.7-7), respectively. Bleomycin-containing regimens were associated with significant pulmonary toxicity. The role of radiotherapy for advanced penile cancer has been largely palliative. Data have suggested that surgical consolidation among patients exhibiting an objective response to chemotherapy could be associated with durable survival.
CONCLUSIONS
Treatment with a cisplatin-containing regimen in Stage IV penile cancer should be considered and might facilitate curative resection. The use of bleomycin was associated with a high level of toxicity and should be discouraged as first-line therapy. Surgical consolidation to achieve disease-free status or palliation should be considered in fit patients with an objective response to systemic chemotherapy. Palliative radiotherapy to inguinal or skeletal metastases might be of benefit.
Topics: Algorithms; Combined Modality Therapy; Humans; Male; Neoplasm Staging; Pelvic Neoplasms; Penile Neoplasms
PubMed: 20691886
DOI: 10.1016/j.urology.2010.03.082 -
European Journal of Surgical Oncology :... Apr 2001Surgery for recurrent rectal cancer is usually traumatic and of questionable curative value. The use of radioimmunoguided surgery (RIGS) in enhancing the surgeon's... (Clinical Trial)
Clinical Trial
AIM
Surgery for recurrent rectal cancer is usually traumatic and of questionable curative value. The use of radioimmunoguided surgery (RIGS) in enhancing the surgeon's assessment of the extent of disease in these patients was investigated.
METHODS
Twenty-one patients diagnosed with recurrent pelvic cancer were operated using the RIGS(O)system. Preoperative assessment included CTs of chest, abdomen and pelvis as well as colonoscopy. Patients were injected with CC49, a monoclonal antibody (MoAb) labelled with 125I. Surgical exploration was followed by survey with the gamma-detecting probe.
RESULTS
Surgical exploration identified eight intra-colorectal recurrences, nine extra-colonic pelvic recurrences and five extra-pelvic lymph node metastases. RIGS exploration confirmed all intra-colonic recurrences except for one (patient with no MoAb localization), identified 13 pelvic recurrences and 10 lymph node metastases. There were seven patients with occult findings (33%), resulting in a modified surgical procedure. Surgery included five abdomino-perineal resections, six low anterior resections, seven excisions of presacral tumour, eight total abdominal hysterectomy and bilateral salpingo-oophorectomy, one pelvic exenteration and one post-exenteration. There were no operative deaths. Eight patients had minor complications, and one patient had a major complication with reoperation due to urinary leak. The mean follow-up was 18 months. Ten patients died of disease.
CONCLUSION
Although not curative, RIGS can help the surgeon in the decision-making process through better disease staging.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Colectomy; Colonoscopy; Female; Humans; Iodine Radioisotopes; Length of Stay; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Neoplasms; Preoperative Care; Prognosis; Radioimmunodetection; Rectal Neoplasms; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 11373109
DOI: 10.1053/ejso.2000.1108 -
Annals of Surgical Oncology Nov 1995The survival in neuroblastoma is influenced by patient age, disease stage, tumor site, and several biologic factors. This study was undertaken to determine if primary...
BACKGROUND
The survival in neuroblastoma is influenced by patient age, disease stage, tumor site, and several biologic factors. This study was undertaken to determine if primary pelvic lesions are associated with an unusually favorable outcome.
METHODS
Nine hundred eighty-six patients registered on Children's Cancer Group studies from 1980 to 1993 were reviewed, and 41 (4.3%) were found to have pelvic tumors. Survival was analyzed, and correlations among age, stage of disease, surgical resectability, histopathology, serum ferritin, and N-myc oncogene amplification were evaluated.
RESULTS
Age at diagnosis was comparable between patients with pelvic and nonpelvic tumors. Disease distribution was similar, with stages III and IV comprising 78% (32 of 41) of pelvic lesions compared with 73% (692 of 945) for nonpelvic tumors. There was no outcome difference in favorable stages (I, II, and IV-S), with 3-year progression-free survival rates of 88% and 82% for pelvic and nonpelvic sites, respectively. However, in stages III and IV, the 3-year progression-free survival was 70% for pelvic lesions compared with 47% for nonpelvic tumors (p = 0.04). Some favorable biologic factors were more common in children with pelvic lesions.
CONCLUSIONS
The pelvis is an unusual primary site for neuroblastoma but represents a more favorable prognostic subgroup, which is most evident in advanced-stage disease.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Neoplasm Staging; Neuroblastoma; Pelvic Neoplasms; Prognosis; Retrospective Studies; Survival Analysis
PubMed: 8591082
DOI: 10.1007/BF02307085