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California Medicine Feb 1973Pelvic exenteration offers the only possibility for cure in patients who have pelvic recurrence after receiving optimum amounts of irradiation. With improved...
Pelvic exenteration offers the only possibility for cure in patients who have pelvic recurrence after receiving optimum amounts of irradiation. With improved radiotherapy techniques, the number of patients with isolated central failure is steadily diminishing, but there remains a significant number of patients with recurrent cancer of the cervix after radiation therapy for whom the procedure offers the only chance for life. Each patient must be assessed individually, with the risks of the procedure weighed against the possible benefits. Technical advances continue to reduce the operative mortality and ameliorate the postoperative morbidity associated with pelvic exenteration.
Topics: Female; Humans; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Uterine Cervical Neoplasms
PubMed: 4701706
DOI: No ID Found -
Revista de Investigacion Clinica;... 2018Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported... (Review)
Review
Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported pelvic cancers in Mexico are cervical, endometrial, bladder, prostate, rectum, and anal canal. Approximately 80% of the population diagnosed with pelvic cancers present with locally advanced tumors and require concomitant chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone. The toxicity of any of these treatment modalities may be manifested as intestinal injury, a significant problem that can compromise the response to treatment, the patient's nutritional state, quality of life, and survival. In this article, we will approach key aspects in nutrition as well as the epidemiological characteristics and toxicities in patients affected by these pelvic tumors.
Topics: Chemoradiotherapy; Gastrointestinal Diseases; Humans; Mexico; Pelvic Neoplasms; Prevalence; Quality of Life; Radiation Injuries
PubMed: 29943771
DOI: 10.24875/RIC.18002528 -
PloS One 2017Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term...
BACKGROUND AND OBJECTIVES
Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.
METHODS
Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing's Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints.
RESULTS
The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001).
CONCLUSIONS
Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Disease-Free Survival; Female; Hemipelvectomy; Humans; Infections; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Neoplasms; Postoperative Complications; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk; Sarcoma; Survival Rate; Treatment Outcome; Vascular Diseases; Young Adult
PubMed: 28199377
DOI: 10.1371/journal.pone.0172203 -
The British Journal of Radiology Dec 2019Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision... (Review)
Review
Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision medicine depends on robust biomarkers. Recently, the requirement for improved non-biologic biomarkers that reflect tumor biology has emerged and there has been a growing interest in the automatic extraction of quantitative features from medical images, denoted as radiomics. Radiomics as a methodological approach can be applied to any image and most studies have focused on PET, CT, ultrasound, and MRI. Here, we aim to present an overview of the radiomics workflow as well as the major challenges with special emphasis on the use of multiparametric MRI datasets. We then reviewed recent studies on radiomics in the field of pelvic oncology including prostate, cervical, and colorectal cancer.
Topics: Algorithms; Colorectal Neoplasms; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Neoplasm Grading; Pelvic Neoplasms; Precision Medicine; Prostatic Neoplasms; Radiation Oncology; Reproducibility of Results; Tumor Burden; Uterine Cervical Neoplasms
PubMed: 31538516
DOI: 10.1259/bjr.20190105 -
BMJ Case Reports Mar 2021Ectopic pregnancy is a common complication of early pregnancy. We present a very atypical case of an ectopic gestation in a woman who presented with a negative pregnancy...
Ectopic pregnancy is a common complication of early pregnancy. We present a very atypical case of an ectopic gestation in a woman who presented with a negative pregnancy test, a large pelvic mass, weight loss and bowel obstruction.
Topics: Female; Humans; Pelvic Neoplasms; Pregnancy; Pregnancy, Ectopic
PubMed: 33653828
DOI: 10.1136/bcr-2019-233534 -
Cancer Treatment Reviews Jul 2018One of the late complications associated with radiation therapy (RT) is a possible increased risk of second cancer. In this systematic review, we analysed the incidence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
One of the late complications associated with radiation therapy (RT) is a possible increased risk of second cancer. In this systematic review, we analysed the incidence of rectal cancer following primary pelvic cancer irradiation.
METHODS
A literature search was conducted using the PubMed and EMBASE libraries. Original articles that reported on secondary rectal cancer after previous RT for a primary pelvic cancer were included. Sensitivity analyses were performed by correcting for low number of events, high risk of bias, and outlying results.
RESULTS
A total of 5171 citations were identified during the literature search, 23 studies were included in the meta-analyses after screening. A pooled analysis, irrespective of primary tumour location, showed an increased risk for rectal cancer following RT (N = 403.243) compared with non-irradiated patients (N = 615.530) with a relative risk (RR) of 1.43 (95% confidence interval [CI] 1.18-1.72). Organ specific meta-analysis showed an increased risk for rectal cancer after RT for prostate (RR 1.36, 95%CI 1.10-1.67) and cervical cancer (RR 1.61, 95% CI 1.10-2.35). No relation was seen in ovarian cancer patients. The modality of RT did not influence the incidence of rectal cancer.
CONCLUSIONS
This review demonstrates an increased risk for second primary rectal cancer in patients who received RT to the pelvic region. This increased risk was modest and could not be confirmed for all primary pelvic cancer sites. The present study does not provide data to change guidelines for surveillance for rectal cancer in previously irradiated patients.
Topics: Humans; Incidence; Neoplasms, Radiation-Induced; Pelvic Neoplasms; Rectal Neoplasms
PubMed: 29957373
DOI: 10.1016/j.ctrv.2018.05.008 -
World Journal of Gastroenterology Apr 2011Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR... (Review)
Review
Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presacral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, or chemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.
Topics: Clinical Trials as Topic; Combined Modality Therapy; Humans; Lymph Node Excision; Meta-Analysis as Topic; Neoplasm Recurrence, Local; Pelvic Neoplasms; Rectal Neoplasms; Risk Factors
PubMed: 21483626
DOI: 10.3748/wjg.v17.i13.1674 -
Oncology (Williston Park, N.Y.) Apr 2017Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and... (Review)
Review
Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and challenging to address. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management. Addressing these issues often necessitates a coordinated multidisciplinary approach; however, the effort required often translates into improvement in patient quality of life. Herein we review the sexual and urinary side effects that may arise during or after treatment of pelvic malignancies.
Topics: Cancer Survivors; Humans; Pelvic Neoplasms; Quality of Life; Sexual Dysfunctions, Psychological; Urinary Incontinence, Stress
PubMed: 28412780
DOI: No ID Found -
World Journal of Gastroenterology Nov 2011Various mucin-producing neoplasms originate in different abdominal and pelvic organs. Mucinous neoplasms differ from non-mucinous neoplasms because of the differences in... (Review)
Review
Various mucin-producing neoplasms originate in different abdominal and pelvic organs. Mucinous neoplasms differ from non-mucinous neoplasms because of the differences in clinical outcome and imaging appearance. Mucinous carcinoma, in which at least 50% of the tumor is composed of large pools of extracellular mucin and columns of malignant cells, is associated with a worse prognosis. Signet ring cell carcinoma is characterized by large intracytoplasmic mucin vacuoles that expand in the malignant cells with the nucleus displaced to the periphery. Its prognosis is also generally poor. In contrast, intraductal papillary mucinous neoplasm of the bile duct and pancreas, which is characterized by proliferation of ductal epithelium and variable mucin production, has a better prognosis than other malignancies in the pancreaticobiliary tree. Imaging modalities play a critical role in differentiating mucinous from non-mucinous neoplasms. Due to high water content, mucin has a similar appearance to water on ultrasound (US), computed tomography (CT), and magnetic resonance imaging, except when thick and proteinaceous, and then it tends to be hypoechoic with fine internal echoes or have complex echogenicity on US, hyperdense on CT, and hyperintense on T1- and hypointense on T2-weighted images, compared to water. Therefore, knowledge of characteristic mucin imaging features is helpful to diagnose various mucin-producing neoplastic conditions and to facilitate appropriate treatment.
Topics: Abdominal Cavity; Abdominal Neoplasms; Adenocarcinoma, Mucinous; Humans; Mucins; Pelvic Neoplasms; Pelvis; Pseudomyxoma Peritonei; Radiography; Ultrasonography
PubMed: 22147976
DOI: 10.3748/wjg.v17.i43.4757 -
International Journal of Surgery... Apr 2024The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This...
BACKGROUND
The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This study aimed to evaluate the effectiveness of EUS in predicting colorectal invasion in patients with pelvic masses and compare its accuracy with that of other imaging methods, namely pelvic MRI and abdominal computed tomography (CT), in predicting intestinal involvement in patients with histologically confirmed colorectal invasion.
METHODS
A hundred and eighty-four female patients with histologically confirmed benign or malignant pelvic masses were enrolled in a retrospective-prospective study. All patients underwent EUS, pelvic MRI, and one or more of abdominal CT, transvaginal sonography, and colonoscopy examinations before surgery. The surgical and pathological results were used as the gold standard to evaluate the diagnostic accuracy of EUS for colorectal invasion of pelvic masses.
RESULTS
This study included 184 patients who underwent surgery, with the time between EUS and surgery ranging from 1 to 309 (mean, 13.2) days. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of EUS for benign and malignant pelvic masses infiltrating the intestine were 83.3, 97.8, 99.1, and 66.2%, respectively. The overall diagnostic accuracy was 87.0%.
CONCLUSIONS
EUS is a simple, noninvasive, reliable, and accurate technique for the preoperative diagnosis of pelvic masses infiltrating the intestine. The authors recommend the use of this technology by gynecologists, as well as its incorporation into the preoperative diagnostic process to determine the most suitable surgical method. This would help in avoiding unexpected situations and unnecessary resource wastage during surgery.
Topics: Humans; Female; Endosonography; Middle Aged; Adult; Aged; Retrospective Studies; Pelvic Neoplasms; Prospective Studies; Aged, 80 and over; Sensitivity and Specificity; Young Adult; Neoplasm Invasiveness; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 38668660
DOI: 10.1097/JS9.0000000000001124