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Journal of Orthopaedic Surgery and... Nov 2020Local treatment in pelvic Ewing sarcoma (ES) consists of operation, radiation therapy, or a combination of both. Reported outcomes vary depending on the treatment...
BACKGROUND
Local treatment in pelvic Ewing sarcoma (ES) consists of operation, radiation therapy, or a combination of both. Reported outcomes vary depending on the treatment modality performed. It is the objective of this study to analyze surgical outcome and complications as well as oncological outcome and complications of chemo- and radiation therapy in this patient cohort and evaluate prognostic factors.
METHODS
Retrospective review of 104 patients who underwent tumor resection for pelvic ES from 1988 to 2014.
RESULTS
All patients underwent pelvic resection and radiation therapy was administered in 77.9%. Margins were clear in 94.2%. The response to chemotherapy was good in 78.8%. Local recurrence occurred in 7.7%. The presence of distant metastases at the time of operation was the most important negative predictor for overall survival (p = 0.003). The cumulative 5- and 10-year survival rates were 82.7% and 80.1% for non-metastasized and 61.4% and 41.6% for metastasized pelvic ES at operation. In the presence of a single-distant metastatic site at operation compared to multiple metastatic sites, the cumulative survival rates were 64.3% versus 50% at five and 50.7% versus 16.7% at 10 years.
CONCLUSIONS
A combined treatment approach of tumor resection and radiation therapy leads to a local control and overall survival rates comparable with those of extremity locations in this study's patient cohort with localized pelvic ES. Therefore, surgical tumor resection (combined with (neo-)adjuvant radiation therapy) in non-metastatic pelvic ES seems feasible. In metastatic patients, however, the significance of tumor resection as a part of local treatment remains less certain and improved outcomes of combined local treatment approaches need to be weighed against these patients' prognosis and quality of life.
Topics: Adolescent; Adult; Child; Child, Preschool; Combined Modality Therapy; Community Health Centers; Female; Hemipelvectomy; Humans; Male; Middle Aged; Pelvic Bones; Pelvic Neoplasms; Quality of Life; Retrospective Studies; Sarcoma, Ewing; Survival Rate; Time Factors; Treatment Outcome; Young Adult
PubMed: 33198775
DOI: 10.1186/s13018-020-02028-3 -
Revista Espanola de Enfermedades... Aug 2017Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen. The most...
Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen. The most frequent locations for colonization are cervicofacial (50%), abdominal (20%) and thoracic (15-20%). The abdominal actinomycosis predisposing factors include recent surgery, trauma and neoplasias. Certain cases have been associated with the intrauterine contraception device (IUD).
Topics: Actinomycosis; Adult; Chronic Disease; Colonic Diseases; Female; Humans; Intestinal Obstruction; Intrauterine Devices; Pelvic Neoplasms; Tomography, X-Ray Computed
PubMed: 28625067
DOI: 10.17235/reed.2017.4396/2016 -
Journal of Nuclear Medicine : Official... Jun 2012In oncology, staging forms the basis for prognostic consideration and directly influences patient care by determining the therapeutic approach. Cross-sectional imaging... (Review)
Review
In oncology, staging forms the basis for prognostic consideration and directly influences patient care by determining the therapeutic approach. Cross-sectional imaging techniques, especially when combined with PET information, play an important role in cancer staging. With the recent introduction of integrated whole-body PET/MRI into clinical practice, a novel metabolic-anatomic imaging technique is now available. PET/MRI seems to be highly accurate in T-staging of tumor entities for which MRI has traditionally been favored, such as squamous cell carcinomas of the head and neck. By adding functional MRI to PET, PET/MRI may further improve diagnostic accuracy in the differentiation of scar tissue from recurrence of tumors such as rectal cancer. This hypothesis will have to be assessed in future studies. With regard to N-staging, PET/MRI does not seem to provide a considerable benefit as compared with PET/CT but provides similar N-staging accuracy when applied as a whole-body staging approach. M-staging will benefit from MRI accuracy in the brain and the liver. The purpose of this review is to summarize the available first experiences with PET/MRI and to outline the potential value of PET/MRI in oncologic applications for which data on PET/MRI are still lacking.
Topics: Abdominal Neoplasms; Brain Neoplasms; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Neoplasms; Pelvic Neoplasms; Positron-Emission Tomography; Thoracic Neoplasms
PubMed: 22582048
DOI: 10.2967/jnumed.112.105338 -
World Journal of Gastroenterology May 2014To describe the imaging features of solitary fibrous tumors (SFTs) in the abdomen and pelvis, and the clinical and pathologic correlations.
AIM
To describe the imaging features of solitary fibrous tumors (SFTs) in the abdomen and pelvis, and the clinical and pathologic correlations.
METHODS
Fifteen patients with pathologically confirmed SFTs in the abdomen and pelvis were retrospectively studied with imaging techniques by two radiologists in consensus. Patients underwent unenhanced and contrast-enhanced imaging, as follows: 3 with computed tomography (CT) and magnetic resonance imaging (MRI) examination, 8 with CT examination only, and 4 with MRI examination only. Image characteristics such as size, shape, margin, attenuation or intensity, and pattern of enhancement were analyzed and correlated with the microscopic findings identified from surgical specimens. In addition, patient demographics, presentation, and outcomes were recorded.
RESULTS
Of the 15 patients evaluated, local symptoms related to the mass were found in 11 cases at admission. The size of the mass ranged from 3.4 to 25.1 cm (mean, 11.5 cm). Nine cases were round or oval, 6 were lobulated, and 10 displaced adjacent organs. Unenhanced CT revealed a heterogeneous isodense mass in 7 cases, homogeneous isodense mass in 3 cases, and punctuated calcification in one case. On MRI, most of the lesions (6/7) were heterogeneous isointense and heterogeneous hyperintense on T1-weighted images and T2-weighted images, respectively. All tumors showed moderate to marked enhancement. Heterogeneous enhancement was revealed in 11 lesions, and 7 of these had cysts, necrosis, or hemorrhage. Early nonuniform enhancement with a radial area that proved to be a fibrous component was observed in 4 lesions, which showed progressive enhancement in the venous and delayed phase. No statistical difference in the imaging findings was observed between the histologically benign and malignant lesions. Three patients had local recurrence or metastasis at follow-up.
CONCLUSION
Abdominal and pelvic SFTs commonly appeared as large, solid, well-defined, hypervascular masses with variable degrees of necrosis or cystic change that often displaced adjacent structures.
Topics: Abdominal Neoplasms; Adult; Aged; Biomarkers, Tumor; Biopsy; Female; Humans; Immunohistochemistry; Infant; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Pelvic Neoplasms; Predictive Value of Tests; Retrospective Studies; Solitary Fibrous Tumors; Tomography, X-Ray Computed; Tumor Burden
PubMed: 24803820
DOI: 10.3748/wjg.v20.i17.5066 -
Journal of Visceral Surgery Apr 2013Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially with suboptimal surgery (non-TME). For numerous patients, diagnosis... (Review)
Review
Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially with suboptimal surgery (non-TME). For numerous patients, diagnosis of LR is done at late stage of the disease because of the high rate of asymptomatic patients. MRI and PET-scan are the most performing exams to assess the local and general extension, with high diagnostic accuracy (sensibility 85% and specificity 92%). For extraluminal pelvic recurrences from rectal cancer, pelvic exenterations alone or with irradiation (preoperative and/or intraoperative) can afford a R0 resection rate ranging from 30% to 45% with acceptable morbidity. Morbidity and mortality rates are high for total exenteration and abdominosacral resection. After curative surgery, 5-year global survival from 30% to 40% is observed. Careful selection of patients with better preoperative status before resection is needed to achieve more curative resections and increase long-term survivor rates.
Topics: Adenocarcinoma; Combined Modality Therapy; Humans; Neoplasm Recurrence, Local; Palliative Care; Pelvic Exenteration; Pelvic Neoplasms; Quality of Life; Plastic Surgery Procedures; Rectal Neoplasms; Rectum; Survival Rate; Treatment Outcome
PubMed: 23623561
DOI: 10.1016/j.jviscsurg.2013.03.007 -
Medicine Sep 2016Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis. (Review)
Review
BACKGROUND
Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis.
METHODS
We report a case of malignant PT. It had recurred locally five times, and the sixth relapse was occurred 54 months after first diagnosis, presenting a huge pelvic mass (14 cm × 11 cm) by CT scan. Histopathological examination has demonstrated a metastatic phyllodes tumor. After postoperative chemotherapy treatment, a longer survival has been achieved, which is more than 72 months.
RESULTS
Our case report describes a breast PT with several local recurrences and a rare metastasis (pelvic cavity), but long-term overall survival was achieved after surgery and chemotherapy.
CONCLUSION
We conclude that trustworthy prognosticators that identify patients with excessive potential of aggressive clinical course should be explored. Moreover, proper treatment could prolong overall survival of metastatic PT patients.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Fatal Outcome; Female; Humans; Immunohistochemistry; Mastectomy; Neoplasm Recurrence, Local; Pelvic Neoplasms; Pelvis; Phyllodes Tumor; Positron Emission Tomography Computed Tomography
PubMed: 27661051
DOI: 10.1097/MD.0000000000004942 -
Journal of the Royal Society of Medicine Nov 1981Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was...
Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through the sacral hiatus into the sacral canal to produce anaesthesia of the lower sacral nerve roots. Forty patients received a total of 70 treatments: 31 patients (78%) were helped by the procedure and the median duration of improvement was 30 days. The treatment was more successful in relieving symptoms in patients suffering from pelvic cancer and coccydynia. The best results were obtained in those patients who received numerous freeze applications or prolonged freezing.
Topics: Coccyx; Cryotherapy; Female; Humans; Male; Middle Aged; Pain, Intractable; Pelvic Neoplasms; Perineum; Spinal Nerve Roots
PubMed: 7299782
DOI: 10.1177/014107688107401106 -
Ultrasound in Obstetrics & Gynecology :... Feb 2012To describe the ultrasound (sonomorphologic and vascular) characteristics of metastatic non-gynecological pelvic tumors, and to identify ultrasound characteristics... (Comparative Study)
Comparative Study
OBJECTIVE
To describe the ultrasound (sonomorphologic and vascular) characteristics of metastatic non-gynecological pelvic tumors, and to identify ultrasound characteristics typical of the most common non-gynecological pelvic tumors.
METHODS
In 92 patients with a pelvic mass who had undergone ultrasound examination with subsequent surgery or tru-cut biopsy revealing a metastatic non-gynecological tumor origin, we analyzed retrospectively the sonomorphologic and vascular parameters. All parameters were evaluated for the whole group of non-gynecological tumors as well as separately for each specific tumor type. The findings were compared with those from 100 women with epithelial ovarian cancer.
RESULTS
We found that CA 125, size of tumor, echogenicity, homogeneity of solid portion, mobility, and presence of ovarian crescent sign, parenchymal metastases and suspicious necrosis were individual statistically significant discriminators (P < 0.01) between the metastatic non-gynecological tumor group and the epithelial ovarian cancer group.
CONCLUSIONS
Metastatic non-gynecological tumors in the pelvis have a significantly different sonomorphologic pattern compared with primary epithelial ovarian cancer. This pattern is dependent on the primary origin of the tumor. Doppler parameters, however, cannot differentiate between primary ovarian cancer and metastatic non-gynecological tumors.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Ovarian Neoplasms; Pelvic Neoplasms; Retrospective Studies; Ultrasonography, Doppler, Color
PubMed: 21845744
DOI: 10.1002/uog.10068 -
Medicine Apr 2018Systematic pelvic lymph node resection may not be needed for patients with cervical cancer, especially in the early stage, if the pre- or intraoperative diagnosis of... (Observational Study)
Observational Study
Which is better for predicting pelvic lymph node metastases in patients with cervical cancer: Fluorodeoxyglucose-positron emission tomography/computed tomography or a sentinel node biopsy? A retrospective observational study.
Systematic pelvic lymph node resection may not be needed for patients with cervical cancer, especially in the early stage, if the pre- or intraoperative diagnosis of lymph node status is correct. The aim of this study was to evaluate the diagnostic accuracy of pelvic lymph node metastasis for fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) and sentinel node biopsy (SNB) of cervical cancer patients.Forty-eight patients with cervical cancer were imaged with FDG PET/CT before radical hysterectomy and underwent an SNB followed by systematic pelvic lymph node dissection. The diagnostic accuracy for predicting pelvic node metastases for FDG PET/CT and SNB compared with the ultimate histologic status was analyzed.Among 96 hemi-pelvises (HPs) in 48 patients, pelvic lymph node metastases were obtained in 12 HPs. The sensitivity of pelvic node metastases for FDG PET/CT and SNB was 8.3% and 75.0%, respectively. The specificity for FDG PET/CT and SNB was 97.6% and 94.0%, respectively. The negative predictive value for FDG-PET/CT and SNB was 88.2% and 100%, respectively.SNB is more suitable for detecting pelvic node metastases than FDG PET/CT. The omission of systematic pelvic lymphadenectomy should be considered based on the findings of SNB, not FDG PET/CT.
Topics: Adult; Female; Fluorodeoxyglucose F18; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Pelvic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Uterine Cervical Neoplasms
PubMed: 29668599
DOI: 10.1097/MD.0000000000010410 -
Academic Radiology Jun 2013This study summarizes the literature on the detection of cancer among indeterminate extracolonic findings on computed tomographic (CT) colonography in five targeted... (Meta-Analysis)
Meta-Analysis Review
RATIONALE AND OBJECTIVES
This study summarizes the literature on the detection of cancer among indeterminate extracolonic findings on computed tomographic (CT) colonography in five targeted organs.
MATERIALS AND METHODS
We searched PubMed for English-language literature published between January 1, 1994, and December 31, 2010. We describe extracolonic findings in the kidney, lung, liver, pancreas, and ovary suspect for malignancy as they are associated with high mortality. For each organ, we calculated the median prevalence, positive predictive value (PPV), and false positive rate of malignancy and a pooled false-positive rate across studies.
RESULTS
Of 91 publications initially identified, 24 were eligible for review. Indeterminate renal masses on CT colonography had 20.5% median PPV and low pooled false positive rate of 1.3% (95% confidence interval 0.6-2.0). In contrast, indeterminate masses of the lung, liver, pancreas, and ovary had low PPV (median values ranged from 0% to 3.8%). Indeterminate masses of the ovary resulted in the highest pooled false-positive rate of 2.2%. Results were similar in studies of both screening and nonscreening populations. We estimated the probability of false positive results through the detection of significant extracolonic findings as 46 per 1000 for men and 68 per 1000 for women.
CONCLUSIONS
Indeterminate renal masses newly detected on CT colonography have an estimated one in five chance of malignancy and therefore warrant further follow-up to provide a definitive diagnosis. Conversely, indeterminate masses of the lung, liver, pancreas, and ovary are associated with high false positive rates and merit more conservative clinical follow-up.
Topics: Abdominal Neoplasms; Colonic Neoplasms; Colonography, Computed Tomographic; Cost-Benefit Analysis; Female; Health Care Costs; Humans; Incidence; Male; Pelvic Neoplasms; Prognosis; Risk Assessment; Survival Rate
PubMed: 23465379
DOI: 10.1016/j.acra.2013.01.017