{"title":"Role of the radiotherapy boost on local control in ductal carcinoma in situ.","authors":"Olivier Riou, Claire Lemanski, Vanessa Guillaumon, Olivier Lauche, Pascal Fenoglietto, Jean-Bernard Dubois, David Azria","doi":"10.1155/2012/748196","DOIUrl":"https://doi.org/10.1155/2012/748196","url":null,"abstract":"<p><p>Ductal carcinoma in situ of the breast is associated with low mortality rates, but local relapse is a matter of concern in this disease. Risk factors for local relapse include young age, close or positive margins, and tumor necrosis. Whole breast irradiation following breast-conserving surgery for ductal carcinoma in situ significantly reduces the risk of local relapse as compared to breast-conserving surgery alone. Studies point to similar outcomes between breast-conserving surgery plus radiotherapy and mastectomy, in the absence of extensive disease. A complementary boost to the surgical bed improves outcomes for patients with invasive breast cancer. However, the effect of this strategy has never been prospectively reported for ductal carcinoma in situ. Two randomized controlled trials assessing this issue are ongoing. This paper represents an update on available literature about radiotherapy for DCIS with a special focus on the role of a radiotherapy boost to the tumor bed.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"748196"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/748196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30610116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management-review.","authors":"Norman Oneil Machado","doi":"10.1155/2012/602478","DOIUrl":"https://doi.org/10.1155/2012/602478","url":null,"abstract":"<p><p>Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the \"Achilles heel\" of pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to pancreatic fistula. The morbidity rate after pancreaticoduodenectomy remains high in the range of 30% to 65%, although the mortality has significantly dropped to below 5%. Most of these complications are related to pancreatic fistula, with serious complications of intra-abdominal abscess, postoperative bleeding, and multiorgan failure. Several pharmacological and technical interventions have been suggested to decrease the pancreatic fistula rate, but the results have been controversial. This paper considers definition and classification of pancreatic fistula, risk factors, and preventive approach and offers management strategy when they do occur.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"602478"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/602478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30631528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ductal carcinoma in situ: recent advances and future prospects.","authors":"Kelly Lambert, Neill Patani, Kefah Mokbel","doi":"10.1155/2012/347385","DOIUrl":"10.1155/2012/347385","url":null,"abstract":"<p><p>Introduction. This article reviews current management strategies for DCIS in the context of recent randomised trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment. Methods. Literature review facilitated by Medline, PubMed, Embase and Cochrane databases. Results. DCIS should be managed in the context of a multidisciplinary team. Local control depends upon clear surgical margins (at least 2 mm is generally acceptable). SLNB is not routine, but can be considered in patients undergoing mastectomy (Mx) with risk factors for occult invasion. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions should be treated by Mx and immediate reconstruction should be discussed. Adjuvant hormonal treatment may reduce the risk of LR in selected cases with hormone sensitive disease. Conclusion. Further research is required to determine the role of new RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of tumour biology in DCIS to rationalise treatment. Reliable identification of low-risk lesions could allow treatment to be less radical.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"347385"},"PeriodicalIF":1.6,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30672068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?","authors":"Jennifer L Baker, Farnaz Hasteh, Sarah L Blair","doi":"10.1155/2012/297832","DOIUrl":"https://doi.org/10.1155/2012/297832","url":null,"abstract":"<p><p>Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"297832"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/297832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31151753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert L Satcher, Patrick Lin, Nursat Harun, Lei Feng, Bryan S Moon, Valerae O Lewis
{"title":"Surgical management of appendicular skeletal metastases in thyroid carcinoma.","authors":"Robert L Satcher, Patrick Lin, Nursat Harun, Lei Feng, Bryan S Moon, Valerae O Lewis","doi":"10.1155/2012/417086","DOIUrl":"https://doi.org/10.1155/2012/417086","url":null,"abstract":"<p><p>Background. Bone is a frequent site of metastasis from thyroid carcinoma, but prognostic factors for patients who have surgery for thyroid carcinoma bone metastases are poorly understood. Methods. A retrospective review at a single institution identified 41 patients that underwent surgery in the appendicular skeleton for thyroid carcinoma bone metastasis from 1988 to 2011. Results. Overall patient survival probability by Kaplan-Meier analysis after surgery for bone metastasis was 72% at 1 year, 29% at 5 years, and 20% at 8 years. Patients who had their tumor excised (P = 0.001) or presented with solitary bone involvement had a lower risk of death following surgery adjusting for age and gender. Disease progression at the surgery site occurred more frequently with a histological diagnosis of follicular carcinoma compared with other subtypes (P = 0.023). Multivariate analysis showed that tumor subtype, chemotherapy, and preoperative radiation treatment had no effect on survival after surgery. Patients treated with radioactive iodine had better survival following thyroidectomy, but not following surgery for bone metastases. Conclusions. For patients undergoing surgery for thyroid cancer bone metastasis, resection of the bone metastasis, if possible, has a survival benefit.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"417086"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/417086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31151754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preya Ananthakrishnan, Fatih Levent Balci, Joseph P Crowe
{"title":"Optimizing surgical margins in breast conservation.","authors":"Preya Ananthakrishnan, Fatih Levent Balci, Joseph P Crowe","doi":"10.1155/2012/585670","DOIUrl":"https://doi.org/10.1155/2012/585670","url":null,"abstract":"<p><p>Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"585670"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/585670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31151755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica A Smith, Aaron T Wild, Aatur Singhi, Siva P Raman, Haoming Qiu, Rachit Kumar, Amy Hacker-Prietz, Ralph H Hruban, Ihab R Kamel, Jonathan Efron, Elizabeth C Wick, Nilofer S Azad, Luis A Diaz, Yi Le, Elwood P Armour, Susan L Gearhart, Joseph M Herman
{"title":"Clinicopathologic Comparison of High-Dose-Rate Endorectal Brachytherapy versus Conventional Chemoradiotherapy in the Neoadjuvant Setting for Resectable Stages II and III Low Rectal Cancer.","authors":"Jessica A Smith, Aaron T Wild, Aatur Singhi, Siva P Raman, Haoming Qiu, Rachit Kumar, Amy Hacker-Prietz, Ralph H Hruban, Ihab R Kamel, Jonathan Efron, Elizabeth C Wick, Nilofer S Azad, Luis A Diaz, Yi Le, Elwood P Armour, Susan L Gearhart, Joseph M Herman","doi":"10.1155/2012/406568","DOIUrl":"https://doi.org/10.1155/2012/406568","url":null,"abstract":"<p><p>Purpose. To assess for differences in clinical, radiologic, and pathologic outcomes between patients with stage II-III rectal adenocarcinoma treated neoadjuvantly with conventional external beam radiotherapy (3D conformal radiotherapy (3DRT) or intensity-modulated radiotherapy (IMRT)) versus high-dose-rate endorectal brachytherapy (EBT). Methods. Patients undergoing neoadjuvant EBT received 4 consecutive daily 6.5 Gy fractions without chemotherapy, while those undergoing 3DRT or IMRT received 28 daily 1.8 Gy fractions with concurrent 5-fluorouracil. Data was collected prospectively for 7 EBT patients and retrospectively for 25 historical 3DRT/IMRT controls. Results. Time to surgery was less for EBT compared to 3DRT and IMRT (P < 0.001). There was a trend towards higher rate of pathologic CR for EBT (P = 0.06). Rates of margin and lymph node positivity at resection were similar for all groups. Acute toxicity was less for EBT compared to 3DRT and IMRT (P = 0.025). Overall and progression-free survival were noninferior for EBT. On MRI, EBT achieved similar complete response rate and reduction in tumor volume as 3DRT and IMRT. Histopathologic comparison showed that EBT resulted in more localized treatment effects and fewer serosal adhesions. Conclusions. EBT offers several practical benefits over conventional radiotherapy techniques and appears to be at least as effective against low rectal cancer as measured by short-term outcomes.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"406568"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/406568","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30787740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Additional gastrectomy after endoscopic submucosal dissection for early gastric cancer patients with comorbidities.","authors":"Naohiko Koide, Daisuke Takeuchi, Akira Suzuki, Satoshi Ishizone, Shinichi Miyagawa","doi":"10.1155/2012/379210","DOIUrl":"https://doi.org/10.1155/2012/379210","url":null,"abstract":"<p><p>Purpose. We investigated the clinicopathologic features of early gastric cancer (EGC) patients who have undergone additional gastrectomy after endoscopic submucosal dissection (ESD) because of their comorbidities. Methods. Eighteen (7.1%) of 252 GC patients were gastrectomized after prior ESD. Reasons for further surgery, preoperative and postoperative problems, and the clinical outcome were determined. Results. The 18 patients had submucosal EGC and several co-morbidities. Other primary cancers were observed in 8 (44.4%). Histories of major abdominal operations were observed in 6 (33.3%). Fourteen patients (77.8%) hoped for endoscopic treatment. Due to additional gastrectomy, residual cancer was suspected in 10, and node metastasis was suspected in 11. A cancer remnant was histologically observed in one. Node metastasis was detected in 3 (16.7%). Small EGC was newly detected in 4. Consequently, additional gastrectomy was necessary for the one third. No patient showed GC recurrence. However, 9 (50%) had new diseases, and 4 (22.2%) died of other diseases. The overall survival after surgery in these patients with additional gastrectomy was poorer than those with routine gastrectomy for submucosal EGC (P = 0.0087). Conclusions. Additional gastrectomy was safely performed in EGC patients with co-morbidities. However, some issues, including presence of node metastasis and other death after surgery, remain.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"379210"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/379210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30654563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leopoldo Costarelli, Domenico Campagna, Maria Mauri, Lucio Fortunato
{"title":"Intraductal proliferative lesions of the breast-terminology and biology matter: premalignant lesions or preinvasive cancer?","authors":"Leopoldo Costarelli, Domenico Campagna, Maria Mauri, Lucio Fortunato","doi":"10.1155/2012/501904","DOIUrl":"10.1155/2012/501904","url":null,"abstract":"<p><p>Morphological criteria for the diagnosis of intraductal proliferative lesions of the breast have been an object of research and much controversy, and its terminology is rather confusing. Knowledge of the molecular aspects of this disease probably necessitates further research to clarify if these entities can be identified as breast cancer precursors or as a malignant preinvasive disease. These issues are of great interest not only for their biological implications, but also to the clinician who must understand the disease and direct therapies. Molecular studies have shown that epitheliosis (usual ductal hyperplasia) is not monoclonal, while malignant lesions (atypical ductal hyperplasia, flat epithelial atypia, low-grade and high-grade intraductal carcinoma) constantly show these characteristics. These malignant lesions, classified with a DIN grading system (ductal intraepithelial neoplasia), are not obligate precursors of invasive ductal carcinoma and do not represent different evolving grades in a linear model of cancerogenesis. Breast cancerogenesis probably has different pathways with different morphologic precursors.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"501904"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30660838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esther Bastiaannet, Willemien van de Water, Rudi G J Westendorp, Maryska L G Janssen-Heijnen, Cornelis J H van de Velde, Anton J M de Craen, Gerrit-Jan Liefers
{"title":"No excess mortality in patients aged 50 years and older who received treatment for ductal carcinoma in situ of the breast.","authors":"Esther Bastiaannet, Willemien van de Water, Rudi G J Westendorp, Maryska L G Janssen-Heijnen, Cornelis J H van de Velde, Anton J M de Craen, Gerrit-Jan Liefers","doi":"10.1155/2012/567506","DOIUrl":"https://doi.org/10.1155/2012/567506","url":null,"abstract":"<p><p>Background. The incidence of ductal carcinoma in situ (DCIS) has increased at a fast rate.The aim of this study was to assess the incidence and treatment in the Netherlands and estimate the excess mortality risk of DCIS. Methods. From the Netherlands Cancer Registry, adult female patients (diagnosed 1997-2005) with DCIS were selected. Treatment was described according to age. Relative mortality at 10 years of follow-up was calculated by dividing observed mortality over expected mortality. Expected mortality was calculated using the matched Dutch general population. Results. Overall, 8421 patients were included in this study. For patients aged 50-64, and 65-74 an increase in breast-conserving surgery was observed over time (P < 0.001). For patients over 75 years of age, 8.0% did not undergo surgery; this percentage remained stable over time (P = 0.07). Overall, treated patients aged >50 years experienced no excess mortality regardless of treatment (relative mortality 1.0). Conclusion. The present population-based study of almost 8500 patients showed no excess mortality in surgically treated women over 50 years with DCIS.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2012 ","pages":"567506"},"PeriodicalIF":1.5,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/567506","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30660839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}