Natural history and prognosis of recurrent breast cancer.

Patterns of recurrent disease were analysed in 603 patients with breast cancer. The time of onset, frequency of recurrence, and survival after recurrence were not influenced by age or menopausal state. While survival after local recurrence was longer than survival after distant metastasis, the time to onset of local and distant disease followed an identical pattern, indicating that local recurrence should be regarded as a manifestation of systemic disease. Postoperative radiotherapy did not affect the time of onset of local recurrence. We suggest that patients with local recurrence should receive both systemic and local treatment and that controlled trials of chemotherapeutic agents in these patients might be valuable in finding the most effective drug combinations to be used as adjuvant treatment after mastectomy.     

Soft-tissue sarcomas of the upper extremity: surgical treatment and outcome

The objective of this retrospective follow-up study was to evaluate the outcome of patients with soft-tissue sarcoma treated by the authors' protocol, which consists of a selective combination of conservative surgery and radiotherapy. Patients who relapsed were especially evaluated to improve treatment results. The authors examined 80 patients with local soft-tissue sarcoma in the upper extremity referred to their multidisciplinary group. Fifteen patients were referred for first or subsequent local recurrence, and 65 patients were treated for primary tumor. The goal of treatment was local control and preservation of a functional limb. Wide excision was attempted. If the margin was less than 2.5 cm, postoperative radiotherapy was administered. Eighty-five percent of the patients were treated by limb salvage. Thirty patients needed reconstructive procedures such as pedicled (20 patients) or free flaps (10 patients). No free flaps were lost. The 5-year disease-specific overall survival rate was 75 percent, the local recurrence-free survival rate was 79 percent, and the metastasis-free survival rate was 68 percent. In univariate analysis, prognostic factors for local recurrence were extracompartmental site; for development of metastases, large size and extracompartmental site; and for decreased disease-specific overall survival, large size and extracompartmental site. Intramuscular, cutaneous, and subcutaneous tumors had a 5-year local control rate of 100 percent, and extracompartmental tumors had a local control rate of 69 percent. Extracompartmental tumors clearly have the worst prognosis and should be the main target for improving treatment strategies. After exclusion of patients with inadequate treatment according to the authors' protocol, the local control rate at 5 years was 90 percent. Strict adherence to treatment protocol should be practiced.     

The impact of local control timing in Ewing sarcoma

AimTo assess the impact of delay in local control on survival outcomes of Ewing sarcoma (ES) patients.BackgroundThe cornerstone of therapy of localized ES includes chemotherapy and local control with surgery or radiotherapy. We sought to assess the impact of delay (>15 weeks) in timing of local control on survival outcomes of ES patients.MethodsData of consecutive patients with primary non-metastatic ES of the extremities, treated at a single institution were collected. The impact of delay of timing for local control, demographics, and disease characteristics on overall survival (OS) was analyzed.ResultsA total of 43 patients with ES of the extremity were included. All patients received neoadjuvant chemotherapy. Local control was by surgery in 36 patients and definitive radiation in 7. A total of 16 patients had delay in local control. At a median follow of up of 48 months, patients with delay in local control had significantly inferior OS compared to those with optimal local control timing (5-year OS 56% vs. 80%, respectively, p = 0.044). Other factors that predicted inferior OS included definitive radiation as opposed to definitive surgery (5-year OS 25% vs. 79%, respectively, p = 0.041) and tumor necrosis <90% as opposed to ≥90% (5-year OS 55% vs. 90%, respectively, p = 0.01).ConclusionDelay in definitive therapy, local control with radiation as opposed to surgery and poor post-chemotherapy tumor necrosis predict inferior OS in ES. Adopting strategies to minimize delay in local control could improve survival outcomes.     

Identification of Locally Advanced Rectal Cancer with Low Risk of Local Recurrence

Background

The routine application of neoadjuvant chemoradiotherapy for T3N0 rectal cancer remains controversial. The aim of this study was to use clinical, Magnetic resonance imaging, and pathological parameters to identify a subgroup of patients with low risk of local recurrence who might be precluded from neoadjuvant chemoradiotherapy.

Methods

We retrospectively reviewed a prospectively maintained database of consecutive rectal cancer patients who underwent curative resection. 166 pathologic confirmed T3N0 rectal cancer patients with tumor located 5–12cm above the anal verge and preoperative circumferential resection margin>1mm were included in analysis. The primary outcomes measured were3- and 5-year local recurrence rates.

Results

Local recurrence was demonstrated during follow-up in 5 patients; the actuarial overall 3- and 5-year local recurrence rates were 2.5% and 3.4%, respectively. Inadequate sampling of lymph nodes (≤12) was associated with higher local recurrence (P = 0.03) in this group of patients.

Conclusion

For upper and middle T3N0 rectal cancer with preoperative circumferential resection margin>1mm, local recurrence rate after total mesorectal excision is low and surgery alone may be enough for this group of patients.     

Regional blood flow and bone uptake of methylene-diphosphonate-technetium-99m

Sudeck's atrophy of the foot is an acute, patchy osteoporosis that, on bone scan, shows an increase in both bone blood flow and local bone uptake of bone-seeking radionuclides. The purpose of this study was to evaluate the relationship between bone uptake of 99mTc-MDP and local bone blood flow. In some patients with Sudeck's atrophy of one foot we measured local bone blood flow and bone uptake of 99mTc-MDP. External counting of radioactivity, with a count-rate of 1 second was performed for 60 minutes after i.v. injection of a known dose of 99mTc-MDP in some patients with Sudeck's atrophy of the foot. The regions of interest (ROI) were selected on the basis of a bone scan performed 24 hours earlier. We assumed that the data recorded during the first seconds (7-10) reflect local blood flow and the data at 60 minutes reflect the bone uptake. The ratio between the local blood flow in the involved and healthy foot was higher than the local bone uptake ratio. The ratio between bone uptake and local bone blood flow was higher in the normal foot than in the affected one. These results suggest that the bone avidity for bone-seeking radionuclides is lower in Sudeck's atrophy than in normal bone.     

Penoscrotal extramammary Paget's disease: a review of 33 cases in a 20-year experience

Extramammary Paget's disease in men most frequently involves the penoscrotal area. The uncertainty of the outcome and of the relationship to the underlying adnexal carcinoma and associated internal malignancy still exists. From 1982 to 2001, 33 patients with penoscrotal extramammary Paget's disease were treated and followed up. Therapeutic modalities included carbon dioxide laser ablation (two patients) and local wide excision (31 patients). Split-thickness skin graft (22 patients), local scrotal flap (six patients), and primary closure (three patients) were utilized to reconstruct the penoscrotal defects after local wide excision. An underlying adnexal carcinoma occurred in seven of 33 patients (21.2 percent). The incidence of associated internal malignancy was 9.1 percent (three of 33 patients), including one concurrently and two nonconcurrently associated malignancies. Eight of 33 patients had local recurrence, representing an incidence of 24.2 percent. Three patients (9.1 percent) had distant metastasis and ultimately died of metastatic carcinoma. Of these patients, 31 were grouped according to the degrees of involvement: limited to the epidermis (group 1, n = 14), involvement of the adnexal gland and/or hair follicle (group 2, n = 10), and the presence of an underlying adnexal carcinoma (group 3, n = 7). Local wide excision with subsequent reconstruction by split-thickness skin graft was favored in this series. Patients with an underlying adnexal carcinoma or pathological invasion of the dermis (group 2 or 3) had a worse prognosis than patients without. From this study, it is difficult to address the particular relationship between the outcome and the associated internal malignancy.     

Intraabdominal chemotherapy of prevailing forms of colon cancer

The efficacy of intraabdominal chemotherapy in patients with prevailing forms of colon cancer, such as peritoneal carcinomatosis, local disseminated and local recurrent colon cancer was estimated. The comparative analysis showed that the intraabdominal chemotherapy allowed to amend the remote results of the treatment in the cases with carcinomatosis, local disseminated colon cancer and local recurrence.     

Sialomucins at resection margin and likelihood of recurrence in colorectal carcinoma.

Oncogenic transformation of colonic epithelium is accompanied by changes in surface carbohydrate, notably an increased secretion of sialomucins at the expense of the normally predominant sulphomucins. In a multicentre prospective trial the correlation between the presence of sialomucins at the resection margin and the subsequent development of local recurrence was studied in 250 patients who had undergone "curative" resection for colorectal carcinoma with a mean follow up period of 14 months. Nineteen of 70 patients (27.1%) with a sialomucin predominant pattern at either resection margin developed local recurrence compared with 15 of 180 patients (8.3%) with a mixed or sulphomucin predominant pattern (p less than 0.01). Increased sialomucin staining at the resection margins was associated with reduced survival in these patients (p less than 0.01). At a mean of 14 months of follow up 153 patients (85%) were alive in the sulphomucin group and 53 patients (76%) were alive in the sialomucin group. Regression analysis predicted five year survivals of 32.8% and 18.9% for the sulphomucin and sialomucin groups respectively. Abnormal mucus production at the resection margin in patients treated for colorectal carcinoma appears to identify those with a higher risk of local recurrence and reduced survival.     

Treatment of Early Breast Cancer: A Report after Ten Years of a Clinical Trial

A controlled clinical trial has been carried out to compare radical mastectomy with wide excision (extended tylectomy) in the treatment of early breast cancer. Only patients aged 50 and over were included and 370 entered the trial during a period of 10 years. Postoperative radiotherapy was given in each case. In patients with clinically involved axillary nodes there was a significantly higher incidence of local and distant recurrence in those having a wide excision, and the survival of these patients was significantly less than those who had a radical mastectomy. In patients with clinically uninvolved nodes, although there was a significantly higher incidence of local recurrence in those having a wide excision, there was no increased incidence of distant recurrence and the survival rate was similar to those having a radical mastectomy.     

Features of overall and local immunity in patients which chronic rhinitis of different etiology

The systemic and mucosal immune status in 50 patients with all-year-round allergic rhinitis (AYRAR), chronic infectious rhinitis (CIR) and non-atopic eosinophilic rhinitis (NER) was evaluated. Patients with concomitant pathology (bronchicial asthma, chronic bronchitis, sinusitis, etc.) were found to have changes in the systemic immunity. Patients with AYRAR and CIR had a high level of SIgA in their nasal secretions, and in the latter--also an elevated level of local IgG NER patients exhibited a considerable decrease in local production of immunoglobulins. In the nasal secretions of AYRAR and CIR patients high phagocytic activity of neutrophilis was established in the nitro blue tetrazolum test. The results of the study showed the expediency of determination of immune disturbances in these patients with a view to administration of immunocorrective therapy.     

Side Effects of Long-Acting Local Anaesthetics in Patients with Preexisting Cardiovascular Condition

The oral surgical anaesthesia is field in which usually long-acting local anaesthetics are being used. Some of the currently used acting local anaesthetics as Levobupivacaine or Ropivacaine have reduced cardiac toxicity. The aim of this review is to provide an overview of acting mechanisms when anaesthetic agents are applied in oral surgery and the effect that they may have in patients with chronic concurrent cardiac conditions. There are notable linking the property of the local anaesthetics lipid solubility and the potency of local anaesthetic-induced vasoconstriction which can additionally compromise cardiac function in patients with previously impaired cardiac function.     

脑转移瘤局部推量的临床观察

目的：观察脑转移瘤放射治疗局部推量的疗效。方法：回顾性分析63例进行放射治疗脑转移瘤病人,采用6MeV-X线,两侧平行相对野作全脑照射,临床靶体积（CTV）包括肿瘤靶体积（GTV）及周围水肿区,处方剂量为30-40Gy,分割次数为10-20次。其中27例缩野后局部推量20Gy。分析常规处方剂量后进行局部推量与未进行局部推量的两个组别局部区域复发率（LRR）、总生存率（OS）和KPS评分改变的差别。结果：中位随访6个月。局部推量组和未局部推量组的LRR分别为18.5%（5/27）和27.8%（10/36）;局部推量组和未局部推量组的OS分别为85.2%（23/27）和77.8%（28/36）;局部推量组和未局部推量组的KPS〉=70分别为18和19。结论：脑转移瘤常规处方剂量放疗后进行局部推量对脑转移瘤的局部控制率及KPS评分有益。     

术中局部化疗对大肠癌患者预后影响的临床观察

目的：观察术中局部化疗对大肠癌患者的预后影响,探讨提高大肠癌患者临床疗效的辅助治疗方法。方法：选择DuckB期和DuckC期患者76例,根据自愿的原则均分为常规手术组和术中化疗组,常规手术组采取常规手术治疗,术中化疗组在常规手术过程中给予局部化疗治疗,比较两组患者术后第7d血常规、肝肾功能及两组患者术后并发症,并随访两组患者术后12个月和24个月局部复发情况。结果：两组患者在术后血常规、肝肾功能及术后并发症方面比较,差异无统计学意义（P〉0．05）;术后12个月和24个月局部复发病例比较,差异具有统计学意义①〈0．05）,术中化疗组显著少于常规手术组。结论：在DuckB期和DuckC期大肠癌患者外科手术治疗过程中．应积极采取术中化疗的治疗措施。     

The effect of the spontaneous level of the chromosome aberration rate on its alterations after a single local irradiation

With X-ray examinations of the stomach and duodenum, changes in chromosomal aberration frequencies in peripheral blood lymphocytes were shown to depend on the spontaneous level of these aberrations in patients exposed to a single local irradiation by 25 R. The cytogenetic efficiency of radiation exposure was found to be local in patients with the lower frequency of spontaneous chromosomal aberrations. A genetic genesis of the revealed dependence is supposed. The effect of irradiation on the correlation between radiosensitivity and radioresistance of the cytogenetic process is regarded as a possible mechanism of the appearance of the observed dependence.     

Orcadian Changes in Stimulus Threshold and in the Effect of a Local Anaesthetic Drug in Human Teeth: Studies with an Electronic Pulptester

An electronic puiptester with constant testing current was used to study the stimulus threshold in human teeth of 28 healthy volunteers and the duration of local anaesthesia by articaine plus epinephrine in 55 patients with caries who underwent a filling therapy. In 21 out of the 28 volunteers, significant daily variations in stimulus threshold were detected by cosinor analysis. Acrophases, however, were scattered over the 24-hr scale. In patients, the local anaesthetic effect was studied at four different times of day (0800,1100,1400 and 1700 hr). The electronic device allowed one to accurately determine the time to peak effect (T_max), duration of effect (E_max, time to return to baseline threshold (T_ret) and the area under the time-effect curve (AUC) as a measure of the total local anaesthetic effect. Significant diurnal variations in AUC and E_max were found in 36 patients with the 0.8 ml dose, with peak and trough values at 1400 and 1700 hr, respectively. No differences in effect were found with the low dose of 0.4 ml applied to 19 patients either at 1400 or 1700 hr giving evidence for a circadian phase-dependency in the dose-response relationship of a local anaesthetic drug. The results clearly demonstrate that this electronic device is suitable for exact evaluation of circadian changes in local anaesthetic effects. Under drug-free control conditions, however, the low stimulus frequence of 5 Hz of this device obviously does not allow to discriminate between stimuli modified by pain perception and/or alertness.     

脐血干细胞局部注射治疗坏死溃疡期巨大压疮1例并文献复习

目的：探讨脐血干细胞局部肌内注射治疗坏死溃疡期巨大压疮的临床治疗效果。方法：坏死溃疡期巨大压疮合并瘘道患者,经常规综合治疗2月,伤口不能愈合,采用脐血干细胞局部肌内注射治疗,治疗后观察局部血液循环及肉芽组织生长情况。结果：局部血液循环改善,肉芽组织生长迅速,4周创面及瘘道痊愈。结论：对于经目前各种综合治疗和护理无效的坏死溃疡期巨大压疮患者,脐血干细胞局部肌内注射治疗是简单、安全、有效的方法,医护人员对这种治疗方法应持更为积极的态度。     

完整胃系膜切除治疗胃癌的研究进展

目前胃癌的主要治疗方式仍是手术治疗,标准D2根治术已得到推广,但胃癌术后的局部复发仍是导致患者远期预后不佳的重要因素。早期胃癌患者的检出率低和手术淋巴结清扫的不规范及胃周软组织切除的不彻底是导致胃癌患者局部复发的重要因素。全直肠系膜切除(TME)和完整结肠系膜切除(CME)对降低结直肠癌术后局部复发效果明显,相同进展程度下远期预后明显好于胃癌。近年提出的完整胃系膜切除治疗胃癌可能会降低胃癌术后局部复发,改善患者预后,规范了完成胃癌根治术的完整流程标准,对于胃癌手术的规范化实施达到整块切除具有指导意义,随着微创理念不断的深入,腹腔镜的应用与发展使我们对系膜的认识更加深入,我们对完整胃系膜切除治疗胃癌的现状及研究进展进行综述如下。     

Comparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancer.

STUDY OBJECTIVE--Comparison of tamoxifen and mastectomy in treatment of breast cancer in elderly patients. DESIGN--Randomised trial of treatment of operable breast cancer by wedge mastectomy or tamoxifen, with median follow up 24 and 25 months respectively (range 1-63). SETTING--University hospital; most patients from primary catchment area. PATIENTS--135 consecutive patients with breast cancer aged over 70 with operable tumours (less than 5 cm maximum diameter); 68 were allocated to tamoxifen group and 67 to mastectomy group. Histological diagnosis by biopsy. Two incorrect randomisations in each group. Patient characteristics similar in the two groups and all under care of one surgical team. INTERVENTIONS--Mastectomy group received wedge mastectomy plus excision of symptomatic axillary lymph nodes. Tamoxifen group received continuous treatment with tamoxifen 20 mg twice daily. Patients in tamoxifen group received wedge mastectomy if there was sign of local progression. Those in mastectomy group received further excision or radiotherapy for locoregional recurrence and when local treatments had been exhausted or metastatic disease diagnosed they received tamoxifen. END POINT--Treatment efficacy was assessed by local control of disease and by survival. MAIN RESULTS--Mortality from metastatic cancer in tamoxifen group was 7 (10.6%) and in mastectomy group 10 (15.3%) (NS). There was no difference in survival between the two groups. In mastectomy group 70% remained alive and free of local recurrence at 24 months; in tamoxifen group only 47% remained alive and free of local progression. In mastectomy group locoregional recurrence occurred in 16 patients and metastatic disease in 13; in tamoxifen group locoregional progression occurred in 29 patients and metastatic disease in seven. CONCLUSIONS--As a high proportion of patients treated with tamoxifen eventually required surgery treatment of elderly patients with breast cancer should include mastectomy. Optimum treatment may include both mastectomy and tamoxifen.     

血清HE4、VEGF、MCP-1及CCL20与乳腺癌患者保乳术后局部复发的关系研究

摘要 目的：探讨血清人附睾蛋白4（HE4）、血管内皮生长因子（VEGF）、单核细胞趋化因子-1（MCP-1）及CC趋化因子配体20（CCL20）与乳腺癌患者保乳术后局部复发的关系。方法：选择2015年7月~2018年7月期间本院收治的乳腺癌患者312例作为研究对象,均符合保乳术手术指征,成功实施乳腺癌保乳术,所有患者均随访3年。检测两组血清HE4、VEGF、MCP-1、CCL20水平情况,单因素及多因素Logistic回归分析影响术后局部复发的因素。使用受试者工作特征（ROC）曲线分析HE4、VEGF、MCP-1、CCL20水平单独及联合检测对保乳术后局部复发的预测价值。结果：随访过程中失访6例,剩余的306例患者根据随访结果,分为局部复发组27例、无局部复发组279例,局部复发率为8.82%。局部复发组的血清HE4、VEGF、MCP-1、CCL20水平均高于无局部复发组（P<0.05）。单因素分析结果显示,乳腺癌患者保乳术后局部复发与年龄、淋巴结转移、切缘状态、人表皮生长因子受体2（Her-2）、细胞增殖相关抗原（Ki-67）、术后规范化疗、术后足程放疗有关（P<0.05）。多因素Logistic回归分析结果显示术后规范化疗、年龄偏高、术后足程放疗是保乳术后局部复发的保护因素,HE4、VEGF、MCP-1、CCL20水平偏高,切缘状态、Her-2、Ki-67阳性以及淋巴结转移是保乳术后局部复发的危险因素（P<0.05）。HE4、VEGF、MCP-1、CCL20联合应用预测乳腺癌患者保乳术后局部复发的效能高于单一指标应用。结论：乳腺癌保乳术后局部复发患者体内HE4、VEGF、MCP-1、CCL20水平高表达,四指标联合检测可辅助预测保乳术后局部复发。且乳腺癌患者保乳术后复发还受到切缘状态、Her-2、Ki-67等多种因素的影响。