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Objective:To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes.Methods:Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS).Results:With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR ( P<0.001) and PFS ( P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest ( P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions ( P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%( P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions:Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.
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Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
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Objective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.
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OBJECTIVE@#To summarize the effect of different treatment of cervical lymph node on the prognosis of patients with clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC), and to explore the significance of selective neck dissection of levels II, III and(or) IV on SGLC patients with cN0 neck.@*METHOD@#A retrospective analysis was undertaken for 83 supraglottic laryngeal squamous cell carcinoma patients with cNo from January 2003 to May 2007 at the Department of Otolaryngology, First Affiliated Hospital of Zhengzhou University. All medical records was complete and all primary tumor were resected by surgery, the follow-up time was at least 5 years or until patients died. The patients' five year survival rate was compared between the selective neck dissection group and other three groups (neck radiotherapy group, combined therapy group and 'wait and see' policy group).@*RESULT@#The rate of cervical lymph node metastasis of cN0 supraglottic carcinoma patients with cN0 neck was 30.77%, and with the increasing of T stage, the rate of cervical lymph node metastasis increased gradually. The cervical lymph node recurrence rate of intervention groups was significantly lower than that of 'wait and see' group (P 0.05) of 5-year survival rate between selective neck dissection group, neck radiotherapy group, combined therapy group was observed, the difference was significant between selective neck dissection group and observation group (P < 0.05).@*CONCLUSION@#Selective neck dissection is one of effective measures to process neck lymph node for cN0 SGLC clinically.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Pathology , General Surgery , Glottis , Pathology , Laryngeal Neoplasms , Pathology , General Surgery , Neck Dissection , Methods , Neoplasm Staging , Prognosis , Retrospective StudiesABSTRACT
OBJECTIVE@#To study a better surgical approach for the resection of tumor in the anterior skull base and the fronto-orbito-ethmoidal region.@*METHOD@#Extend external frontal sinus approach was made in the lesion side. The incision can be extended outward to the nasal side or superciliary arch according to the tumors extent and size so as to get a full exposure of tumors of anterior skull base, fronto-orbito-ethmoidal region, or exterior margin of arcola.@*RESULT@#From January 1998 to December 2003, 28 patients suffered tumors of anterior skull base and fronto orbito-ethmoidal region were received tumors resection through this approach. Postoperatively, no death or recurrence have occurred up to now in 8 cases of benign tumors, and the one-year survival rate was 95% (19/20), the three-year survival rate was 61.5% (8/13), and the five-year survival rate was 57.1% (4/7) in 20 cases of malignant tumors.@*CONCLUSION@#This approach provide good exposure. Bleeding is little, operation field is clear, operating is easy re-establish skull base is convenience, surgical trauma is small, and reaction is mild when using decohesion tumors and block blood supply in skull base method. We believe this approach is a better method for resection of tumors in anterior skull base and the fronto-orbito-ethmoidal region.