Serum calcitonin nadirs to undetectable levels within 1 month of curative surgery in medullary thyroid cancer

ABSTRACT Objective: Because serum calcitonin (CT) is a reliable marker of the presence, volume, and extent of disease in medullary thyroid cancer (MTC), both the ATA and NCCN guidelines use the 2-3 month post-operative CT value as the primary response to therapy variable that determines the type and intensity of follow up evaluations. We hypothesized that the calcitonin would nadir to undetectable levels within 1 month of a curative surgical procedure. Subjects and methods: This retrospective review identified 105 patients with hereditary and sporadic MTC who had at least two serial basal CT measurements done in the first three months after primary surgery. Results: When evaluated one year after initial surgery, 42 patients (42/105, 40%) achieved an undetectable basal calcitonin level without additional therapies and 56 patients (56/84, 67%) demonstrated a CEA within the normal reference range. In patients destined to have an undetectable CT as the best response to initial therapy, the calcitonin was undetectable by 1 month after surgery in 97% (41/42 patients). Similarly, in patients destined to have a normalize their CEA, the CEA was within the reference range by 1 month post-operatively in 63% and by 6 months in 98%. By 6 months after curative initial surgery, 100% of patients had achieved a nadir undetectable calcitonin, 98% had reached the CEA nadir, and 97% had achieved normalization of both the calcitonin and CEA. Conclusion: The 1 month CT value is a reliable marker of response to therapy that allows earlier risk stratification than the currently recommended 2-3 month CT measurement.

Analysis of Prognostic Factors after Curative Resection for Gallbladder Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Despite the development in diagnostic tools, gallbladder carcinoma is often diagnosed at an advanced stage. Therefore, early diagnosis and radical resection are most important factors for the prognosis of gallbladder carcinoma. However, prognostic factors after radical resection of gallbladder carcinoma have not been well identified. The aim of this study was to evaluate the prognostic factors of gallbladder carcinoma after curative resection. METHODS: We reviewed the records of the 115 patients with gallbladder carcinoma who underwent curative surgery between 1989 and 2004 at Yonsei University Medical Center (YUMC). The relationship between survival and clinicopathological variables was assessed. RESULTS: In 311 patients presenting with gallbladder carcinoma, 195 patients (62.5%) were radically resected. Among 195 patients, 80 patients were excluded because of incomplete clinicopathologic data and unsatisfactory follow-up. The 5 year overall survival rate was 36.0%, and disease free 5 year survival rate was 3.9%. Univariate analysis showed that survival was closely related to gross morphology, depth of tumor invasion, lymph node metastasis and preoperative serum CA19-9 level. Three significant factors identified by multivariate analysis were depth of tumor invasion, gross morphology, and preoperative serum CA19-9 level. CONLUSIONS: Depth of tumor invasion, gross morphology, and preoperative serum CA19-9 level are independent significant prognostic factors of resectable gallbladder carcinoma.

Intractable Chyloperitoneum after Curative Surgery for Gastrointestinal Malignancy

Chyloperitoneum, also called chylous ascites, is a rarely reported complication of abdominal surgery. In most cases, the diagnosis and treatment is not difficult. The characteristic milky colored odorless fluid is easily detected by drainage or aspiration. With the help of diagnostic radiology and laboratory tests, it has become easier to detect the chyloperitoneum. Chyloperitoneum subsides spontaneously or responds well to medical treatment. Death from chyloperitoneum is extremely rare. However, 3 cases of medically intractable chyloperitoneum were encountered at our hospital after curative surgery for gastrointestinal malignancies (two colorectal cancers and one gastric cancer). Herein, the authors report these case and discuss their treatments.

Recurrent Gastric Cancer after Curative Surgery / 대한암학회지

PURPOSE: Our aim was to determine the patterns of recurrence after curative resection of gastric cancer and to analyze the factors related with recurrence. We hypothesized that aggressive surgical approach including extended lymphadenectomy performed during last several decades may alter the patterns of recurrence. MATERIALS AND METHODS: A retrospective analysis of 91 patients with recurrent gastric cancer after curative surgery at Department of Surgery, College of Medicine, The Catholic University of Korea, from 1989 to 1992. RESULTS: Average time to recurrence was 21.8+/-17.9 months and 64 cases(70.3%) were recurred in 24 months after surgery. The most common type of recurrence was peritoneal dissemination(46.2%), followed by distant lymph node metastasis(24.2%), hematogenous metastasis(19.8%), and local recurrence(7.7%). Borrmann type III and IV, serosal invasion, lymph node metastasis, lymphatic and perineural invasion were the factors associated with recurrence. In peritoneal dissemination, serosal invasion and poorly differentiated adenocarcinoma were high risk factors. Mean duration of life after recurrence was 5.4+/-5.2 months. Re-operation was performed in 12 cases(13.2%), and survival was longer in resection cases compared to non-resection cases(10.9 vs 3.8 months)(p=0.034). CONCLUSION: With the use of aggressive surgical approach, relative incidence of local recurrence has been lowered. On the other hand, peritoneal seeding was the most frequently encountered pattern of recurrence. Serosal invasion, Borrmann type III or IV and poorly differentiated adenocarcinoma were risk factors for peritoneal recurrence. Intensive follow-up examination is strongly suggested during the first 24 months after curative surgery for advanced gastric cancer because of high probability of recurrence in this period. Surgical resection for locally recurrent gastric cancer seems to prolong survival time.

Locally Advanced Rectal Carcinoma: Curative Surgery Alone vs. postoperative Radiotherapy and Chemotherapy / 대한치료방사선과학회지

PURPOSE: To evauate the effects of postoperative radiotherapy an dchemotherapy on the pattern of failure and survival for locally advanced rectal carcinoma, we analyzed the two groups of patients who received curative resection only and who received postoperative radiochemotherapy retrospectively. MATERIALS AND METHODS: From June 1989 to December 1992, ninety nine patients with rectal cancer were treated by curative resection and staged as B2-3 or C. Group I(25) patients received curative resection only and group II(74) patients postoperative adjuvant therapy. Postoperative adjuvant group received radiation therapy (4500 cGy/ 25fx to whole pelvis)with 5-FU (500 mg/M2 , day 1-3 IV infusion) as radiosensitizer and maintenance chemotherapy with 5-FU(400mg/m2 for 5 days) and leuconvorin (20mg/m2 for 5 days) for 6 cycles. RESULTS: The patients in group I and group II were comparable in terms of age, sex, performance status, but in group II 74% of patients showed stage C compared with 56% of group I. All patients were flowed from 6 to 60 months with a median follow up of 29 months. Three year overall survival rates and disease free survival rates were 68%, 64% respectively in group I and 64%, 61%, respectively in group II. There was no statistical difference between the two treatment groups in overall survival rate and disease free survival rate. Local recurrences occurred in 28% of group I, 21% of group II (>0.05) and distant metastases occurred in 20% of group I, 27% of group II(p>0.05). The prognostic value of several variables other that treatment modality was assessed. In multivariate anaysis for prognostic factors stage and histologic grade showed statistically significant effect on local recurrences, and lymphatic or vessel invasion on distant metastasis. CONCLUSION: This retrospective study showed no statistical difference between two groups on the pattern of failure and survival. But considering that group II had more advanced stage and poor prognostic factors that group I, postoperative adjuvant radiochemotherapy improves the results for locally advanced rectal carcinoma as compared with curative surgery alone.