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Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.
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Objective:To analyze locoregional recurrence (LRR) pattern of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, with and without adjuvant radiotherapy (RT). Methods:A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included. The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed. The Kaplan-Meier method was used to calculate the cumulative LRR rate, and the difference was compared by the log-rank test.Results:With a median follow-up time of 63.8 months for the entire cohort, 395 patients developed LRR. The chest wall and supraclavicular fossa were the most common LRR sites, regardless of RT or molecular subtypes. The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%( P=0.003); the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%( P<0.001); the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%( HR=0.31, 95% CI: 0.04-2.23, P=0.219); and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%( HR=0.45, 95% CI: 0.11-1.90, P=0.268). Conclusions:The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, which is not affected by adjuvant RT or molecular subtypes. The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area. However, axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.
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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 analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.@*Methods@#From September 1997 to April 2015, 2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital. 1898 patients who did not undergo adjuvant radiotherapy were included in this study. The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the prognostic factors were identified in univariate analyses with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis.@*Results@#With a median follow-up of 71.3 months (range 1.1-194.6), 164 patients had LRR, including supraclavicular/infraclavicular lymph nodes in 106(65%), chest wall in 69(42%), axilla in 39(24%) and internal mammary lymph nodes (IMNs) in 19 patients (12%). In multivariate analysis, age (>45 years vs.≤45 years), tumor location (other quadrants vs. inner quadrant), T stage (T1 vs. T2), the number of positive axillary lymph nodes (1 vs. 2-3), hormone receptor status (positive vs. negative) were significant prognostic factors for both LR and RR.@*Conclusions@#In patients with T1-2N1 breast cancer after modified radical mastectomy, the most common LRR site is supraclavicular/infraclavicular nodal region, followed by chest wall. The axillary or IMN recurrence is rare. The prognostic factors for LR and RR are similar, which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective@#To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.@*Methods@#From December 2011 to December 2015, 152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed. The overall survival (OS) after treatment failure, clinical efficacy and prognostic factors of different salvage treatments were analyzed. OS was calculated by Kaplan-Meier method. Prognostic analysis was performed by using multivariate Cox regression model.@*Results@#The median interval of the first recurrence was 10.6(2.0 to 69.1) months. The median OS after recurrence was 8.0(0.8 to 43.3) months. The 1-, 2-and 3-year OS rates after recurrence were 36.0%, 15.1% and 5.2%, respectively. The median OS of patients with locoregional recurrence alone, distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months, 6.7(1.2 to 28.6) months and 5.1(0.8 to 22.9) months, respectively. Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009), ypTNM stage (P=0.012), comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma.@*Conclusions@#Neoadjuvant therapy, ypTNM stage, recurrence pattern and post-recurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory. After recurrence, combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment.
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Objective To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.Methods From September 1997 to April 2015,2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital.1898 patients who did not undergo adjuvant radiotherapy were included in this study.The distribution of accumulated LRR was analyzed.The LR and RR rates were estimated by the Kaplan-Meier method,and the prognostic factors were identified in univariate analyses with Log-rank test.Multivariate analysis was performed using Cox logistic regression analysis.Results With a median follow-up of 71.3 months (range 1.1-194.6),164 patients had LRR,including supraclavicular/infraclavicular lymph nodes in 106(65％),chest wall in 69(42％),axilla in 39(24％) and internal mammary lymph nodes (IMNs) in 19 patients (12％).In multivariate analysis,age (＞45 years vs.≤45 years),tumor location (other quadrants vs.inner quadrant),T stage (T1 vs.T2),the number of positive axillary lymph nodes (1 vs.2-3),hormone receptor status (positive vs.negative) were significant prognostic factors for both LR and RR.Conclusions In patients with T1-2N1 breast cancer after modified radical mastectomy,the most common LRR site is supraclavicular/infraclavicular nodal region,followed by chest wall.The axillary or IMN recurrence is rare.The prognostic factors for LR and RR are similar,which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Methods From December 2011 to December 2015,152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed.The overall survival (OS) after treatment failure,clinical efficacy and prognostic factors of different salvage treatments were analyzed.OS was calculated by Kaplan-Meier method.Prognostic analysis was performed by using multivariate Cox regression model.Results The median interval of the first recurrence was 10.6(2.0 to 69.1) months.The median OS after recurrence was 8.0(0.8 to 43.3) months.The 1-,2-and 3-year OS rates after recurrence were 36.0％,15.1％ and 5.2％,respectively.The median OS of patients with locoregional recurrence alone,distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months,6.7(1.2 to 28.6) months and 5.1 (0.8 to 22.9) months,respectively.Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009),ypTNM stage (P=0.012),comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma.Conclusions Neoadjuvant therapy,ypTNM stage,recurrence pattern and postrecurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory.After recurrence,combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment.
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Objective@#To investigate the locoregional benefit from adjuvant anti-HER-2 target therapy and the possibility of omitting postmastectomy radiation therapy (PMRT) in HER-2 positive breast cancer patients.@*Methods@#Clinical data of 1398 patients diagnosed with HER-2+ breast cancer admitted to our hospital who underwent mastectomy without PMRT from 2009 to 2014 were retrospectively analyzed, and 370 of them received adjuvant anti-HER-2 target therapy mainly with trastuzumab.@*Results@#Anti-HER-2 target therapy significantly improved the disease-free survival (DFS) and overall survival (OS), whereas reduced the locoregional recurrence (LRR) insignificantly. Multivariate analysis demonstrated that anti-HER-2 target therapy improved the locoregional recurrence-free survival (LRRFS)(P=0.06). After propensity score matching, the 5-year LRR rate was 4.4% vs. 6.4%(P=0.070) for those treated with and without anti-HER-2 target therapy. Subgroup analysis revealed that the locoregional control benefit was only significant in patients with pathological Grade Ⅰ-Ⅱtumors (2.5% vs. 5.9%, P=0.046). For patients with pN1 tumors with and without anti-HER-2 target therapy, the 5-year LRR rate was 8.2% vs. 12.3%(P=0.150). Patients with hormone receptor-positive tumors obtained significant benefit from anti-HER-2 target therapy. The 5-year LRR rate could be less than 5% in patients with favorable risk factors who received anti-HER-2 target therapy.@*Conclusions@#Anti-HER-2 target therapy with trastuzumab can improve the LRRFS of patients with HER-2+ breast cancer after mastectomy. Nevertheless, patients with radiotherapy indications have to receive radiotherapy due to relatively high recurrence rate. Newly approved dual HER-2 blockade is a promising approach to further reduce LRR. Subgroup analysis is required to identify the low-risk patients.
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PURPOSE: The indication of elective neck treatment (ENT) for clinically N0 (cN0) paranasal sinus (PNS) carcinoma remains unclear. We aimed to investigate different treatment outcomes regarding ENT and propose optimal recommendations for ENT. MATERIALS AND METHODS: We identified patients with cN0 PNS carcinoma who underwent curative-intent treatment between 1992 and 2015. Survival outcomes and pattern of failure were compared between patients who received ENT and those who did not. We sought to identify significant patient or pathologic factors regarding treatment outcomes. RESULTS: Among 124 patients meeting the inclusion criteria, 40 (32%) received ENT (‘ENT (+) group’) and 84 (68%) did not (‘ENT (−) group’). With a median follow-up of 54 months, the 5-year overall survival (OS) was 67%, and the 5-year progression-free survival (PFS) was 45%. There was no significant difference between the ENT (+) and ENT (−) groups regarding OS (p = 0.67) and PFS (p = 0.50). Neither group showed a significantly different pattern of failure, including regional failure (p = 0.91). There was no specific benefit, even in the subgroups analysis by tumor site, histologic type, and T stage. Nevertheless, patients who ever had regional and/or distant failure showed significantly worse prognosis. CONCLUSION: ENT did not significantly affect the survival outcome or pattern of failure in patients with cN0 PNS carcinomas, showing that ENT should not be generalized in this group. However, further discussion on the optimal strategy for ENT should continue because of the non-negligible regional failure rates and significantly worse prognosis after regional failure events.
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Humans , Disease-Free Survival , Follow-Up Studies , Neck , Prognosis , Treatment OutcomeABSTRACT
Objective:To observe the locoregional recurrence and survival of stageⅢA-N2 non-small cell lung cancer (NSCLC) after in-duction chemotherapy and surgery, to analyze the prognosis influenced by nodal downstaging, and to explore the necessity for postop-erative radiotherapy. Methods:A total of 116 cases of stageⅢA-N2 NSCLC were treated with induction chemotherapy and surgery be-tween January 2009 and June 2014. These cases underwent R0 resection. Kaplan-Meier method was employed to calculate the local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) of the patients. Log-rank test was con-ducted to compare the differences between groups. Cox models were used to perform multivariate analysis. Results:The median fol-low-up of the patients was 24.42 months. The numbers of patients with pN0, pN1, and pN2 were 40 (34.5%), 16 (13.8%), and 60 (51.7%), respectively. The 3-year local recurrence rates of patients with pN0, pN1, and pN2 were 27.5%, 56.2%, and 51.7%, respectively. In the group treated with adjuvant chemotherapy, the 3-year local-recurrence rates of patients with pN0, pN1, and pN2 were 26.9%, 58.3%, and 46.2%, respectively. Multivariate analysis revealed that the significant predictor of LRFS was pN0 during the surgery. The LRFS of patients with pN0 was greater than that of the patients with pN1 (P=0.048). The LRFS of patients with pN1 was not significantly associated with that of patients with pN2 (P=0.314). The 5-year OS rate of the groups was 46.6%. The multivariate analysis also demon-strated that pT1, pN0-1, and induction chemotherapy effects were associated with OS. The patients with pN2 yielded a poorer OS than those with pN0 and pN1 (P<0.05). The patients with pN0 did not significantly differ from those with pN1 in terms of OS (P=0.412). Conclu-sion:Although the occurrence of pathologic downstaging is a well-known positive prognostic indicator after stageⅢ-N2 NSCLC is sub-jected to chemotherapy, the local-recurrence rate of nodal-downstaged patients remains high, even when they receive adjuvant che-motherapy. Therefore, new postoperative strategies after induction chemotherapy and surgery should be developed.
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PURPOSE: To analyze the results of locoregional and systemic therapy in the breast cancer patients with locoregional recurrence (LRR) after mastectomy. MATERIALS AND METHODS: Seventy-one patients who received radiotherapy for isolated LRR after mastectomy between January 1999 and December 2009 were retrospectively reviewed. Among the 71 patients, 59 (83.1%) underwent wide excision and radiotherapy and 12 (16.9%) received radiotherapy alone. Adjuvant hormonal therapy was given to 45 patients (63.4%). Oncologic outcomes including locoregional recurrence-free survival, disease-free survival (DFS), and overall survival (OS) and prognostic factors were analyzed. RESULTS: Median follow-up time was 49.2 months. Of the 71 patients, 5 (7%) experienced second isolated LRR, and 40 (56%) underwent distant metastasis (DM). The median DFS was 35.6 months, and the 3- and 5-year DFS were 49.1% and 28.6%, respectively. The median OS was 86.7 months, and the 5-year OS was 62.3%. Patients who received hormone therapy together showed better 5-year DFS and OS than the patients treated with locoregional therapy only (31.6% vs. 22.1%, p = 0.036; 66.5% vs. 55.2%, p = 0.022). In multivariate analysis, higher N stage at recurrence was a significant prognostic factor for DFS and OS. Disease free interval (30 months) from mastectomy to LRR was also significant for OS. The patients who received hormone therapy showed superior DFS and showed trend to better OS. CONCLUSION: DM was a major pattern of failure after the treatment of LRR after mastectomy. The role of systemic treatment for LRR after mastectomy should be investigated at prospective trials.
Subject(s)
Humans , Breast , Breast Neoplasms , Disease-Free Survival , Follow-Up Studies , Mastectomy , Multivariate Analysis , Neoplasm Metastasis , Recurrence , Retrospective StudiesABSTRACT
PURPOSE: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/mortality , Neoplasm Recurrence, Local/radiotherapy , Survival Rate , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: A total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment. RESULTS: High MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; p < 0.001). A cut-off value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis. CONCLUSION: MTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.
Subject(s)
Humans , Carcinoma, Squamous Cell , Chemoradiotherapy , Disease-Free Survival , Electrons , Follow-Up Studies , Head , Head and Neck Neoplasms , Neck , Neck Dissection , Positron-Emission Tomography , Radiotherapy, Adjuvant , Recurrence , ROC Curve , Tumor BurdenABSTRACT
PURPOSE: Despite the increasing use of breast-conserving therapy, modified radical mastectomy retains an important primary treatment of breast cancer. The aim of this study was to evaluate the survival of patients with isolated locoregional recurrence (LR) and the prognostic factors for LR after mastectomy. METHODS: We retrospectively analyzed 76 patients who were treated for LR after mastectomy at our hospital between 1987 and 2002. These patients had only isolated LR. The following parameters were analyzed: primary tumor size, primary nodal status, stage, estrogen receptor status, treatment modalities for LR, disease free interval from primary operation and re-recurrence interval. RESULTS: The median time to develop LR was 18.4 months and the median follow-up period from LR was 19.3 months (range 1.3~113 months). The 2-year overall survival rate from LR showed 46% and 5-year overall survival rate was 15%. Out of 76 patients, 47 patients (61.8%) developed re-recurrence and the median duration to re-recurrence was 9.6 months. The pattern of re-recurrence showed 45 patients with systemic recurrence and 2 patients with LR. The initial node status (P=0.041), the estrogen receptor status (P=0.009) and re-recurrence interval from LR (P=0.017) were statistically significant factors for survival. The primary tumor size, the stage, the disease free interval, and the treatment modalities for LR were not statistically significant. CONCLUSION: The re-recurrence rate after isolated LR in patients with breast cancer showed 61.8% and these patients almost always had systemic recurrence. This study could not show the difference of survival according to the treatment modality for LR but the systemic treatment should be considered for the patients with unfavorable prognostic factors.
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Humans , Breast Neoplasms , Estrogens , Follow-Up Studies , Mastectomy , Mastectomy, Modified Radical , Prognosis , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. METHODS: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). RESULTS: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12~86). During a mean follow-up of 32.5+/-18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P 1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.
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Female , Humans , Male , Carcinoma, Papillary , Follow-Up Studies , Lymph Nodes , Mortality , Multivariate Analysis , Neck , Neoplasm Metastasis , Recurrence , Thyroid Gland , Thyroidectomy , Treatment OutcomeABSTRACT
PURPOSE: The locoregional recurrence (LRR) in breast cancer, without distant metastasis has traditionally been regarded as a predictor of subsequent distant metastasis. This study was designed to attain the survival rate, disease progress in patients with a LRR only and to approve a locoregional treatment able to increase the survival in specific locoregional recurrent breast cancer. METHODS: The records of 223 patients with LRR, after initial treatment at the Asan Medical Center, between 1989 and 2003, were retrospectively reviewed. The patients were classified into the LRR only and simultaneous distant metastasis groups with the LRR group subdivided into the operable and inoperable groups. The data were analyzed using SPSS 11.0. RESULTS: There were 152 and 71 patients in the LRR only and simultaneous distant metastasis groups respectively: 105 patients in the LRR only group were operable cases. The 5-year survival rate of LRR was 42.5%, but this was 50.1% in the LRR only group. The 5-year survival rates following a recurrence in the operable and inoperable groups were 66.2% and 21.1%. On multivariate analysis, age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. The operable group indicated less tumor size at the primary surgery, less lymph node metastasis and more chest wall or axillary lymph node recurrences, compared to the inoperable group. CONCLUSION: In some of the LRR only cases, the survival rate was relatively good, especially in the operable group. Age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. Surgical treatment could be resulted in good responses to the LRR patients with early stage or chest wall or axillary recurrences.
Subject(s)
Humans , Breast Neoplasms , Breast , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Recurrence , Retrospective Studies , Survival Rate , Thoracic WallABSTRACT
PURPOSE: This study was performed to evaluate the patterns of secondary failure, and the prognostic factors for survival, following surgical treatment of an isolated locoregional recurrence after a mastectomy in breast cancer patients. METHODS: Forty-nine patients, who had undergone an excision, or a wide excision, either with or without radiation therapy, for an isolated locoregional recurrence following a mastectomy, between 1991 and 2001, were retrospectively analyzed according to the secondary recurrence patterns, the time to the secondary failure, survival rate, and prognostic factors for survival. RESULTS: During the 33 month median follow-up, 28 patients (57%) developed a secondary recurrence; an isolated locoregional failure in 7 (25%), a systemic dissemination in 20 (71%), and both in 1 (4%). The median times from the first recurrence to the second failure, according to the pattern of the secondary failure, were 16, 14 and 6 months for locoregional, for systemic dissemination, and for both, respectively. The disease-free interval (DFI) from first surgery to the recurrence was a significant independent prognostic factor for the second failure. A Univariate analysis identified the DFI, and hormone therapy administered due to a recurrence, as significant prognostic factors for overall survival, but these were not from a multivariate analysis. The 5-year disease- free and overall survival rates for an isolated locoregional recurrence were 27% and 79%, respectively, compared with 0% for both these rates for a recurrence combined with a systemic recurrence (P=0.002). CONCLUSION: A secondary failure, following treatment of an isolated locoregional recurrence, developed in more than half the patients, with a locoregional failure in 25%, and a systemic dissemination in the remainder. DFI and hormone therapy for a recurrence were independent prognostic factors of the overall survival. The survival rates after surgical treatment of isolated locoregional recurrences were increased compared with those for a recurrence combined with a systemic recurrence.
Subject(s)
Humans , Breast Neoplasms , Breast , Follow-Up Studies , Mastectomy , Multivariate Analysis , Recurrence , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Cutaneous involvement from breast cancer is rarely seen in dermatologic clinics although the breast is the most common source of cutaneous metastasis in women. OBJECTIVE: Our purpose was to study the clinical and histopathological characteristics of cutaneous involvement from breast cancer in our hospital. METHODS: A clinical and histopathological observation was made analyzing 42 cases of cutaneous involvement from breast cancer during the last 13 years from 1990 to 2002 in Asan Medical Center. RESULTS & CONCLUSION: The mean age at diagnosis of breast cancer was 45.8 years. The most common histologic type was infiltrating ductal carcinoma(39 cases), followed by infiltrating lobular carcinoma(1 case) and malignant cystosarcoma phyllodes(1 case). The patterns of cutaneous manifestations were nodular(22 cases), lymphadenopathic(10 cases), inflammatory(5 cases), indurated(3 cases), and zosteriform(2 cases). The sites of locoregional recurrence(LRR) were as follows: the chest wall(28 cases), the ipsilateral supraclavicular node(8 cases), the axillary node(2 cases). The sites of distant skin metastasis were as follows: the contralateral chest wall(6 cases), the scalp(5 cases), the arm(3 cases), the abdomen(1 case), the finger(1 case). LRR or distant skin metastasis appeared within the first decade after treatment in all patients.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Diagnosis , Neoplasm Metastasis , Skin , ThoraxABSTRACT
BACKGROUND: Cutaneous involvement from breast cancer is rarely seen in dermatologic clinics although the breast is the most common source of cutaneous metastasis in women. OBJECTIVE: Our purpose was to study the clinical and histopathological characteristics of cutaneous involvement from breast cancer in our hospital. METHODS: A clinical and histopathological observation was made analyzing 42 cases of cutaneous involvement from breast cancer during the last 13 years from 1990 to 2002 in Asan Medical Center. RESULTS & CONCLUSION: The mean age at diagnosis of breast cancer was 45.8 years. The most common histologic type was infiltrating ductal carcinoma(39 cases), followed by infiltrating lobular carcinoma(1 case) and malignant cystosarcoma phyllodes(1 case). The patterns of cutaneous manifestations were nodular(22 cases), lymphadenopathic(10 cases), inflammatory(5 cases), indurated(3 cases), and zosteriform(2 cases). The sites of locoregional recurrence(LRR) were as follows: the chest wall(28 cases), the ipsilateral supraclavicular node(8 cases), the axillary node(2 cases). The sites of distant skin metastasis were as follows: the contralateral chest wall(6 cases), the scalp(5 cases), the arm(3 cases), the abdomen(1 case), the finger(1 case). LRR or distant skin metastasis appeared within the first decade after treatment in all patients.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Diagnosis , Neoplasm Metastasis , Skin , ThoraxABSTRACT
PURPOSE: In spite of improved local control and adjuvant therapy in breast cancer, many patients after a modified radical mastectomy suffer from locoregional or systemic failure. The purpose of this study was to assess both the patterns of failure following a mastectomy and the predictive factors affecting the risks of locoregional or systemic failure. METHODS: The study population consisted of 195 patients who developed locoregional or systemic failure from among 1,187 patients treated by using a modified radical mastectomy between July 1989 and October 1998 at the Asan Medical Center's Breast Clinic. The median follow-up time following the mastectomy was 41 months (range; 1-119 months). RESULTS: Isolated locoregional recurrence (LRR) developed in 46 patients (24%), LRR with distant metastasis in 43 (22%), and only distant metastasis in 106 (54%). The sites of LRR were as follows: the chest wall, 52%; the ipsilateral supraclaviclar node, 22%; and the axillary node, 15%; etc. The first sites of distant metastasis were as follows: bone, 46%; lung, 38%; liver, 12%; brain, 6%; and pleura, 6%; etc. Local or systemic failure appeared within the first 3 years following the mastectomy in 75-82% of the patients, and within 5 years in 95-98%. Multivariate analysis showed that increasing initial tumor size, increasing number of involved nodes, negative progesterone receptor, and increasing histologic grade were significant factors for increased risks of LLR or distant metastasis. CONCLUSION: Half of the locoregional recurrences following a mastectomy are isolated. T-stage, nodal status, progesterone receptor, and histo logic grade may help to identify patients at risk for locoregional or systemic failure after a mastectomy.