Therapeutic management and outcome of locoregional recurrence after curative colorectal cancer therapy-a single-center analysis.

Locoregional tumor recurrence after curative therapy for colorectal cancer is therapeutically challenging and associated with poor prognosis. Goal of this single-center study was to analyze patients with locoregional recurrence with regard to therapeutic strategies and outcome for colon and rectal cancer each. Charts of all patients surgically treated for colorectal cancer in the period from 2000 to 2011 (n = 1296) were examined; patients with locoregional recurrence (n = 86) were then further analyzed. Fifty-three (10.2%) patients with rectal and 33 (5.6%) patients with colon cancer developed a locoregional recurrence, median 24.5 months after first diagnosis. Recurrence-specific therapy was applied in the majority of the patients (84.8% colon, 90.7% rectum); a surgical approach was undertaken in 82.1% (colon) and in 56.3% (rectum). Five-year overall survival after locoregional recurrence was 13% for rectal cancer and 9% for colon cancer. Itemized analysis for the approached therapeutic regimens revealed that radical recurrence resection (R0) significantly prolongs overall survival (p = 0.003) in rectal cancer, as does a surgical approach itself, as compared to conservative treatment modalities. If feasible, oncologic radical resection of the relapse (R0) significantly influences patient outcome and overall survival in rectal cancer.

[Consensus diagnosis and therapy of soft tissue sarcoma]. / Konsensus Diagnose und Therapie von Weichteilsarkomen.

Soft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.

High-dose-rate intraoperative brachytherapy (IOHDR) using flab technique in the treatment of soft tissue sarcomas.

BACKGROUND: Adjuvant radiotherapy has been shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should therefore be able to further diminish the rate of local recurrence even when performing marginal resection. There are sparse data on IOHDR using flab applicators as adjuvant boost to EBRT in combination with marginal resection of soft tissue sarcomas. PATIENTS AND METHODS: Within a period of 8 years, we prospectively studied 39 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 32 high-grade and seven low-grade tumors, 35 were > 5 cm. Mean follow-up was 26 months (range 3-59 months). RESULTS: We could not detect any local recurrences. No treatment-related loss of limb or life occurred. There were no neurologic or vascular complications, all patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 88.5 (70-100). Treatment-related wound morbidity occurred in eleven patients necessitating revision surgery in eight. Metastatic disease developed in seven patients, six of them had died. The 2-year actuarial disease-free survival was 84%. CONCLUSIONS: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to optimal local control rates and limited functional impairment.