Since the hepatocellular carcinoma (HCC) develops in cirrhotic liver and is often multicentric, liver transplantation (LT) seems to be a rational approach for the treatment of HCC. Current selection criteria of LT for HCC are Milan criteria (single nodule < or = 5 cm , or < or = 3 nodules and Carcinoma, Hepatocellular/etiology/*mortality/*surgery ; Humans ; Liver Cirrhosis/*complications ; Liver Neoplasms/etiology/*mortality/*surgery ; *Liver Transplantation ; Salvage Therapy ; Survival Rate

OBJECTIVETo examine the benefit of restaging recurrent oral squamous cell carcinoma (R-OSCC) and the effect on salvage surgery.

METHODSAn analysis was performed on 30 patients with local only first failure (n = 13) or loca-regional only first failure (n = 9) or first recurrence in the neck (n = 8) after surgery and/or radiation treatment given for oral squamous cell carcinoma. All the 30 patients were restaged and treated with salvage surgery.

RESULTSThe overall survival time and disease-free survival time of patients with early staged R-OSCC was longer than that of patients with advanced staged R-OSCC. The 1-year survival and 1-year disease-free survival rates for early staged R-OSCC is also higher than that of advanced staged R-OSCC.

CONCLUSIONSThe re-stage of the recurrent tumor is significantly correlated with survival. The salvage surgery is an effective measure in patients with recurrent oral squamous cell carcinoma, especially in early staged patients of R-OSCC.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mouth Neoplasms ; mortality ; surgery ; Neoplasm Recurrence, Local ; mortality ; surgery ; Salvage Therapy ; Survival Rate

BACKGROUND AND OBJECTIVEThe efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC) is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC.

METHODSBetween December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dahan Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A) and 29 patients received postoperative chemotherapy combined with radiotherapy (group B). Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT). The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed.

RESULTSThe median survival was 32.5 months in group A and 31.9 months in group B (P = 0.371). Progression-free survival extended about 6 months (P = 0.044). The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P > 0.05). Radioactive esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities were below degree 2. Distant metastases were the main reason of disease progression. There was no significant difference in the rates of local recurrence and metastases between the two groups (P > 0.05).

CONCLUSIONCombined modality therapy should be the main therapy of stage IIIa NSCLC. The addition of radiotherapy can effectively prolong progression-free survival and don't highly increase the toxicities.

Carcinoma, Non-Small-Cell Lung ; drug therapy ; mortality ; radiotherapy ; surgery ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms ; drug therapy ; mortality ; radiotherapy ; surgery ; Male ; Middle Aged

OBJECTIVE: To evaluate the efficacy of combined modality therapy for advanced hypopharyngeal carcinoma in order to improve the curative effect of hypopharyngeal carcinoma. METHOD: Seventy-six male patients with the stage III - IV hypopharyngeal carcinoma were treated with postoperative combined modality. Of all the 76 cases, 44 were treated with postoperative radiotherapy, and the other 32 treated with chemoradiotherapy concurrently. RESULT: Kaplan Meier analysis indicated that the overall 5 survival rates of patients treated with postoperative radiotherapy was 25.9%, and that of patients treated with postoperative chemoradiotherapy was 27.8%. There was no significant difference between the two groups (P>0.05). Three and five years relapse-free survival rates of the patients treated with postoperative radiotherapy were 36.0%, 22.5%, and those of the patients treated with postoperative chemoradiotherapy were 68.0%, 45.3%. Significant difference was calculated between the two groups (P<0.05). According to the NCI CTC3.0 criteria, the toxicities on grade 3 or above of the two groups showed no significant difference (P>0.05). CONCLUSION For advanced hypopharyngeal carcinoma, postoperative chemoradiotherapy yielded satisfactory relapse free survival and laryngeal function preservation rate which was superior to that of postoperative radiotherapy. Also the treatment toxicities were not increased.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; mortality ; surgery ; therapy ; Chemoradiotherapy ; Combined Modality Therapy ; Humans ; Hypopharyngeal Neoplasms ; mortality ; surgery ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Survival Rate

OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy on cervical carcinoma and its association with clinical data. METHODS: A total of 97 patients with stage Ib2 approximately IIIa of cervical cancinoma were treated with neoadjuvant chemotherapy. The effect of chemotherapy, factors associated with outcome of chemotherapy, and histology were analyzed. RESULTS: Effective rate of chemotherapy was 86.6% which was associated with clinical stage and histology. Eight-four patients received radical hysterectomy. The histological grade of 17 patients was lowered, lymph nodes in 19 patients were positive, and 6 patients had parametrium invasion. One patient died within 1 year after the operation, and 5 patients recurred. CONCLUSION The effect of neoadjuvant chemotherapy for locally advanced cervical cancinoma is good. Surgery after chemotherapy can improve the prognosis and 5-year survival rate.
Adenocarcinoma ; drug therapy ; mortality ; surgery ; Adult ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; surgery ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; methods ; Prognosis ; Survival Rate ; Uterine Cervical Neoplasms ; drug therapy ; mortality ; surgery

BACKGROUND/AIMS: We investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer. METHODS: Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20). RESULTS: The median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1. CONCLUSIONS: Endoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer.
Adenocarcinoma/mortality/*surgery/therapy ; Aged ; Carcinoma, Squamous Cell/mortality/*surgery/therapy ; Combined Modality Therapy ; Endoscopy, Gastrointestinal/*methods ; Esophageal Neoplasms/mortality/*surgery/therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/mortality/*surgery/therapy ; Nutritional Status ; Risk Factors ; Stomach Neoplasms/mortality/*surgery/therapy ; Survival Analysis

We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (chi-square(trend)=6.755, P=0.009), but was not associated with DR (chi-square(trend)=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.
Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell/mortality/*surgery/therapy ; Female ; Humans ; Kidney Neoplasms/mortality/*surgery/therapy ; *Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Recurrence ; Retrospective Studies ; Survival Analysis ; Ureteral Neoplasms/mortality/*surgery/therapy

Sixty patients, treated with postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for stage lb carcinoma of the uterine cervix between Jan. 1980 and Dec. 1984 at Department of Radiation Oncology, Yonsei University College of Medicine, were retrospectively analysed. The minimum follow-up period was 5 years. The indications for postoperative radiotherapy were positive pelvic lymph node (34 pts), a large tumor size more than 3 cm in longest diameter (18 pts), positive surgical margin (10 pts), deep stromal invasion (10 pts), and lymphatic permeation (9 pts). The overall 5-year survival rate was 81.8%. The univariate analysis of prognostic factors disclosed tumor size (less than 3cm, greater than or equal to 3cm) and the status of the surgical margin (positive, negative) as significant factors (tumor size; 88.1% vs 6.3%, surgical margin; 85.5% vs 60%, p less than 0.05). Age (less than or equal to 40, greater than 40 yrs) was marginally significant (90.2% vs 73.1%, p less than 0.1). Multivariate analysis clarified two independent prognostic factors; tumor size (p = 0.010) and surgical margin (p = 0.004). Analysis of the tumor factors with the radiation dose disclosed a better survival rate for patients with a positive surgical margin who were given over 50 Gy than for those who were given below 50 Gy in patients (4/4, 100% vs 2/6, 33.4%; p = 0.06). Significant complications requiring surgical correction were not observed. In conclusion, it is believed that the status of the surgical margin and tumor size both have important prognostic significance, and that a radiation dose over 50 Gy is advisable for patients with a positive surgical margin.
Adult ; Carcinoma/mortality/*radiotherapy/surgery ; Cervix Neoplasms/mortality/*radiotherapy/surgery ; Combined Modality Therapy ; Female ; Human ; Hysterectomy ; Lymph Node Excision ; Lymphatic Metastasis ; Prognosis ; Retrospective Studies ; Support, Non-U.S. Gov't

OBJECTIVETo evaluate the feasibility and curative effects of CO2 laser in treatment of supraglottic carcinoma.

METHODSThe retrospective analysis included 32 case of supraglottic carcinoma from February 1995 to June 2005, TNM classified as follows: T1N0M0: 20 cases, T1N1M0: 2 cases, T2N0M0: 8 cases and T2N1M0: 2 cases. The patients were treated with endoscopic laser surgery and selective neck dissection (12 cases) or functional neck dissection (4 cases). The follow-up period was more than 3 years.

RESULTSKaplan-Meier survival analysis shows the overall 5-year survival rate was 90.6%, and the 5-year survival rate of T1 lesions and T2 lesions was 95.6% and 78.2%, respectively. The overall 5-year local control rate was 96. 8%. The 5-year local-regional control rate was 90.3%. With T1 90.9% and T2 89.0% respectively. Two patients had local recurrences, one underwent salvage supraglottic horizontal laryngectomy, another one underwent total laryngectomy. Two cases with regional recurrences underwent radical neck dissection. One of them with concurrent local recurrence was survival after salvage operation. Another one with only regional lesion died of recurrence and pulmonary metastasis after treatment. Four patients experienced minor complications without sequelae. All survival patients had laryngeal preservation except the one who received total laryngectomy.

CONCLUSIONSThe results of this study show that endoscopic CO2 laser surgery is highly effective in the treatment of selected supraglottic carcinoma. It shows reliable curative effects and a high larynx preservation rate.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; surgery ; Female ; Glottis ; Humans ; Laryngeal Neoplasms ; mortality ; surgery ; Laryngectomy ; methods ; Laser Therapy ; Lasers, Gas ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome

UNLABELLEDThe aim of this paper was to study the efficacy, side effects and complications of radiofrequency (RF) ablation of primary and metastatic liver malignancies.

MATERIALS AND METHODSWe retrospectively reviewed 57 patients (39 men, 18 women; mean age, 63 years; age range, 44 to 83 years) who underwent RF ablation for liver malignancies from January 2002 to December 2004. A total of 87 tumours were ablated - 71 (81.6%) hepatocellular carcinomas and 16 (18.4%) metastases (from primaries in the colon, stomach and pancreas). RF ablation was performed either percutaneously (n = 71) under conscious sedation or intraoperatively (n = 16) under general anaesthesia. Follow-up ranged from 1 month to 41 months (mean, 15.2) and included computed tomography (CT) 1 day, 1 month and 3 months after ablation, and half-yearly thereafter. Patients were observed for local tumour progression and for the emergence of new tumours.

RESULTSFour patients with a total of 5 tumours were lost to follow-up. Of the remaining 82 tumours treated, complete ablation was attained in 66 tumours after a single procedure, giving a primary effectiveness rate of 80.5%. Seven (8.5%) required 2 procedures to achieve complete ablation, giving a secondary effectiveness rate of 89% after 2 ablations. One tumour (1.2%) required 3 procedures to achieve complete ablation. One tumour required 4 procedures to date, with the latest follow-up CT still demonstrating incomplete ablation. Two tumours (2.4%) had an initial RF ablation and subsequent transarterial chemoembolisation (TACE). One tumour had an initial RF ablation followed by 32Phosphorus-biosilicon (BrachySil) injection, the latter as part of a Phase IIA trial. One tumour required 2 RF ablations and a subsequent TACE. Lastly, 3 tumours received initial RF ablation but subsequent local tumour progression was not treated as the patients were deemed unfit for repeat ablation. No procedure-related deaths or major complications were encountered. Minor complications were reported in 2 patients (3.8%) - subcapsular haematoma and thermal injury to the adjacent gastric antrum, both not necessitating surgical intervention.

CONCLUSIONSRF ablation is an effective, safe and relatively simple procedure for the treatment of unresectable liver malignancies.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; mortality ; secondary ; surgery ; therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Female ; Hospitals, General ; Humans ; Liver Neoplasms ; mortality ; secondary ; surgery ; therapy ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted