Esophageal cancer is the 7th leading cause of cancer deaths worldwide. While squamous cell carcinoma is the most prevalent histology internationally, adenocarcinoma of the distal esophagus accounts for nearly 50% of cases in developed countries due to the differences in the etiologic factors such as gastroesophageal reflux disease (GERD) and obesity that predominate. While surgery is the mainstay of treatment of this disease, the utilization of chemoradiation, either used postoperatively or neoadjuvantly, has become a standard practice in the United States. What is the optimal management approach is still an area of contention, however, and may be different in different regions around the world. This article reviews some of these controversies, including the role for surgery in patients treated with definitive chemoradiation. At the end, we will also outline recommendations regarding radiotherapy procedures and techniques.
Adenocarcinoma ; diagnosis ; epidemiology ; pathology ; therapy ; Carcinoma, Squamous Cell ; diagnosis ; epidemiology ; pathology ; therapy ; Chemoradiotherapy ; Esophageal Neoplasms ; diagnosis ; epidemiology ; pathology ; therapy ; Esophagectomy ; methods ; Humans ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Risk Factors

A retrospective study was carried out on Ewing's sarcoma as seen between 1973 and 1987 at the Cancer Treatment Centre, Angau Memorial Hospital, Lae, Papua New Guinea. Some striking differences were observed in the epidemiological indices and the clinical picture of this disease here, when compared with other centres in the world. Most notably, Ewing's sarcoma, hitherto a rare tumour in this country, seems to be on the increase. In addition, among the flat bones, involvement of the scapula was disproportionately high. The early response to treatment was similar to findings elsewhere, although the long-term patient follow-up in this series was not satisfactory enough to allow proper estimates of long-term survival rates. The most recently advocated approach to the management of Ewing's sarcoma, which emphasizes surgery in preference to radiotherapy for local disease control, and adjuvant chemotherapy for micrometastases, is outlined.
Adolescent ; Adult ; Child ; Pre-school ; Female ; Hospitalization - statistics & ; numerical data ; Neoplasm Recurrence, Local - epidemiology ; Papua New Guinea - epidemiology ; Remission Induction ; Sarcoma, Ewing - diagnosis

The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.
Adult ; Cervical Intraepithelial Neoplasia/pathology/*surgery ; Electrosurgery/*methods ; Female ; Humans ; Hysterectomy ; Medical Records ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Neoplasm, Residual/diagnosis/epidemiology ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Uterine Cervical Neoplasms/pathology/*surgery

OBJECTIVEThe aim of the present study was to investigate the outcome of surgical management in patients with giant cell tumor (GCT) of extremity long bone and the risk factors for recurrence.

METHODSClinicopathological data of 145 patients with giant cell tumor of long bone treated in our hospital from 2002 to 2008 were retrospectively reviewed. There were 79 male and 66 female patients. The mean age at first diagnosis was 29 (11-66) years. There were 45 GCTs localized in the distal femur, followed by 36 in the proximal tibia, 22 in the proximal femur, 19 in the distal radius, 8 in the proximal fibula, 8 in the proximal humerus, 4 in the distal tibia and one in the distal fibula, distal humerus and proximal radius, for each. Surgical treatment included extensive curettage in 81 cases and resection in 64 cases. The possible risk factors for recurrence included age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery. The patients were followed up with a mean duration of 50 months ranging from 36 to 104 months. The correlation of age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery with the risk for recurrence was analyzed.

RESULTSThe overall local recurrence rate was 4.8% (7/145) and the mean duration for recurrence was 20 months ranging from 4 to 52 months. The local recurrence rate was 7.4% (6/81) in the extensive curettage group and 1.6% (1/64) in the resection group (P = 0.134). The difference was not statistically significant. Age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery were not risk factors for recurrence.

CONCLUSIONSThe results of the present study suggest that clinical and imaging features and types of surgery are not affecting factors for recurrence of giant cell tumor of long bone. Extensive curettage provides similar favorable local control of the tumor as resection. We would recommend extensive curettage while resection should be done following indications.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; diagnosis ; epidemiology ; Child ; Curettage ; Female ; Femur ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnosis ; epidemiology ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; epidemiology ; Radius ; Retrospective Studies ; Risk ; Risk Factors ; Tibia

OBJECTIVETo review the diagnosis methods and treatment modalities of vulvar intraepithelial neoplasia III (VINIII) and to analyse its prognostic factors.

METHODSThe data of 24 patients with VINIII from 1992 to 2002 were retrospectively reviewed and analysed.

RESULTSAmong these 24 patients, 62.5% (15 patients) were aged less than 40 years and 37.5% (9 patients) over 40 years. Human papillomavirus (HPV) infection was found in 53.3% and 2/9 of these two groups. Treatment modality for all patients was surgical excision including extended local excision (33.3%) and simple vulvectomy (66.7%). 3 patients (12.5%) developed recurrence. Positive resection margin was correlated with recurrence, while age, HPV infection, multifocality and resection modality were not.

CONCLUSIONDuring recent years, the incidence of VIN has been on the increase in younger woman patients which maybe due to the increase of HPV infection, and the data show that the recurrence rate is correlated with positive margin. Treatment should be individualized and either extended local excision or simple vulvectomy is appropriate. Periodical follow-up should be done.

Adult ; Aged ; Carcinoma in Situ ; diagnosis ; surgery ; virology ; China ; epidemiology ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasms, Squamous Cell ; diagnosis ; surgery ; virology ; Papillomaviridae ; Papillomavirus Infections ; epidemiology ; Prognosis ; Retrospective Studies ; Vulvar Neoplasms ; diagnosis ; surgery ; virology

PURPOSE: After esophagectomy and gastric reconstruction for esophageal cancer, patients suffer from various symptoms that can detract from quality of life. Endoscopy is a useful diagnostic tool for evaluating patients after esophagectomy. This observational study was performed to investigate the correlation between symptoms and endoscopic findings one year after esophageal surgery and to assess the clinical usefulness of one-year endoscopic follow-up. MATERIALS AND METHODS: From 2001 to 2008, 162 patients who underwent esophagectomy with gastric reconstruction were endoscopically examined one year after operation. RESULTS: Patients suffered from the following symptoms: nocturnal cough (n=10), regurgitation (n=7), cervical heartburn (n=3), lump sensation (n=2), dysphagia (n=20) and odynophagia (n=22). Eighty-five (52.5%) patients had abnormal findings on endoscopic examination. Twelve (7.4%) patients had reflux esophagitis, and 37 (22.8%) patients had an anastomotic stricture. Only stricture-related symptoms were correlated with the finding of anastomotic strictures (p<0.001). Two patients had recurrences at the anastomotic sites, and four patients had regional lymph node recurrences with gastric conduit invasion visualized by endoscopy. Newly-developed malignancies in the esophageal remnant or hypopharynx that were not detected by clinical symptoms and imaging studies were reported in two patients. CONCLUSION: One year after esophagectomy, endoscopic findings were not correlated with clinical symptoms, except those related to stricture. Routine endoscopic follow-up is a useful tool for identifying latent functional and oncological lesions.
Anastomosis, Surgical ; Carcinoma, Squamous Cell/pathology/*surgery ; Esophageal Neoplasms/pathology/*surgery ; Esophagectomy/*adverse effects ; Follow-Up Studies ; Humans ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Postoperative Complications/*diagnosis/epidemiology ; Reconstructive Surgical Procedures ; Retrospective Studies

To investigate the expression of hypoxia-inducible factor 1α (HIF-1α) and CD133 in predicting pathologic remission and survival of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy.One hundred and fourteen patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy from January 2010 to December 2015 in Jinhua Municipal Central Hospital were enrolled in the study. RT-PCR and immunohistochemistry methods were used to detect the mRNA and protein expression of HIF-1α and CD133 before and after chemoradiotherapy. Spearman rank correlation was used to analyze the correlation between HIF-1α and CD133 mRNA expression. Univariate and logistic multivariate analyses were used to determine the factors related to pathological complete response (pCR). Logistic regression analysis and Cox's proportional hazard model were used to determine factors related to overall survival and recurrence-free survival.The expression of HIF-1α and CD133 mRNA was correlated with pT, ypTNM, pCR, recurrence and metastasis of rectal cancer, while not correlated with sex, age and BMI of patients. HIF-1α mRNA expression was positively correlated with CD133 mRNA expression (=0.579,=0.000). Immunohistochemistry analysis showed that residual cancer cells strongly expressing HIF-1α also expressed CD133 strongly. Univariate analysis showed that HIF-1α mRNA and CD133 mRNA were significantly correlated with pCR (=0.001,=0.022, respectively). Multivariate analysis showed that HIF-1α and CD133 mRNA expression were independent prognostic factors of pCR (=0.012,=0.047, respectively). Cox regression analysis showed that the expression of HIF-1α mRNA and CD133 mRNA were independent predictors of recurrence-free survival and overall survival (=0.025,=0.033, respectively).The study indicates that HIF-1α and CD133 can predict pathological complete remission and survival of patients with locally advanced rectal cancer.
AC133 Antigen ; analysis ; genetics ; Biomarkers, Tumor ; analysis ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; analysis ; genetics ; Male ; Neoadjuvant Therapy ; Neoplasm Grading ; Neoplasm Metastasis ; diagnosis ; Neoplasm Recurrence, Local ; epidemiology ; genetics ; Neoplasm, Residual ; genetics ; Prognosis ; Proportional Hazards Models ; Rectal Neoplasms ; chemistry ; epidemiology ; genetics ; therapy ; Survival Rate

The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (> or =T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.
Aged ; Female ; Humans ; Longitudinal Studies ; Middle Aged ; Neoplasm Recurrence, Local/*mortality/*prevention & control ; Prevalence ; Prognosis ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Treatment Outcome ; Urethral Neoplasms/diagnosis/*mortality/*therapy ; Women's Health/*statistics & numerical data

PURPOSE: Combined hepatocellular-cholangiocarcinoma (CHCC) is an uncommon form of cancer, and its clinicopathological features have rarely been reported in detail. This study was undertaken to evaluate the clinicopathological characteristics and prognostic factors of CHCC. MATERIALS AND METHODS: The clinicopathological features of patients diagnosed with CHCC at Severance Hospital between January 1996 and December 2007 were retrospectively studied by comparing them with the features of patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) who had undergone a hepatic resection during the same period. RESULTS: Forty-three patients diagnosed with CHCC were included in this study (M : F=35 : 8, median age, 55 years). According to the parameters of the American Joint Committee on Cancer staging, there were 6 (14.0%), 9 (20.9%), 25 (58.1%), and 3 (7.0%) patients with stages I, II, III, and IV cancer, respectively. Thirty-two of the 43 patients underwent resection with curative intent. After resection, 27 patients (84.4%) had tumor recurrence during the follow-up period of 18 months (range: 6-106 months), and the median time to recurrence was 13 months. Overall median survival periods after hepatic resection of CHCC, HCC and CC were 34, 103 and 38.9 months, respectively (p<0.001). The median overall survival for all patients with CHCC was 21 months, and the 5-year survival rate was 18.1%. The presence of portal vein thrombosis and distant metastasis were independent prognostic factors of poor survival. CONCLUSION: Even after curative hepatic resection, the presence of a cholangiocellular component appeared to be a poor prognostic indicator in patients with primary liver cancer.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*pathology ; Cholangiocarcinoma/mortality/*pathology ; Diagnosis, Differential ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies

OBJECTIVE: To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm. MATERIALS AND METHODS: The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival. RESULTS: Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test). CONCLUSION: When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.
Carcinoma, Hepatocellular/diagnosis/mortality/*therapy ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/diagnosis/mortality/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate/trends ; Treatment Outcome