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The purposes of this study were to describe the endoscopic-assisted orbital exenteration surgical techniques, to report preliminary outcomes and to discuss advantages, indications and limitations of this approach. All patients who underwent endoscopic-assisted orbital exenteration at a single tertiary-care center were retrospectively reviewed. A concomitant reconstruction was performed in all cases. The extent of surgical resection was tailored to the size and location of tumor and was classified into four subtypes. A total of 40 patients were included in this series. Orbital exenteration type 1 was performed in 7 cases, type 2 in 11 cases, type 3 in 19 cases, and type 4 in 3 cases. The reconstruction was performed with a pedicled temporal flap in 5 patients and with a free vascularized flap in 34 cases. A radical resection of disease was obtained in 32 cases. After a mean follow-up of 36 months, 14 patients died of disease, one patient died of other causes, 7 are alive with disease, and 18 patients are currently alive without evidence of disease. The preliminary data emerging from this case-series support the feasibility and safety of endoscopic-assisted orbital exenteration.

OBJECTIVE The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease. METHODS A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed. RESULTS A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27 months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival. CONCLUSIONS Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.

Background Endometrial cancer presenting with peritoneal metastases carries a poor prognosis. The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to the surgical management of these patients has been studied in recent years, but only with cisplatin. Cases This is a series of 3 patients presenting with endometrial cancer and synchronous peritoneal metastases who underwent cytoreductive surgery and carboplatin HIPEC as primary treatment. Complete cytoreductive surgery was achieved for each patient. No grade 3–5 complications were observed. Two patients died at 12 and 18 months, respectively, and 1 patient was alive with disease at 29 months. Conclusion This case series suggests that the addition of carboplatin HIPEC to the surgical management of peritoneal metastases from endometrial cancer is safe as primary treatment. However, long-term survival remains poor.

The purpose of this study was to evaluate the outcomes of surgery involving the use of folded trapezius flaps to repair large pharyngocutaneous fistulae (PCFs) developing after salvage total laryngectomy. Folded extended vertical lower trapezius island myocutaneous flaps (TIMFs) were created to repair large PCFs that developed after salvage total laryngectomy in eight patients. The maximum fistula dimension was 4.5 × 3.0 cm and the minimum was 2.0 × 1.8 cm. The skin paddle of the extended vertical TIMF ranged from 5 cm to 9 cm in width and 10 cm to 23 cm in length. The inner lining ranged from 3 cm × 3 cm to 6 cm × 6 cm in dimension and the outer lining from 6 cm × 5 cm to 16 cm × 9 cm. The folded flaps provided both inner mucosa and outer lining. All flaps survived. No fistula recurrence or stricture developed. After 6–24 months of follow-up, six patients showed no evidence of disease, one was alive with disease, and one had died of local recurrence at 20 months. The folded flap was very reliable and is well-suited for repairing large PCFs, even early large PCFs and those featuring carotid artery rupture.

In 1999, we developed a technique using frozen autografts—tumour-containing bone treated with liquid nitrogen—for the reconstruction of malignant bone tumours. The purpose of this study was to evaluate the functional and oncological outcomes of frozen autografts for intercalary reconstruction of malignant bones and soft tissue tumours. This retrospective study was designed to assess 34 patients of mean age 35 (range, 6–79) years. The mean follow-up period was 62 (24–214) months. The median length of the frozen autografts was 138.4 ± 60.39 (50–290) mm. Postsurgically, 20 patients remained disease-free, seven patients survived with no evidence of disease, five patients were alive with disease, and two patients died of disease. The five- and ten-year survival rates of the frozen autografts were 91.2% and the mean International Society of Limb Salvage score was 90%. Complete bony union was achieved in 97% of the patients. There were five cases of nonunion, six cases of fracture, two cases of deep infection and four cases of local recurrence. Utilizing intercalary frozen autografts for patients with a nonosteolytic primary or secondary bone tumour without involvement of the subchondral bone is a good alternative treatment, because it is a straightforward biological technique and can provide excellent limb function.

BACKGROUND/AIM: Chondrosarcomas (CS) of the chest wall are rare, but present an aggressive biological behavior compared to CS of the extremities. The aims of the present study were to determine factors associated with oncological outcomes as well as complications. PATIENTS AND METHODS: We retrospectively analyzed 53 patients (42 primary, 11 recurrent tumors). In total, 39 central CS, 10 peripheral CS, 3 dedifferentiated CS and 1 mesenchymal CS were included. The ribs were most commonly affected (68%). Overall survival and disease-free survival were estimated with Kaplan-Meier analyses and compared with log-rank test. RESULTS: Mean follow-up was 7 years. Negative margins were achieved in 87% of patients. Thirty patients (57%) remained continuously disease-free (NED), three (5%) NED after treatment of relapse, seven (13%) were alive with disease, twelve (23%) were dead with disease and one of other cause. The 10-year survival rate was 81% and 45% in primary and recurrent tumors, respectively. Survival was significantly affected by tumor stage (p

Until recently, undifferentiated round cell sarcomas (URCS) in infants have been considered a wastebasket diagnosis, composed of various pathologic entities and lacking consistent genetic alterations. The recent identification of recurrent BCOR internal tandem duplications (ITD) and less common alternative YWHAE-NUTM2B/E fusions in half of infantile URCS and the majority of so-called primitive myxoid mesenchymal tumors of infancy (PMMTI) suggests a common pathogenesis with clear cell sarcoma of the kidney which also harbors the same genetic alterations. These tumors also share a similar morphology and immunoprofile, including positivity for BCOR, cyclin D1, and SATB2. In this study, we investigate the largest cohort to date of genetically confirmed URCS and PMMTI with BCOR ITD or YWHAE fusions to better define their morphologic spectrum and clinical behavior. Twenty-eight cases harbored BCOR ITD and five YWHAE fusions, occurring in 29 infants and 4 children, 19 males and 14 females. Microscopically, 20 were classified as URCS and 13 as PMMTI. Follow-up was available in 25 patients, with 14 (56%) succumbing to their diseases at a mean duration of 18-months follow-up (range: 2-62). Six patients remained with no evidence of disease at a mean follow-up of 63 months (range: 4-192), four patients were still alive with disease (mean follow-up: 46 months, range: 4-120), and one died of other causes. Local recurrence and distant metastasis were each observed in 11/25 (44%) of the patients. The overall survival was 42% at 3 years and 34% at 5 years (median survival: 26 months). There was no statistically significant survival difference between cases diagnosed as URCS and PMMTI and between those with BCOR ITD and YWHAE fusions.

The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves. At a mean follow-up of 13.7 months (range, 6–26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term.

Chromophobe renal cell carcinoma (ChRCC) with neuroendocrine differentiation/morphology (NED/NEM) is exceedingly rare. We present three cases of ChRCC with NED/NEM, two of which showed positivity for neuroendocrine markers on immunohistochemical analysis. Patients ranged in age from 49 to 79 years (mean: 64.3 years). One of the three patients died of metastatic disease to multiple organs. Of the remaining two patients, one is currently alive without disease and the other is alive with disease. Histologically, all three tumors were composed of conventional ChRCC and NEM showed glandular and rosette formation. Immunohistochemically, tumor cells were positive for CK7, KAI1, E-cadherin, and c-kit in both ChRCC and neuroendocrine areas in three cases. CD56 and synaptophysin immunoreactivity were detected in two cases; in only the neuroendocrine area in one case and in both components in the other. Neuroendocrine granules were ultrastructurally observed at both neuroendocrine and conventional areas of ChRCC. Array comparative genomic hybridization (CGH) study indicated losses of chromosomes 1, 2, 6, 10, 17, 21, and Y in both conventional ChRCC and NED in one case. In addition, losses of chromosomes 1, 2, 4, 6, 9, 10, 13, 16p, 17, and 21 were observed in both components of the remaining one tumor. Furthermore, loss of chromosome 5 was identified only in the neuroendocrine area in this case. We concluded that the neuroendocrine area may reflect dedifferentiation within ChRCC. It is possible that losses of chromosomes 4, 5, and 16p may be involved in the neuroendocrine differentiation or progression of ChRCC.

There is paucity of outcome data regarding juvenile myelomonocytic leukemia from India. We report a series of eight children. Three had monosomy 7 and one had complex cytogenetics. One with Down’s syndrome recovered spontaneously. Three refused therapy of whom only one is alive with disease. One died post chemotherapy. Three underwent allogeneic stem cell transplant after protracted delay with funds arranged from various governmental and non-governmental organizations. Of these two died (relapse-1 and intracranial bleed-1) and one is alive and disease free. In India, it’s a milestone to reach transplant due to high cost and cure still remains a distant dream.

Sclerosing RMS (SRMS) is a recently described subtype of RMS that has not yet been included in any of the classification systems for RMSs. We did pubmed search using keywords “sclerosing, and rhabdomyosarcomas” and included all pediatric cases (age ≤ 18 years) of SRMSs in this review. We also included our case of an eleven-year-old male child with skull base SRMS and discuss the clinical, histopathological, immunohistochemical, and genetic characteristics of these patients. Till now, only 20 pediatric cases of SRMSs have been described in the literature. Pediatric SRMS more commonly affects males at a mean age of 9 years. Extremeties and head/neck regions were most commonly affected. Follow-up details were available for 16 patients with mean follow-up of 25.3 months. Treatment failure rate was 43.75%. Overall amongst these 16 patients, 10 were alive without disease, 4 were alive with disease, and two died. Thus, overall and disease-free survival amongst these 16 patients were 87.5% and 62.5%, respectively. The literature regarding clinical behaviour and outcome of pediatric patients with SRMSs is patchy. Detailed molecular/genetic analysis and clinicopathological characterization with longer follow-ups of more cases may throw some light on this possibly new subtype of RMS.

Second-generation radiofrequency ablation (RFA) probes and their successors have more power, shorter ablation times, and an increased area of ablation compared with the first-generation probes used before 2000. We examined whether the use of the newer probes has improved the clinical outcome of RFA for hepatic metastases of colorectal cancer at our tertiary cancer center. Of 160 patients who underwent RFA between 1997 and 2003, 52 had metastases confined to the liver: 21 patients underwent 46 ablations with the first-generation probes and 31 patients underwent 58 ablations with the newer probes. The two groups had similar demographic characteristics. At a median follow-up of 26.2 months, patients treated with the newer probes had a longer median disease-free survival (16 months vs 8 months, P < 0.01) and a lower rate of margin recurrence (5.2% vs 17.4%); eight patients had no evidence of disease and one patient was alive with disease. By contrast, of the 46 patients treated with the first-generation probes, 2 patients had no evidence of disease and 1 patient was alive with disease. Newer-generation probes are associated with lower rates of margin recurrence and higher rates of disease-free survival after RFA of hepatic metastases from colorectal cancer.

The objective of this study was to review the clinical outcome and prognosis of patients with primary peritoneal carcinoma (PPC) treated with cytoreductive surgery and combination chemotherapy. We retrospectively reviewed the charts of 27 patients with histologically confirmed PPC, treated between March 1990 and February 2004 at Asan Medical Center, South Korea. The review included demographic data, pathologic findings, treatments, and outcomes. The mean age of the 27 patients was 57.5 +/- 7.2 years, and the rate of optimal cytoreduction was 70.4%. Seven patients had stage IIIB, 17 had stage IIIC, and 3 had stage IV; all patients received adjuvant chemotherapy. There were 4 patients with progressive disease, 5 partial responders, and 15 complete responders; the remaining 3 patients were nonevaluable. At the time of the review, 10 patients were alive without evidence of disease, 3 were alive with disease, and 14 had died from disease. The median overall survival time was 41 months, and the overall 5-year survival rate was 18.1%. Patients who had optimal cytoreduction had a longer median survival (42 months) than those who had suboptimal cytoreduction (10 months; P0.05). Combination chemotherapy after optimal cytoreductive surgery may be effective in the treatment of patients with PPC.

Little has been published about the outcome of patients with recurrent chondrosarcoma of the pelvis. The current study is a review of patients with surgically treated locally recurrent pelvic chondrosarcoma at one institution. Twenty-one patients had surgical resection of recurrent pelvic chondrosarcoma between July 1974 and July 1996. There were nine women and 12 men with a mean age of 46 years (range, 24-67 years) at first recurrence. Patients were followed up for a minimum of 3.3 years and median of 12 years from first (index) recurrence or until death. The mean time to index recurrence was 27 months (range, 5-87 months). In three cases (14%), the tumor at index recurrence was a higher grade than the initial lesion. There were six additional tumors that became a higher grade during subsequent recurrences. Fifteen of the 21 patients (71%) had a second local recurrence. Five patients (24%) had distant metastasis. At death or final followup, 11 patients (52%) had no evidence of disease, two patients (10%) are alive with disease, and eight patients (38%) died of their disease. The three patients with high-grade tumors at index recurrence all died of disease. The treatment of recurrent pelvic chondrosarcoma is a challenging problem. Tumor-free margins may require radical surgery, and the best chance of cure is at the time of initial resection. With aggressive surgical intervention, approximately 50% of patients with recurrent pelvic chondrosarcoma can achieve long-term survival.

The purpose of this study was to evaluate the outcomes of second salvage surgery with extended vertical lower trapezius island myocutaneous flap (TIMF) reconstruction for patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). The subjects were 23 patients with advanced re-recurrent oral and oropharyngeal SCC undergoing second salvage surgery and reconstruction with a TIMF. A TIMF with a skin paddle measuring 6 cm × 7 cm to 10 cm × 22 cm was used to reconstruct the major defects. Three patients experienced minor complications: minor flap failure ( n = 1), wound dehiscence at the donor site ( n = 1), and an orocutaneous fistula ( n = 1). The patients were followed for 3–72 months. Fifteen patients were alive with no evidence of disease, two were alive with disease, and six died of local recurrence or distant metastases. Second salvage surgery remains an effective treatment modality for select patients with advanced re-recurrent oral and oropharyngeal SCCs, and the extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing the major defect following second salvage surgery.

Several recent reports have described low-grade fibromyxoid sarcoma with sclerosing epithelioid fibrosarcoma-like areas. We evaluated cases of pure sclerosing epithelioid fibrosarcoma lacking areas of low-grade fibromyxoid sarcoma for FUS rearrangement to determine whether this entity could be related to low-grade fibromyxoid sarcoma. Available formalin-fixed paraffin-embedded tissue of 27 sclerosing epithelioid fibrosarcoma from 25 patients was retrieved and tabulated with clinical information. Unstained slides from formalin-fixed paraffin-embedded blocks were prepared and fluorescence in-situ hybridization was performed using a commercial FUS break-apart probe. The median patient age at presentation was 50 (range, 14-78) years, with 14 males and 10 females. Sclerosing epithelioid fibrosarcoma most commonly involved the extremities (n=8) or chest (n=6). Sixteen patients had a median follow-up of 17 (range, 1-99) months; seven were alive and well at 12 (range, 5-30) months; three alive with disease at 28 (range, 9-99) months; five dead of disease at a median of 22 (range, 1-36) months and one was dead of unknown causes. Twelve patients were known to have metastases; the most common site was lung (n=7), followed by bone (n=3), lymph nodes (n=2) and peritoneum (n=1). Only 2 of 22 (9%) analyzable cases of sclerosing epithelioid fibrosarcoma showed rearrangement in the FUS locus by fluorescence in-situ hybridization. Although cytogenetically confirmed low-grade fibromyxoid sarcoma can have sclerosing epithelioid fibrosarcoma-like areas, FUS rearrangement, which is characteristic of low-grade fibromyxoid sarcoma, appears to be relatively rare in pure sclerosing epithelioid fibrosarcoma.

The clinical findings in 9 cases of malignant fibrous histiocytoma (MFH) with follow-up information are presented. These 9 cases were treated in our hospital from 1979 to 1990. One case was bone tumor and eight were soft-part tumor. The average follow-up period was 46 months (7months-110months). 3 cases were continuous disease free (CDF), 2 cases were no evidence of disease (NED), one case was alive with disease (AWD) and 3 cases were dead of disease (DOD).In our study, 2 cases of more than 80 years of age better prognoses despite of larger tumor size than 10cm.

Twenty-five cases of primary lymphoma of bone (PLB) reported over a 10-year period were reviewed. The presenting symptom was related to involvement of a single bone with or without regional nodal disease. None showed dissemination of lymphoma in the subsequent six months. Patients affected were 7-65 years of age. An equal predilection for the axial and appendicular skeleton was noted. Histologically, the commonest subtype was diffuse histiocytic lymphoma (DHL, 17 cases), whereas four were poorly differentiated lymphocytic (PDL) type and another four were unclassifiable. Follow-up was available in 18 out of 25 patients for periods ranging from 7 months to 8 years. On clinicopathologic correlation we found that 75% of disease-free patients had a DHL whereas 60% of those alive with disease had a PDL. This study reiterates the view that PLB has a good prognosis and the DHL subtype is especially amenable to complete eradication.

Introduction The purpose of this study is to report the clinical course and outcome in 7 patients with aggressive fibromatosis. Material and Methods Between the years 2000 and 2003, 7 patients who were treated with combined modalities were evaluated retrospectively. Patients' demographic information, including age and gender, tumour characteristics, surgical resection, and the use of radiotherapy were recorded and evaluated. Results The mean patient age was 34 years. The median time to follow-up was 15.5 months. Resection was performed with positive surgical margins in three cases. Three patients were evaluated as inoperable and one patient was treated with debulking surgery. All patients received radiation therapy with a median dose of 51 Gy. At followup, three patients had no evidence of disease, three patients were alive with disease, and one patient died 15 days after radiotherapy. Conclusion Local control is the primary problem in aggressive fibromatosis. There is no appropriate treatment for aggressive fibromatosis and the type of treatment depends on tumour characteristics and location as well as patient characteristics.

Introduction: Malignant invasion of the brain and/or dura are known negative prognostic factors for patients undergoing craniofacial resection for cancer. However, no evaluation has been conducted to identify factors that stratify prognosis in this subgroup. Methods: Between 1993 and 2003, 212 patients underwent craniofacial resection. Twenty-eight patients (8 females, 20 males; mean age 50.9 y, range 26–76 y) had evidence of transdural invasion (subdural tumor or brain invasion) of skull base malignancy. These patients were retrospectively identified and reviewed. Results: Subdural tumor was found in 16. Brain invasion was detected in 12. Gross total resections were achieved in 22 patients (13 with microscopically negative margins). Surgical complications occurred in 6 patients. There was no surgical mortality. The mean overall survival was 40 months. Eleven had no evidence of disease (NED), 11 were dead of disease (DOD), and 6 were alive with disease (AWD). Progression-free survival was 29 months. One of 12 patients (8%) with brain invasion was alive without disease versus 10 of 16 patients (63%) in the group with subdural spread. Seven of 12 patients (58%) with low-grade cancers were alive without disease. Four of 16 (25%) with high-grade cancers were alive without disease. Conclusions: Patients with transdural disease associated with malignant skull base tumors have a worse prognosis when treated for cure. Brain invasion seems to decrease survival when compared with subdural spread without brain invasion. Low-grade tumors have a better prognosis in the cohort with transdural invasion.

Seventeen patients with advanced ovarian malignancy were treated with high-dose medroxyprogesterone acetate. No objective responses were achieved. Four patients had stable disease, one of whom remains alive with disease at 30+ months.

Purposes The purpose of our study was to compare the oncologic outcome between major and minor salivary gland ACC during the 18-year follow-up. Materials and methods The records of 61 consecutive patients with ACC were reviewed. Thirty patients had major gland ACC and 31 patients had minor gland ACC. Stage I–II disease was found in 36 patients and stage III–IV disease was found in 25 patients. Surgical treatment was performed in all patients. Adjuvant treatment was applied if indicated. Results There were no significant differences in patients or tumor characteristics between major and minor gland ACC. Local and regional recurrence rates were similar ( Table 1 ). However, minor gland ACC had shorter duration of regional recurrence significantly. The overall survival rate was 79.8% at 5 years, 76.85% at 10 years and 64.04% at 15 years. Survival rate and duration were not different in both groups. However, when we compared the patients who had no evidence of disease (NED) status and who had alive with disease (AWD) status in survivors at the end of follow-up, minor gland ACC had more AWD status than major gland ACC significantly. Conclusions ACCs in minor salivary gland had more rapid regional recurrence, frequent distant metastasis and higher alive with disease status than ACCs in major salivary gland.

Background: Operations for patients with colorectal cancer are based on traditions established by historical experience. Radioimmunoguided surgery (RIGS) provides new information that challenges these traditions. Methods: Thirty-two patients with primary colorectal cancer underwent RIGS after being injected with anti-TAG-72 murine monoclonal antibody CC49 labeled with iodine-125. Sixteen of the patients had all gross tumor and RIGS-positive tissue removed (RIGS-negative group), and 16 had only traditional extirpation of the tumor because RIGS-positive tissue was too diffuse (RIGS-positive group). Results: In the 16 patients having all RIGS-positive tissue removed, five had traditional regional en bloc resections and 11 had additional extraregional tissues resected. Identification of extraregional disease added two liver resections and 25 lymphadenectomies: 10 of the gastrohepatic ligament, five celiac axis, six retroperitoneal, and four iliac. With a median follow-up of 37 months, survival in the RIGS-negative group is 100%. In 14 of 16 patients (87.5%) there is no evidence of disease. In the RIGS-positive group, follow-up shows 14 of 16 patients are dead and two are alive with disease (p

152 Background: To report outcomes in two prospective proton therapy (PT) trials for localized prostate cancer. Methods: From 2006 to 2007, 171 low- and intermediate-risk prostate cancer patients were treated with PT on prospective trials. Low-risk patients (N=89) were treated on PR01 with 78 CGE/39 fractions to the prostate. Intermediate-risk patients (N=82) were treated on PR02, a dose-escalation trial, with 78-82 CGE to the prostate and proximal seminal vesicles. Based on organ-constraint goals, 57 (69%), 13 (16%), and 12 (15%) PR02 patients received 82 CGE, 80 CGE, and 78 CGE, respectively. Toxicity was scored by CTCAE v3 and biochemical failure defined as nadir + 2 ng/mL. Results: The proportions of PR01 and 02 patients alive with no evidence of disease are 83 (93%) and 73 (89%); alive with disease, 1 (1%) and 1 (1%); and dead of intercurrent disease, 5 (6%) and 8 (10%), respectively. Only 2 patients had disease progression, both isolated pelvic-node recurrences. No patient died of prostate cancer or recurred locally. Grade (GR) 3 genitourinary (GU) and gastrointestinal (GI) complications occurred in 2 of 101 (2%), 0 of 13, and 4 of 57 (7%) patients receiving 78, 80, and 82 CGE, respectively. GR 3 GU toxicity occurred in 1 PR01 and 3 PR02 patients, including hematuria in 1 PR01 patient on anticoagulation; posttreatment TURP in 2 who had pretreatment (pre-tx) TURP; and dysuria in 1 with severe chronic pre-tx prostatitis. Multivariate analysis (MVA) of protocol, dose, age, prostate volume, pre-tx IPSS, pre-tx medical or surgical GU symptom management (SM), anticoagulation, and bladder wall V70 or V30 showed only pre-tx SM (P< .0001) and age (P =.007) to be associated with GR2+ toxicity. GR 3 GI toxicity occurred in 2 PR02 patients, including rectal bleeding in a patient on anticoagulation, and rectal bleeding and proctitis in a patient on anticoagulation who had a transrectal prostate biopsy. MVA of protocol, age, dose, anticoagulation, and rectal wall V70 or rectum V30 showed only rectal wall V70 (.045) and rectum V30 (.027) to be associated with GR 2+ rectal bleeding and proctitis. Conclusions: PT may provide sufficiently reduced toxicity to permit further dose intensification and/or concomitant chemotherapy.

• This report summarizes our 5-year experience with cryosurgery for in situ ablation of liver tumors. The liver was exposed with laparotomy, and the tumors were subjected to two freeze-thaw cycles using liquid nitrogen delivered by insulated probes; cryoablation was monitored with intraoperative ultrasonography. Tumor markers and computed tomography evaluated tumor response during long-term follow-up. From 1985 to 1990, 32 patients (19 men and 13 women) were entered into this study. The histologic characteristics of the tumors were as follows: colorectal, 24 patients; hepatoma, three patients; neuroendocrine, two patients; and others, three patients. After a follow-up period of 5 to 60 months (median follow-up, 24 months), nine patients (28%) remained disease free, 11 patients (34%) were alive with disease, and 12 patients (38%) died. The patterns of failure included liver and extrahepatic disease in 54% of cases, liver disease only in 32% of cases, and extrahepatic disease only in 14% of cases. In patients with "liver only" failure, recurrence at the treatment site occurred in three patients (9%). This study establishes the long-term effectiveness of cryosurgery in the treatment of primary and metastatic liver tumors. ( Arch Surg . 1991;126:1520-1524)

16 patients (29%) had non-invasive disease (pTis, pTa, pT1), and 30 patients (56%) had invasive disease (pT2-pT4). Ten patients (19%) had nodal involvement, with a mean of 19.6 lymph nodes removed for all patients. Two patients (4%) had a positive surgical margin. At a median follow up of 5.4 months, 42 patients (78%) were alive without disease, 5 patients (9%) were alive with disease, and 7 patients (13%) had died of cancer or other causes. CONCLUSIONS: In the hands of an experienced robotic surgeon, robotic-assisted laparoscopy is a safe approach to radical cystectomy, with the majority of complications requiring a low level of intervention. While nodal yields and margin rates are comparable to the open approach, long-term follow up and head-to-head comparison of oncologic outcomes are needed.

to lightly eosinophilic cytoplasm, but 10 tumors had cells with abundant eosinophilic cytoplasm. Large cytoplasmic vacuoles were prominent in 26 tumors. Nuclear atypicality was absent or mild in 54 cases, moderate in 4 cases, and marked in 2 cases. Mitotic rate ranged from less than 1 to 21 per 10 high power fields, with 50 tumors having no or only rare mitoses. Vascular space invasion was present in 11 cases and was prominent in 8. Follow-up of more than five years (average 8.4 years), or until evidence of metastasis was seen, was available for 16 patients. Nine were alive and well with no evidence of disease. Four were alive with disease and three died of disease. The pathologic features that best correlated with a clinically malignant course were as follows: a tumor diameter of 5.0 cm or greater, necrosis, moderate to severe nuclear atypia, vascular invasion and a mitotic rate of more than 5 mitoses per 10 high power fields. Only one of nine benign tumors for which follow-up data of 5 years of more were available had more than one of these features, whereas five of seven malignant tumors had at least three.

From August 1991 to November 1994, we observed brain metastasis in 15 pts with colorectal cancer (CRC):4 Males/11 Females, median age 59 y (43–69), CRC staging 7B, 4C, 4D. Treatment of the primitive tremor consisted with surgery (8 pts) plus chemotherapy (CT) (4 pts) or radiation therapy (RT) (3 pts). 12 pts developed non CNS metastases mostly, hepatic and/or pulmonary (9 pts). 3 pts had isolated CNS metastases. Median time to first metastasis was 18 months (0–66) and median time to CNS metastases was 27 months (1–129). CNS treatment was RT (36 Gy) in all pts, 2 had a previous surgical excision. 10 pts died of CNS metastases, 3 pts of other metastases ± local recurrence. Median survival time was 3 months (0–17). 2 pts are alive with disease at 2 and 17 months. Brain metastases, classically unusual In CRC become more frequent, potentially because of the wider use of systematic CT. Despite RT, their prognosis remains very poor.

Increasingly sophisticated diagnostic studies have shown a high incidence of tumor spread to the regional lymph nodes. The status of the lymph nodes has been evaluated by non-invasive diagnostic procedures such as lymphangiography and computerized axial tomography. The applicability of these procedures has been enhanced by the use of stringent criteria. Gross lymph node metastasis can be diagnosed with considerable confidence. Serial observations of lymphangiograms and computerized axial tomograms before and two months after the administration of estrogens provide an added dimension to the interpretation of lymph node metastasis. The nature and range of the response of lymph node metastasis were observed. Survival of patients with gross lymph node metastasis treated by sequential estrogen and radiation therapy was evaluated. A total of 11 18 (61 per cent) of patients remained free of symptoms, 8 11 (74 per cent) with a favorable lymph node metastasis responsive to estrogen therapy, and 3 7 (42 per cent) with lymph node metastasis refractory to estrogen therapy. Follow-up computerized axial tomograms of the lymph nodes done at one and two years after irradiation showed a persistent favorable response. Five patients are alive with disease, and 2 patients died of the disease.

Fourteen patients with hepatocellular carcinoma and mild to moderate liver dysfunction and 2 with metachronous liver metastases from rectal cancers underwent central bisegmentectomy of the liver, i.e., en bloc removal of the left medial and right anterior segments. One patient who had undergone preoperative liver artery embolization died in the hospital. Four patients survived without relapse 60-135 months postoperatively. Eleven patients had recurrent tumors, all in the liver remnant, and 2 also had recurrent tumors in the lungs. Six patients who relapsed died 28-93 months postoperatively. Four were alive with disease at 7-89 months, 1 after a second liver resection 54 months after central bisegmentectomy. Six of the 16 patients survived for 5 years or more. The results are favorable for these advanced tumors, often in the presence of liver dysfunction. The indications, technique, and results are discussed.

A study was made of 80 patients whose lymph nodes were characterized by the presence of follicles throughout the lymph node. The patients were divided into two groups on the basis of the clinical follow-up information. The first group consisted of 20 patients who were alive and disease-free at the end of five years without therapy. The patients in this group were classified as having florid reactive follicular hyperplasia (FRFH). The second group of 60 patients had progressive, recurrent, clinically active disease and were classified as having follicular lymphoma (FL). Forty-six were dead of active disease, and 14 were alive with disease. Various morphologic parameters were evaluated at low and high magnification, and statistical comparisons were made between FRFH and FL. Although several criteria were helpful in distinguishing FRFH from FL, the single most valuable criterion was the type of pattern encountered. Follicles of variable size and shape lying adjacent to each other throughout the lymph node without or with very little intervening tissue are diagnostic of FL. This pattern was evident in 85% of the FL cases, but was not observed in any of the cases of FRFH.

The medical records of 51 patients with primary small bowel cancer were reviewed. Twenty patients had carcinoid tumors, 17 had adenocarcinomas, 8 had leiomyosarcomas, and 6 had lymphomas. Presenting complaints were protean in nature and only 33 percent of patients had a correct diagnosis at the time of operation. Curative resection was attempted in 55 percent, but most patients presented late in their illness and only 27 percent had localized tumors. Survival has been poor: at most recent follow-up, 59 percent were dead, 14 percent were alive with disease, and 27 percent were alive and well. Earlier diagnosis may improve survival. Patients at risk for these tumors are usually more than 50 years of age with vague complaints such as weight loss, pain, abdominal fullness, and fatigue. They should undergo complete evaluation centered around exhaustive radiographic studies and liberal use of endoscopy.

Sixty-one patients with gynecologic malignancies had percutaneous transperitoneal lymph node aspiration performed by a flexible 8-inch needle guided to the nodes under monoplanar fluoroscopy. Of the patients who had malignant cells aspirated from pelvic and periaortic lymph nodes, 64% died or are alive with disease. Only 30% who had negative cytologic testing died or are alive with disease. Of the patients who had malignant cells aspirated from periaortic nodes, 69% died or are alive with disease whereas only 8% with negative cytologic testing died or are alive with disease. We believe that therapy such as extended field irradiation can be given on the basis of these results.

One hundred and two patients with a diagnosis of squamous cell carcinoma of the tonsillar region received complete Co60 radiation treatment at the Alice Crocker Lloyd Radiation Therapy Center of the University of Michigan from the years 1955 through 1963. The absolute 5 year survival was 32.4 per cent, counting as if dead of the disease 1 patient who was alive with disease at 5 years and 1 who had recurrence of the primary lesion later cured by surgery. The determinate 5 year survival was 39.8 per cent.The prognosis decreased as the primary lesion became larger or if there was regional metastasis. The degree of control of the primary lesion by irradiation was high in the T1 and T2 cases (80 per cent and 76.6 per cent, respectively). In larger lesions the local control decreased. The neck lymphadenopathy was less amenable to control by irradiation than the primary lesion; only one-fourth of the patients with initial lymphadenopathy were controlled with radiation therapy.The findings in this study lend supp...

We report the case of a 72-year-old woman in whom the sole manifestation of recurrent endometrial adenocarcinoma was a large splenic mass. The clinical presentation mimicked that of malignant lymphoma. Although as many as 9% of carcinomas are associated with splenic metastases, such involvement is typically encountered only at autopsy and associated with widespread extrasplenic metastases. In contrast, we have found only three other reported cases of gynecological malignancy in which a splenic mass was the sole presenting manifestation of recurrent tumor.

Nine cases of microsurgical tissue transfer following wide tumor resection are reported. A free vascularized fibula graft was used in six cases, a pedicle fibula graft in two cases, and a free vascularized muscle graft in one. In all cases except one, the grafted tissue survived completely. The average follow-up period was 3.9 years for tumor resection and 2.3 years for reconstructive surgery. Function according to Enneking’s grading was found to be excellent in one case, good in five, fair in one, poor in one, and undetermined in one. The oncological status of these cases was disease-free (CDF) in seven cases, no evidence of disease (NED) in one, and alive with disease (AWD) in one.

In non-seminomatous testicular tumor, 60% of failures are seen within the first three months after diagnosis. The most common site of metastasis is the lung. Occasionally, bone, liver and brain metastases are seen. In this series of 33 cases, the definitively treated Stage I patients are alive and well for an average of 6.3 years (12 patients); one was lost to follow-up. The 20 more advanced patients have not done well--16 are dead from disease with an average survival of 17 months, 3 are alive with disease for an average of two years, and one was lost to follow-up. In Stages II and III, the best results were obtained with an aggressive multimodality approach of surgery, postoperative irradiation and chemotherapy.

Eleven cases of sinonasal undifferentiated carcinoma were treated between 1975 and 1986. This distinctive neoplasm involved the orbital cavity in 6 of 11 patients (55%) and the cranial cavity in 7 of 11 patients (64%) at the time of presentation. Of the eight patients (73%) who died of disease, six died within 13 months after the diagnosis. One patient has no evidence of disease 10 months after therapy, and two are alive with disease after 15 and 22 months.

We have described a 38-year-old woman with a lesion of the cervix found on routine physical examination. The lesion proved to be a primary leiomyosarcoma of the cervix. Despite radiation therapy, surgery, and chemotherapy, the tumor recurred and grew relentlessly. She is alive with disease at two years seven months after initiation of therapy. The biologic behavior of leiomyosarcoma appears to be quite different from that of squamous cell carcinoma of the cervix.