• Archives of Plastic Surgery
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• 제38권4호
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• pp.339-344
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• 2011

Purpose: The goal of cancer surgery is complete removal of cancer tissue and prevention of recurrence. Surgeons can change the surgical instruments after total resection of the cancer mass. The purpose of this procedure is to prevent dissemination of the cancer cells attached to the surgical instruments. Authors hypothesize the possibility of local recurrence caused by the cancer cells attached to the surgical instruments in the skin cancer cases. Methods: Skin cancers were induced by using DMBA-TPA two-stage carcinogenesis model in 10 of Balb/c mice. In 2-weeks, skin cancer was developed in all 10 mice. cancer cell attached surgical instruments were made by pinching the removed cancer tissue using Adson tissue forcep 10, 20, 30 times each. To count number of cancer cells in each forcep with different number of pinching was done, the forceps were washed in 30 mL of the normal saline and Cytospin preparation was done. To make recurrence models from cancer cell attached surgical instrument, three incisions were made in normal skin of each mouse, and local seeding was done by pinching subcutaneous tissue in 10, 20, 30 times each by using Adson teeth forceps mentioned above as cancer cell attached surgical instrument. Results: All skin cancers were squamous cell carcinoma. Local recurrences were developed in 7 mice (3 in 10 times forceping site, 2 in 20 times forceping and 3 in 30 times forceping). In the cytospin test, the mean number of squamous cells in 100 microscope was 28.6 in 10 times, 47.2 in 20 times, 93.6 in 30 times, respectively. P value was 0.002 in Wilcoxon-Sign test. Conclusion: The number of cell count was significantly increased as number of pinching was increased. And these cells are able to induce local recurrence by local seeding. Considering this result, authors are able to confirm that the minimal handling in cancer surgery is important factor to prevent local recurrence.

• Radiation Oncology Journal
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• 제34권3호
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• pp.216-222
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• 2016

Purpose: To evaluate the benefit of adjuvant radiation therapy (RT) for retroperitoneal liposarcoma (RPLS) following gross tumor removal. Materials and Methods: We reviewed 77 patients with primary RPLS surgically treated between January 2000 and December 2013. Cases with gross residual disease were excluded. Tumor grade was evaluated according to the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system. Adjuvant RT was delivered to 32 patients (42%) using external beam RT alone. Median follow-up time was 36 months (range, 5 to 169). Results: Among 77 patients, 33 (43%) presented with well-differentiated, 31 (40%) with de-differentiated, 8 (10%) with myxoid/round and 4 (5%) with pleomorphic morphology. The RT group included less well-differentiated subtype than surgery group (28% vs. 53%). During follow up, 34 patients (44%) showed local recurrence. Local recurrence rate was lower in the RT group (38%) compared to the surgery group (49%). The 3-year local control rate (LC) was 55.6%, and the 3-year overall survival (OS) was 82.1%. Tumor histology and FNCLCC grade were significantly associated with local recurrence. There was no statistical significance of adding adjuvant RT in LC (p = 0.312). However, patients with tumor histology other than well-differentiated subtype showed marginally decreased local recurrence rate after adjuvant RT (3-year LC, RT 43.9% vs. no RT 35.3%; p = 0.087). Conclusion: RPLS patients receiving RT experienced less local recurrence. We suggest that the addition of adjuvant RT may be related to improvement of LCs, especially in patients with non-favorable histologic subtypes.

• Radiation Oncology Journal
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• 제2권1호
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• pp.115-122
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• 1984

Total 125 patinets with primary and metastatic Ewing's sarcoma were treated in various ways between 1963 to 1977. Patients were divided into 3 groups according to the treatment methods. Group 1 was nonprotocol patients with or without chemotherapy. Total 58 patients were entered. Group 1 was divided into 2 subgroups. 33 patients were treated locally without chemotherapy and 25 Patients were treated with local therapy and nonprotocol chemotherapy. Group 2 was treated with local therapy and plus T-2 regimen multiagent chemotherapy. 29 patients were entered. Group 3 was treated with local therapy and T-6 regimen multiagent chemotherapy. 38 patients were entered. Local treatments for primary tumor were surgery and/or radiation therapy. Radiation dose ranged between 2,000 and 8,000 rad. Patients with pulmonary metastases received bilateral pulmonary RT. Local recurrence rate was analyzed according to treatment groups and was $16.8\%$. Local 15 yr survival was $33\%$ and 8 yr survival of T-6 group was $64.9\%$. An analysis of time were pattern of recurrence of each group, and the correlation of with radiation dose with local recurrence done. This study concluded that intensive multiagent chemotherapy RT and/or surgery (T-6 regimen) reduced distant metastases, and produced significant increase in local control and survival.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8587-8589
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• 2014

Background: Although a great deal of progress has been made in the management of colorectal cancer in terms of neoadjuvant modalities, surgical techniques and adjuvant therapies, the recurrence of tumors remains an enigmatic complication in patients. A better understanding of colorectal cancer and of factors that lead to recurrence of disease can provide helpful information for designing more effective screening and surveillance methods. Aim: To investigate the factors that may lead to local recurrence of colorectal cancers. Materials and Methods: The current retrospective case study evaluated 617 patients admitted to the Iranian Cancer Institute (the largest referral cancer center in the country) from 1995 to 2009 with confirmed colorectal cancer. Patients with distant metastasis, or with pathology other than adenocarcinoma and no follow-up, were excluded (175 patients). The remainder (442) included 294 (66.5%) with rectal cancer and 148 (33.5%) with colon cancer. The median duration of follow-up was 26 months. Results: The total rate of recurrence was 17.4%, comprising 19.6% and 16.3% recurrence rates in colon and rectal cancer, respectively. Conclusions: Recurrence of colorectal cancer was significantly correlated to tumor grade (p<0.008).

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6513-6518
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• 2013

Background: To evaluate the treatment outcome and major late complications of all patients with recurrent nasopharyngeal carcinoma (NPC) treated with intracavitary brachytherapy (ICBT) in Hospital Kuala Lumpur. Materials and Methods: This retrospective study was conducted at the Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Malaysia. All patients with histologically confirmed recurrent NPC in the absence of distant metastasis treated in the period 1997-2010 were included in this study. These patients were treated with ICBT alone or in combination with external beam radiotherapy (EBRT). Treatment outcomes measured were local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS). Results: Thirty three patients were eligible for this study. The median age at recurrence was 56 years with a median time to initial local recurrence of 27 months. Majority of patients were staged as rT1-2 (94%) or rN0 (82%). The proportion of patients categorised as stage III-IV at first local recurrence was only 9%. Twenty one patients received a combination of ICBT and external beam radiotherapy while 12 patients were treated with ICBT alone. Median interval of recurrence post re-irradiation was 32 months (range: 4-110 months). The median LRFS, DFS and OS were 30 months, 29 months and 36 months respectively. The 5 year LRFS, DFS and OS were 44.7%, 38.8% and 28.1% respectively. The N stage at recurrence was found to be a significant prognostic factor for LRFS and DFS after multivariate analysis. Major late complications occurred in 34.9% of our patients. Conclusions: Our study shows ICBT was associated with a reasonable long term outcome in salvaging recurrent NPC although major complications remained a significant problem. The N stage at recurrence was a significant prognostic factor for both LRFS and DFS.

• Radiation Oncology Journal
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• 제2권2호
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• pp.229-235
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• 1984

Surgery remains the mainstay in the management of carcinoma of the rectum. However, local recurrence and systemic metastasis remain the challenge. It appears that post operative radiotherapy has a very definite role in the reduction of local recurrence. Minty two patients of carcinoma of the rectum after curative surgery received post operative radiotherapy $5,000rad/5\~6weeks$ to whole pelvis at the Department of Therapeutic Radiology, Seoul National University Hospital between March 1979 and December 1982. Fifty three percent of patients show modified Astler-Coiler stage C2. Actuarial disease free survival rate of rectal cancer was : stage B1, 2 $75\%$, stage C1 $81\%$ stage C2 $39\%$, and stage C3 $20\%$, Twelve percent shows local recurrence and distant metastasis occurred in $28\%$. Prognostic significance of nodal metastasis is also analysed. Incidence of small bewel obstruction, requiring surgery, is $8\%$, occurring between 5th month to 12 th month after operation. It is suggested that post operative radiotherapy of the rectal cancer following curative surgery has a significant role in the reduction of local recurrence.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제61권12호
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• pp.702-704
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• 2018

The most common cause of treatment failure in oral cavity cancer is when it is found to have local recurrence, usually occurring in the ipsilateral cervical lymph node. On the contrary, it is extremely rare to find local recurrence in soft tissue metastasis (STM) in the contralateral neck. Furthermore, lung cancer and malignant lymphoma are most commonly confined to their primary sites. The poor general condition increases the likelihood of STM, which indicates bad prognosis. A 72-year-old man with a hard and fixed mass on the right submandibular space visited our clinic. He had received a wide excision with local flapreconstruction for squamous cell carcinoma in the left corner of lower lip 18 months ago. We performed the wide excision with bilateral selective neck dissection (I-III), and he was finally diagnosed as STM from contralateral lip cancer. We report this unique and rare disease entity with a literature review.

• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1243-1249
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• 2016

Background: Expression of p53, cyclin D1, p21 (WAF1) and Ki-67 (MIB1) was evaluated in oral squamous cell carcinoma (OSCC) to test whether levels of these markers at invasive tumour fronts (ITFs) could predict the development of local recurrence. Materials and Methods: Archived paraffin-embedded specimens from 51 patients with T1/T2 tumours were stained immunohistochemically and analysed quantitatively. Local recurrence-free survival was tested with Kaplan-Meier survival plots (log-rank test) using median values to define low and high expression groups and with a Cox's proportional hazards model in which the expression scores were entered as continuous variables. Results: The assessment of expression of all markers was highly reliable, univariate analysis showing that patients with clear surgical margins, with low cyclin D1 and high p21 expression at the ITF had the best local recurrence-free survival. Multivariate analysis showed that these three parameters were independent prognostic factors but that neither p53 nor MIB1 expression were of prognostic value. Conclusions: Assessment of p53, cyclin D1, p21 (WAF1), and Ki-67 (MIB1) at the ITF could help to predict local recurrence in early stage oral squamous cell carcinoma cases.

• Radiation Oncology Journal
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• 제10권2호
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• pp.205-212
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• 1992

1982년 1월 부터 1990년 12월까지 전남대학교 병원에서 치료를 받은 95명의 직장암 환자를 대상으로 국소종양제어에 대한 수술후 방사선 치료의 역할을 알아보기 위하여 후향적 분석을 시행하였다. 95명의 환자중 72명은 수술만 받았으며 나머지 23명은 수술후 방사선 치료를 함께 받았다. 환자의 성별 분포는 남자가 45명 여자가 50명으로 비슷하였으며 연령의 중앙치는 53세 였다. 최소 추적기간은 19개월(범위 : $19\~125$)이었으며 중앙치는 47개월이었다. 종양의 국소재발율과 생존율은 Kaplan-Meier 법으로 계산하였으며 두 군간의 비교는 Log-rank test에 의하였다. 전체 95명의 환자중 27명 ($28.4\%$)에서 국소 종양의 재발이 관찰되었으며 13명($17.3\%$)에서는 원격 전이가 동시에 관찰되었다. 국소 종양 재발이 관찰된 27명중 24명 ($89\%$)이 수술 후 24개월이내에 재발되었으며 부위는 원발 병소 주위의 골반강내 조직에 가장 흔하였다. 수술만 받은 72명의 환자중 24명에서 국소 재발이 관찰되었다. 병기 A와 B1의 17명중 6명에서, B2와 B3 33 명중 7명 ($29.9\%$)에서, C2와 C3 19명중 11 명 ($54.7\%$)에서 각각 재발되었으며 병기에 따른 재발율의 차이는 통계학적 의의가 있었다(p<0.05). 수술후 방사선 치료를 받은 23명의 환자중 병기 B2와 B3 10명중 1명 ($10\%$)에서, 병기 C2와 C3 10명중 2명($22.2\%$)에서 재발이 관찰되었으며 두 군간의 차이는 통계학적 의의가 없었다(p<0.05). 한편 병기 B2와 B3에서 수술 후 방사선 치료를 시행한지 않은 군 보다 시행한 군에서 국소 종양 재발율이 낮았으나 통계학적 의의를 갖지 못하였으며 ($29.9\%$ vs $10.0\%$, p<0.05), 병기 C2와 C3의 경우는 수술 후 방사선 치료를 시행한 군에서 종양의 재발이 낮았으며 통계학적 의의가 있었다($34.7\%$ vs $22.2\%$, p<0.05).

• Archives of Plastic Surgery
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• 제37권3호
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• pp.285-288
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• 2010

Purpose: Dermatofibrosarcoma protuberans is a rare tumor, accounting for 0.1% of all malignant tumors. Although metastasis is very uncommon, local recurrence occur frequently. Dermatofibrosarcoma protuberans occurring in children is even more rare; this is the first case report of congenital dermatofibrosarcoma protuberans in Korea. Methods: The patient is a 14-month-old male infant with a lesion that was first thought to be a birthmark. The lesion grew larger, and a punch biopsy revealed dermatofibrosarcoma protuberans. A wide local excision was performed with a 2 cm peripheral resection margin beyond the gross tumor lesion. Deep fascia and a portion of muscle underneath the central part of the lesion were also taken. The surgical defect was covered by a split-thickness skin graft. Results: There has been no clinical sign of recurrence over one year after the surgery. Conclusion: A patient with congenital dermatofibrosarcoma protuberans detected at an early stage underwent a wide local excision of the tumor after accurate diagnosis was carried out by biopsy and immunohistochemical studies. There was no clinical evidence of tumor recurrence during over a 1-year follow-up.