Partial Laryngectomy after Irradiation Failure

2003 ◽  
Vol 128 (2) ◽  
pp. 200-209 ◽  
Author(s):  
John Yiotakis ◽  
Pelagia Stavroulaki ◽  
Thomas Nikolopoulos ◽  
Leonidas Manolopoulos ◽  
Dimitrios Kandiloros ◽  
...  
Keyword(s):  
Early Cancer ◽  
Early Stage ◽  
Partial Laryngectomy ◽  
Laryngeal Function ◽  
Supraglottic Laryngectomy ◽  
Regional Control ◽  
Oncologic Result ◽  
Oncologic Results ◽  
The Mean

INTRODUCTION: Radiation therapy is often the first method of treating patients with early cancer of the glottis. There is a substantial failure rate among these patients. Total laryngectomy has usually been the means of treating patients with failure after radiation. In recent decades, partial laryngectomy has been used for salvage in such patients. This article will discuss the use of partial laryngectomy for radiation failure both from the oncologic result as well as the morbidity. PATIENTS AND METHODS: Between 1984 and 1995, 27 patients with early-stage laryngeal carcinoma underwent salvage partial laryngectomy after irradiation failure. Vertical laryngectomy was performed in 18 patients (13 with T1 N0 and 5 with T2 N0) and horizontal-supraglottic laryngectomy in 9 patients (3 with T1 N0, 1 with T2 N0, and 5 with T2 N1). The mean follow-up was 4.1 years. RESULTS: Local control was obtained in 77.7% of patients with glottic lesions (T1: 84.6%; T2: 60%, P = NS) and in 55.5% of patients with supraglottic lesions (T1: 66.6%; T2: 50%; P = NS). There was no regional recurrence in the vertical laryngectomy group, whereas the regional control rate in the horizontal-supraglottic laryngectomy group was 77.7%. Distant control was achieved in 94.4% of patients with glottic disease and in 77.7% of patients with supraglottic disease. The overall survival rate for glottic lesions was 88.8% (T1: 92.3%; T2:80%; P = NS) versus 66.6% for supraglottic lesions (T1: 100%; T2: 50%; P = NS). CONCLUSION AND SIGNIFICANCE: Vertical laryngectomy was not associated with an increased complication rate. Morbidity in the horizontal-supraglottic laryngectomy group was higher, but a satisfactory functional outcome was obtained in all cases. Therefore, in early laryngeal cancer (glottic T1-T2, supraglottic T1) partial laryngectomy can be performed with good expectation of cure and satisfactory laryngeal function. In T2 supraglottic lesions, the oncologic results are less satisfactory; further research is required for developing more efficient complimentary or alternative treatments modalities.

scholarly journals The Clinical Non-Motor Connectome in Early Parkinson’s Disease

2020 ◽  
Vol 10 (4) ◽  
pp. 1797-1806
Author(s):  
Nico J. Diederich ◽  
Nicolas Sauvageot ◽  
Vannina Pieri ◽  
Géraldine Hipp ◽  
Michel Vaillant
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Early Stage ◽  
Correlation Coefficients ◽  
P Value ◽  
The Mean ◽  
Disease Initiation ◽  
Non Motor Symptoms ◽  
Early Parkinson’S Disease

Background: Non-motor symptoms (NMS) of various anatomical origins are seen in early stage idiopathic Parkinson’s disease (IPD). Objective: To analyse when and how NMS are linked together at this stage of the disease. Methods: Prospective study recruiting 64 IPD patients with ≤3 years of disease duration and 71 age-matched healthy controls (HC). NMS were clustered in 7 non-motor domains (NMD): general cognition, executive function, visuospatial function, autonomic function, olfaction, mood, and sleep. Correlation coefficients ≥|0.3| were considered as significant. Bootstrapped correlation coefficients between the scores were generated in both groups. Fourteen IPD patients and 19 HC were available for a follow-up study two years later. Results: The mean age of both groups was similar. 58% of IPD patients and 37% of HC were male (p = 0.01). At baseline IPD patients performed less well than HC on all NMD (p value between 0.0001 and 0.02). Out of 91 possible correlations between NMD, 21 were significant in IPD patients and 14 in HC at the level of ≥|0.3|. The mean correlation level was higher in IPD patients than in HC, as evidenced by the higher box plot of correlation coefficients. Visuospatial scores at baseline were predictive of the motor deterioration at the follow-up exam. Conclusion: At early IPD stage various NMS are linked together, although not connected by anatomical networks. Such a clinical NMD connectome suggests almost synchronous disease initiation at different sites as also supported by fMRI findings. Alternatively, there may be compensation-driven interconnectivity of NMD.

scholarly journals Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy

Cancers ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1047 ◽  
Author(s):  
Adélaïde Toutée ◽  
Martina Angi ◽  
Sylvain Dureau ◽  
Christine Lévy-Gabriel ◽  
Livia Lumbroso-Le Rouic ◽  
...  
Keyword(s):  
Proton Beam ◽  
Optic Disc ◽  
Uveal Melanoma ◽  
Early Stage ◽  
Tumor Control ◽  
Proton Beam Radiotherapy ◽  
Visual Outcomes ◽  
The Mean

There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 (n = 75), and 20/40 and 20/80 for GInf3 (n = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7–99.1) and 60.1%(CI95%:54.9–65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant (p < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location (p < 0.001), tumor touching optic disc (p = 0.04), initial VA inferior to 20/40 (p < 0.001), documented growth (p = 0.002), and age greater than 60 years (p < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.

Predictive factors for metastasis in patients (pts) with gastric cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15056-15056
Author(s):  
S. Kilickap ◽  
O. Dizdar ◽  
H. Harputluoglu ◽  
S. Aksoy ◽  
S. Yalcin
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Early Stage ◽  
Stage Iv ◽  
Stage I ◽  
Early Stage Disease ◽  
Increased Risk ◽  
Metastasis Development ◽  
The Mean

15056 Background: Determination of patients (pts) with early stage disease who have a high risk for developing metastatic disease is crucial. We investigated the risk factors associated with metastases development in pts with operable gastric cancer. Patients and Methods: In this retrospective study, pts with stage I-III and non-metastatic stage IV gastric cancer diagnosed between 1990 and 2006 were evaluated. The medical records of all pts including patient characteristics, laboratory results, histopathological examinations, were reviewed. Logistic regression methods were used to determine the risk factors for developing metastasis and to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: 184 pts (70% male, 30% female) were analyzed. The mean age ± standard deviation was 56.5±11.9. The mean age of female were higher than male (p=0.014). At the time of diagnosis, 13.6% of the pts had stage I, 19.0% had stage II, 53.3% had stage III, and 14.1% had non-metastatic stage IV disease. The tumors were distally localized in 80% of the cases. Median follow-up period was 35 months. During follow up, 51 pts developed metastases. Median time to metastases development was 14 months. Overall survival was shorter in pts who developed metastasis than those who did not. (20 months vs. not reached, respectively, p=0.002). In univariate analyses, stage (p=0.020), tumor localization (p=0.006), extracapsular lymphatic extension (ELE) (p<0.001), the number of metastatic lymph nodes (p=0.001), CEA level (p<0.001), lymphovascular invasion (LVI) (p=0.001), and perineural invasion (p=0.007) were associated with metastasis development. In multivariate analysis, elevated CEA levels (p=0.009; OR: 2.8; CI 95%: 1.29–6.19), LVI (p=0.041; OR: 2.2; CI 95%: 1.03–4.64) and ELE (p=0.029; OR: 2.3; CI 95%: 1.09–4.78) were associated with increased risk of metastasis development while distal localization (p=0.038; OR: 0.42; CI%: 0.18–0.95) was associated with decreased risk in pts with gastric cancer. Discussion: In pts with early stage or locally advanced gastric cancer, elevated CEA levels, LVI, proximal localization and ELE were associated with increased risk of developing metastasis. Aggressive treatment options and closer follow up should be considered for pts with these risk factors. No significant financial relationships to disclose.

scholarly journals Does the Difference in Leukocyte Concentration of PRP Affect the Short-Term Follow-Up Results in Cases Diagnosed with Early Stage Knee Osteoarthritis?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Ismail Oltulu ◽  
Ozgur Korkmaz ◽  
Mehmet Isyar ◽  
Adnan Kara ◽  
Ahmet Murat Bulbul ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Society Score ◽  
Early Stage ◽  
High Concentration ◽  
The Mean ◽  
The Difference ◽  
Leukocyte Concentration ◽  
Knee Functionality ◽  
Group 1

Abstract This prospective study was conducted for the clinical evaluation of pain severity and knee functionality following PRP injections with different leukocyte (WBC) concentrations applied to cases diagnosed with knee osteoarthritis. A total of 109 patients were included in the study. According to the leukocyte content the PRP injections were prepared as low-leukocyte content PRP (PPRP) and high concentration leukocyte content PRP (L-PRP). Patients were divided into 2 groups. Group 1 (n=44) received low-leukocyte content PRP and Group II (n =65) received high-leukocyte content PRP. The patients were evaluated clinically with Visual Analog Scale (VAS) and Knee Society Score (KSS). The changes in the PLT levels of the L-PRP group after the procedure compared to the levels prior to the procedure were found to be statistically significantly greater than the changes in the PPRP group. The mean VAS score of all the cases before treatment was 9.05±0.91 and this score decreased to 3.71±1.46 within 12 months. The increases in the mean Knee Society Score (KSS) values were determined as 16.92±1.97 within 6 months and 16.89±2.97 within 12 months in the P-PRP group and 19.71±1.24 within 6 months and 19.86±0.42 within 12 months in the L-PRP group. The most important aspect of this study is that, in contrast to many other studies, the results continued after the 6th month and were reported to be good in the 12th month. It was also recorded that L-PRP was clinically superior to P-PRP in the treatment of early stage knee osteoarthritis.

scholarly journals Mechanical Evaluation of Collapse Risk for Osteonecrosis of Femoral Head Post-Medical Treatment

2021 ◽  
Author(s):  
Yuqian Mei ◽  
Qi Tang ◽  
Songhao Chen ◽  
Duanduan Chen
Keyword(s):  
Femoral Head ◽  
Medical Treatment ◽  
Early Stage ◽  
Equivalent Stress ◽  
Stress Index ◽  
Patient Specific ◽  
Relative Stress ◽  
The Mean ◽  
One Year

Abstract Background: Early-stage osteonecrosis of the femoral head can progressively induce the bone collapse and the accuracy of the collapse risk evaluation is limited. This study aims to propose a potential collapse indicator by biomechanical evaluating the treatment effectiveness. Methods: Six patient-specific models pre- (initial presentation) and post- medical treatment were established and elastic properties of the bone were assigned with a function of spatial-variant Hounsfield unit values. Morphological and mechanical analyses were compared between pre- and post-treatment models. Results: In the morphological study, four cases show the reduced ratio of low-density necrotic volume, but not consistent with one-year follow-up results. In the mechanical analysis, the equivalent stress variation near the Ward triangle shows consistency in the one-year outcome. Moreover, a parameter - relative stress index, the ratio between the mean volume stress index and the mean volume equivalent stress, is proposed. A smaller value of the relative stress index indicates stronger bone compressive strength and its variation is consistent with the follow-up results. Conclusions: Results implicate that to evaluate the effectiveness of medical treatments, the morphologic analysis should be considered but the mechanical capability and the loading transfer path through the necrotic and viable bone play a more important role.

Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma.

1991 ◽  
Vol 9 (6) ◽  
pp. 988-996 ◽  
Author(s):  
A Recht ◽  
S M Pierce ◽  
A Abner ◽  
F Vicini ◽  
R T Osteen ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Axillary Dissection ◽  
Salvage Surgery ◽  
Early Stage ◽  
Conservative Surgery ◽  
Potential Toxicity ◽  
Regional Control ◽  
Joint Center ◽  
Nodal Failure

We retrospectively analyzed the likelihood of regional nodal failure (RNF) for 1,624 patients with stage I or II invasive breast carcinoma treated with conservative surgery and radiotherapy (RT) at the Joint Center for Radiation Therapy (JCRT) between 1968 and 1985. The median follow-up time was 77 months. RNF was the first site of failure for 38 of the 1,624 patients (2.3%). The incidence of axillary failure for patients undergoing axillary dissection (AXD) who were irradiated to the breast only was 2.1% (nine of 420) for patients with negative nodes and 2.1% (one of 47) for patients with one to three positive nodes. The incidence of supraclavicular failure in these two groups was 1.9% (eight of 420) and 0% (zero of 47), respectively. The incidences of axillary and supraclavicular failure in patients without clinically suspicious axillary involvement who did not have AXD but were treated with RT were 0.8% (three of 355) and 0.3% (one of 364), respectively. Despite various combinations of salvage surgery, RT, and systemic therapy, only 47% of patients (18 of 38) achieved complete regional control after nodal relapse. We conclude that RNF is uncommon in patients treated to the breast alone following an adequate AXD when the axillary nodes are negative or when one to three nodes are positive. RNF is also uncommon in patients with a clinically uninvolved axilla treated with nodal RT without AXD. Symptoms of RNF can be controlled in most but not all patients. Further study is needed to determine if the benefits of RT in preventing a small number of symptomatic RNF outweigh the potential toxicity for any subgroup of patients.

Clinical Utility of Follow-up Urinary Gram-Stain for Pyelonephritis: A Retrospective Observational Study

2020 ◽  
Author(s):  
Masafumi Abe ◽  
Takeshi Ueda ◽  
Satoshi Yoshikawa ◽  
Kazusa Saegusa
Keyword(s):  
Likelihood Ratio ◽  
Clinical Utility ◽  
Early Stage ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Resistant Bacteria ◽  
Gram Stain ◽  
Antibiotic Resistant ◽  
The Mean

Abstract Background: The effectiveness of antibiotic therapy for the treatment of pyelonephritis is typically evaluated by the clinical course and results of urine culture. The purpose of this study was to evaluate the usefulness of follow-up urinary gram-stain. Methods: We analyzed the results of hospitalized pyelonephritis patients treated in our department during the last 6.5 years. We investigated whether follow-up urinary gram-stain within 48 hours after initiating antibiotic treatment can help predict resistance to antibiotics at an early stage. Results: 271 patients were enrolled in the study. The mean age was 84.1 years old, and 204 of them (72%) were female. the diagnostic accuracy of using follow-up gram-stain to predict the presence of antibiotic-resistant bacteria was as follows: sensitivity: 41%, specificity: 82%, positive likelihood ratio: 2.32, and negative likelihood ratio: 0.71. It was also shown that the presence of elongated cells can help predict resistant bacteria more accurately. Conclusions: Follow-up urinary gram-stain is considered useful on treating patients with pyelonephritis as it facilitates evaluation of antibiotic effectiveness at an early stage.

Supraglottic Laryngectomy: Functional and Oncologic Results

1996 ◽  
Vol 105 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Jesús Herranz-González ◽  
José Martínez-Vidal ◽  
Javier Gavilán ◽  
César Gavilán
Keyword(s):  
Squamous Cell Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Total Laryngectomy ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Supraglottic Laryngectomy ◽  
Regional Control ◽  
Significant Difference ◽  
Oncologic Results ◽  
N Stage

Between January 1980 and December 1989, 110 patients with squamous cell carcinoma of the supraglottis were treated with supraglottic laryngectomy and neck dissection. The stage distribution was stage I 23%, II 34%, III 15%, and IV 28%. Adjuvant radiotherapy (5,000 to 6,500 cGy) was given to all pN+ cases. All patients were followed until death or for a minimum of 36 months, with an average of 65 months. Decannulation was achieved in 96% of the cases, with only 1 patient undergoing total laryngectomy because of aspiration. The average hospital stay was 22 days. Arytenoid edema was a frequent cause of delayed decannulation in patients undergoing radiotherapy. The overall 3-year survival was 78%, with 10 patients dying of unrelated causes. Local control was 94.6% and regional control was 83.6%. No significant difference was found in survival according to T stage, but survival rate was significantly influenced by N stage.

scholarly journals Late Radiation–Related Toxicities in Patients Treated for Early-Stage Cervical Carcinoma by Surgery and Adjuvant Radiotherapy: A Retrospective Imaging Study

2021 ◽  
Vol 27 ◽  
Author(s):  
Katarina Nadova ◽  
Miroslava Burghardtova ◽  
Klara Fejfarova ◽  
Klaudia Reginacova ◽  
Hana Malikova
Keyword(s):  
Cervical Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Inclusion Criteria ◽  
Imaging Results ◽  
The Mean ◽  
Risk Of Cancer ◽  
Tomography Scan

Surgical treatment is preferred therapy of early-stage cervical carcinoma. In the risk of cancer recurrence surgery is often followed by adjuvant radiotherapy. In our retrospective study we aimed at identifying late (≥6 months) and very late (≥5 years) radiation adverse effects on imaging scans as CT, PET/CT and MRI in patients who underwent successful treatment for cervical carcinoma by radical surgery combined with radiotherapy ± chemotherapy. We correlated imaging results with clinical manifestations. We selected young and middle-aged patients with long life expectancy, as late radiation-related toxicities may significantly affect their quality of life. Patients were selected from those who were primary diagnosed and treated between the years 1987–2011 and regularly visited our Oncology department in years 2011–2012. Following inclusion criteria were applied: age ≤55 years at diagnosis, clinical follow-up ≥5 years and at least one tomography scan ≥3 years after finished treatment. One hundred and three subjects were reviewed: 73 patients met all inclusion criteria, while 30 patients fulfilled the inclusion criteria except for available tomography scan ≥3 years after therapy. The mean imaging follow-up was 11.2 ± 7.6 years and the mean clinical follow-up was 15.0 ± 6.9 years. In 20 (27%) subjects 27 cases grade I radiation-related toxicities were found; 9 (33%) of those 27 cases were clinically silent. In 14 (19%) females only grade I toxicities were observed. Grade III-IV toxicities were found in 5 (6.8%) subjects. No grade V toxicities were observed. We concluded that severe late side effects caused by radiotherapy were exceedingly rare in females successfully treated for early-stage cervical carcinoma, only 1 bilateral osteonecrosis, 2 cases of ileus, and 2 potentially radiation-induced tumors were found. The majority of radiation-related comorbidities found on imaging scans were clinically silent.

scholarly journals Ankylosing spondylitis and non-radiographic axial spondyloarthritis: Two stages of disease?

2017 ◽  
Vol 89 (5) ◽  
pp. 33-37 ◽  
Author(s):  
D G Rumyantseva ◽  
T V Dubinina ◽  
A B Demina ◽  
O A Rumyantseva ◽  
E M Agafonova ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Duration ◽  
Axial Spondyloarthritis ◽  
Early Stage ◽  
Clinical Manifestations ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Two Stages

Aim. To compare the clinical manifestations of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA). Subjects and methods. A Moscow early spondyloarthritis cohort has now included 132 patients with axial spondyloarthritis, of whom 69 patients who have been followed up at least 12 months are to be involved in a preliminary analysis. The mean age at the time of inclusion in the study was 28.1±5.5 years; the mean disease duration was 24.7±15.8 months; 63 (91.3%) patients were HLA-B27 positive; 41 and 28 included patients were diagnosed with AS and nrAxSpA, respectively. Results. Men were significantly more in the AS group than in the nrAxSpA group (58.5 and 32.1%, respectively; p=0.05). The patients of the two groups did not differ in main clinical parameters (the presence of arthritis and enthesitis), disease activity (BASDAI, ASDAS-CRP) and functional status (BASFI). All indicators of inflammatory activity decreased nearly 2-fold in both groups after 12 months of follow up. In 7 (25%) patients with nrAxSpA, radiologically detectable sacroiliitis (SI) developed over 12 months and the diagnosis of AS was verified. Among them, 2 (28.5%) patients had initially active SI detected by magnetic resonance imaging (MRI); 4 (57.1%) had chronic SI, and 1 (14.4%) had no pathological MRI changes. Conclusion. Due to the fact that the clinical manifestations of AS and nrAxSpA are comparable, it can be assumed that the latter is an early stage of AS.

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