Anti-tumor effect of boron neutron capture therapy in pelvic human colorectal cancer in a mouse model.

Local recurrence of colorectal cancer (CRC) can occur in patients after curative resection, and additional surgical resection may therefore be required; however, this is a significant burden for patients, because additional surgical resection may necessitate the resection of other organs such as the bladder, prostate, uterus, or sacral bone. Therefore, there is a need for alternative therapeutic strategies. We focused on boron neutron capture therapy (BNCT) as a treatment modality that can selectively target tumor cells without excessive damage to normal tissues. The usefulness of BNCT to pelvic CRC remains unknown. This study investigated the anti-cancer effect of boronophenylalanine (BPA)-mediated BNCT in a previously established mouse model of pelvic recurrence of CRC. Uptake of BPA in CRC was observed both in vitro and in vivo, and the concentrations were sufficient for BNCT. Our results are the first to show that BPA-mediated BNCT prolonged the survival of experimental mice with pelvic tumors; moreover, it did not cause any obvious severe side effects in the treated animals. In conclusion, BPA-mediated BNCT could contribute to treating local recurrence of pelvic CRC.

[Pelvic limb-salvage surgery for malignant tumors: 30 years of progress in China].

This article reviews the development and progress in the field of limb salvage treatment, surgical techniques, and function reconstruction of pelvic malignant tumors in China in the past 30 years. Based on the surgical classification of pelvic tumor resection in different parts, the development of surgical techniques and bone defect repair and reconstruction methods were described in detail. In recent years, in view of the worldwide problem of biological reconstruction after pelvic tumor resection, Chinese researchers have systematically proposed the repair and reconstruction methods and prosthesis design for bone defects after resection of different parts for the first time in the world. In addition, a systematic surgical classification (Beijing classification) was first proposed for the difficult situation of pelvic tumors involving the sacrum, as well as the corresponding surgical plan and repair and reconstruction methods. Through unremitting efforts, the limb salvage rate of pelvic malignant tumors in China has reached more than 80%, which has preserved limbs and restored walking function for the majority of patients, greatly reduced surgical complications, and achieved internationally remarkable results.

Stress Incontinence Surgery Does Not Cause Pelvic Malignancy: A Population-Based Cohort Study.

PURPOSE: We sought to determine if stress urinary incontinence surgery (mesh or nonmesh) is associated with the development of pelvic malignancies later in life. MATERIALS AND METHODS: We performed a retrospective cohort study between January 1, 2002 and October 31, 2015 of all women in Ontario, Canada without a history of pelvic malignancy who underwent an index stress incontinence surgery. The primary outcome was a composite of any pelvic malignancy (including urological and gynecological cancers) following stress incontinence surgery. Secondarily, we considered each cancer individually. A survival analysis using a Cox proportional-hazards model with a 3-level categorical exposure (mesh surgery, nonmesh surgery, and control) was performed. Patients were followed until death, emigration or the study end (October 31, 2017). RESULTS: Of the women 74,968 underwent stress urinary incontinence surgery during the study period. There were 5,505,576 women in the control group. Over a median followup of 8.5 years (IQR, 5.5-11.9), 587 pelvic malignancies occurred in the surgery group. Women who underwent stress incontinence surgery had a reduced risk of pelvic malignancy independent of surgery type, compared to controls (Wald type 3 p <0.001; mesh HR, 0.68 [95% CI, 0.62-0.76]; p <0.0001; nonmesh HR, 0.37 [95% CI, 0.29-0.46]; p <0.0001). The individual pelvic cancers similarly demonstrated a reduced risk of malignancy following stress incontinence surgery. CONCLUSIONS: At a median followup of 8.5 years, women had no increased risk of pelvic malignancy following either mesh or nonmesh stress urinary incontinence surgery in a large population-based cohort.

Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar - two cases report and literature review.

BACKGROUND: Malignant endometriosis in an episiotomy scar is rare; only seven cases have been reported previously. Here, we compare two cases of benign endometriosis and clear cell carcinoma. CASE PRESENTATION: The first case was a 54-year-old woman who presented with a large perineal lesion in her episiotomy scar with high 18F-fluorodeoxyglucose uptake. This location had a history of endometriosis many years ago. She underwent radical excision of the mass and bilateral inguinal lymph node dissection. Histological and immunohistochemical analysis confirmed the presence of clear cell carcinoma arising from endometriosis. Assisted radiotherapy was performed after surgery due to a positive lymph node. No recurrence was detected over a 1-year follow-up period. The second case deals with a 3 × 2 cm mass in the episiotomy scar of a 33-year-old woman. Part of the anal sphincter was resected because of the close proximity of the lesion. Because the disease lay very close to the anus, she received anal sphincter reconstruction combined with mass excision. Pathology result showed typical endometrial glands and interstitial tissues. CONCLUSIONS: Deleterious change only happens in patients experiencing perineal endometriosis. Complete excision is crucial for this form of disease; sometimes impairment of the anal sphincter is also necessary. Patients with malignancy required a combination of treatments in order to improve their prognosis.

Radiotherapy for pelvic nodal recurrences after radical prostatectomy: patient selection in clinical practice.

AIM: There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides androgen deprivation therapy (ADT) as standard of care, both elective nodal radiotherapy (ENRT) and stereotactic body radiotherapy (SBRT) as well as salvage lymph node dissection (sLND) are common treatment options. The aim of our study was to assess decision making and practice patterns for salvage radiotherapy (RT) in this setting. METHODS: Treatment recommendations from 14 Swiss radiation oncology centers were collected and converted into decision trees. An iterative process using the objective consensus methodology was applied to assess differences and consensus. RESULTS: PSMA PET/CT was recommended by 93% of the centers as restaging modality. For unfit patients defined by age, comorbidities or low performance status, androgen deprivation therapy (ADT) alone was recommended by more than 70%. For fit patients with unfavorable tumor characteristics such as short prostate-specific antigen (PSA) doubling time or initial high-risk disease, the majority of the centers (57-71%) recommended ENRT + ADT for 1-4 lesions. For fit patients with favorable tumor characteristics, there were low levels of consensus and a wide variety of recommendations. For 1-4 nodal lesions, focal SBRT was offered by 64% of the centers, most commonly as a 5-fraction course. CONCLUSIONS: As an alternative to ADT, ENRT or SBRT for pelvic nodal oligorecurrences of PC are commonly offered to selected patients, with large treatment variations between centers. The exact number of lymph nodes had a major impact on treatment selection.

Para-anal lipoma as a rare consequence to perineal trauma. Case-report and review of the literature.

Introduction: Lipomas are the most common benign mesenchymal tumors which can be found in any part of the body. Nevertheless, their etiology and pathogenesis remain unknown. It is hypothesized that some of these lesions could result from an acute or chronic trauma. Patients and methods: We report a case of a 54-year-old man presenting a perineal lipoma which volume grew rapidly after he fell on his buttock, in the context of inaugural epileptic seizure. Pelvic MRI showed a voluminous fatty mass, measuring 6.6 × 5 × 9 cm without any signs of local invasion. Furthermore, we review the latest research on lipomas originating from traumatic lesion. Results: The mass was completely excised in one block under general anesthaesia, using an elliptical incision and a deep dissection. We did not close the skin incision in view of the cutaneous defect. Post-operative recovery was uneventful and the patient was discharged from hospital two days after the operation. Histopathology indicated a reorganised lipoma with no evidence of malignancy. Conclusion: Perineal lipomas are extremely rare, pathological examination of imaging guided biopsies are needed to exclude malignancy especially a well-differentiated liposarcoma. MRI remains the first option and radical surgical excision is the gold standard treatment.

Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations.

AIM: The aim of this study was to determine the incidence, risk factors, consequences and accuracy of imaging evaluation of lymph node (LN) metastasis in a cohort of 406 patients treated with radical hysterectomy (RH), lymphadenectomy of pelvic LN (PLN) and para-aortic LN (PALN), which was performed primarily by one physician. METHODS: From February 2001 to November 2015, patients with cervical cancer of FIGO stage IB were included, if they received RH of class III or type C performed by Dr. M. Wu in Peking Union Medical College Hospital. Follow-up ended in December 2016. Incidences and accuracy of imaging evaluation of LN metastasis were described, and predictive factors of LN metastasis and its impact on survival outcomes were determined in univariate and multivariate models. RESULTS: Among 406 patients with clinical stage IB, 57 (14.0%) had lymphatic metastasis. In multivariate model, positive parametrium was independent factor for general LN metastasis (odds ratio [OR] 5.1; 95% confidence interval [95% CI], 2.1-12.1) and PLN metastasis (OR 5.3; 95% CI, 2.2-12.8). Positive PLN was independent factor for metastasis to common iliac LN and PALN. After adjusted with clinico pathologic factors, general and site-specific LN metastases were independent risk factors of progression-free survival and overall survival (all P values <0.05). Preoperative imaging evaluation had low sensitivity but high specificity for predicting LN metastasis. Various imaging methods had similar predictive accuracy. CONCLUSION: Lymphatic metastasis was significantly related to the clinico pathologic characters and survival of cervical cancer. More sensitive preoperative evaluation is needed for predicting the LN metastasis.

Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh.

OBJECTIVE: To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer. METHODS: We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression. RESULTS: The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3-0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5-1.2), endometrial (HR 1.1, 95% CI 0.8-1.4), cervical (HR 0.4, 95% CI 0.2-1.0), bladder, and urethra (HR 0.7, 95% CI 0.4-1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7-0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3-29.5) vs 21.0 (20.6-21.5) for rectal cancer, 25.5 (18.4-35.3) vs 19.8 (19.4-20.2) for ovarian cancer, 65.0 (53.0-79.8) vs 33.1 (32.6-33.7) for endometrial cancer, 5.7 (2.8-11.3) vs 11.9 (11.6-12.2) for cervical cancer, and 19.1 (13.1-27.8) vs 13.3 (13.0-13.7) for bladder and urethra cancer. CONCLUSION: Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.

The risk of second malignancies after 125I prostate brachytherapy as monotherapy in a single Australian institution.

PURPOSE: To report the incidence of second primary cancer (SPC) after 125I brachytherapy (BT) for early prostate cancer in an Australian institution. METHODS AND MATERIALS: All the patients in our cohort had a cystoscopy before the implant. Data were prospectively collected on all subsequent SPC diagnoses. Standardized incidence ratios (SIRs) were calculated to compare data with the Australian population. Kaplan-Meier analysis was used to determine the actuarial second malignancy and pelvic malignancy rates and the death from SPC and from any cause. RESULTS: A total of 889 patients were followed up for a median of 4.16 (0-13) years with 370 (42%) patients having ≥5 years of followup. Sixty patients subsequently developed an SPC of which 11 were pelvic malignancies. The 5- and 10-year cumulative incidences were 1.3% (95% confidence interval [CI]: 0.6-3) and 3.3% (95% CI: 1-7) for any pelvic malignancy and 1% (95% CI: 0.4-2) and 2.6% (1-6) for bladder cancer, respectively. The SIR was significantly higher than expected for all bladder cancers at 2.9 (95% CI: 1-6) and close to significance (SIR, 3.0; 95% CI: 0.97-7) for bladder cancers within the first 5 years of followup in the subgroup analysis. On multivariate analysis, older age was associated with increased SPC risk and older age and positive smoking status were associated with increased overall mortality, mortality due to SPC, and mortality from second malignancy (p < 0.05). CONCLUSIONS: There may be a small increased risk of bladder SPC after prostate BT. A tendency toward a higher risk of bladder SPC after BT was found within the first 5 years of followup probably reflecting screening bias.

Three radiation-induced metachronous pelvic tumors in a patient who underwent radiotherapy for cervical cancer: a case report.

INTRODUCTION: Patients treated with radiotherapy are under increased long-term risk of developing radiation-induced tumors. In this report we present an exceptionally rare case of a patient who, following radiotherapy for cervical cancer, developed 3 radiation-induced metachronous pelvic tumors. CASE PRESENTATION: In 1997, a 37-year-old patient with cervical adenocarcinoma (FIGO stage IB2) was subjected to adjuvant conventionally fractionated external-beam radiation therapy and brachytherapy following surgical treatment. Eleven, 14 and 15 years later, 3 radiation-induced malignant tumors developed: a leiomyosarcoma of the gluteus and 2 separate carcinomas of the rectum. DISCUSSION AND CONCLUSION: Radiotherapy for cervical carcinoma increases the standardized incidence ratios for rectal cancer and soft tissue sarcoma. Unfortunately, the current guidelines on contraindications to radiotherapy appear insufficient as they take into account a very limited number of clinical states and associated conditions, which is in disproportion to the rather high risk of radiation-induced malignancies of 0.45%. Information on the molecular characteristics of human radiation-induced tumors is still of no relevance for everyday clinical practice. Although radiotherapy is one of the most important modalities of oncological treatment, it should be judiciously used in cases where the benefits clearly outweigh the risk of serious untoward effects. In the case of patients undergoing pelvic irradiation, careful follow-up is needed for years.

Differentiated therapy in pre- and postmenopausal adnexal torsion based on malignancy rates: A retrospective multicentre study over five years.

INTRODUCTION: The purpose of this study was to investigate the clinical presentation, intra and postoperative outcomes in pre and postmenopausal women who underwent operations for adnexal torsion, and to define our experience diagnosing and managing postmenopausal women with adnexal torsion. METHODS: One hundred and fifty-seven patients who underwent operation with a diagnosis of adnexal torsion were analyzed according to demographic characteristics, menopausal status, preoperative signs and symptoms, surgical findings and applied surgical procedures, and pathological results in four tertiary centers. RESULTS: The main indication for surgery for the postmenopausal women was pelvic mass (58% vs. 40%), while for premenopausal women the main indication was suspicion of torsion (55% vs. 24%), (each p < 0.001). The duration of time between being admitted to the hospital and entering operating room as well as the duration of surgery and postoperative hospitalization were statistically longer in the postmenopausal group (each p < 0.001). While extensive surgeries were performed for 68% of the postmenopausal group, this was required for only 3% of the premenopausal group. Functional cysts were the most common pathologic finding in premenopausal women, and only 2 cases of malignancy (1.6%) were seen as opposed to the postmenopausal group, where malignancy was diagnosed in 16% of cases (p < 0.001). DISCUSSION: Adnexal torsion in postmenopausal women is an uncommon event. Malignancy risk should be considered before operation. CONCLUSION: The malignancy rate was 16% in postmenopausal women with adnexal torsion. Thus, extensive surgeries are more common in postmenopausal women with adnexal torsion.

Intrapelvic Bulky Tumor as an Unusual Presentation of Erdheim-Chester Disease.

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis, which is known to affect various organs; however, there have been no reports of its intrapelvic involvement. We herein describe the case of 69-year-old man who died of a rapidly-growing intrapelvic tumor, which was finally diagnosed as ECD at autopsy. Immunohistochemically, the tumor cells were positive for CD68 and BRAF V600E, and negative for CD1a. Since BRAF V600E has recently been reported to be specific to ECD, it can be a useful biomarker for diagnosis, especially in atypical cases.

Radiation-associated sarcoma after recurrent colorectal primary tumor: A complex surgical case.

Radiation associated sarcoma is a significant consequence of cancer therapy. Incidence of radiation associated sarcoma correlates with overall radiotherapy exposure. Prognosis is generally poor with 5 year survival rates lower than that for spontaneously occurring sarcomas. Surgical management presents many challenges including having to work in irradiated tissue planes while trying to achieve negative margins. We present a patient with a rare radiation associated pelvic sarcoma whose course illustrates the complexity of this problem.

Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration.

For most patients with bulky pelvic tumors, pelvic exenteration remains the only curative option. Although initially reported as a palliative procedure, nowadays it is rather performed with curative intent. Once the resectional phase is ended, a large defect will remain at the level of the pelvic diaphragm, predisposing to severe complications which are generically included under the name of empty pelvis syndrome. It has been widely demonstrated that this type of complication is associated with severe mortality, even if the patient is free of any pelvic recurrence. We present the case of a 56-year-old patient submitted to total pelvic exenteration for locally invasive previously chemo-irradiated cervical cancer who presented six months after surgery with a severe enteroperineal fistula. We decided to reoperate on the patient; intraoperatively we found recurrence on both pelvic walls and an enteroperineal fistula caused by tumoral invasion. We performed an intestinal resection with enteroenteral anastomosis. In order to isolate the intestinal loops from the unresectable pelvic recurrence, in the pelvis we placed three Foley catheters inflated with 60 ml of saline each, in order to hold the intestinal loops away from the pelvic wall. The postoperative course was uneventful. The urinary cathethers were removed after six weeks.

Surgical cytoreduction for disseminated benign disease after open power uterine morcellation.

BACKGROUND: Uterine morcellation is a technique used in gynecologic surgery to facilitate a laparoscopic approach to the removal of an enlarged uterus. The safety of this technique has been a source of recent debate, as uterine morcellation can result in the intraperitoneal dissemination of undiagnosed uterine malignancies. CASES: We report on three women who previously underwent minimally invasive hysterectomy and open power morcellation for benign disease, who subsequently presented with peritoneal implants highly suspicious for malignancy. Each woman required a laparotomy and extensive, multiorgan resection to clear the disease. Benign pathology was diagnosed in all cases. CONCLUSION: Even in the setting of benign conditions, open power morcellation of the uterus may be associated with clinically significant dissemination of uterine disease.