Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
Curr Oncol ; 26(5): 330-337, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31708651

RESUMO

Background: In 2012 in the United States, the American Society of Clinical Oncology and the Society of Surgical Oncology (asco/sso) published a joint guideline about indications for sentinel lymph node biopsy (slnb) in cutaneous melanoma. The guideline supported completion lymph node dissection (clnd) for all patients with positive sentinel nodes. We examined the rates and predictors of slnb and clnd for melanoma patients in Ontario (population 13.6 million) after publication of that guideline. Methods: We used the Ontario Cancer Registry to identify patients diagnosed with cutaneous melanoma in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient, including surgical procedures. Results: Of the 3298 patients with melanoma identified in Ontario in 2013, 1973 (59.8%) could be analyzed. Most of that group (n = 1227, 62.2%) underwent local excision alone; 746 (37.8%) had a slnb. The slnb was performed in 13.9%, 67.8%, 62.6%, and 47.2% of patients with T1, T2, T3, and T4 primary melanomas respectively. In multivariate analysis, receipt of slnb was positively associated with younger age (<80 years), higher T stage, and a non-head-and-neck primary. Of the patients who had a slnb, 136 (18.2%) were found to be node-positive. A clnd was performed in 82 of those patients (60.3%). Conclusions: In Ontario, only two thirds of patients with intermediate-thickness melanomas (T2, T3) underwent slnb as recommended by the asco/sso guideline. Use of slnb was less frequent for patients with a head-and-neck primary and higher for younger patients (<80 years). The rate of clnd after a positive slnb was also low relative to the guideline recommendation.


Assuntos
Excisão de Linfonodo , Metástase Linfática/diagnóstico , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Ontário , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Oncologia Cirúrgica
2.
Can J Gastroenterol ; 24(1): 33-9, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20186354

RESUMO

BACKGROUND: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada. OBJECTIVE: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC). METHODS: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living's administrative databases, a patient's first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT. RESULTS: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT. CONCLUSIONS: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Listas de Espera , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Gastroenterologia/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Manitoba , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Encaminhamento e Consulta/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , População Urbana
4.
Curr Oncol ; 16(5): 58-64, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19862362

RESUMO

INTRODUCTION: Our study examined the wait time from ready-to-treat to radiation therapy for cohorts of breast cancer patients requiring adjuvant radiation therapy in 2001 and in 2005 after the implementation of strategies to reduce wait times for radiation treatment. We also examined the overall time from diagnosis to radiation treatment and whether distance from the cancer treatment centre or month of referral had an effect on wait times. METHODS: This population-based retrospective study looked at representative samples of women newly diagnosed with breast cancer in 2001 and 2005. Patients who required radiation treatment to the breast or chest wall were followed from first contact to the start of radiation treatment. RESULTS: Time from ready-to-treat to first radiation treatment was significantly reduced for patients in 2005 as compared with 2001, regardless of whether chemotherapy was administered before radiation treatment. Time from diagnosis to radiation treatment was not different by year for those who received radiation only. Time from diagnosis to chemotherapy was significantly longer in 2005. No effect of month of diagnosis on wait times was observed. INTERPRETATION: A significant improvement in the median wait time from ready-to-treat to first radiation treatment was noted from 2001 to 2005. This improvement may be attributable to measures taken to reduce such waits. However, we observed an increase in the median time from diagnosis to referral and from referral to consultation with medical or radiation oncology (or both), so that the overall time from diagnosis to radiation treatment was not different. Although specific intervals related to radiation treatment delivery were improved, the entire trajectory of breast cancer care experienced by patients needs to be considered.

5.
J Surg Oncol ; 98(6): 399-402, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18767118

RESUMO

BACKGROUND: Histologically positive margins are generally considered unacceptable with breast conserving therapy (BCT) given the increased risk of local recurrence (LR). What constitutes an adequate negative margin remains controversial. Margin status was explored as a predictor of LR post-BCT. METHODS: Manitoba women with loco-regional progression and/or mastectomy >6 months following BCT for Stage I/II invasive cancer (1995-2004) were identified from the Manitoba Cancer Registry; LR cases were confirmed by chart review. Three controls per case were matched by age, grade, stage, and adjuvant chemotherapy use. Margin status was categorized as histologically positive, < or =1 mm, < or =2 mm or >2 mm. Conditional logistic regression determined the odds ratio of LR by margin category. RESULTS: There were 50 LR cases in 3,017 patients who underwent BCT, with a median follow-up of 60 months. Wider margins were associated with a non-significant reduction in LR: >1 mm versus < or =1 mm (OR 0.69; 95% CI 0.28-1.69) and >2 mm versus < or =2 mm (OR 0.90; 95% CI 0.44-1.84). CONCLUSIONS: No clear benefit to wider histologically negative margins is demonstrated.


Assuntos
Neoplasias da Mama/patologia , Carcinoma/patologia , Mastectomia Segmentar , Recidiva Local de Neoplasia/patologia , Neoplasias da Mama/terapia , Carcinoma/terapia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Modelos Logísticos , Manitoba , Pessoa de Meia-Idade , Invasividade Neoplásica , Radioterapia Adjuvante , Sistema de Registros
6.
Eur J Surg Oncol ; 34(6): 655-61, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17980543

RESUMO

AIM: To explore trends in rectal cancer survival in Manitoba, particularly in patients where local control was an issue. METHOD: Patients diagnosed with rectal or rectosigmoid adenocarcinoma from 1985 to 1999 were included. Demographic, treatment and mortality information were abstracted from the registry. Relative survival was examined for all patients for the periods 1985-1989, 1990-1994 and 1995-1999, and subsequently limited to those who underwent major surgery (Hartmann's, anterior, and abdominal perineal resection). RESULTS: Of the 2925 patients identified, 2163 (74%) had undergone a major surgery. Five-year relative survival was 46%, 54% and 53% for all patients for the three periods, respectively; major surgery results were 53%, 59% and 60%. Radiotherapy was used in 32% of cases in 1985-1989 and in 40% of cases in 1995-1999. Chemotherapy was used in 13% of cases in 1985-1989 and in 37% of cases in 1995-1999. CONCLUSION: Consistent with other studies, overall rectal cancer survival in Manitoba has improved since 1985. Better local control, as suggested in other studies, does not appear to be a major factor in that improvement. Future work should include review of the local control strategy in Manitoba and factors to explain the improved survival.


Assuntos
Adenocarcinoma/mortalidade , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Retais/mortalidade , Adenocarcinoma/terapia , Idoso , Feminino , Humanos , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Qualidade da Assistência à Saúde , Neoplasias Retais/terapia , Estudos Retrospectivos , Taxa de Sobrevida
7.
J Surg Oncol ; 78(1): 2-7; discussion 8-9, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11519060

RESUMO

BACKGROUND AND OBJECTIVE: Adjuvant radiotherapy for node positive breast cancer postmastectomy has been recommended by two previously published randomized controlled trials (RCT). The local-regional recurrence rates in the control arms, however, were considered by some critics to be excessive (> 25% at 10 years). Inadequate surgery, as evidenced by the low number of axillary nodes reported, may have resulted in the high local-regional recurrence rates, allowing for the benefits seen with radiotherapy. Fellowship trained surgical oncologists might provide "better quality" surgery, resulting in lower recurrence rates and thus making adjuvant radiotherapy unnecessary. Our objective was to establish the local-regional control rate postmastectomy in node positive breast cancer patients operated on by surgical oncologists, and to determine if treatment recommendations from previous RCTs are generalizable. METHODS: Node positive stage IIb and IIIa breast cancer patients treated with mastectomy at the Medical College of Virginia Hospitals by surgical oncologists, without adjuvant radiotherapy, and entered into adjuvant chemotherapy trials between 1978 and 1993 were identified retrospectively. Pathology and follow-up records were reviewed. RESULTS: One hundred and thirty-seven patients were identified. A median of 18 axillary nodes was reported with a median of 4 positive nodes. The locoregional recurrence at 10-years was 27% (95% confidence interval, 19-35%). CONCLUSION: Despite some evidence of "better quality" surgery, there was no clinically significant difference in the local-regional recurrence rate in this case series compared to controls in two previous RCTs. Recommendations for postmastectomy radiotherapy should be considered for node positive breast cancers, even if operated upon by surgical oncologists.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Linfonodos/patologia , Mastectomia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Estudos Retrospectivos , Análise de Sobrevida
9.
Breast Cancer Res Treat ; 60(3): 277-83, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10930116

RESUMO

Stereotactic core needle biopsy (SCNB) has become a popular method for diagnosis of occult breast abnormalities. There are few large series of SCNB from a single institution. Data on patients undergoing SCNB for mammographic abnormalities were collected prospectively over 43 months at a university hospital. Mammographic findings were categorized as benign, probably benign, indeterminate, suspicious or malignant. For lesions with SCNB pathology that were non-diagnostic, showed atypical hyperplasia or malignancy (in situ or invasive), or were discordant with the pre-biopsy mammogram findings, surgical excision was recommended. Subsequent surgical pathology was reviewed. All remaining lesions were followed mammographically after SCNB. SCNB was performed on 692 lesions in 607 patients. There were 79 malignancies, for a positive SCNB rate of 11.4%. The 349 SCNB performed for benign, probably benign and indeterminate lesions on mammography had a positive SCNB rate of only 4%. Surgery was recommended for 127 (18.3%) lesions, while 565 (81.6%) were followed mammographically after SCNB. A compliance rate of 61 % for at least one follow-up mammogram was obtained, with a median follow-up of 17.2 months and with no cancers found. The sensitivity for malignancy with SCNB was 93%. SCNB provides a minimally invasive method to assess mammographic abnormalities. Abnormalities considered radiographically to be other than malignant or suspicious yielded few cancers. In this series a low positive SCNB rate resulted in no false negatives on mammographic follow-up. The optimal positive biopsy rate for SCNB is debatable.


Assuntos
Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Neoplasias da Mama/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Mamografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...