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Parapharyngeal Space
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Lesions of the parapharyngeal space are predominantly treated by surgery. The aim of surgery is to remove the lesion with minimal morbidity. Adjuvant radiotherapy is reserved for malignant lesions or recurrent benign lesions with a high risk of recidivism. Chemotherapy is administered when indicated by specific histology, such as rhabdomyosarcoma, positive margin status, tumour histology, and perineural and lympho-vascular spread. Radiotherapy has also been used in patients who are considered a high surgical risk or for unresectable lesions.
Soft Tissue Sarcomas
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Thomas F. DeLaney, David C. Harmon, Karol Sikora, Francis J. Hornicek
Complete surgical resection is the most important component of treatment for retroperitoneal sarcomas. Nevertheless, local recurrences occur in a substantial proportion of patients after surgery. Adjuvant radiotherapy is still being evaluated in an ongoing randomized study but may be of benefit; if employed, pre-operative radiotherapy is preferred.
Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
Adenoid cystic carcinoma arises within the minor salivary glands of the paranasal sinus. In general it tends to grow at an intermediate rate and has a low risk of lymphatic spread [28]. Perineural spread is common therefore accounting for delayed local recurrence and metastasis, despite aggressive surgery and radiotherapy. Distant metastases most commonly are found in the lungs. Though adjuvant radiotherapy is usually given, there is no definitive evidence it improves survival [28].
Alveolar soft tissue sarcoma: a report of 50 cases at a single institution
Published in Acta Chirurgica Belgica, 2023
Pengyuan Zhao, Huixiang Li, Huayan Ren
There is no consensus on whether patients with localized disease need adjuvant treatment after surgery. First, no study on adjuvant chemotherapy reported a significant survival benefit for patients [15,25], which is also consistent with our study. Anderson et al. reported that there was no local recurrence after expanded resection of primary tumors and adjuvant radiotherapy in 14 ASPS patients [26]. Haotong Wang et al. reported a better prognosis for patients with localized disease undergoing both surgery and radiotherapy compared with those undergoing surgery alone (p = 0.02) [11]. However, a multicenter ASPS study from Japan showed that topical radiotherapy is not necessary for patients undergoing complete surgical resection and recommends that radiotherapy be used only for patients with insufficient surgical margins [14]. Thus, most of the benefits of postoperative radiotherapy occur in patients with inadequate surgical margins. Specifically, adjuvant radiotherapy can reduce local recurrence and thus improve survival in these cases. However, no observation that receiving adjuvant radiotherapy allowed good localized control in localized patients compared to patients with surgery alone in our study. This may be because fewer patients had received radiotherapy. In some localized patients, a long survival period can be achieved with extensive surgical resection of the tumor [21,24]. Radiotherapy and chemotherapy also have certain side effects for the patients themselves [27]. We do not recommend postoperative adjuvant radiotherapy and chemotherapy for patients with localized disease.
Radiopathologic predictors of recurrence in patients with a gross totally resected atypical meningioma
Published in Neurological Research, 2022
Sharath Kumar Anand, Hamid Sardari, Alireza Sadeghsalehi, Seyed Reza Bagheri, Sonia V Eden, Michael T Lawton, Ehsan Alimohammadi
Another major finding from our study is the relationship between Ki67 and recurrence of AM following GTR. Similar to the role of mitotic index in AM recurrence, the literature on Ki67 and AM recurrence remains unclear. That being said, a recent meta-analysis on the topic found a negative prognostic value of higher Ki67 expression levels on overall survival and recurrence/progression-free survival [25]. Liu et al. recommended a cutoff value for Ki67 expression of 4%, however their analysis included meningiomas of all grades. We selected a Ki67 expression level of 15% using a similar method to mitotic rate as described above. While this cutoff value may not be ideal for all populations, we encourage this methodology to determine cutoff values in future studies. Our data highlight Ki67 expression levels greater than 15% in AMs as a predictor of recurrence following GTR. While further research is necessary, these patients may also benefit significantly from adjuvant radiotherapy.
Tenosynovial giant cell tumors (TGCT): molecular biology, drug targets and non-surgical pharmacological approaches
Published in Expert Opinion on Therapeutic Targets, 2022
Geert Spierenburg, Lizz van der Heijden, Kirsten van Langevelde, Karoly Szuhai, Judith V.G.M. Bovée, Michiel A.J. van de Sande, Hans Gelderblom
To date, the preferred choice of treatment for TGCT remains surgical excision. However, there is a need for other therapeutic strategies in patients where local tumor control cannot be achieved and (repeated) surgery is associated with iatrogenic morbidity. Furthermore, the role of (neo)adjuvant radiotherapy is disputed, because it is associated with unacceptable long-term side effects. A better understanding of the pathogenesis of TGCT led to opportunities for the development of medical therapies. In the last decade, new drug targets were discovered, and the efficacy and safety of several drugs have been studied. Currently, pexidartinib is the only drug approved for TGCT by the US FDA. Pexidartinib showed significant radiological and clinical efficacy, but also severe adverse events occurred, including hepatotoxicity. Therefore, active monitoring of liver functions is mandatory. Contrarily, the EMA refused marketing authorization because it was unclear how long treatment effects would last and because of an unbalanced risk/benefit ratio. More recently, new treatments are under research and recent discoveries regarding new therapeutic targets are promising for the development of drugs with even better tolerability and higher efficacy.