375 research outputs found
Prognostic and Survival Factors in Myxofibrosarcomas
Aim. Our study aimed to determine prognostic factors for survival and recurrence in myxofibrosarcomas based on the experience of a single institution. Methods. Patients who had been diagnosed with a myxofibrosarcoma were identified from our database. Survival and recurrence were evaluated with Kaplan Meier survival curves for univariate and cox regression for multivariate analysis. Results. 174 patients with a diagnosis of myxofibrosarcoma were identified. Two patients were excluded due to incomplete information, leaving 172 patients with a mean age of 67 years. Surgery was undertaken in all but 6 patients. Five-year survival was better for myxofibrosarcomas when compared to other soft tissue sarcomas (63% versus 57%). Size, grade of tumour, age, and metastases were all found to be prognostic factors. Local recurrence occurred in 29 patients (17%) with an overall risk of 15% at 5 years. Previous inadvertent excision significantly raised this risk to 45%. Wide surgical margins and depth of tumour, however, had no impact on recurrence. Conclusion. Factors previously identified as prognostic did not demonstrate such a relationship in our study, highlighting the unpredictable nature of myxofibrosarcomas. Future treatment may lie in developing an understanding molecular basis of the tumour and directing therapies accordingly
Sacral chordoma: do the width of surgical margin and the use of photon/proton radiotherapy affect local disease control?
Purpose
Chordoma is a rare but highly aggressive primary bone sarcoma that arises commonly from the sacrum. While en bloc resection has been the mainstay of the treatment, the role of resection margin in millimetres with/without adjuvant radiotherapy (RT) has been unknown. We investigated the prognostic impact of surgical margin width, adjuvant RT, and their combined factor for sacral chordoma.
Methods
Forty-eight patients who underwent surgical treatment between 1996 and 2016 were studied. Of these, 11 patients (23%) received adjuvant RT; photon RT in 7 (15%) and proton RT in 4 (8%). Margins were microscopically measured in millimetres from the resection surface to the closest tumour on histologic slides.
Results
The five year and ten year disease-specific survival was 88% and 58%, respectively, and the local recurrence (LR) rate was 48%. The LR rate with 0-mm,
Conclusion
This study identified the lowest risk of local failure in tumour resection with ≥ 1.5-mm margin or negative but < 1.5-mm margin with the use of adjuvant photon/proton radiotherapy for sacral chordoma. Early results of adjuvant proton RT demonstrated excellent local control
Sum-frequency generation of 589 nm light with near-unit efficiency
We report on a laser source at 589 nm based on sum-frequency generation of
two infrared laser at 1064 nm and 1319 nm. Output power as high as 800 mW are
achieved starting from 370 mW at 1319 nm and 770 mW at 1064 nm, corresponding
to converting roughly 90% of the 1319 nm photons entering the cavity. The power
and frequency stability of this source are ideally suited for cooling and
trapping of sodium atoms
What is an adequate margin for infiltrative soft-tissue sarcomas?
Objectives
What constitutes an adequate margin of resection for infiltrative subtypes of soft-tissue sarcomas remains unclear. We aimed to determine the prognostic significance of the margin in millimetres for myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS).
Methods
305 patients diagnosed with either a high-grade, localised MFS (n = 98) or UPS (n = 207) were included. The relationship of closest margin in millimetres to viable tumour and oncological outcomes was analysed.
Results
The overall local recurrence (LR) rate for all patients were 12%: 19% with positive margin and 10% with negative margin (p = 0.051). The LR rate was similar in patients with negative but
Conclusion
The resection margin, when measured as a metric distance, correlates with a reduction in LR, and appears to be more significant on local control than radiotherapy. To minimise the risk of LR, a margin distance of at least 10 mm is advocated for MFS and UPS
Low-grade soft-tissue sarcomas: What is an adequate margin for local disease control?
Background
Whilst the resection margin is an established factor predictive of local control of soft-tissue sarcomas (STSs), the adequacy of margin width for low-grade STSs has been rarely described. We aimed to investigate the margin adequacy and its prognostic relevance in low-grade STSs.
Methods
109 patients who underwent surgical treatment for a low-grade STS were studied. The prognostic value of margin status was evaluated according to the R–, R+1–classification, and width in millimetres.
Results
The 10-year local recurrence (LR) rates were 6%, 27%, 54% in R0, R1, and R2, respectively (p
Conclusion
Whilst negative margin provided local control over 90%, excellent local control was achieved with microscopic margins ≥2 mm. The role of margins is more important than radiotherapy in local control. Margins do not determine survival, but LR is associated with a poor prognosis
Long-term outcomes after an initial experience of computer-navigated resection of primary pelvic and sacral bone tumours:soft-tissue margins must be adequate to reduce local recurrences
The adequacy of resection margin for non-infiltrative soft-tissue sarcomas
Objectives
There remains no consensus on what constitutes an adequate margin of resection for non-infiltrative soft-tissue sarcomas (STSs). We aimed to investigate the role of resection margins in millimetres for non-infiltrative STSs.
Methods
502 patients who underwent surgical resection for a localized, non-infiltrative, high-grade STSs were studied. The prognostic significance of margin width was analysed and compared with the conventional R- and R+1-classification of surgical margins.
Results
The overall local recurrence (LR) rate was 13%; 9% and 27% with negative and positive margins, respectively (p 5.0 mm. When classified by the R- (or R+1)-classification, the 5-year cumulative LR incidence was 8%, 23% (16%), and 31% for R0, R1, and R2, respectively, which did not stratify the LR risk with negative margins. On the other hand, an accurate risk stratification was possible by metric distance; the 5-year cumulative incidence of LR was 29%, 10%, and 1% with 0 mm, 0.1–5.0 mm, and >5.0 mm, respectively (p
Conclusion
While a negative margin is essential to optimize local control in patients with non-infiltrative STSs, surgical margin width greater than 5 mm minimises the risk of local failure regardless of the use of adjuvant radiotherapy
Leiomyosarcomas of Vascular Origin in the Extremity
Between 1996 and 2006 a total of 278 patients with soft tissue
Leiomyosarcoma were treated at our centre. We identified 16
patients (5.8%) where the tumour directly arose from the blood
vessels. These tumours were studied to determine their prognosis
and behaviour. All tumors were in the lower limbs: 11 from the
femoral vein, 3 popliteal vein, and 2 from the posterior tibial
vein. Mean tumour size was 10.4 cm (3 to 33). Histological
grade was high in all patients. Surgical treatment was amputation
in one, excision with or without vascular reconstruction in 12
followed by radiotherapy, and 3 patients had no surgery because of
advanced disease at diagnosis. Seven out of the 16 patients
(44%) had metastasis at diagnosis, and five patients without
metastasis at diagnosis rapidly developed metastases at a median
time of 5 months from diagnosis (2–30 months). The overall
survival of the patients at 5 years was 25% which was
considerably worse than those with nonvascular leiomyosarcoma. We
conclude that patients with leiomyosarcoma of vascular origin have
a very high risk of metastases and poor prognosis when treated in
the conventional way
Hemodynamics during the 10-minute NASA Lean Test: evidence of circulatory decompensation in a subset of ME/CFS patients.
BACKGROUND: Lightheadedness, fatigue, weakness, heart palpitations, cognitive dysfunction, muscle pain, and exercise intolerance are some of the symptoms of orthostatic intolerance (OI). There is substantial comorbidity of OI in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). The 10-minute NASA Lean Test (NLT) is a simple, point-of-care method that can aid ME/CFS diagnosis and guide management and treatment of OI. The objective of this study was to understand the hemodynamic changes that occur in ME/CFS patients during the 10-minute NLT.
METHODS: A total of 150 ME/CFS patients and 75 age, gender and race matched healthy controls (HCs) were enrolled. We recruited 75 ME/CFS patients who had been sick for less than 4 years (\u3c 4 ME/CFS) and 75 ME/CFS patients sick for more than 10 years (\u3e 10 ME/CFS). The 10-minute NLT involves measurement of blood pressure and heart rate while resting supine and every minute for 10 min while standing with shoulder-blades on the wall for a relaxed stance. Spontaneously reported symptoms are recorded during the test. ANOVA and regression analysis were used to test for differences and relationships in hemodynamics, symptoms and upright activity between groups.
RESULTS: At least 5 min of the 10-minute NLT were required to detect hemodynamic changes. The \u3c 4 ME/CFS group had significantly higher heart rate and abnormally narrowed pulse pressure compared to \u3e 10 ME/CFS and HCs. The \u3c 4 ME/CFS group experienced significantly more OI symptoms compared to \u3e 10 ME/CFS and HCs. The circulatory decompensation observed in the \u3c 4 ME/CFS group was not related to age or medication use.
CONCLUSIONS: Circulatory decompensation characterized by increased heart rate and abnormally narrow pulse pressure was identified in a subgroup of ME/CFS patients who have been sick for \u3c 4 years. This suggests inadequate ventricular filling from low venous pressure. The 10-minute NLT can be used to diagnose and treat the circulatory decompensation in this newly recognized subgroup of ME/CFS patients. The \u3e 10 ME/CFS group had less pronounced hemodynamic changes during the NLT possibly from adaptation and compensation that occurs over time. The 10-minute NLT is a simple and clinically useful point-of-care method that can be used for early diagnosis of ME/CFS and help guide OI treatment
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