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   Table of Contents - Current issue
April-June 2022
Volume 9 | Issue 2
Page Nos. 45-85

Online since Wednesday, June 1, 2022

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Experts' opinions progress and trends in the surgical management of breast cancer in Taiwan Highly accessed article p. 45
Chia-Hua Liu, Chih-Chiang Hung, Guo-Shiou Liao, Chuan-Hsun Chang, Cheng-Chung Wu
Objective: Radical mastectomy was first described by Halsted almost 130 years ago, and has been applied as a treatment strategy in Taiwan since the middle of the 20th century. However, due to the development of nonsurgical treatment modalities, the management of breast cancer has undergone tremendous change. This study examined Taiwanese publications between 1965 and 2020 to identify trends in the surgical management of breast cancer. Data Sources: We searched for papers published by authors from the Taiwan Breast Cancer Society and 18 tertiary referral medical centers in Taiwan. Study Selection: After excluding papers completely unrelated to surgery, there were 50 English language articles and 5 Chinese language articles available for historical review. Results: This nationwide survey of breast cancer over the past 40 years revealed the following trends in surgical management. (1) As detection rates of early-stage breast cancer increased, the amount of removed breast tissue decreased, with a corresponding reduction in percentage of total mastectomy. (2) Axillary sentinel node biopsy should be routinely performed in early breast cancer rather than axillary lymph node dissection without lymph node metastasis. (3) Since the development of gonadotropin antagonist, bilateral oophorectomy is no longer needed in the early stage in premenopausal population. Further pregnancy is allowed if the cancer is well controlled. (4) Breast reconstruction may be recommended, depending on the patients' preference, after total mastectomy for malignancy. Conclusion: Although this review of the literature may not be complete, the trends revealed in our analysis indicate that surgical management of breast cancer has become more patient-friendly, humanistic, and feasible in Taiwan. Currently, breast cancer may not have a poor outcome if the tumor can be detected at an earlier stage.
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Bleeding complications and possible resistance patterns of anti-angiogenesis treatments in recurrent/metastatic head-and-neck squamous cell carcinoma – Reflections from a phase II study of pazopanib in recurrent/metastatic head-and-neck squamous cell carcinoma p. 52
Jo-Pai Chen, Ruey-Long Hong
Background: Due to smoking, alcohol, and betel nut use, head-and-neck squamous cell carcinoma (HNSCC) is a serious public health problem in Taiwan. Materials and Methods: We performed a single-arm Phase II trial of pazopanib in patients with platinum-refractory recurrent or metastatic HNSCC in 2011. Results: We screened 43 patients in about 6 months. Thirty-three of the patients were excluded due to easy bleeding and vessel contact resulting from the advanced tumor status. The remaining ten patients were included in this study. An objective response was seen in one patient; six patients had clinical benefits, which was comparable with the outcomes of sorafenib or sunitinib in this patient group. Four patients experienced at least Grade 3 bleeding. The tumor response was usually seen in the central cavity; the rim of the cavity extended outside, reflecting peripheral invasion and future resistance. Conclusion: The early use of anti-angiogenesis treatments is necessary for better tumor control and to prevent bleeding and potential resistance. In future, vascular endothelial growth factor receptor and/or epidermal growth factor receptor tyrosine kinase inhibitors may be used in combination with immunotherapy to increase the clinical benefits and avoid the risk of hyperprogression.
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Comparison of survival outcomes using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colon versus rectal cancer with peritoneal carcinomatosis in an asian medical center p. 59
Hsin-Hsien Yu, Mao-Chih Hsieh, Bor-Chyuan Su
Background: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer (CRC) with peritoneal carcinomatosis (PC) is still very controversial. The National Comprehensive Cancer Network guideline only recommends cytoreductive surgery (CRS) combined with HIPEC for colon cancer with PC for patients with limited metastases and can be removed with surgery. The short-term and long-term outcomes between colon versus rectal origin in this setting remain unclear. The present study compared our experience in the management of colon versus rectal cancer with PC through CRS-HIPEC and investigated whether the feasibility of extending the indication to the PC of rectal origin. Materials and Methods: The data of 78 and 10 patients with PC of colon and rectal origin, respectively, were collected from a prospectively maintained database of patients receiving CRS-HIPEC for peritoneal surface malignancy at any period during 2002–2018. CRS followed by HIPEC with mitomycin-C or 5-fluorouracil plus oxaliplatin was administered at 42° for 60 min. In addition, adjuvant chemotherapy was administered postoperatively. Data on sex, age, prior surgical score, preoperative or postoperative peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, blood loss, operation time, transfusion unit, and hospital stay were recorded. Survival was compared between the colon and rectal groups. Results: The average patient was 56.4 years old, and 44 were men and 44 were women. The mean preoperative and postoperative PCI scores were 15.6 and 6.6, respectively. A complete CC score of 0-1 was achieved in 507 (56.9%) patients. The median overall survival durations were 34.0 ± 7.8 and 20.8 ± 13.2 months in the colon and rectal groups, respectively (P = 0.367). The 1-, 2-, 3-, 4-, and 5-year survival rates in the colon and rectal groups were 79% and 68%, 63% and 68%, 50% and 51%, 44% and 10%, and 44% and 0%, respectively. In multivariate analysis, the location of the primary tumor did not affect survival (P = 0.597; 95% confidence interval [CI] = 0.237–2.291); however, the postoperative PCI strongly predicted long-term survival (P = 0.001; 95% CI = 3.715–255.547). Conclusion: The management of CRC with PC remains challenging. CRS-HIPEC can provide similar survival benefits when applied to PC of rectal origin than when applied to PC of colon origin. The usage of mitomycin-C for HIPEC yields to a comparable survival benefit and a safe therapeutic option. However, the indication should be only extended to highly selective patients considering the possibility of adequate cytoreduction and performed in experienced centers.
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Total metabolic regression after everolimus in an adult patient with pseudomyogenic hemangioendothelioma p. 65
Derek De-Rui Huang, Yi-Hua Liao, Jen-Chieh Lee, Tom Wei-Wu Chen
Pseudomyogenic hemangioendothelioma (PHE) is a rare vascular tumor harboring the pathognomonic SERPINE1-FOSB fusion. Most patients are treated primarily with surgical resection, but some patients require systemic therapy due to multiple metastases at initial presentation or multifocal recurrence after definitive resection. The most optimal treatment strategy for the disease has yet to be clearly defined; however, mammalian target of rapamycin inhibitors show promise-given–reported anecdotal responses from case reports of pediatric patients. We present an adult patient with multifocal PHE who was successfully treated with everolimus with a significant clinical response.
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Hepatic arterial infusion chemotherapy for liver tumor control in a patient with liver metastasis from lung small cell carcinoma, a case report and discussion p. 69
Po-Hsu Su, Chun-Feng Wu
Hepatic arterial infusion (HAI) chemotherapy was now used in the treatment of liver metastasis in the patients with colorectal cancer and in the treatment of hepatocellular carcinoma. The blood supplies of cancer cells were from hepatic artery instead of portal system which mainly supply normal liver cells. By delivering chemotherapeutic agents directly to cancer cells through catheter in hepatic artery, it provided much more selective treatment and better local tumor control. The feasibility of liver tumor excision was increased after HAI chemotherapy. Theoretically, HAI chemotherapy may be applied to any tumors that mainly get blood supply from hepatic arteries. However, there were few reports of HAI chemotherapy for metastatic liver tumors from other solid tumors. Our report provided a case treated by HAI chemotherapy for liver metastasis from lung small cell carcinoma. This may give us an idea of extended application of HAI chemotherapy to more solid tumors with liver metastasis.
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Primary intimal sarcoma with chondrosarcoma differentiation of the pulmonary artery p. 74
Tzer-Ming Chuang, Hui-Hua Hsiao, Kun-Bow Tsai
We report a rare case and our experience of successfully treating intimal sarcoma (IS) with chondrosarcoma differentiation arising in the pulmonary artery. A 36-year-old man presented with a thrombosis-like mass in the pulmonary trunk. Anticoagulant therapy was initiated, but his clinical condition worsened despite adequate anticoagulation. Positron-emission tomography/computed tomography (CT) revealed a neoplastic lesion. The patient underwent endarterectomy and tumor resection. Microscopically, marked cartilaginous differentiation of the cancer cells admixed with pleomorphic, spindle, and round cells was noted. They were immunoreactive for S-100 protein and isocitrate dehydrogenase 1, focal and weak for desmin and murine double minute-2, but negative for ERG, CD34, and myogenin. A diagnosis of IS with chondrosarcoma differentiation was made. The patient received six cycles of adjuvant chemotherapy, and a follow-up chest CT did not show evidence of recurrence.
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Marked Response to Chemoimmunotherapy in a Patient with Follicular Lymphoma of Huge Mesenteric Lymphadenopathy p. 77
Chia-Chen Li, Shan-Chi Yu, Sung-Hsin Kuo
Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin's lymphomas. We present the case of a 57-year-old woman who initially complained of abdominal fullness and unintentional weight loss. A computerized tomography scan disclosed a huge mesenteric mass and confluent lymphadenopathy in the paraaortic area, and the pathological diagnosis of a paraaortic lymph node biopsy showed histological Grade 1–2 FL. She received chemoimmunotherapy, including rituximab plus cyclophosphamide, vincristine, and prednisolone, for Ann Arbor Stage III FL disease accompanied by compression symptoms, and achieved a nearly complete remission after completing eight cycles of chemoimmunotherapy. She is currently receiving maintenance rituximab therapy.
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Intramuscular metastasis in carcinoma of the cervix: Atypical site of clinical presentation p. 82
Yamini Bachheti, Sharanya R Nair, Prashant Durgapal, Sweety Gupta
Cervical carcinoma is the second most common malignancy among Indian women. It spreads mainly through the regional lymphatics to nodes in the pelvic and para-aortic regions. If distant metastasis occurs, it is typically in the lung, bone, and liver. Melanoma, renal, lung, thyroid, lymphoma, and leukemia malignancies frequently metastasize to muscles. Subcutaneous and intramuscular metastasis from carcinoma of the cervix is a rare manifestation. The reported incidence for subcutaneous metastasis ranges from 0.1% to 2%, and only 19 cases of intramuscular deposits have been reported. Here, we discuss the occurrence of subcutaneous and intramuscular metastatic lesions in a patient with carcinoma of the cervix.
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