341 PEPJOPERATIVE BLOOD TRANSFUSION SURGERYFORCOLORECTALCANCER TiSka-Rudman
V., JuzbaSiC S., Stanec M., Rudman
SURGICAL CHOICE’S R.CAPORALI, 2nd
for Tumors, Zagreb. Croatia
The relationship between blood transfusion. survival, and other potential prognostic factors was prospectively studied in 222 consecutive patients operated on for colorectal cancer in University Hospital for Tumors, Zagreb, and were followed during period of eight years (1983-1990). there were 1 I9 males and 103 females form 17 to 85 years of age (most were between 50 and 70). Out of 222 patients, 143 received blood transfusion in the course of the treatment and 79 did not (45 had resectable lesion and 34 inoperative tumor). Out of 222 patients, 187 were operated on for rectosigmoidal tumor and 35 for tumor localised in the other part of the colon. In 139 patients out of 187 the tumor was resected (hemicolectomia, abdominoperineal resection, or resection with tenninoterminal anostomosis was done). Out of 143 transfused patients 71 did not haw metastasis in this period, and 72 had metastatic disease during operation. Out of 79 patients that did not receive transfusion less than a year survived 43 patients (41,89/o), less than 3 years survived 15 patients (19,0%), less than 5 years sunrived 6 patients (7.6%). more than 5 years 25 patients (31,6%). Out of 143 patients who were transfused less than a year survived 23 patients (16.1%). less than 3 years 28 patients (19.6%), less than 5 years 29 patients (20,3%) and 63 patients (44,0%) survived more than 5 years. It is statistically significant that transfused patients have better survival rate (less than 5 ~7s. and more than 5 yrs.) than patients that did not receive transfusion. It is also statistically significant that polytransfused paitents had longer survival.
,BENIGN METASTASIZING LEIOMYOMA” ? A CYTOGENETICLY BALANCED BUT MONOCLONAL DISEASE. L. Tietze , K. Gilnther, S. Merkelbach-Bruse. S. Handt, Ch. Mittermayer Institute of Pathology, RWTH Aachen, FRG Aim: There are rare cases of histologically benign appearing uterine l&myomas with subsequent development of multifocal extrauterine smooth muscle tumors, most c&en located in the lung. It remains unclear whether this evolves &om a morphological innocent appearing low grade sarcoma or from proliferation of multifocal but autochtonous cellular foci. Frequently, 4 i: yt rer*.!72?.’ kzyt,rpic sbnorza!tic: wr: +esctibed ti;: l&myomas and leiomyosarcomas. Thus, we looked for imbalanced genetic aberrations and for clonality in a case of a ,,benign metastasizing leiomyoma” by means of comparative genomic hybridisation (CGH) and a x-chromosome inactivation assay. Methods: A 46 year old female developed multiple bilateral lung nodules 4 years after hysterectomy. Fine needle biopsy of one nodule and subsequent resection of three lung nodules were performed. These and the hysterectomy investigated conventional histology, specimen were by immunohistochemistry and CGH using standard protocols. Clonality analysis was based on a x-chromosome inactivation assay. Results: Revision of the hysterectomy specimen revealed multiple l&myomas without any evidence for malignancy. Lung nodules were composed of benign appearing smooth muscle cells with epithelial lined cl& like spaces. Leiomyomata of the uterus and the lung showed a reactivity against actin, desmin, estrogen- and progesteron receptor antigens. DNA analysis by CGH revealed a normal karyotype without evidence for a” imbalanced loss or gain of DNA. A monoclonal and identical x-chromosome inactivation pattern was detected for all lung nodules suggesting a common primary clone of these nodules. Conclusion: Recurrent cytogenetic alterations are common in uterine (iJ(qll.i-LLqjl-jL) t+iXt I(li;l~J i&myunlas, nwa *ten ucl (q14-15; q23-24). Leiomyosarcomas display diverse karyotypic abnonnalties, most often involving chromosomes 1,7,13 and 14. We did not found any unbalanced cytogenetic aberrations, but the fact that all lung nodules belonged to the same clone strongly suggest a metastasizing nature of this disease.
TREATMENT CRITERIA. C.NESTI,
OF METASTATIC G.LONGO,
ORTHOPAEDIC DEPARTMENT (chief: prof.N.Marchetti)
Trying to standardize surgical techniques in the treatment of metastatic lesions of long bones we analyzed retrospectively 28 patients with a total of 29 metastases operated from 1994 to 1997 at our Department. We excluded rachis because of its peculiarity. We considered 19 lesions in femor, 7 in homerus, 2 in tibia, These patients have been treated 1 in forearm. in close cooperation among Oncology and Radiotherapy Departments. Choice about kind of surgical treatment has been made with regard to the type of primitive tualour I the date of development of bone’s metastases, the site (extremity, diaphyseal), the development of impending fracture or simple pathological fracture, osteolytic lesion, chemioand/or radiotherapy sensitivity, the performance status of patient( Karnovsky index) . The surgical procedures that we used were: minimal ostheosintesis (intramidullar nail) in patients with very short life expectancy; ostheosintesis (plate with or without cement) in disseminated cancer disease with good life expectancy; prosthesis or megaprosthesis in patients with single metastasis with long life expectancy. Fixing a score to the prognostic factors, we evaluated our results. In conclusion, while orthopaedic surgeons are being called more frequently to manage patients who have metastatic bone disease, the method of surgical treatment needs more consideration and preoperative planning.
PREOPERATIVE LOCALIZATION OF LYMPHNODE METASTASES (LNM) OF HEAD/NECK NEOPLASMS BY MEANS OF FLUORINE-ISDEOXYGLUCOSE (FDG) POSITRON EMISSION TOMOGRAPHY (PET). D.Rubello, R.Mattei’, F.Chierichetti, A.Fini, P.Zanco, S.Cargnel, G. Ferlin. Medicina Nucleare - Centro PET. “ORL, Ospedale di Castelfranco V.to, (TV), Italy. FDG PET is widely used in preoperative staging of various types of neoplasms with the aims to perform an accurate removal of all neoplastic lesions or to avoid unnecessary surgery m patients (pts) with distant metastases. In the present study we prospectively investigated 24 pts with head/neck neoplasma (5 F, I9 M, mean age 54.6 years). In all the cases a preoperative evaluation with FDG PET, .MmC of the head and neck region was obtained within a 2-weeks interval, and subsequent surgery was performed by the same surgical team within 1 week. In addition, in pts with advanced disease, chemotherapy and radiotherapy were performed. Post-therapeutic follow-up ranged 8-34 mo.. FDG PET was evaluated both with visual and quantitative analysis by means of calculation of the standardized uptake value (SUV; n.v. in our center i 2.5). The primitive tumor was correctly Identified in all the pts both by RMlCT and FDG PET (usual analysis). However, RM/CT provided better information about sze, border and local infiltratIon of the primitive tenor. On the other hand, FDG PET (visual analysis) provided better results regarding the localizaiion of LNM (sensitivity: PET = 87.5%, MRfTC = 53.1%; specificity: PET = 99%, MRffC = 87.8%). Also the NPV was higher for PET than MR/TC (99% vs 96%, respectively) as well as rhe PPV (87.5% vs 24.696, respectively). In other words, MR/TC provided a significantly higher number of false negative and false positive cases in comparison with FDG PET. The smallest LNM revealed by FDG PET was 7 mm in diameter. SUV values ranged from 1.4-7.9 in the LNM, and were significantly higher in neoplastic than in inflammatory LN (3.9 vs 1.8, p < .05). However, it has to be pointed out that using SUV analysis, i.e. considering pathologic a SUV > 2.5, 7 LNM in our series should be considered negative (false negative). On the basis of our data we can conclude that FDG PET is a highly accurate imaging technique in prwperative ldentitication of LNM in head/neck neoplasms; PET could be proposed as a guide to performe a conservative surgery in these pts. From a technical point of wew, visual analysis appears to be more sensitive than quantitawve analysis in the evaluation of LNM m pts with head/neck “eoplasms.