RESUMEN
AIMS: To gain insight into the quality of pancreatic cancer surgery in 10 low-volume (median sized) hospitals, each serving 150,000-250,000 people, in the Comprehensive Cancer Centre South (CCCS) area and of referred patients to academic centres to determine the need for further regionalization. METHOD: The population-based Eindhoven Cancer Registry was used to select all patients in the CCCS area with pancreatic, peri-ampullary and ampullary cancer diagnosed between January 1, 1995 and April 30, 2000 (N = 1130). Of those, 124 patients (11%) underwent surgical resection (of which 40 were treated in university hospitals outside the region). RESULTS: For all pancreatic carcinoma resections, the 3-month survival rate was 82%, varying from 95% for referred patients to 76% for patients treated within the region (p = 0.014). One- and two-year survival rates showed no difference between both groups (p = 0.36 and p = 0.55, respectively). Surgically treated patients who were referred to university hospitals outside the CCCS area were younger, more often male, more often diagnosed with pTNM stage III, exhibited less comorbidity and had a higher socio-economic status than patients surgically treated within the region. CONCLUSION: Although the results are based on small numbers and patient selection probably influenced these outcomes, these data seem to support further hospital specialisation, to which the surgeons of the CCCS area have committed themselves.
Asunto(s)
Ampolla Hepatopancreática/cirugía , Carcinoma/cirugía , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Pancreáticas/cirugía , Sistema de Registros , Centros Médicos Académicos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Áreas de Influencia de Salud , Femenino , Hospitales Generales , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Estadificación de Neoplasias , Países Bajos , Vigilancia de la Población , Derivación y Consulta , Factores Sexuales , Clase Social , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
We have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At 10 years from the date of salvage treatment, the overall survival rate for the 226 patients with invasive local recurrence was 39% (95% CI, 32-46), the distant recurrence-free survival rate was 36% (95% CI, 29-42), and the local control rate (i.e., survival without subsequent local recurrence or local progression) was 68% (95% CI, 62-75). Among patients with a local recurrence at or near the original tumour site a better distant disease-free survival was observed for patients with recurrences measuring 1cm or less, compared to those with larger recurrences. This suggests, though does not prove, that early detection of local recurrence can improve the treatment outcome but might as well point towards a different biologic behaviour, facilitating early detection.
Asunto(s)
Neoplasias de la Mama/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Adulto , Anciano , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Análisis de Regresión , Resultado del TratamientoRESUMEN
The aim of this study was to describe the extent and yield of daily clinical practice when staging patients with a locoregional recurrence (LRR) of breast carcinoma and to explore the prospects for positron emission tomography (PET). The population-based Eindhoven Cancer Registry was used to select all breast cancer patients in the southeast of the Netherlands with a first episode of LRR between January 1, 1994 and June 30, 2000 (n = 175). Additional data concerning staging procedures and follow-up were collected from the medical records. Furthermore, we asked 77 physicians (response: 75%) about their opinions on staging procedures and actual treatment policy. At LRR presentation, 16% of patients were found to have distant metastases. An additional 24% were diagnosed with distant metastases within 18 months. The questionnaire revealed that 33% of clinicians thought that the sensitivity of conventional imaging techniques was too low. We tend to conclude that in daily clinical practice there is a need for more sensitive dissemination tests for patients with a LRR of breast cancer.