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H H Lien

Publications and source records attributed to H H Lien.

At least 37 records · Page 2Linked to original sources
PubMed1993

Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging.

In patients with malignant pelvic tumors, radiation-induced insufficiency fractures of the sacrum may be mistaken for metastasis. Magnetic resonance (MR) imaging was performed in 18 patients with this condition, and the findings were studied retrospectively. The diagnosis was confirmed with at least one additional imaging modality in 16 patients, whereas the other two patients underwent clinical follow-up at 13 and 20 months without evidence of metastasis. In 17 patients, the lesions were consistent with edema and had diffuse low signal intensity on T1-weighted images and diffuse high signal intensity on short-inversion-time inversion-recovery images, thereby simulating metastasis. In one patient, bilateral sacral wing fractures were demonstrated directly as fairly well-defined linear zones. The alae sacri were involved in all patients; 16 patients had bilateral lesions. Awareness of this clinical entity and of the high sensitivity of MR imaging for demonstrating edema caused by the fracture should prevent confusion with metastatic disease and inappropriate treatment.

Aged↗
PubMed1993

A double blind study to evaluate the tolerability of gadodiamide injection and its effect on renal function in patients undergoing cerebral magnetic resonance imaging.

Gadodiamide injection was administered intravenously to 28 patients with cancer undergoing cerebral magnetic resonance imaging (MRI). Two parallel groups were used to evaluate the safety of single doses of 0.1 and 0.3 mmol per kilogram body weight (kgbw). Adverse events, vital signs, blood chemistry, haematology and urinalysis were the principal measures of safety. Four patients, all in the 0.1 mmol kgbw-1 group, experienced a total of six adverse events. No adverse events were reported in the 0.3 mmol kgbw-1 group. No clinically significant changes in blood chemistry, haematology or urinalysis occurred. No significant changes in renal tubular function or glomerular filtration rate were observed after injection at either dose. Overall, this study suggests that gadodiamide injection is a safe and effective contrast medium for use in patients undergoing cerebral MRI at both the 0.1 and 0.3 mmol kgbw-1 doses.

Adult↗
PubMed1993

Postirradiation changes in the pelvic wall. Findings on MR.

MR images of 45 patients who had received radiation therapy for carcinoma of the anus or recurrent carcinoma of the rectum were reviewed with regard to postirradiation changes of the pelvic wall. High signal intensity in bone marrow on T1-weighted images due to fatty replacement was almost always observed. Presacral edema occurred in 7 of 36 patients who were examined 4 to 6 weeks after the end of irradiation and was more frequent at later studies. The pelvic wall muscles showed high signal intensity on T2-weighted images compatible with edema. This finding was most frequent on studies performed more than 6 weeks after the end of irradiation. The changes subsided more than a year after radiation therapy. To avoid an erroneous diagnosis of tumor infiltration into the pelvic wall, it is important to be familiar with the normal postirradiation changes of the presacral space and the muscles.

Adult↗
PubMed1993

Clinical stage I carcinoma of the cervix. Value of MR imaging in determining invasion into the parametrium.

Using MR imaging with a body coil parametrial invasion was determined prospectively in 169 consecutive patients considered on the basis of clinical examination to have carcinoma confined to the cervix. After radical hysterectomy correlation with histologic examination was performed for the left and right parametrium separately. The criterion for parametrial invasion was a high-signal-intensity lesion with disruption of the full thickness of the cervical stroma combined with areas of abnormal signal intensity within the parametrial region on T2-weighted images. Histologic examination showed that 18 parametria in 13 patients were invaded by tumor. MR had an overall accuracy of 93%, a sensitivity of 89%, and a specificity of 93% in demonstrating parametrial involvement. Positive and negative predictive values were 43% and 99%. The main weakness of MR was 21 false-positive tests. This represents a limitation when MR is performed with a body coil.

Adult↗
PubMed1992

Retroperitoneal surgery in patients with nonseminomatous testicular cancer and minimal residual tumor.

In the period 1980-1991, 78 patients with advanced nonseminomatous testicular cancer underwent retroperitoneal lymphadenectomy for post-chemotherapy residual masses less than 2 cm. To decrease the frequency of "dry ejaculation" in these patients with no or limited residual disease, the extent of dissection was reduced during the period, with bilateral dissections (49 cases, 1980-1986) being initially replaced by unilateral procedures (19 cases, 1983-1990) and subsequently by nerve-sparing techniques (10 cases, 1990-1991). As expected, a higher total number of lymph nodes was found in the retroperitoneal specimens after bilateral (44 (13-100)) than after unilateral (21 (7-35)) and nerve-sparing (18 (7-60)) procedures. The number of lymph nodes with pathological changes was low, with 3 (1-16) after bilateral, 2 (1-9) after unilateral, and 2 (1-4) after nerve-sparing operations. Histological examination revealed only necrosis/fibrosis in 65% of the patients, elements of mature teratoma in 28%, and remnants of viable malignant tumor in 6%. There were no major postoperative complications. "Dry ejaculation" was reported by 84% of the patients with bilateral operations, but was generally avoided after the unilateral (16%) and nerve-sparing (nil) procedures. After a mean follow-up of 83 (5-138) months, 6 patients have developed a recurrence, only one of them primarily in the retroperitoneal space. It is concluded that in patients with minimal residual retroperitoneal tumor, postchemotherapy lymphadenectomy using a unilateral or nerve-sparing technique seems to offer an effective therapeutic alternative with acceptable postoperative morbidity and preserved ejaculation.

Adolescent↗
PubMed1992

Is postchemotherapy retroperitoneal surgery necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses?

PURPOSE: At least one third of the patients with metastatic testicular cancer are rendered tumor-free by cisplatin-based chemotherapy. One may question, therefore, the routine use of postchemotherapy retroperitoneal lymph node dissection (RLND), especially if the residual masses are less than 20 mm in diameter. To define the role of such surgery, we analyzed the postchemotherapy histology in testicular cancer patients with minimal residual disease. PATIENTS AND METHODS: Seventy-eight patients with advanced nonseminomatous testicular cancer underwent RLND after three to four cycles of cisplatin- or carboplatin-based chemotherapy. In all patients, the largest diameter of the residual retroperitoneal mass was less than 20 mm. RESULTS: Complete fibrosis/necrosis was found in 51 patients, mature teratoma in 22, and vital malignant germ cell tumor in five. In two of the latter five patients, alphafetoprotein (AFP) had increased immediately before RLND. In the 76 patients with normal pre-RLND tumor markers, the presence of undifferentiated malignant teratoma (MTU) in the primary tumor and normal prechemotherapy tumor markers were independent parameters predicting complete fibrosis/necrosis, which was demonstrated in all 15 patients with these two pretreatment parameters. CONCLUSIONS: Postchemotherapy RLND can be omitted in patients with MTU in the primary tumor who have normal AFP/human chorionic gonadotropin (AFP/HCG) before chemotherapy and whose residual retroperitoneal mass is less than 20 mm in diameter. If the pre-RLND tumor markers are normal, RLND should be performed in all other patients with small residual masses, even in the presence of a normal computed tomography (CT) and particularly if regular follow-up of the patients is not guaranteed.

Adolescent↗
PubMed1991

Osteogenic sarcoma: MR signal abnormalities of the brain in asymptomatic patients treated with high-dose methotrexate.

The advent of lesions with high signal intensity in periventricular white matter was incidentally observed on T2-weighted images in one patient who underwent magnetic resonance (MR) imaging of the brain after administration of high-dose methotrexate (HDMTX) for osteogenic sarcoma. Twenty-one additional symptom-free patients who had been treated with the same regimen and 10 patients who had undergone cisplatin-based chemotherapy for testicular cancer also underwent examination. Fourteen of the patients with osteosarcoma showed high-signal-intensity lesions in white matter on T2-weighted images. The interval between the last course of chemotherapy and MR imaging was a factor in this finding, as 12 of 14 patients who underwent examination within 2 years after chemotherapy had a positive finding, as opposed to two of eight patients who underwent examination later. The patients with testicular cancer had normal MR images. The occurrence of MR imaging abnormalities in asymptomatic patients treated with HDMTX for osteogenic sarcoma may be subclinical evidence of treatment-related central nervous system toxicity.

Brain↗
PubMed1991

Clinical stage I carcinoma of the cervix: value of MR imaging in determining degree of invasiveness.

The depth of tumor invasion measured at histologic examination is the most important prognostic factor in early-stage carcinoma of the uterine cervix. The ability of MR to estimate the depth of tumor invasion was studied in 47 patients who subsequently underwent radical hysterectomy. In two patients, MR failed to detect tumors with infiltration depths of 2 and 4 mm. The maximum sagittal tumor length along the axis of the cervix (D) and the maximum tumor area on sagittal (S) and axial (A) images were measured with MR. The depth of tumor infiltration determined histologically (I) correlated with the degree of infiltration noted on MR images. The univariate correlation coefficients for log I vs log D, log S, and log A were .87, .84, and .77, respectively. By stepwise inclusion of the variables in a multivariate analysis, the contributions to the coefficient of determination from including log S and log A after log D were less than 1%. The regression analysis showed that the best estimate for the depth of invasion was close to half of the sagittal tumor length measured on MR, I = D/2. Our experience shows that MR is valuable in determining the degree of invasiveness in clinical stage I tumors.

Adult↗
PubMed1991

Cancer of the endometrium: value of MR imaging in determining depth of invasion into the myometrium.

The depth of invasion into the myometrium correlates with the frequency of lymph node metastases in patients with cancer of the endometrium. A distinction between superficial invasion (less than 50% of the thickness of the myometrium) and deep invasion (greater than 50%) is particularly important. The ability to distinguish between these two groups on MR was studied in 33 patients with endometrial cancer who had primary hysterectomy. The overall accuracy of MR in showing deep invasion was 82%, with a sensitivity of 91% and a specificity of 64%. The main limitation of MR was four false-positive results with regard to deep invasion. In all of these, the erroneous diagnosis was found at histologic examination to be due to a large polypoid tumor that distended the uterus so that a thin rim of myometrium was stretched over it rather than being deeply infiltrated by it. Our experience shows that MR can be used to distinguish between superficial and deep invasion of the myometrium. However, degree of invasiveness may be overestimated in exophytic polypoid tumors with significant intraluminal extension.

Aged↗
PubMed1991

CT in primary malignant germ cell tumors of the retroperitoneum.

Malignant germ cell tumors may exist as a primary entity in the retroperitoneum. In a CT study of 14 males with this condition (2 seminomas and 12 non-seminomatous tumors) all masses were large, lobulated and of mixed density. Fat plane obliteration against adjacent structures was frequent. The aorta was embedded in 9 patients and the inferior vena cava was affected in 7, 2 of whom had signs of compromised caval blood flow. Distant metastases were found in the lungs (7 patients), liver (n=4), posterior mediastinum (n=3), and in brain and supraclavicular lymph nodes in one patient each. Serum biomarkers were elevated in 11 patients. An extragonadal germ cell tumor should be considered when CT of the abdomen reveals a large retroperitoneal mass with mixed density.

Adult↗
PubMed1990

Prognosis in patients with metastatic non-seminomatous testicular cancer.

155 patients with metastatic non-seminomatous testicular cancer were treated with cisplatin-based chemotherapy which in most cases was combined with surgery. The 5 year crude survival was 90% for all patients (98 patients with small volume disease: 97%; 32 patients with large volume disease: 91%; 25 patients with very large volume disease: 64%). High pre-chemotherapy serum tumour marker levels (AFP greater than 500 micrograms/l; and/or HCG greater than 1000 U/l) decreased the survival rates in all groups. Only 4 of 17 relapsing patients were rendered tumour-free by salvage chemotherapy. In a multivariate analysis, a pre-chemotherapy alpha-foetoprotein (AFP) level greater than 500 micrograms/l was associated with poor survival as was the presence of a retroperitoneal tumour greater than 10 cm, lung metastases greater than 3 cm and/or extrapulmonary hematogenous metastases. It is concluded that easily assessable clinical pre-treatment variables can be used to define high risk or low risk patients with metastatic testicular cancer. Treatment intensity should be adjusted in accordance to such prognostic factors.

Adolescent↗
PubMed1990

Is routine primary retroperitoneal lymph node dissection still justified in patients with low stage non-seminomatous testicular cancer?

We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non-seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage IIa (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM+) and 121 had normal tumour markers (CSIM-). Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM-, in 19 of 33 patients with CSIIM+ and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half-life were predictive factors for PSII. These 2 factors enabled a group of non-seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases. Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post-operative complications. In addition, "dry ejaculation" was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients). The comparative cost to the health service during the first year of follow-up was estimated for low risk non-seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable. It was concluded that a surveillance policy should be followed in low risk non-seminoma CSI patients provided that frequent follow-up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve-sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.

Adolescent↗
PubMed1990

Distribution of retroperitoneal lymph node metastases in patients with non-seminomatous testicular cancer in clinical stage I.

118 Patients with non-seminomatous testicular cancer (NSTC) in clinical stage I (CSI = no metastases by clinical, radiological and biochemical evaluation) underwent retroperitoneal lymph node dissection (RLND). The operation was done unilaterally (95 patients) in peroperatively tumor-free patients or in those with limited metastatic growth. In 23 patients with more extensive metastases, bilateral RLND was performed. Metastatic lymph nodes were found in 36 patients, and these patients received 3-4 cycles of a cisplatin-based combination chemotherapy. If no metastases were detected the patients had no further treatment. The 5-year disease-free survival rate was 100%. 8 of 82 patients without detected metastases in the operation specimen relapsed (all outside the retroperitoneal space), but were cured by salvage chemotherapy. Solitary metastases were found in 11 patients, whereas 25 patients had more than 1 metastatic lymph node. The size of the largest metastasis ranged from 0.3 to 40 mm. Metastases from right-sided tumors were detected at all levels of the lumbar region, predominantly to the right of the inferior vena cava and/or within the interaortocaval space. Left-sided tumors metastasized to the upper two thirds of the lumbar space, only rarely crossing the midline. This anatomical distribution of metastatic lymph nodes indicates that the presacral sympathetic nerve plexus and the sympathetic nerve fibers around the aortic bifurcation can be spared from extensive resection in the majority of patients with NSTC in CSI. Unilateral RLND or other nerve-sparing techniques are thus possible, preserving antegrade ejaculation in greater than 80% of the patients. This RLND represents a reasonable alternative to the 'surveillance' policy in NSTC.

Adult↗
PubMed1990

Magnetic resonance imaging of malignant extradural tumors with acute spinal cord compression.

Thirty-six cancer patients with extradural spinal metastatic disease and acute symptoms of spinal cord compression underwent magnetic resonance (MR) imaging at 1.5 T. Cord involvement was found in all 36, 7 of whom had lesions at 2 different sites. Vertebral metastases in addition to those corresponding to the cord compressions were detected in 27 patients, and 18 of these had widespread deposits. MR displayed the extent of the tumors in the craniocaudal and lateral directions. The ability to identify multiple sites of cord and vertebral involvement and to delineate tumor accurately makes MR the examination of choice in cancer patients with suspected spinal cord compression. It obviates the need for myelography and postmyelography CT in this group of patients.

Adult↗
PubMed1989

Histology of tumor residuals following chemotherapy in patients with advanced nonseminomatous testicular cancer.

A total of 111 patients with advanced nonseminomatous testicular cancer underwent cisplatin-based combination chemotherapy, followed by surgical removal of residual masses in 101. Surgery included retroperitoneal lymph node dissection in 92 patients, thoracotomy in 19 and hepatic resection in 1 (11 patients underwent 2 operations). Complete necrosis and/or fibrosis was found in 52 operative specimens, mature teratoma in 37 and vital malignant tumor in 12. Of the 11 patients who underwent 2 operations 4 had complete necrosis and/or fibrosis in both histological specimens. After a median observation of 55 months 83 of 89 patients with complete necrosis and/or fibrosis or mature teratoma were without evidence of disease. Only 7 of 12 patients with vital malignant tumor in the operative specimen survived without evidence of disease. Relapses were observed in 16 patients, 4 of them in the retroperitoneal space. Of the 16 relapses 5 were in 12 patients with residual vital malignant tumor, 5 in 37 patients with post-chemotherapy mature teratoma and 4 in 52 patients with complete necrosis and/or fibrosis after chemotherapy. Two patients with recurrence did not undergo an operation. In patients in whom post-chemotherapy retroperitoneal lymph node dissection is considered complete necrosis and/or fibrosis can be predicted by the combination of several factors, including absence of teratomatous elements in the testicular tumor, complete response on post-chemotherapy computerized tomography, and normal alpha-fetoprotein and human chorionic gonadotropin levels after chemotherapy (sensitivity 83%, specificity 76% and correctly predicted 79%). With the knowledge of these factors it seems possible to omit post-chemotherapy retroperitoneal lymph node dissection in approximately 20% of the patients with advanced metastatic nonseminomatous testicular cancer with initial retroperitoneal tumors.

Adolescent↗
PubMed1989

Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer.

A total of 37 patients with initially advanced metastatic nonseminomatous testicular cancer underwent retroperitoneal lymph node dissection after cisplatin-based combination chemotherapy. Abdominal computerized tomography was negative at retroperitoneal lymphadenectomy (lymph nodes not exceeding 10 mm. in the transverse computerized tomography plane). Complete necrosis and fibrosis were found in 25 patients. In 11 patients the retroperitoneal lymphadenectomy specimen showed a mature teratoma. Residual vital malignant tumor was observed in 1 patient. Neither the initial size of the retroperitoneal mass nor the histological status of the primary tumor was predictive of the histological findings in the retroperitoneal lymphadenectomy specimen. The high frequency of mature teratoma raises the question whether omitting post-chemotherapy surgery is a safe routine policy in patients with negative computerized tomography, especially if long-term followup is not feasible. We recommend a post-chemotherapy retroperitoneal operation as routine treatment even in patients with negative computerized tomography.

Antineoplastic Combined Chemotherapy Protocols↗