Strategie watch-and-wait (WW) nabízí u vybraných pacientů s distálním adenokarcinomem rekta alternativu k radikální resekci s totální mezorektální excizí (TME) po dosažení kompletní klinické odpovědi (complete clinical response – cCR) na neoadjuvantní terapii. Tento přístup je založen na intenzivním sledování, kdy je multidisciplinární tým, zejména chirurg, konfrontován s náročným follow-up režimem zahrnujícím opakované anorektoskopie, per rectum vyšetření a magnetické rezonance. Problematická je především predikce patologické kompletní odpovědi v případě cCR. Klíčovým faktorem je riziko recidivy (regrowth) u cCR, která se vyskytuje u 26–36 % pacientů zejména během prvních 3 let sledování a zvyšuje riziko vzniku metastáz. Včasná salvage R0 resekce je indikována při detekci regrowth a je proveditelná ve více než 90 % případů. WW nabízí u compliantních pacientů srovnatelné onkologické výsledky a lepší funkční výsledky ve srovnání s TME u pacientů s pCR.

Watch-and-wait (WW) strategy offers an alternative to radical resection with total mesorectal excision (TME) in selected patients with distal rectal adenocarcinoma after achieving complete clinical response (cCR) to neoadjuvant therapy. This approach is based on intensive follow-up, where a multidisciplinary team, especially the surgeon, is confronted with a demanding follow-up regimen including repeated anorectoscopies, per rectum examinations and magnetic resonance imaging. The prediction of pathological complete response in cCR is particularly problematic. The risk of recurrence (regrowth) in cCR is a key factor, which occurs in 26–36% of patients, especially during the first 3 years of follow-up, and increases the risk of metastasis. Early salvage R0 resection is indicated when regrowth is detected and is feasible in more than 90% of cases. WW offers comparable oncologic outcomes in compliant patients and better functional outcomes compared to TME in patients with pCR.

• MeSH
• Clinical Decision-Making MeSH
• Organ Sparing Treatments methods   MeSH
• Humans MeSH
• Neoplasm Metastasis MeSH
• Rectal Neoplasms * surgery   diagnostic imaging   complications   therapy   MeSH
• Neoadjuvant Therapy methods   MeSH
• Watchful Waiting * methods   MeSH
• Recurrence MeSH
• Risk MeSH
• Statistics as Topic MeSH
• Patient Selection MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

INTRODUCTION: Management for elderly patients (> 65yo) with incidental meningiomas remains unclear. This study aims to characterize the functional and tumor outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma elderly patients. METHODS: Using retrospectively collected data from 14 centers, SRS outcomes were compared to radiographic and clinical observation of asymptomatic meningiomas in elderly patients following propensity score matching. RESULTS: Following propensity score matching, 114 patients were in each cohort. Tumor control was achieved at 97.37% in the SRS cohort, and no meningioma growth was seen 71.93% of the observation cohorts (p < 0.01; OR 14.44 [95% CI 4.27-48.78]). New neurological deficits developed in 1.39% of the SRS cohort but in none of the patients managed conservatively. 3.5% of patients underwent resection in the active surveillance matched cohort compared to 0.9% of patients in the SRS cohort (p = 0.063; OR 0.135 [95% CI 0.163-1.117]). The all-cause mortality rate was almost half in the SRS group (9.65%) compared to the observation group (18.42%) (p = 0.06; OR 0.47 [95% CI .22-1.03]). CONCLUSION: SRS achieves superior radiological tumor control compared to surveillance but with a slightly increased the risk of new SRS-related neurological deficits in elderly patients with asymptomatic meningiomas. Although SRS reduces meningioma progression, the need for of an open neurosurgical procedure and mortality were not significantly reduced. Furthermore, mortality in the observation group was not directly related to the meningioma in any of the patients.

• MeSH
• Humans MeSH
• Meningeal Neoplasms * surgery   MeSH
• Meningioma * surgery   radiotherapy   MeSH
• Incidental Findings MeSH
• Watchful Waiting * methods   MeSH
• Radiosurgery * methods   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Propensity Score MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

• MeSH
• Diabetes Mellitus, Type 1 * complications   MeSH
• Adult MeSH
• Pregnancy Complications etiology   drug therapy   classification   MeSH
• Humans MeSH
• Macular Edema * diagnosis   etiology   drug therapy   MeSH
• Tomography, Optical Coherence methods   MeSH
• Watchful Waiting methods   MeSH
• Pregnant People MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

INTRODUCTION: Conservative active surveillance has been proposed for low-risk papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm and lacking clinical aggressive features, but controversy exists with accepting it as not all such PTMCs are uniformly destined for benign prognosis. This study investigated whether BRAF V600E status could further risk stratify PTMC, particularly low-risk PTMC, and can thus help with more accurate case selection for conservative management. METHODS: This international multicenter study included 743 patients treated with total thyroidectomy for PTMC (584 women and 159 men), with a median age of 49 years (interquartile range [IQR], 39-59 years) and a median follow-up time of 53 months (IQR, 25-93 months). RESULTS: On overall analyses of all PTMCs, tumour recurrences were 6.4% (32/502) versus 10.8% (26/241) in BRAF mutation-negative versus BRAF mutation-positive patients (P = 0.041), with a hazard ratio (HR) of 2.44 (95% CI (confidence interval), 1.15-5.20) after multivariate adjustment for confounding clinical factors. On the analyses of low-risk PTMC, recurrences were 1.3% (5/383) versus 4.3% (6/139) in BRAF mutation-negative versus BRAF mutation-positive patients, with an HR of 6.65 (95% CI, 1.80-24.65) after adjustment for confounding clinical factors. BRAF mutation was associated with a significant decline in the Kaplan-Meier recurrence-free survival curve in low-risk PTMC. CONCLUSIONS: BRAF V600E differentiates the recurrence risk of PTMC, particularly low-risk PTMC. Given the robust negative predictive value, conservative active surveillance of BRAF mutation-negative low-risk PTMC is reasonable whereas the increased recurrence risk and other well-known adverse effects of BRAF V600E make the feasibility of long-term conservative surveillance uncertain for BRAF mutation-positive PTMC.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Thyroid Neoplasms genetics   MeSH
• Carcinoma, Papillary genetics   MeSH
• Watchful Waiting methods   MeSH
• Prognosis MeSH
• Proto-Oncogene Proteins B-raf genetics   MeSH
• Decision Making MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

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• MeSH
• Chemoradiotherapy, Adjuvant methods   trends   utilization   MeSH
• Surgical Procedures, Operative methods   trends   utilization   MeSH
• Diagnostic Techniques and Procedures trends   utilization   MeSH
• Herpesviridae Infections diagnosis   complications   therapy   MeSH
• Disease Attributes MeSH
• Combined Modality Therapy * methods   trends   utilization   MeSH
• Humans MeSH
• Neoplasm Metastasis diagnosis   therapy   MeSH
• Oropharyngeal Neoplasms * diagnosis   etiology   therapy   MeSH
• Mouth Neoplasms * diagnosis   epidemiology   etiology   MeSH
• Positron Emission Tomography Computed Tomography methods   trends   utilization   MeSH
• Watchful Waiting methods   trends   utilization   MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Practice Guidelines as Topic standards   MeSH
• Carcinoma, Squamous Cell diagnosis   surgery   radiotherapy   MeSH
• Neoplasm Staging methods   utilization   MeSH
• Neoplasm Grading MeSH
• Papillomavirus Vaccines administration & dosage   adverse effects   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.

• MeSH
• Chemotherapy, Adjuvant methods   mortality   MeSH
• Survival Analysis MeSH
• Adult MeSH
• Neoplasms, Germ Cell and Embryonal drug therapy   mortality   surgery   MeSH
• Humans MeSH
• Disease Management MeSH
• Young Adult MeSH
• Watchful Waiting methods   MeSH
• Recurrence MeSH
• Neoplasm Staging MeSH
• Testicular Neoplasms drug therapy   mortality   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Diagnostic Techniques, Urological trends   utilization   MeSH
• Endoscopy methods   utilization   MeSH
• Prostatic Hyperplasia diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Prostatic Neoplasms diagnosis   etiology   therapy   MeSH
• Prostatic Diseases * diagnosis   etiology   therapy   MeSH
• Watchful Waiting methods   organization & administration   utilization   MeSH
• Prostatectomy methods   utilization   MeSH
• Prostate-Specific Antigen isolation & purification   MeSH
• Prostatitis diagnosis   prevention & control   therapy   MeSH
• Statistics as Topic MeSH
• Urologic Surgical Procedures * methods   trends   utilization   MeSH
• Urology * methods   organization & administration   trends   MeSH
• Age Factors MeSH
• Life Style MeSH
• Check Tag
• Humans MeSH
• Publication type
• Interview MeSH

• MeSH
• Biopsy methods   utilization   MeSH
• Drug Therapy MeSH
• Middle Aged MeSH
• Humans MeSH
• Interdisciplinary Communication MeSH
• Prostatic Neoplasms * diagnosis   prevention & control   therapy   MeSH
• Watchful Waiting methods   utilization   MeSH
• Prostate-Specific Antigen * isolation & purification   MeSH
• Radiotherapy methods   utilization   MeSH
• Urogenital Surgical Procedures methods   instrumentation   utilization   MeSH
• Age Factors * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH

• Keywords
• Endoskopická polyektomie (EPE) a endoskopická mukozální resekce (EMR, Dispenzarizace pacientů po endoskopické terapii KRK, Evropské směrnice pro screening,
• MeSH
• Endoscopy, Gastrointestinal * methods   trends   utilization   MeSH
• Colonoscopy methods   utilization   MeSH
• Colorectal Surgery methods   utilization   MeSH
• Colorectal Neoplasms * diagnosis   prevention & control   MeSH
• Humans MeSH
• Watchful Waiting * methods   utilization   MeSH
• Primary Prevention methods   organization & administration   trends   MeSH
• Risk Factors MeSH
• Secondary Prevention methods   organization & administration   trends   MeSH
• Statistics as Topic MeSH
• Tertiary Prevention methods   organization & administration   trends   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Meeting Abstract MeSH

Vzhledem k tomu, že karcinom prostaty představuje urology nejčastěji léčený tumor, je zátěž vyvolaná tímto onemocněním poměrně vysoká. U velkého počtu mužů je diagnostikován klinicky nevýznamný karcinom prostaty s nízkým rizikem. V současné době bohužel neexistují žádná spolehlivá diagnostická kritéria, podle nichž by bylo možné spolehlivě stanovit individuální riziko a identifikovat onemocnění, která se rozvinou do stadia ohrožujícího život pacienta. Tuto situaci dále komplikuje skutečnost, že v současné době užívaná technika biopsie naváděné transrektálním ultrazvukovým vyšetřením (TRUS) má velmi špatnou senzitivitu. Rozhodování o tom, kteří pacienti by měli podstoupit definitivní léčbu a kteří by měli být zařazeni pouze do programu aktivního monitorování, je tak velmi obtížné a není podloženo dostatečnými důkazy. Před nedávnem byla vyvinuta zcela nová technika trojrozměrné mapovací biopsie (3DM), s jejíž pomocí lze získat model prostaty s přesnou lokalizací zhoubného nádoru. Pomocí této metody lze pacienty lépe stratifikovat na základě rizika onemocnění, a navíc ji lze využít při TFT (cílené fokální terapii). Tato technologie spočívá v identifikaci ložisek karcinomu pomocí 3DM a jejich následné léčbě, díky čemuž je ušetřena benigní tkáň. Rovněž není nutné provádět rozsáhlejší zákrok spojený s větší morbiditou. V současné době dostupné zobrazovací techniky neumožňují adekvátně identifikovat karcinom prostaty. Příslibem mohou být pokroky v zobrazovacích technikách magnetické rezonance (MR) a pozitronové emisní tomografie (PET), s jejichž pomocí snad bude v budoucnosti možné neinvazivně identifikovat ložisko karcinomu, což by přispělo k dalšímu zdokonalení techniky TFT.

The burden of prostate cancer remains high, and it is the most common cancer treated by urologists. Many men are diagnosed with low risk, clinically insignificant prostate cancer. However, no adequate clinical diagnostic criteria currently exist to accurately risk stratify patients, or identify which tumors will progress to life-threatening cancer. Further compounding this problem, current transrectal ultrasound (TRUS)-guided biopsy technique has poor sensitivity. Thus, defining which patients should undergo definitive therapy, and which should undergo active monitoring is difficult and influenced by inadequate data. Three-dimensional mapping biopsy (3DM) is an emerging technique that gives the physician a model of the prostate with precise locations of malignancy. This allows for more accurate risk stratification of patients. Additionally, it allows for the use of targeted focal therapy (TFT). This is a technology that utilizes 3DM to identify focal cancerous lesions and then subsequently treats them, sparing benign tis­sue and the decreasing the need for more morbid, larger procedures. Imaging techniques are currently inadequate for the identification of prostate cancer. However, advances in magnetic resonance imaging (MR) and positron emission tomography (PET) are promising and will hopefully be able to identify focal cancers non-invasively, further improving the technique of focal targeted therapy.

• Keywords
• klinicky nevýznamný karcinom prostaty, cílená fokální terapie, trojrozměrná mapovací biopsie, aktivní monitorování, biopsie naváděná pomocí transrektálního ultrazvuku (TRUS), antigen karcinomu prostaty 3,
• MeSH
• Antigens, Neoplasm urine   MeSH
• Diagnostic Techniques, Urological MeSH
• Risk Assessment MeSH
• Biopsy, Needle MeSH
• Cryosurgery MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures MeSH
• Biomarkers, Tumor urine   MeSH
• Prostatic Neoplasms * diagnosis   pathology   therapy   MeSH
• Watchful Waiting * methods   standards   MeSH
• Prostate ultrasonography   MeSH
• Prostate-Specific Antigen MeSH
• Neoplasm Staging MeSH
• Ultrasonography methods   MeSH
• Patient Selection * MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Humans MeSH
• Male MeSH