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Panni, Roheena Z., Ivan Gonzalez, Christopher P. Hartley, et al. "Residual Tumor Index." American Journal of Surgical Pathology 42, no. 11 (2018): 1480–87. http://dx.doi.org/10.1097/pas.0000000000001144.
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Wittekind, Christian, and Paul Hermanek. "Residual Tumor Classification." Advances in Anatomic Pathology 2, no. 4 (1995): 277–79. http://dx.doi.org/10.1097/00125480-199507000-00055.
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Kishida, Takeshi. "Postchemotherapy residual tumor." Annals of Oncology 28 (October 2017): ix52. http://dx.doi.org/10.1093/annonc/mdx627.001.
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Kasbekar, Anand, Guleed Adan, Alaina Beacall, Ahmed Youssef, Catherine Gilkes, and Tristram Lesser. "Growth Patterns of Residual Tumor in Preoperatively Growing Vestibular Schwannomas." Journal of Neurological Surgery Part B: Skull Base 79, no. 04 (2017): 319–24. http://dx.doi.org/10.1055/s-0037-1607421.
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Objectives To analyze growth of residual vestibular schwannoma (VS) following incomplete tumor resection and determine the influence of residual location and size. Design Retrospective case note and scan review. Setting Tertiary skull base unit. Participants Patients with residual tumor following primary surgery for medium and large unilateral growing vestibular schwanomas between 2006 and 2009. Main Outcome Measures Location of residual VS and post-operative growth, comparing those with more (>5%) or less than 5% of tumor residual (<5%). Results Fifty-two patients had visible residual tumor left behind at surgery. Twenty had < 5% and 32 had > 5% residual. The residual growth rates were 38% overall, 20% in < 5%, and 50% in > 5% residuals. There was no significant difference in growth rates at different residual locations. Median follow-up was 6.4 years. Conclusions There is a greater risk of regrowth of residuals > 5%. All positions of residual tumor can regrow, and the preoperative tumor size plays a role in this. Further data is needed to confirm if residual tumor in the fundus is less likely to grow.
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Lusch, A., and P. Albers. "Residual tumor resection (RTR)." World Journal of Urology 35, no. 8 (2016): 1185–90. http://dx.doi.org/10.1007/s00345-016-1984-2.
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Xu, Xiaohong, Liangping Luo, Jiexin Chen, et al. "Acoustic Radiation Force Impulse Elastography for Efficacy Evaluation after Hepatocellular Carcinoma Radiofrequency Ablation: A Comparative Study with Contrast-Enhanced Ultrasound." BioMed Research International 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/901642.
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Aim. To explore acoustic radiation force impulse (ARFI) elastography in assessing residual tumors of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).Materials and Methods. There were 83 HCC lesions among 72 patients. All patients were examined with ARFI, contrast enhanced ultrasound (CEUS), and CT or MRI. Tumor brightness on virtual touch tissue imaging (VTI) and shear wave velocity (SWV) were assessed before and approximately one month after RFA.Results. There were 14 residual tumors after RFA. VTI showed that all the tumors were darker after RFA. VTI was not able to distinguish the ablated lesions and the residual tumors. 13 residual tumor lesions were detected by CEUS. All completely ablated nodules had SWV demonstration of x.xx., while with those residual nodules, 6 tumors had x.xx measurement and 8 tumors had measurable SWV. nine lesions with residual tumors occurred in cirrhosis subjects and 5 lesions with residual tumors occurred in fibrosis subjects; there was no residual tumor in the normal liver subjects.Conclusion. VTI technique cannot demonstrate residual tumor post RFA. While SWV measurement of less than x.xx is likely associated with residual tumors, measurement of less than x.xx cannot exclude residual tumors. Liver cirrhosis is associated with decreased chance of a complete ablation.
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Yi, Huiming, Baohuan Cai, Xi Ai, Kaiyan Li, Pengfei Song, and Wei Zhang. "Early Identification of Residual Tumors following Microwave Ablation Using Contrast-Enhanced Ultrasonography in a Rabbit VX2 Liver Cancer Model." BioMed Research International 2020 (September 27, 2020): 1–9. http://dx.doi.org/10.1155/2020/2462058.
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Objective. It is difficult to evaluate the ablation effect immediately after thermal ablation of liver cancer by clinical imaging methods, due to the immediate formation of an annular inflammatory reaction band (IRB). This study is aimed at exploring the early identification indicators of the IRB and residual tumor postmicrowave ablation (MVA) using contrast-enhanced ultrasonography (CEUS). Methods. MVA was used to inactivate part of the tumor nodules in rabbit VX2 liver cancer models, leading to the coexistence of the IRB with residual tumors. Quantitative analysis of the perfusion parameters of the tumor and ablation zone was performed using CEUS, followed by liver biopsy and VEGFR-2 immunohistochemical staining. Results. All rabbits successfully tolerated VX2 tumor inoculation and MVA operation. No statistically significant difference existed between the IRB vs. residual tumors, the IRB vs. junctional areas, and residual tumors postablation vs. VX2 tumors before ablation in regional blood volume, blood velocity, and blood flow estimated by parameters A, k, and A∗k of CEUS quantitative analysis. There was a statistically significant difference between the IRB and normal liver parenchyma in regional blood velocity and blood flow (p=0.005 and p=0.023, respectively). Normal liver parenchyma showed nonspecific VEGFR-2 staining, while VX2 tumor before ablation and residual tumor after ablation both showed positive VEGFR-2 staining; the necrosis zone showed negative staining by VEGFR-2 immunohistochemical staining. Conclusion. MVA had no significant effect on the residual tumor hemodynamics. The blood flow in the IRB increased significantly as compared to normal liver parenchyma, resembling tumor hemodynamic patterns. CEUS can detect residual tumors immediately postablation only when they protrude from the annular-shaped IRB. In addition, VEGFR-2 targeted CEUS may have a great potential for detecting residual tumor after thermal ablation of hepatocellular carcinoma.
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Widhalm, Georg, Stefan Wolfsberger, Matthias Preusser, et al. "Residual nonfunctioning pituitary adenomas: prognostic value of MIB-1 labeling index for tumor progression." Journal of Neurosurgery 111, no. 3 (2009): 563–71. http://dx.doi.org/10.3171/2008.4.17517.
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Object In residual nonfunctioning pituitary adenomas, reliable prognostic parameters indicating probability of tumor progression are needed. The Ki 67 expression/MIB-1 labeling index (LI) is considered to be a promising candidate factor. The aim in the present study was to analyze the clinical usefulness of MIB-1 LI for prognosis of tumor progression. Methods The authors studied a cohort of 92 patients with nonfunctioning pituitary adenomas. Based on sequential postoperative MR images, patients were classified as tumor free (51 patients) or as harboring residual tumor (41 individuals). The residual tumor group was further subdivided in groups with stable residual tumors (14 patients) or progressive residual tumors (27 patients). The MIB-1 LI was assessed in tumor specimens obtained in all patients, and statistical comparisons of MIB-1 LI of the various subgroups were performed. Results . The authors found no significant difference of MIB-1 LI in the residual tumor group compared with the tumor-free group. However, MIB-1 LI was significantly higher in the progressive residual tumor group, compared with the stable residual tumor group. Additionally, the time period to second surgery was significantly shorter in residual adenomas showing an MIB-1 LI > 3%. Conclusions The data indicate that MIB-1 LI in nonfunctioning pituitary adenomas is a clinically useful prognostic parameter indicating probability of progression of postoperative tumor remnants. The MIB-1 LI may be helpful in decisions of postoperative disease management (for example, frequency of radiographic intervals, planning for reoperation, radiotherapy, and/or radiosurgery).
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De Santis, Maria, Alexander Becherer, Carsten Bokemeyer, et al. "2-18fluoro-deoxy-D-glucose Positron Emission Tomography Is a Reliable Predictor for Viable Tumor in Postchemotherapy Seminoma: An Update of the Prospective Multicentric SEMPET Trial." Journal of Clinical Oncology 22, no. 6 (2004): 1034–39. http://dx.doi.org/10.1200/jco.2004.07.188.
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Purpose To define the clinical value of 2-18fluoro-deoxy-D-glucose positron emission tomography (FDG PET) as a predictor for viable residual tumor in postchemotherapy seminoma residuals in a prospective multicentric trial. Patients and Methods FDG PET studies in patients with metastatic pure seminoma who had radiographically defined postchemotherapy residual masses were correlated with either the histology of the resected lesion or the clinical outcome documented by computer tomography (CT), tumor markers, and/or physical examination during follow-up. The size of the residual lesions on CT, either > 3 cm or ≤ 3 cm, was correlated with the presence or absence of viable residual tumor. Results Fifty-six FDG PET scans of 51 patients were assessable. All 19 cases with residual lesions > 3 cm and 35 (95%) of 37 with residual lesions ≤ 3 cm were correctly predicted by FDG PET. The specificity, sensitivity, positive predictive value, and negative predictive value of FDG PET were 100% (95% CI, 92% to 100%), 80% (95% CI, 44% to 95%), 100%, and 96%, respectively, versus 74% (95% CI, 58% to 85%), 70% (95% CI, 34% to 90%), 37%, and 92%, respectively, for CT discrimination of the residual tumor by size (> 3 cm/≤ 3 cm). Conclusion This investigation confirms that FDG PET is the best predictor of viable residual tumor in postchemotherapy seminoma residuals and should be used as a standard tool for clinical decision making in this patient group.
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Morita, Yoshihiro, Macall Leslie, Hiroyasu Kameyama, et al. "Functional Blockade of E-Selectin in Tumor-Associated Vessels Enhances Anti-Tumor Effect of Doxorubicin in Breast Cancer." Cancers 12, no. 3 (2020): 725. http://dx.doi.org/10.3390/cancers12030725.
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Chemotherapy is a mainstay of treatment for solid tumors. However, little is known about how therapy-induced immune cell infiltration may affect therapy response. We found substantial CD45+ immune cell density adjacent to E-selectin expressing inflamed vessels in doxorubicin (DOX)-treated residual human breast tumors. While CD45 level was significantly elevated in DOX-treated wildtype mice, it remained unchanged in DOX-treated tumors from E-selectin null mice. Similarly, intravenous administration of anti-E-selectin aptamer (ESTA) resulted in a significant reduction in CD45+ immune cell density in DOX-treated residual tumors, which coincided with a delay in tumor growth and lung metastasis in MMTV-pyMT mice. Additionally, both tumor infiltrating T-lymphocytes and tumor associated-macrophages were skewed towards TH2 in DOX-treated residual breast tumors; however, ESTA suppressed these changes. This study suggests that DOX treatment instigates de novo intratumoral infiltration of immune cells through E-selectin, and functional blockade of E-selectin may reduce residual tumor burden as well as metastasis through suppression of TH2 shift.
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Winter, Christian, Cigdem Bingöl, and Peter Albers. "Postchemotherapy Retroperitoneal Residual Tumor Resection for Minimal Residual Disease." European Urology Supplements 10, no. 3 (2011): e64-e70. http://dx.doi.org/10.1016/j.eursup.2011.03.013.
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Borzomati, Domenico, Giuseppe Perrone, Gennaro Nappo, et al. "Microscopic Residual Tumor After Pancreaticoduodenectomy." Pancreas 45, no. 5 (2016): 748–54. http://dx.doi.org/10.1097/mpa.0000000000000540.
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Wittekind, Christian, Carolyn C. Compton, Frederick L. Greene, and Leslie H. Sobin. "TNM residual tumor classification revisited." Cancer 94, no. 9 (2002): 2511–16. http://dx.doi.org/10.1002/cncr.10492.
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Theodosopoulos, Philip V., James Leach, Robert G. Kerr, et al. "Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?" Journal of Neurosurgery 112, no. 4 (2010): 736–43. http://dx.doi.org/10.3171/2009.6.jns08916.
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Object Endoscopic approaches to pituitary tumors have become an effective alternative to traditional microscopic transsphenoidal approaches. Despite a proven potential to decrease unexpected residual tumor, intraoperative MR (iMR) imaging is infrequently used even in the few operating environments in which such technology is available. Its use is prohibitive because of its cost, increased complexity, and longer operative times. The authors assessed the potential of intrasellar endoscopy to replace the need for iMR imaging without sacrificing the maximum extent of resection. Methods In this retrospective study, 27 consecutive patients underwent fully endoscopic resection of pituitary macroadenomas. Intrasellar endoscopy was used to determine the presence of residual tumor within the sella turcica and tumor cavity. Intraoperative MR imaging was used to identify rates of unexpected residual tumor and the need for further tumor resection. Results Intraoperative estimates of the extent of tumor resection were correct in 23 patients (85%). Of 4 patients with unacceptable tumor residuals, 3 underwent further tumor resection. After iMR imaging, the rate of successful completion of the planned extent of resection increased to 26 patients (96%). Rates of both endocrinopathy reversal and postoperative complications were consistent with previously published results for microscopic and endoscopic resection techniques. Conclusions The findings in this study provided quantitative evidence that intrasellar endoscopy has significant promise for maximizing the extent of tumor resection and is a useful adjunct to surgical approaches to pituitary tumors, particularly when iMR imaging is unavailable. A larger prospective study on the extent of resection following endoscopic transsphenoidal surgery would strengthen these findings.
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Park, Jung Ho, So Eun Ahn, Sanghwa Kim, Mi Jung Kwon, Yong Joon Suh, and Doyil Kim. "Complete Surgical Excision Is Necessary following Vacuum-Assisted Biopsy for Breast Cancer." Current Oncology 29, no. 12 (2022): 9357–64. http://dx.doi.org/10.3390/curroncol29120734.
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Vacuum-assisted breast biopsy (VABB) has been replacing excisional biopsy in the treatment of benign breast lesions. Complete surgical excision is still needed for the lesions occasionally diagnosed with breast cancer after VABB. We aimed to characterize residual tumors after VABB and define a subset of patients who do not need surgical excision after VABB. From a retrospective database, we identified patients diagnosed with breast cancer after VABB guided with ultrasonography. Patients who underwent stereotactic biopsies were excluded. We reviewed clinicopathologic data and radiologic findings of the sample. We identified 48 patients with 49 lesions. After surgical excision, the residual tumors were identified in 40 (81.6%) lesions, and there was no residual tumor in nine (18.3%) patients. Imaging studies could not accurately locate residual tumors after VABB. A small tumor size on a VABB specimen was associated with no residual tumor on final pathology. However, residual tumors were identified in four (40%) of 10 lesions with a pathologic tumor size less than 0.5 cm. In conclusion, complete surgical excision remains the primary option for most of the patients diagnosed with breast cancer after VABB. Imaging surveillance without surgery should be carefully applied for selected low-risk patients.
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Villarreal-Garza, Cynthia Mayte, Enrique Soto-Perez-de-Celis, Erika Sifuentes, et al. "Pathologic response and disease-free survival (DFS) after neoadjuvant trastuzumab (T) for HER2+ breast cancer (BC): Results from the National Cancer Institute (NCI) of Mexico." Journal of Clinical Oncology 31, no. 15_suppl (2013): e11533-e11533. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e11533.
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e11533 Background: The most accurate definition of pathologic complete response (pCR) in HER2+ BC patients (pts) receiving T-based neoadjuvant chemotherapy associated with improved DFS is controversial, particularly regarding the role of residual ductal carcinoma in situ (ypTis) and focal invasive residuals (ypT1mic). The effect of pCR on DFS in various subgroups of HER2+ BC is also uncertain. Methods: Pts with localized HER2+ BC that received T-based neoadjuvant chemotherapy at NCI between January 2007 and May 2012 were identified. We conducted an exploratory analysis of DFS in pts according to their tumor response. DFS curves were derived from Kaplan-Meier estimates and compared by log-rank test. Multivariate analysis was performed using Cox’s regression model. Results: 243 pts were included for analysis. Median follow-up was 39 months (mo). 49% of pts had no invasive and no in situ residuals at surgery (ypT0), 14.4% had ypTis/ypT1mic residuals and 36.6% had gross residual BC. DFS was significantly superior in pts with both ypT0 and ypTis/ypT1mic (no gross invasive residual BC) compared with those with gross residual disease (60.6 and 62.7 mo respectively vs. 51.6 mo, p=0.011 and 0.017). There was no difference in DFS between ypT0 and ypTis/ypT1mic pts (p=0.402). The rate of no gross invasive residual BC was significantly superior in pts with ER-PR- tumors compared with patients with ER+/PR+ tumors (69.9% vs. 56.7%, p=0.034). No gross invasive residual BC was associated with improved DFS in pts with HER2+ ER-/PR- (60.3 vs. 49.0 mo; p=0.005), as opposed to HER2+ ER+/PR+ tumors (61.0 vs. 51.6 mo; p=0.100). Multivariate analysis showed that tumor size (p=0.013) and no gross invasive residual BC (p=0.13) were associated with improved DFS in all subgroups. Conclusions: The absence of gross invasive residual BC was associated with improved DFS in pts with HER2+ BC treated with T-based neoadjuvant chemotherapy, particularly in those with HER2+ ER-/PR- BC. Our data suggest a comparable DFS in HER2+ BC patients with no gross invasive residual BC regardless of the presence or absence of both ypTis and ypT1mic disease after neoadjuvant treatment.
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Maskey, Pukar, Pawan Raj Chalise, Uttam Kumar Sharma, Prem Raj Gyawali, Guna Kumar Shrestha, and Bhola Raj Joshi. "Role of second transurethral resection in determining residual tumor in nonmuscle-invasive bladder cancer." Journal of Society of Surgeons of Nepal 20, no. 2 (2017): 35–42. http://dx.doi.org/10.3126/jssn.v20i2.24379.
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Introduction: Presence of residual tumors is not an uncommon event after transurethral resection of bladder tumor, and no studies from Nepal so far has addressed this issue. We conducted this study to determine the rate of residual tumors after first transurethral resection of nonmuscle-invasive bladder cancer, and to determine the factors associated with the presence of residual tumors and upstaging of nonmuscle-invasive bladder cancer.
 Methods: This was a prospective observational study of 43 patients of bladder cancer who had a diagnosis of nonmuscle-invasive bladder cancer following an initial transurethral resection. Demographic data and data on tumor characteristics were obtained. Patients underwent a second transurethral resection within 2 to 8 weeks. Histopathological findings at first and second resection were compared.
 Results: There were 20 patients with Ta tumor and 23 patiens with T1 tumor at initial resection. Residual tumor was detected in 18 (41.86%) patients overall, 2 in patients with Ta tumor (10%) and 16 in patients with T1 tumor (69.5%). Tumors with T1 stage, high grade, size more than 3 centimeters and sessile growth pattern were seen to have significant association with the presence of residual tumors. Six patients with T1 disease upstaged to T2 disease after second resection (26%), while there were no upstaging with Ta tumors. Tumors with T1 stage, sessile configuration and size more than 3 centimeters were found to be significantly associated with upstaging.
 Conclusion: A second transurethral resection for nonmuscle-invasive bladder cancer should be considered if the initial tumor is T1 stage, high grade, more than 3 centimeters in size and has sessile growth pattern.
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Kochi, Masato, Youichi Itoyama, Shoji Shiraishi, Isao Kitamura, Toru Marubayashi, and Yukitaka Ushio. "Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors." Journal of Neurosurgery 99, no. 1 (2003): 106–14. http://dx.doi.org/10.3171/jns.2003.99.1.0106.
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Object. The goal of this study was to confirm the effectiveness of our novel treatment strategy, neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy, which are performed before complete excision of residual tumor in patients with intracranial nongerminomatous malignant germ cell tumors (NGMGCTs). Methods. The authors treated 11 consecutive patients with NGMGCTs by applying NAT consisting of combined platinum-based chemotherapy and radiotherapy, followed by complete excision of residual tumors. The pretreatment diagnosis, based on tumor markers with or without biopsy, was yolk sac tumor in five patients, embryonal carcinoma in one patient, immature teratoma in one patient, and mixed germ cell tumor containing malignant tumor components in four patients. Among the 11 patients, NAT achieved a complete response in two and a partial response in six patients; two patients manifested no change and one suffered disease progression. Residual tumors that occurred post-NAT were surgically removed in nine patients. Of the 11 patients, 10 are currently alive without recurrence of their disease, 30 to 177 months (mean 96 months) after diagnosis. In one patient a leptomeningeal tumor recurred and he died of the disease 21 months after diagnosis. Conclusions. Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.
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Taussky, Philipp, Ricky Kalra, Jeroen Coppens, Jahan Mohebali, Randy Jensen, and William T. Couldwell. "Endocrinological outcome after pituitary transposition (hypophysopexy) and adjuvant radiotherapy for tumors involving the cavernous sinus." Journal of Neurosurgery 115, no. 1 (2011): 55–62. http://dx.doi.org/10.3171/2011.2.jns10566.
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Object Stereotactic radiosurgery and fractionated stereotactic radiotherapy are commonly used in the treatment of residual or recurrent benign tumors of the skull base and cavernous sinus. A major risk associated with radiosurgical or radiotherapy treatment of residual or recurrent tumors adjacent to normal functional pituitary gland is radiation of the pituitary, which frequently leads to the development of hypopituitarism. The authors have used a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual tumor within the cavernous sinus. Here, the authors analyze the long-term endocrinological outcomes in patients with residual and recurrent tumors who undergo hypophysopexy and adjuvant radiosurgical or conformal fractionated radiotherapy treatment. Methods Pituitary transposition involves placement of a fat graft between the normal pituitary gland and residual tumor in the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and the graft is interposed between the pituitary gland and the residual tumor. The residual tumor may then be treated with stereotactic radiosurgery or conformal fractionated radiation therapy. The authors evaluated endocrinological outcome, safety of the procedure, and postoperative complications in patients who underwent this procedure during a 7-year period. Results Hypophysopexy has been used in 34 patients with nonfunctioning pituitary adenomas (19), functional pituitary adenomas (8), chordomas (2), meningiomas (2), chondrosarcoma (1), hemangiopericytoma (1), or hemangioma (1) involving the sella and cavernous sinus. Follow-up (radiographic and endocrinological) has been performed yearly in all patients. Two patients experienced postoperative endocrine deficits before radiosurgery (1 transient), but none of the patients developed new hypopituitarism during the median 4-year follow-up (range 1–8 years) after radiosurgery or fractionated stereotactic radiotherapy. Conclusions The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery or radiotherapy and effectively reduces the incidence of radiation injury to the normal pituitary gland when compared with historical controls.
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Kopke, Luis Fernando Figueiredo. "The importance of residual tumor detection." Anais Brasileiros de Dermatologia 94, no. 3 (2019): 374–75. http://dx.doi.org/10.1590/abd1806-4841.20198074.
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Wittekind, Christian, Carolyn Compton, Phil Quirke, et al. "A uniform residual tumor (R) classification." Cancer 115, no. 15 (2009): 3483–88. http://dx.doi.org/10.1002/cncr.24320.
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Hermanek, Paul, and Christian Wittekind. "Residual tumor (R) classification and prognosis." Seminars in Surgical Oncology 10, no. 1 (1994): 12–20. http://dx.doi.org/10.1002/ssu.2980100105.
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Gugel, Isabel, Lan Kluwe, Julian Zipfel, et al. "Minimal Effect of Bevacizumab Treatment on Residual Vestibular Schwannomas after Partial Resection in Young Neurofibromatosis Type 2 Patients." Cancers 11, no. 12 (2019): 1862. http://dx.doi.org/10.3390/cancers11121862.
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Hearing-preserving partial resection of neurofibromatosis type 2 (NF2) associated vestibular schwannomas (VS) is a preferred treatment strategy, particularly for children and adolescents. However, the residual tumors do grow and lead at some point to continued hearing deterioration. An adjuvant bevacizumab treatment may provide an option for slowing down this process. In this retrospective study, we reviewed tumor volume and hearing data of 16 operated VS in nine patients younger than 30 years over a period of 63 to 142 months. All these patients had one or more bevacizumab treatment periods and most of them had a non-treatment period after surgery. Four different patterns of growth were observed for the residual tumors: (1) growth in the non-treatment periods, which slowed down in the treatment periods; (2) growth slowed down in one but not in another on-period; (3) unaffected growth; (4) no or minimal growth regardless of the treatment. Neither radiological regression of tumor volume nor hearing improvement were observed in the treatment periods. Accelerated hearing deterioration was observed in several non-treatment periods, but also in some treatment periods. No straightforward correlation can be drawn between tumor growth and hearing scores. Tumor growth and worsening of hearing between two measurement points were slightly less in the treatment periods; however, the differences were not significant, because variations were large. In conclusion, our comprehensive follow-up on 16 VS in nine NF2 patients did show heterogenous effects of bevacizumab on small residual vestibular schwannomas after surgery both regarding tumor size and hearing preservation. Thus, smaller and slower growing tumor residuals seem to behave differently to bevacizumab than reported for not-operated faster growing VS.
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Nakamura, Hideo, Keishi Makino, Masato Kochi, Yukitaka Ushio, and Jun-ichi Kuratsu. "Evaluation of neoadjuvant therapy in patients with nongerminomatous malignant germ cell tumors." Journal of Neurosurgery: Pediatrics 7, no. 4 (2011): 431–38. http://dx.doi.org/10.3171/2011.1.peds10433.
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Object The authors evaluated the effectiveness of a neoadjuvant therapy (NAT) consisting of combined chemoand radiotherapy followed by complete resection of the residual tumor in patients with nongerminomatous malignant germ cell tumors (NGMGCTs). Methods The authors treated 14 consecutive patients in whom NGMGCTs were diagnosed based on elevated levels of the tumor markers α-fetoprotein, human chorionic gonadotropin, and the β-subunit of human chorionic gonadotropin (β-HCG). Chemotherapy and radiotherapy were performed, and after the serum tumor markers level was in the normal or near-normal range, the residual tumors were completely resected. Results Residual tumors were confirmed in 11 of the 14 patients after NAT, and total removal was successful in 10 of the 11 patients. In the other patient the residual tumor could not be completely excised because it was attached to a deep vein. The follow-up duration ranged from 1.2 to 22.2 years. The 5-year event-free and total survival rates were 86% and 93%, respectively. Although 3 patients died, 2 of tumor recurrence and 1 of a radiation-induced secondary tumor (glioblastoma), the other 11 are alive and without evidence of tumor recurrence. Conclusions The authors consider their NAT protocol for NGMGCT to be highly effective in relation to survival for the patients with NGMGCT, but there are several quality of life issues that need to be resolved.
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Friedman, Jonathan A., James J. Lynch, Jan C. Buckner, Bernd W. Scheithauer, and Corey Raffel. "Management of Malignant Pineal Germ Cell Tumors with Residual Mature Teratoma." Neurosurgery 48, no. 3 (2001): 518–23. http://dx.doi.org/10.1097/00006123-200103000-00011.
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Abstract OBJECTIVE The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component. We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy. METHODS Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy. After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030–5940 cGy). Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans. Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two. Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination. Tumor markers were elevated in four of the six patients at presentation. RESULTS All patients with residual pineal tumors underwent surgical resection via an infratentorial, supracerebellar approach. Pathological examination revealed mature teratoma in five patients and amorphous debris in one patient. No patient had recurrent malignancy. Significant neurological morbidity occurred in one patient, with no mortality. At a mean follow-up of 23 months, no recurrence on magnetic resonance imaging has been documented. CONCLUSION Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma. Operative resection of these benign recurrences is safe and effective.
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Juvekar, Parikshit, Erickson Torio, Wenya Linda Bi, Dhiego Chaves De Almeida Bastos, Alexandra J. Golby, and Sarah F. Frisken. "Mapping Resection Progress by Tool-Tip Tracking during Brain Tumor Surgery for Real-Time Estimation of Residual Tumor." Cancers 15, no. 3 (2023): 825. http://dx.doi.org/10.3390/cancers15030825.
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Surgical resection continues to be the primary initial therapeutic strategy in the treatment of patients with brain tumors. Computerized cranial neuronavigation based on preoperative imaging offers precision guidance during craniotomy and early tumor resection but progressively loses validity with brain shift. Intraoperative MRI (iMRI) and intraoperative ultrasound (iUS) can update the imaging used for guidance and navigation but are limited in terms of temporal and spatial resolution, respectively. We present a system that uses time-stamped tool-tip positions of surgical instruments to generate a map of resection progress with high spatial and temporal accuracy. We evaluate this system and present results from 80 cranial tumor resections. Regions of the preoperative tumor segmentation that are covered by the resection map (True Positive Tracking) and regions of the preoperative tumor segmentation not covered by the resection map (True Negative Tracking) are determined for each case. We compare True Negative Tracking, which estimates the residual tumor, with the actual residual tumor identified using iMRI. We discuss factors that can cause False Positive Tracking and False Negative Tracking, which underestimate and overestimate the residual tumor, respectively. Our method provides good estimates of the residual tumor when there is minimal brain shift, and line-of-sight is maintained. When these conditions are not met, surgeons report that it is still useful for identifying regions of potential residual.
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Albagoush, Sara, Jonathan Gootee, Kevin Nguyen, Sarah J. Aurit, Christina Curtin, and Peter T. Silberstein. "The importance of surgical margins in dedifferentiated liposarcoma survival." Journal of Clinical Oncology 37, no. 15_suppl (2019): e22528-e22528. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e22528.
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e22528 Background: Among the types of soft tissue sarcomas (STS), liposarcoma is the most common malignant STS. Considering therapeutic options, surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma. Methods: The National Cancer Database (NCDB) was used to select patients with dedifferentiated liposarcoma to determine if surgical margins and other variables were associated with worse overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis. Results: Of the 1,004 patients, 64.4% were male, 87.0% were white, and the median age was 63 years. Approximately 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, and 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). When compared to no residual tumor after surgery, patients with macroscopic residual tumors, had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; p= 0.004). Conclusions: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, high grade tumors, and macroscopic or residual tumor present after surgery led to an increased risk of mortality.
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Kinoshita, Osamu, Masayoshi Nakanishi, Yasutoshi Murayama, Yoshiaki Kuriu, Yukihito Kokuba, and Eigo Otsuji. "Flattened Tumor Requires a More Careful Attention for Residual Distal Cancer Spread in Locally Advanced Lower Rectal Carcinoma after Chemoradiotherapy." Digestive Surgery 32, no. 3 (2015): 159–65. http://dx.doi.org/10.1159/000371586.
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Background/Aims: Limited data are available on distal resection margin (DRM) for lower rectal cancer (LRC) after preoperative chemoradiotherapy (pre-CRT); thus, we aimed to establish the criteria for DRMs as estimated by the macroscopic tumor appearance. Methods: This was a pathological study using whole-mount sections that included the entire circumference of tumor. Residual cancer spread located most distally from the macroscopic tumor border was mainly evaluated. Results: A retrospective cohort of 42 consecutive patients with locally advanced LRC after pre-CRT was enrolled, and 38 patients were eligible for this study. According to the macroscopic tumor appearance, 18 patients had raised-type and 20 had flattened-type tumors. Patients with flattened-type tumors were closely associated with histopathological regression grade. Residual distal cancer spread (RDCS) was located ≤4.0 mm (median, 0.1 mm) in the raised-type tumors and ≤17.1 mm (median, 4.2 mm) in the flattened-type tumors. RDCS in flattened-type tumors was distributed diffusely and distally from the tumor border (p = 0.022). Conclusion: Even in patients evaluated as pre-CRT responders, flattened tumors often accompanied distally located residual cancer that had spread from the tumor border and require more careful attention in order to ensure cancer clearance.
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Losa, Marco, Pietro Mortini, Raffaella Barzaghi, et al. "Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence." Journal of Neurosurgery 108, no. 3 (2008): 525–32. http://dx.doi.org/10.3171/jns/2008/108/3/0525.
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Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.
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Maletkovic, Jelena, Asmaa Dabbagh, Dongyun Zhang, et al. "Residual Tumor Confers a 10-Fold Increased Risk of Regrowth in Clinically Nonfunctioning Pituitary Tumors." Journal of the Endocrine Society 3, no. 10 (2019): 1931–41. http://dx.doi.org/10.1210/js.2019-00163.
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Abstract Objective We evaluated tumor recurrence and regrowth rates following endoscopic transnasal transsphenoidal (TNTS) surgical removal in a consecutive series of clinically nonfunctioning pituitary adenomas (CNFTs). Design Retrospective chart review of clinical, biochemical, and sellar MRI findings in all TNTS surgeries in patients with CNFT, performed by a single surgeon, between 2008 and 2015 (n = 280). Patients Ninety-three patients met eligibility criteria, with complete clinical, biochemical, and imaging follow-up for a 3-year minimum. Results Of 85 patients who were not irradiated, 3-month postsurgical MRI demonstrated no residual tumor in 58 of 85 (68.2%), equivocal findings in 12 of 85 (14.1%), and definite residual tumor in 15 of 85 (17.6%) patients. Six of 85 (7.1%) demonstrated tumor regrowth by 3 years, and 2 further patients demonstrated true tumor recurrence at 3 and 6 years after surgery, respectively, for a total recurrence rate of 9.4% (8 of 85). Eight of the 93 patients were irradiated between 3 months and 4 years after pituitary surgery. In 3 patients with tumor regrowth, 2 exhibited residual tumor and 1 had no residual findings at the 3-month postoperative imaging. Overall, Ki-67 labeling index or Knosp grading did not predict recurrence. Conclusion Tumor recurrence at 3 years was low (1 of 58; 1.7%) if the 3-month postoperative MRI showed no residual tumor. The findings support a less frequent imaging schedule for this group. Patients with definite residual tumor visible at 3 months harbor the greatest risk for tumor growth, but regrowth does not occur in all patients (6 of 15; 40%).
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Germanwala, Anand V., Jeffrey C. Mai, Nestor D. Tomycz, et al. "Boost Gamma Knife surgery during multimodality management of adult medulloblastoma." Journal of Neurosurgery 108, no. 2 (2008): 204–9. http://dx.doi.org/10.3171/jns/2008/108/2/0204.
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Object The aim of this paper was to determine prognostic factors for adult medulloblastoma treated with boost Gamma Knife surgery (GKS) following resection and craniospinal irradiation. Methods The authors performed a retrospective analysis of 12 adult patients with histologically proven medulloblastoma or supratentorial primitive neuroectodermal tumor who between February 1991 and December 2004 underwent ≥ 1 sessions of GKS for posttreatment residual or recurrent tumors (6 tumors in each group). Before GKS, all patients had undergone a maximal feasible resection followed by craniospinal irradiation. Nine patients also received systemic chemotherapy. Stereotactic radiosurgery was applied to residual and recurrent posterior fossa tumor as well as to foci of intracranial medulloblastoma metastases. The median time interval from initial diagnosis and resection to the first GKS treatment was 24 months (range 2–37 months). The mean GKS-treated tumor volume was 9.4 cm3 (range 0.5–39 cm3). Results Following adjunctive radiosurgery, 5 patients had no evidence of tumor on magnetic resonance (MR) imaging, 3 patients had stable tumor burden on MR imaging, and 4 patients had evidence of tumor progression locally with or without intracranial metastases. All patients with tumor progression died. Eight patients survive with a mean cumulative follow-up of 72.4 months (range 21– 152 months). No acute radiation toxicity or delayed radiation necrosis was observed among any of the 12 patients. The majority of patients who achieved tumor eradication (80%) and tumor stabilization (67%) after GKS had residual tumor as the reason for their referral for GKS. The best outcomes were attained in patients with residual disease who were younger, had smaller tumor volumes, had no evidence of metastatic disease, and had received higher cumulative GKS doses. Conclusions Single or multiple GKS sessions were a well-tolerated, feasible, and effective adjunctive treatment for posterior fossa residual or recurrent medulloblastoma as well as intracranial metastatic medulloblastoma in adult patients.
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Bhide, Shreerang, Jen Lee, Isaac Garcia-Murillas, et al. "Predicting response to radical (chemo)radiotherapy (R-CRT) with circulating HPV DNA and tumor DNA (ctDNA) analysis in locally-advanced head and neck squamous cell carcinoma (LAHNC)." Journal of Clinical Oncology 35, no. 15_suppl (2017): 6043. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6043.
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6043 Background: Following R-CRT for human papilloma virus positive (HPV+) and negative (HPV-) LAHNC, patients frequently undergo unnecessary neck dissection (ND) and/or repeated biopsies for abnormal PET-CT findings even in the presence of a complete pathological response (pCR), which causes significant morbidity. We assessed the role of circulating tumor DNA analysis in identifying patients with true residual disease. Methods: We prospectively recruited development (DC, n=55) and test (TC, n=33) cohorts of LAHNC patients having R-CRT. For HPV+ tumors we developed a novel amplicon based next generation sequencing assay (HPV-detect) to detect circulating HPV DNA and for HPV- tumors we used personalised droplet digital PCR assays of somatic mutations. Circulating tumor DNA levels at 12 weeks post-R-CRT were correlated to residual disease assessed by PET-CT and surgery. Results: In the DC (27 HPV+), baseline HPV-detect demonstrated 100% sensitivity and 93% specificity, confirmed in the TC (20 HPV+). 37 HPV+ patients (DC&TC) had complete samples-set. 36 had a negative HPV-detect at end of treatment, including 6 patients who underwent ND (3) and repeat primary site biopsies (3) for positive PET-CT but had pCR on surgical/biopsy specimen. 1 patient had positive HPV-detect and positive biopsy, indicating 100% agreement for HPV-detect and residual cancer. In a 10 HPV- patients with complete sample-set, there was 90% agreement between ctDNA and residual disease in HPV- tumors (3 ctDNA positive and tumor present, 1 ctDNA negative but tumor present, and 6 negative ctDNA negative tumor) with 80% sensitivity for residual disease and 100% specificity. Combined agreement between ctDNA testing (HPV+ and -) & residual disease was 98% (Table). Conclusions: Circulating HPV DNA quantified using HPV-detect and ctDNA identifies patients with residual disease post-R-CRT in LAHNC. Further studies are required to validate these findings. [Table: see text]
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Freeman, J. E., S. Yang, S. V. Panasyuk, et al. "In situ evaluation of residual breast tumor and tumor grade using medical hyperspectral imaging (MHSI)." Journal of Clinical Oncology 24, no. 18_suppl (2006): 10677. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.10677.
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10677 Background: MHSI is a camera-based technique providing spectral data regarding tissue chemistry for each pixel in an image. Over 30% of women suffer local recurrence after resection. Intraoperative assessment of residual tumor & tumor grade would optimize care. Methods: We studied 42 S-D rats w/ breast tumors induced by gavage of DMBA & 15 controls. Tumors were exposed & resected, intentionally leaving ∼1mm residual tumor pieces. Gross examination, histo-pathology & MHSI (total 335) were performed for tumors, tumor beds after partial and total resection & control sites. A visible light MHSI system (HyperMed,Waltham, MA) w/ 40μm resolution & algorithms based on spectral features of the surgical field were developed and implemented for this study. Gross observation at surgery represents truth, as small tumor pieces were left intentionally by the surgeon and recorded. Samples from tumor beds were collected and histopathologically analyzed. When seen, gross tumor was removed from tumor bed by the pathologist. Results: MHSI performed well at identifying tumor. The kappa statistic(κ) for gross vs MHSI (84%) is significantly higher than κ for gross vs histopathology (76%) where for the κ the estimated asymptotic standard error is 3%. MHSI associates more strongly with gross than histopathology does. 81 tissue samples were separated into histologic grade: 0 = normal, 1 = benign tumor, 2 = intraductal Ca, 3 = papillary & cribiform Ca, 4 = papillary & cribiform Ca with invasion &/or comedo Ca. The imaging team (blinded) assigned tumor grade to each MHSI image. Statistical analysis defined 3 histologic groups: 9 normal (grade 0) tissue, 18 benign & intraductal tumors (grades 1–2), 54 advanced tumors (papillary, cribiform with invasion/comedo Ca, grades 3–4). Both histopathology & MHSI identified all 9 normal samples. Of 18 samples in group 2 (benign/intraductal by histopathology), 17 were qualified as benign/intraductal by MHSI (94% sens) & 1 as advanced. Of 54 samples with adv tumors by histopathology, MHSI identified 48 (89% sens) as advanced & 6 as intraductal. Conclusions: MHSI may provide convenient intraoperative, near real-time images with useful data about residual tumor & tumor grade. Human trials are planned. [Table: see text]
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Baldock, Anne, Russell Rockne, Sunyoung Ahn, et al. "Patient-specific biomathematical model to predict benefit of resection in human gliomas." Journal of Clinical Oncology 31, no. 15_suppl (2013): e13017-e13017. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e13017.
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e13017 Background: Gliomas are incurable, primary brain tumors noted for their invasion of brain parenchyma. Our goal was to apply a biomathematical model to estimate the overall tumor invasiveness on an individual basis and determine whether the estimated number of residual glioma cells after resection of any extent is predictive of survival. Methods: Estimates of net rates of proliferation (ρ) and diffusion (D) of glioma cells, based on a biomathematical model of cell density, yield a ratio describing relative invasiveness (ρ/D). This metric was derived for 185 contrast enhancing gliomas from pretreatment MRIs. The residual MRI-detectable volume was combined with the ρ/D tuned to each patient's tumor to allow estimation of the number of glioma cells remaining post-resection. The patients were split into three cohorts by ρ/D values. Within each cohort, all possible cut-off values were considered as a possible threshold between low and high residual patient groups. Log-rank tests were performed for each possible threshold to determine if the Kaplan-Meyer curves were significantly different. Results: We demonstrate that for low ρ/D tumors there was no threshold of residual tumor cell population observed that could yield a significant survival benefit. Both the mid ρ/D and high ρ/D had robust thresholds of residual tumor cell population, below which patients saw significantly higher survival than patients with similar invasiveness and more residual tumor. Conclusions: These results suggest that our patient-specific biomathematical model-based estimates of tumor invasiveness and residual tumor cells have clinical utility in driving neurosurgical decision making. Given the physicians understanding of patient-specific risk factors such as tumor location, age, and physical health, an understanding of the differential surgical benefit allows for more informed cost-benefit analysis and improved quality of life. This metric enables physicians to identify a subset of patients who do not see a survival benefit from resection, making the operation potentially not worth the risks.
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Che, Yue, Carolin Buddensieck, Peter Albers, et al. "Postchemotherapy Residual Tumor Resection in Patients with Elevated Tumor Markers." Journal of Urology 207, no. 3 (2022): 617–26. http://dx.doi.org/10.1097/ju.0000000000002270.
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Sato, Hiroshi, Takuji Kaburaki, Masahiro Niihara, et al. "Risk Factors for Residual Tumors in Surgery Following Neoadjuvant Chemotherapy for Esophageal Cancer." International Surgery 103, no. 11-12 (2019): 572–77. http://dx.doi.org/10.9738/intsurg-d-17-00048.1.
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Neoadjuvant chemotherapy (NAC) followed by esophagectomy is considered the standard treatment for resectable advanced esophageal squamous cell carcinoma in Japan. The purpose of this study was to identify the risk factors for residual tumors in surgery following NAC. We herein described risk factors for residual tumors in surgery following neoadjuvant chemotherapy for thoracic esophageal cancer. We reviewed the medical records of patients in our institution selected by using the following criteria: (1) pathologically confirmed squamous cell carcinoma or adenosquamous carcinoma before treatment; (2) cT1 to cT3; and (3) receipt of thoracotomy performed between 2007 and 2010 with the intention of curative resection after NAC composed of 5-fluorouracil plus cisplatin. The patients were divided into the complete resection group (R0 group), and the macroscopic or microscopic residual tumor group [R(+) group]. A total of 88 patients were eligible (R0, 70 patients; R1, 9 patients; R2, 7 patients; and not resected, 2 patients). There were more cT3 cancers and clinical node-positive diseases in the R(+) group than in the R0 group. Multivariate analysis identified tumor depth (cT3) and tumor location (above the carina) as risk factors for residual tumor. Patients with cT3 esophageal cancer above the carina have a high risk of residual tumor in esophagectomy following NAC. In these patients, more intensive preoperative therapy will be required.
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Forsyth, P. A., E. Petrov, H. Mahallati, et al. "Prospective study of postoperative magnetic resonance imaging in patients with malignant gliomas." Journal of Clinical Oncology 15, no. 5 (1997): 2076–81. http://dx.doi.org/10.1200/jco.1997.15.5.2076.
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PURPOSE We studied the natural history of postoperative enhancement on magnetic resonance (MR) scans in patients with malignant glioma to determine the following: (1) when a postoperative MR scan most accurately shows residual enhancing tumor; and (2) whether repeated doses of the contrast agent gadopentetate dimeglumine (Gd-DTPA) were well tolerated. PATIENTS AND METHODS Seventeen patients with malignant glioma underwent tumor resection; four (24%) had nonenhancing tumors preoperatively. Serial MR scans were performed on postoperative days 1, 3, 5, 7, 14, and 21 and were analyzed qualitatively and quantitatively. The evolution of enhancement and subacute hemorrhage were described and measured. A uniform schedule of postoperative dexamethasone administration was used in all but four patients (24%) (each required higher doses to maintain neurologic function). RESULTS Nontumoral, marginal (i.e., postsurgical) enhancement, potentially mimicking residual tumor, developed in eight patients (53%), including tumors that were nonenhancing preoperatively, and was maximal from days 5 to 14. Tumor enhancement was optimally visualized on postoperative days 3 to 5. Nine of 10 patients (90%) with gross residual enhancing tumor showed an increase of enhancing tumor size during the study. Methemoglobin was detected at some time in all patients (100%) and was usually minor, but in six (35%) it interfered with residual tumor assessment. The 97 doses of Gd-DTPA, administered in 17 patients, were well tolerated. CONCLUSION When accurate assessment of residual enhancing tumor is needed in patients with malignant glioma, an MR scan performed on postoperative days 3 to 5 should minimize the confounding effects of postsurgical enhancement and methemoglobin. The repeated administration of Gd-DTPA over several weeks is well tolerated.
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Miyake, Yohei, Susumu Ito, Mio Tanaka, and Yukichi Tanaka. "Spontaneous regression of infantile dural-based non-Langerhans cell histiocytosis after surgery: case report." Journal of Neurosurgery: Pediatrics 15, no. 4 (2015): 372–79. http://dx.doi.org/10.3171/2014.10.peds14378.
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The authors report the case of a large left occipital mass lesion in an 8-month-old boy who presented with seizure. Neuroimaging demonstrated an approximately 5-cm extraaxial tumor, and the patient underwent partial resection. The tumor was strongly attached to the tentorium and falx. In the postoperative course the residual lesion regressed spontaneously, and after 5 years only a slight residual tumor remained along the tentorium. Histopathological examination of the tumor revealed non-Langerhans cell histiocytosis (non-LCH). However, the tumor was not diagnosed as juvenile xanthogranuloma (JXG) because it lacked Touton giant cells. Hence, the authors described this lesion as a fibroxanthogranuloma. Most intracraniospinal non-LCHs have been reported as JXG; however, several cases of xanthomatous tumors with histopathological features resembling those of JXG have been described as fibrous xanthoma, xanthoma, fibroxanthoma, and xanthogranuloma. Among JXG and the xanthomatous tumors, a review of the literature revealed several cases of dural-based tumors; these dural-based tumors have had favorable courses, including the case described in this report. In addition, the patient in the present case experienced spontaneous regression of the residual tumor. The authors report this unique case and review the literature on isolated intracraniospinal non-LCHs, especially in cases of dural-based lesion.
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Hattori, Masaya, Padma Sheila Rajagopal, Lise Sveen, et al. "Genomic profiling of residual tumor after neoadjuvant chemotherapy for breast cancer." Journal of Clinical Oncology 37, no. 15_suppl (2019): e12106-e12106. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e12106.
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e12106 Background: Patients who have residual disease after neoadjuvant chemotherapy (NAC) have a higher risk of metastatic recurrence. Residual disease likely includes therapy-resistant subclones of breast cancer cells, which untreated lead to metastases. The aim of this study was to identify additional adjuvant therapies based on genomic profiling of residual disease post NAC therapy. Methods: Next-generation sequencing of tumor samples from patients (pts) with residual invasive breast cancer after NAC was performed using a Tempus xT, 595 gene panel on matched tumor-normal samples. All samples were obtained from the University of Chicago Breast Cancer tissue bank. Clinical information was obtained from electronic health records and the cancer registry. Results: Of 23 evaluable patients enriched for African Americans, 65% were HER2-positive, 22% TNBC and 13% ER+/HER2-. At a median follow up of 2.9 years, 8 pts (35%) have recurred and 8 were dead. We identified 119 clinically actionable variants in 22 tumors, and the most commonly altered genes were TP53 (18 alterations, 74% of cases), ERBB2 (8, 26%), PIK3CA (7, 30%), CDK4 (4, 17%), MCL1 (4, 17%), and MDM2 (4, 17%). Of significance, 67% of HER2-positive pts had no detectable ERBB2 copy number gain in the residual tumor. 78% of pts had at least one potential druggable target according to CIViC and/or OncoKB: 19 variants in HER2-positive, 8 in HER2-negative. The mean estimated tumor mutation burden (TMB) was 4.34 m/MB (range: 0-26.7), and 13% were considered TMB-high ( > 9 m/MB). No patients had high-microsatellite instability type residual tumors. Conclusions: Many potentially targetable alterations reside in residual disease of both HER2-positive and -negative breast cancer after NAC. Post-NAC treatment targeting these harbored alterations and post-NAC immunotherapy could have impact on the prognosis of breast cancer patients who have residual disease after NAC. [Table: see text]
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Zhang, Jianxin, Xiaogang Lv, Hengbo Zhang, and Bin Liu. "AResU-Net: Attention Residual U-Net for Brain Tumor Segmentation." Symmetry 12, no. 5 (2020): 721. http://dx.doi.org/10.3390/sym12050721.
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Automatic segmentation of brain tumors from magnetic resonance imaging (MRI) is a challenging task due to the uneven, irregular and unstructured size and shape of tumors. Recently, brain tumor segmentation methods based on the symmetric U-Net architecture have achieved favorable performance. Meanwhile, the effectiveness of enhancing local responses for feature extraction and restoration has also been shown in recent works, which may encourage the better performance of the brain tumor segmentation problem. Inspired by this, we try to introduce the attention mechanism into the existing U-Net architecture to explore the effects of local important responses on this task. More specifically, we propose an end-to-end 2D brain tumor segmentation network, i.e., attention residual U-Net (AResU-Net), which simultaneously embeds attention mechanism and residual units into U-Net for the further performance improvement of brain tumor segmentation. AResU-Net adds a series of attention units among corresponding down-sampling and up-sampling processes, and it adaptively rescales features to effectively enhance local responses of down-sampling residual features utilized for the feature recovery of the following up-sampling process. We extensively evaluate AResU-Net on two MRI brain tumor segmentation benchmarks of BraTS 2017 and BraTS 2018 datasets. Experiment results illustrate that the proposed AResU-Net outperforms its baselines and achieves comparable performance with typical brain tumor segmentation methods.
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Kawai, Taketo, Haruki Kume, Keiji Inoue, et al. "Reduction of residual tumors by photodynamic diagnosis-assisted TURBT using 5-aminolevulinic acid for high-risk nonmuscle-invasive bladder cancer (BRIGHT study)." Journal of Clinical Oncology 40, no. 6_suppl (2022): 489. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.489.
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489 Background: High-risk non-muscle invasive bladder cancer (NMIBC) has high tumor residual rate of 40–60% after TURBT, and second TUR is strongly recommended. Photodynamic diagnosis-assisted TURBT (PDD-TURBT) using 5-aminolevulinic acid (5-ALA) has been reported to reduce residual tumors and intravesical recurrence. The purpose of this study is to investigate the residual tumor-reducing effect of PDD-TURBT for high-risk NMIBC and to explore the possibility that second TUR could be omitted by PDD-TURBT. Methods: We conducted an investigator-initiated multicenter prospective observational study (BRIGHT study; UMIN000035712) involving patients who underwent PDD-TURBT using 5-ALA and second TUR for high-risk NMIBC (high-grade UC or pT1 or concurrent CIS). The primary endpoint was tumor residual rate and the secondary endpoint was recurrence-free survival, which were compared with historical data (conventional TURBT) using propensity score-matching (PSM; caliper: 0.2). Assuming that the difference between the two groups was 20%, the planned number of cases was statistically set to 200 PDD-TURBT cases and 300 historical data cases, and the registration period was 2 years from January 2019 to December 2020, and the follow-up period was 2 years after second TUR. Results: In this study, 188 patients in the PDD-TURBT group and 313 patients in the historical group were enrolled, and 177 patients and 306 patients were included in the final analysis, respectively. After PSM adjustment, 167 patients in both groups were compared, and no significant differences were observed in age, gender, history of bladder cancer, tumor diameter, number of tumors, history of upper tract urothelial cancer, and period from initial TURBT to second TUR. The tumor residual rate was 25.8% in the PDD-TURBT group compared with 47.3% in the historical group, showing a significant decrease (odds ratio 0.39 [95% CI: 0.24–0.63]; p = 0.000064). Logistic regression analysis revealed that significant factors predicting residual tumors in PDD-TURBT were current or past smoking history, multiple tumors, and non-pTa (pT1 or pTis) tumors. Focusing on these three factors, patients with 0–1 of these three factors have a significant less tumor residual rate compared with patients with 2–3 factors (8.33% vs. 33.3%; odds ratio 5.46 [95% CI: 1.81–22.3]; p = 0.00052). Conclusions: PDD-TURBT for high-risk NMIBC significantly reduced the tumor residual rate at the second TUR compared to the conventional TURBT. PDD-TURBT using 5-ALA may enable to omit second TUR in some high-risk NMIBC cases. Clinical trial information: UMIN000035712.
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Eliseu, Miguel, Vera Marques, Hugo Antunes, et al. "Results of Repeat Transurethral Resection of Bladder Tumor After Macroscopically Complete Primary Resection." Acta Urológica Portuguesa 37, no. 1-2 (2022): 7–11. http://dx.doi.org/10.24915/aup.37.1-2.147.
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Introduction: Non-muscle invasive (NMI) bladder cancers (BC) account for 75% of BC cases, and most are initially diagnosed and treated with transurethral resection of bladder tumor (TURB). After primary TURB, a repeat resection (rTURB) should be carried out in cases of incomplete resection; however, rTURB is recommended by EAU guidelines in pT1 tumors even when the completeness of the original resection is believed by the surgeon, with reported rates of residual tumor in up to 33%-55% and upstaging in up to 25%. Since the quality of initial resection impacts in the result of a rTURB, these rates are largely dependent on the primary treatment and accurate prediction of completeness, with a probable high variability between surgeons and Centres. Our objectives to determine whether rTURB after initial perceived complete resection would frequently identify residual tumor and if this procedure would improve outcomes in NMIBC patients. Methods: Patients submitted to TURB from 2015 to 2017 were analysed, identifying which underwent rTURB after initial resection without follow-up cystoscopy in between. Primary perception of completeness, stage and grade were correlated with the eventual presence, stage and grade of residual tumor. Results: We analyzed 546 TURB procedures; of these, 275 (50.4%) were for primary bladder cancer. pT1 lesions were found in 85 (30.9%) of primary TURBs; 12 of these were selected for rTURB due to incomplete resection. Of the remaining 73 macros- copically completely resected primary pT1 tumors, 26 (30.6%) underwent elective rTURB. Repeat TURB after complete resection of primary pT1 tumors yielded residual tumor in 11.5% of patients (n= 3). All patients with residual tumor had primary pT1 high grade lesions; no upstaging or upgrading was observed. Patients had similar recurrence rates at 1-year regardless of rTURB. Discussion/Conclusion: Standard practice in primary TURB pro- cedures varies across surgeons and centers and will reflect on residual tumor rates. Indications for rTURB might not be suitable for all patients, and single Centre results should be taken in consideration when selecting patients for rTURB.
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Mohammadi, Alireza Mohammad, T. Barrett Sullivan, Gene H. Barnett, et al. "Use of High-Field Intraoperative Magnetic Resonance Imaging to Enhance the Extent of Resection of Enhancing and Nonenhancing Gliomas." Neurosurgery 74, no. 4 (2013): 339–50. http://dx.doi.org/10.1227/neu.0000000000000278.
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ABSTRACT BACKGROUND: Intraoperative magnetic resonance imaging (IoMRI) is used to improve the extent of resection of brain tumors. Most previous studies evaluating the utility of IoMRI have focused on enhancing tumors. OBJECTIVE: To report our experience with the use of high-field IoMRI (1.5 T) for both enhancing and nonenhancing gliomas. METHODS: An institutional review board–approved retrospective review was performed of 102 consecutive glioma patients (104 surgeries, 2010-2012). Pre-, intra-, and postoperative tumor volumes were assessed. Analysis was performed with the use of volumetric T2 images in 43 nonenhancing and 13 minimally enhancing tumors and with postcontrast volumetric magnetization-prepared rapid gradient-echo images in 48 enhancing tumors. RESULTS: In 58 cases, preoperative imaging showed tumors likely to be amenable to complete resection. Intraoperative electrocorticography was performed in 32 surgeries, and 14 cases resulted in intended subtotal resection of tumors due to involvement of deep functional structures. No further resection (complete resection before IoMRI) was required in 25 surgeries, and IoMRI showed residual tumor in 79 patients. Of these, 25 surgeries did not proceed to further resection (9 due to electrocorticography findings, 14 due to tumor in deep functional areas, and 2 due to surgeon choice). Additional resection that was performed in 54 patients resulted in a final median residual tumor volume of 0.21 mL (0.6%). In 79 patients amenable to complete resection, the intraoperative median residual tumor volume for the T2 group was higher than for the magnetization-prepared rapid gradient-echo group (1.088 mL vs 0.437 mL; P = .049), whereas the postoperative median residual tumor volume was not statistically significantly different between groups. CONCLUSION: IoMRI enhances the extent of resection, particularly for nonenhancing gliomas.
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Kolyadina, Irina Vladimirovna, Irina Poddubnaya, Olga Pavlikova, et al. "Features of p53 expression in residual tumors in Russian women after neoadjuvant chemotherapy of breast cancer stage T1-3N0-1." Journal of Clinical Oncology 35, no. 15_suppl (2017): e12121-e12121. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12121.
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e12121 Background: Residual tumor is an important prognostic factor after neoadjuvant therapy, however, p53 expression in the residual breast tumors poorly understood. Methods: In our study included 164 Russian women (24-76, median age - 47) with breast cancer stage T1-3N0-1 treated in RCRC from 2004 to 2016. Biological subtype of primary tumor was luminal A (8,1%), luminal B HER2-negative (43,6%), luminal HER2+ (15,4%), triple negative (22,8%) and non-luminal HER2+ (10,1%). After neoadjuvant chemotherapy by anthracycline ± taxanes (in HER2+ cancer ± trastuzumab) patients had radical surgery. We analyzed pathological response after neoadjuvant therapy and features of p53 expression in residual tumors. Results: The rate of pCR was 23% for all women, and was a very various for biological type (luminal A – 0%, HER2- luminal B - 11%, HER2+ luminal - 38%, triple negative – 35% and HER2+ non-luminal - 50%), p=0,003. In 15% cases pathological response was a very similar to pCR, in 62% - was low. In analyze of 38 residual tumors we found p53 low expression (<10% stained cells) in 66% cases and high (>10% stained cells) - in 34%. We did not find any correlation between p53 rate in residual tumors and stage, Ki67 and PR-status (p>0,05). But p53 expression strongly correlated with age, tumor grade and biological type (p<0,05). So, high rate of p53 was found more often in women <45 years (50%) vs women 45-59 years (15,4%) and patients 60 years older (20%), p=0,04. All G1-tumors was p53-negative, p53 high expression was seen in 29% of G2 tumors and 80% - G3, p=0,04. The high rate of p53 residual tumor was seen in luminal A subtype in 0%, HER2- luminal B – 30%, HER2+ luminal – 75%, triple negative -50%, HER2+ non-luminal - 100%, p=0,01. Conclusions: High expression of p53 in the residual tumors after neoadjuvant chemotherapy is associated with younger age and unfavorable biological characteristics that may be a very important for the further prognosis in breast cancer.
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Guo, Fang, Bing Hu, Lei Chen, and Jia Li. "Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation." British Journal of Radiology 92, no. 1103 (2019): 20190183. http://dx.doi.org/10.1259/bjr.20190183.
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Objective: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). Methods: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. Results: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. Conclusion: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. Advances in knowledge: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.
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Sheehan, Jason P., Douglas Kondziolka, John Flickinger, and L. Dade Lunsford. "Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma." Journal of Neurosurgery 97 (December 2002): 408–14. http://dx.doi.org/10.3171/jns.2002.97.supplement_5.0408.
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Object. Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. Methods. A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. Conclusions. Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.
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Prada, Francesco, Massimiliano Del Bene, Riccardo Fornaro, et al. "Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection." Neurosurgical Focus 40, no. 3 (2016): E7. http://dx.doi.org/10.3171/2015.11.focus15573.
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OBJECTIVE The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection. METHODS The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence. RESULTS In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings. CONCLUSIONS As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.
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Vuky, Jacqueline, Manjit Bains, Jennifer Bacik, et al. "Role of Postchemotherapy Adjunctive Surgery in the Management of Patients With Nonseminoma Arising From the Mediastinum." Journal of Clinical Oncology 19, no. 3 (2001): 682–88. http://dx.doi.org/10.1200/jco.2001.19.3.682.
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PURPOSE: To evaluate the role of postchemotherapy surgery in patients with nonseminomatous germ cell tumors arising from the anterior mediastinum. PATIENTS AND METHODS: Thirty-two patients with nonseminoma arising from a mediastinal primary site were treated on a clinical trial at our center, and they underwent postchemotherapy surgery. The results of postchemotherapy surgical resection, frequency of viable tumor found during postchemotherapy surgery, and prognostic factors for survival were assessed. RESULTS: Complete resection of all gross residual disease was achieved in 27 patients (84%). Histologic analysis of resected residua postchemotherapy revealed viable tumor in 66%, teratoma in 22%, and necrosis in 12% of the specimens. Viable tumor included embryonal carcinoma, choriocarcinoma, yolk sac carcinoma, seminoma, and teratoma with malignant transformation to nongerm cell histology (eg, sarcoma). Clinical characteristics associated with a shorter survival after surgery included the presence of viable tumor in a resected specimen (P = .003) and more than one site resected during surgery (P = .06). There were no statistically significant differences in survival for patients who underwent surgical resection with normal markers compared with patients with elevated serum tumor markers (P = .33). A trend toward shorter survival was found in patients with increasing tumor markers before surgery compared with patients with normal and declining serum tumor markers (P = .09). CONCLUSION: Surgical resection of residual mass after chemotherapy plays an integral role in the management of patients with primary mediastinal nonseminoma. Teratoma and viable tumor were found in the majority of resected residua after chemotherapy. Because patients who undergo conventional salvage chemotherapy programs rarely achieve long-term disease-free status, selected patients with elevated markers after chemotherapy are considered candidates for surgical resection.
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Valcz, Gábor, Edit I. Buzás, Anna Sebestyén, et al. "Extracellular Vesicle-Based Communication May Contribute to the Co-Evolution of Cancer Stem Cells and Cancer-Associated Fibroblasts in Anti-Cancer Therapy." Cancers 12, no. 8 (2020): 2324. http://dx.doi.org/10.3390/cancers12082324.
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Analogously to the natural selective forces in ecosystems, therapies impose selective pressure on cancer cells within tumors. Some tumor cells can adapt to this stress and are able to form resistant subpopulations, parallel with enrichment of cancer stem cell properties in the residual tumor masses. However, these therapy-resistant cells are unlikely to be sufficient for the fast tumor repopulation and regrowth by themselves. The dynamic and coordinated plasticity of residual tumor cells is essential both for the conversion of their regulatory network and for the stromal microenvironment to produce cancer supporting signals. In this nursing tissue “niche”, cancer-associated fibroblasts are known to play crucial roles in developing therapy resistance and survival of residual stem-like cells. As paracrine messengers, extracellular vesicles carrying a wide range of signaling molecules with oncogenic potential, can support the escape of some tumor cells from their deadly fate. Here, we briefly overview how extracellular vesicle signaling between fibroblasts and cancer cells including cancer progenitor/stem cells may contribute to the progression, therapy resistance and recurrence of malignant tumors.
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Lupo, Barbara, Francesco Sassi, Marika Pinnelli, et al. "Colorectal cancer residual disease at maximal response to EGFR blockade displays a druggable Paneth cell–like phenotype." Science Translational Medicine 12, no. 555 (2020): eaax8313. http://dx.doi.org/10.1126/scitranslmed.aax8313.
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Blockade of epidermal growth factor receptor (EGFR) causes tumor regression in some patients with metastatic colorectal cancer (mCRC). However, residual disease reservoirs typically remain even after maximal response to therapy, leading to relapse. Using patient-derived xenografts (PDXs), we observed that mCRC cells surviving EGFR inhibition exhibited gene expression patterns similar to those of a quiescent subpopulation of normal intestinal secretory precursors with Paneth cell characteristics. Compared with untreated tumors, these pseudodifferentiated tumor remnants had reduced expression of genes encoding EGFR-activating ligands, enhanced activity of human epidermal growth factor receptor 2 (HER2) and HER3, and persistent signaling along the phosphatidylinositol 3-kinase (PI3K) pathway. Clinically, properties of residual disease cells from the PDX models were detected in lingering tumors of responsive patients and in tumors of individuals who had experienced early recurrence. Mechanistically, residual tumor reprogramming after EGFR neutralization was mediated by inactivation of Yes-associated protein (YAP), a master regulator of intestinal epithelium recovery from injury. In preclinical trials, Pan-HER antibodies minimized residual disease, blunted PI3K signaling, and induced long-term tumor control after treatment discontinuation. We found that tolerance to EGFR inhibition is characterized by inactivation of an intrinsic lineage program that drives both regenerative signaling during intestinal repair and EGFR-dependent tumorigenesis. Thus, our results shed light on CRC lineage plasticity as an adaptive escape mechanism from EGFR-targeted therapy and suggest opportunities to preemptively target residual disease.