The aim of the present study was to compare the effect of radiotherapy (RT) on abdominal recurrence-free survival (ARFS) in patients with primary retroperitoneal sarcoma treated in the EORTC-STBSG-62092 (STRASS) phase 3 randomized controlled trial (STRASS cohort) and off-trial (STREXIT cohort) and to pool STRASS and STREXIT data to test the hypothesis that RT improves ARFS in patients with liposarcoma. Background: The STRASS trial did not show any difference in ARFS between patients treated with preoperative radiotherapy+surgery (RT+S) versus surgery alone (S). Methods: All consecutive adult patients not enrolled in STRASS and underwent curative-intent surgery for a primary retroperitoneal sarcoma with or without preoperative RT between 2012 and 2017 (STRASS recruiting period) among ten STRASS-recruiting centres formed the STREXIT cohort. The effect of RT in STREXIT was explored with a propensity score (PS)-matching analysis. Primary endpoint was ARFS defined as macroscopically incomplete resection or abdominal recurrence or death of any cause, whichever occurred first. Results: STRASS included 266 patients, STREXIT included 831 patients (727 after excluding patients who received preoperative chemotherapy, 202 after 1:1 PS-matching). The effect of RT on ARFS in STRASS and 1:1 PS-matched STREXIT cohorts, overall and in patients with liposarcoma, was similar. In the pooled cohort analysis, RT administration was associated with better ARFS in patients with liposarcoma [N = 321, hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.42-0.89]. In particular, patients with well-differentiated liposarcoma and G1-2 dedifferentiated liposarcoma (G1-2 DDLPS, n = 266) treated with RT+S had better ARFS (HR, 0.63; 95% CI, 0.40-0.97) while patients with G3 DDLPS and leiomyosarcoma had not. At the current follow-up, there was no association between RT and overall survival or distant metastases-free survival. Conclusions: In this study, preoperative RT was associated with better ARFS in patients with primary well-differentiated liposarcoma and G1-2 DDLPS.
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Este artículo trata de la relación ambigua y compleja que se establece entre las figuras del poeta y del tirano en la Grecia arcaica. Ensalzado en algunas ocasiones por los poetas, pero objeto de sus críticas en la mayoría de casos, convertido casi siempre en un personaje odioso que no merece vivir en una comunidad civilizada, el tirano ejerce, no obstante, una fascinación poderosa a la que no es fácil sustraerse.
Les fistules rectovaginales (FRV) représentent une pathologie rare mais complexe dans sa prise en charge, du fait de la population affectée, le plus souvent des femmes jeunes, et des caractéristiques propres liées à leurs étiologies. Les causes sont nombreuses et variées. Les FRV imputables à la maladie de Crohn et celles d'origine obstétricale sont certainement les plus communes. Les FRV postradiques, celles dues à une infection cryptoglandulaire et celles d'origine postchirurgicale occupent une place moins importante. Des causes plus rares sont retrouvées, comme les néoplasies pelviennes et les traumatismes. Les différentes origines ainsi que le mécanisme physiopathologique des principales étiologies des FRV acquises de l'adulte sont revues dans cette mise au point.
Mots clés : Fistule rectovaginale -ÉtiologiesRectovaginal fistula: physiopathology and etiopathogenesis Abstract: Rectovaginal fistula (RVF) is an uncommon pathology that generally occurs in young women. Because of the affected population and specific characteristics related to its aetiology, RVF represents a challenge for surgeons attempting surgical repair. RVF is most often caused by Crohn's disease and obstetric injuries. Radiation-induced fistulas and those related to cryptoglandular disease or pelvic surgery are more rare. Other causes include pelvic tumours and trauma. The aim of this study was to review etiologies and pathophysiological mechanisms of RVF in adults.
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