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Favere K, Vanderbiest K, Bresseleers J, Depuydt P. Benign gastrobronchial fistula following oesophagectomy in a patient presenting with respiratory failure. BMJ Case Rep 2019; 12:12/9/e228537. [PMID: 31488439 DOI: 10.1136/bcr-2018-228537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Benign gastrobronchial fistula (GBF) is a rare but potentially life-threatening complication of oesophagectomy for malignancy. We present a case of GBF post Ivor-Lewis surgery manifesting as pulmonary sepsis and type II respiratory failure. Clues to the diagnosis were persistent hypercapnia despite high minute ventilation, aspiration of gastric content through the endotracheal tube and accumulation of air in the nasogastric drainage bag. Flexible bronchoscopy confirmed the diagnosis. Surgical exploration identified necrosis of the proximal stomach as causative factor. Despite reconstruction of the oesophagogastric anastomosis and interposition of an intercostal muscle flap, the patient developed a new episode of type II respiratory failure. Bronchoscopy revealed in situ recurrence of the fistula. Patency of the fistula was proven through application of methylene blue with subsequent gastroscopy. A conservative, symptom-based, management was conducted. The patient died 6 hours later.
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Affiliation(s)
- Kasper Favere
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Klaas Vanderbiest
- Intensive Care Department, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Jan Bresseleers
- Intensive Care Department, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Pieter Depuydt
- Intensive Care Department, Universitair Ziekenhuis Gent, Gent, Belgium
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52
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Di Giorgio A, Abatini C, Attalla El Halabieh M, Vita E, Vizzielli G, Gallotta V, Pacelli F, Rotolo S. From palliation to cure: PIPAC for peritoneal malignancies. Minerva Med 2019; 110:385-398. [DOI: 10.23736/s0026-4806.19.06081-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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53
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Evaluation of Survival Rate and Non-Fetal Outcomes in Patients with Esophageal Cancer Under Treatment with Neoadjuvant Chemoradiotherapy Plus Additional Platinium-Based Chemotherapy from 2010 to 2016. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.89003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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54
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Braun LH, Baumann D, Zwirner K, Eipper E, Hauth F, Peter A, Zips D, Gani C. Neutrophil-to-Lymphocyte Ratio in Rectal Cancer-Novel Biomarker of Tumor Immunogenicity During Radiotherapy or Confounding Variable? Int J Mol Sci 2019; 20:ijms20102448. [PMID: 31108935 PMCID: PMC6566677 DOI: 10.3390/ijms20102448] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to investigate the predictive value of blood-derived makers of local and systemic inflammatory responses on early and long-term oncological outcomes. A retrospective analysis of patients with locally advanced rectal cancer treated with preoperative long-course 5-fluorouracil-based radiochemotherapy was performed. Differential blood counts before neoadjuvant treatment were extracted from the patients' electronic charts. Optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were determined. Potential clinical and hematological prognostic factors for disease-free survival (DFS) were studied using uni- and multivariate analysis. A total of 220 patients were included in the analysis. Median follow-up was 67 months. Five-year DFS and overall survival (OS) were 70% and 85%, respectively. NLR with a cut-off value of 4.06 was identified as optimal to predict DFS events. In multivariate analysis, only tumor volume (HR 0.33, 95% CI (0.14-0.83), p = 0.017) and NLR (HR 0.3, 95% CI (0.11-0.81), p = 0.017) remained significant predictors of DFS. Patients with a good histological response (Dworak 3 and 4) to radiotherapy also had a lower NLR than patients with less pronounced tumor regression (3.0 vs. 4.2, p = 0.015). A strong correlation between primary tumor volume and NLR was seen (Pearson's r = 0.64, p < 0.001). Moreover, patients with T4 tumors had a significantly higher NLR than patients with T1-T3 tumors (6.6 vs. 3.3, p < 0.001). An elevated pretherapeutic NLR was associated with higher T stage, inferior DFS, and poor pathological response to neoadjuvant radiochemotherapy. A strong correlation between NLR and primary tumor volume was seen. This association is important for the interpretation of study results and for the design of translational studies which are warranted.
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Affiliation(s)
- Lore Helene Braun
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - David Baumann
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Kerstin Zwirner
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Ewald Eipper
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany.
| | - Franziska Hauth
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany.
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
- Gastrointestinal Cancer Center, Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany.
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
- Gastrointestinal Cancer Center, Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany.
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55
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Manur JG, Patel RB, Chandramouli S. Efficacy of preoperative chemoradiotherapy in downstaging rectal cancer and its impact on the long-term outcome. South Asian J Cancer 2019; 8:98-101. [PMID: 31069187 PMCID: PMC6498706 DOI: 10.4103/sajc.sajc_203_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction: Response to preoperative chemoradiation (PRTCT) for rectal cancer predicts the long-term outcome. Context: Tertiary care hospital. Aims: The aim is to study the factors affecting the response to chemoradiation. Settings and Design: Retrospective. Materials and Methods: Twenty-three patients of rectal cancer undergoing PRTCT followed by surgery and adjuvant chemotherapy were followed up for 20–56 months. Postoperative response, tumor downstaging and nodal downstaging were correlated with the disease status. Results: Tumor downstaging was seen in 11 (50%) and nodal downstaging in 12 (63.15%) patients. Nodal downstaging was statistically significant with P = 0.004. Pathological complete response (PCR) was seen in one patient and partial response (PR) in 17 patients. Thirteen (72.2% of patients) were alive and disease free and the negative nodal status correlated with long-term control with P = 0.04. Conclusion: Most patients of rectal cancer show PR to PRTCT, and the benefit is more for node-positive patients. Nodal PCR is associated with a higher chance of long-term disease control.
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Affiliation(s)
| | | | - Sathish Chandramouli
- Department of Surgical Oncology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
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56
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Bashir U, Foot O, Wise O, Siddique MM, Mclean E, Bille A, Goh V, Cook GJ. Investigating the histopathologic correlates of 18F-FDG PET heterogeneity in non-small-cell lung cancer. Nucl Med Commun 2018; 39:1197-1206. [PMID: 30379750 DOI: 10.1097/mnm.0000000000000925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Despite the growing use of fluorine-18-fluorodeoxyglucose (F-FDG) PET texture analysis to measure intratumoural heterogeneity in cancer research, the biologic basis of F-FDG PET-derived texture variables is poorly understood. We aimed to assess correlations between F-FDG PET-derived texture variables and whole-slide image (WSI)-derived metrics of tumour cellularity and spatial heterogeneity. PATIENTS AND METHODS Twenty-two patients with non-small-cell lung cancer prospectively underwent F-FDG PET imaging before tumour resection. We tested nine F-FDG PET parameters: metabolically active tumour volume, total lesion glycolysis, mean standardized uptake value (SUVmean), first-order entropy, energy, skewness, kurtosis, grey-level co-occurrence matrix entropy and lacunarity (SUV-lacunarity). From the haematoxylin and eosin-stained WSIs, we derived mean tumour-cell density (MCD) and lacunarity (path-lacunarity). Spearman's correlation analysis and agglomerative hierarchical clustering were performed to assess variable associations. RESULTS Tumour volumes ranged from 2.2 to 74 cm (median: 17.9 cm). MCD correlated positively with total lesion glycolysis (rs: 0.46, P: 0.007) and SUVmean (rs : 0.55; P: 0.008) and negatively with skewness and kurtosis (rs: -0.47 for both; P: 0.028 and 0.026, respectively). SUV-lacunarity and path-lacunarity were positively correlated (rs: 0.5; P: 0.018). On cluster analysis, larger tumours trended towards higher SUVmean and entropy with a predominance of tightly concentrated high SUV-voxels (negative skewness and low kurtosis on the histogram); on WSI analysis such larger tumours also displayed generally higher MCD and low SUV-lacunarity and path-lacunarity. CONCLUSION Our data suggest that histopathological MCD and lacunarity are associated with several commonly used F-FDG PET-derived indices including SUV-lacunarity, metabolically active tumour volume, SUVmean, entropy, skewness, and kurtosis, and thus may explain the biological basis of F-FDG PET-uptake heterogeneity in non-small-cell lung cancer.
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Affiliation(s)
- Usman Bashir
- Centre for Cancer Imaging, The Institute of Cancer Research, Sutton
| | | | | | - Muhammad M Siddique
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences
| | | | - Andrea Bille
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences
- Department of Radiology, Guy's Hospital, Great Maze Pond, London, UK
| | - Gary J Cook
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust
- PET Imaging Centre and the Division of Imaging Sciences and Biomedical Engineering, King's College
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57
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Canbey Göret C, Göret NE. Histopathological Analysis of 173 Consecutive Patients with Colorectal Carcinoma: A Pathologist's View. Med Sci Monit 2018; 24:6809-6815. [PMID: 30255856 PMCID: PMC6178881 DOI: 10.12659/msm.911012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Worldwide, colorectal carcinomas are the third most common carcinomas in men and the second most common carcinomas in women. Pathological examination of rectum specimens requires special attention for correctly evaluating many prognostically important factors. In this study, we present pathological results of 173 lower anterior resection (LAR) and abdominoperineal resection (APR) specimens retrospectively evaluated. Material/Methods We included 173 LAR and APR specimens in this study. Patients were evaluated in the Istanbul Ekin Private Pathology Laboratory and underwent surgery at Çanakkale State Hospital, General Surgery Clinic. Results Of the 173 specimens, 15 (8.7%) were APR and 158 (91.3%) were LAR specimens. Ninety-four patients (54.3%) were males and 79 patients (45.7%) were females. The mean age of the patients was 63.5 years (range 26–90 years). In the histopathological examination, malignant neoplasm was detected in 172 of the cases (99.4%) and benign endometriosis was detected in 1 of the cases (0.6%). There were 151 (87.2%), 8 (4.6%), 5 (2.9%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), and 4 (2.3%) patients with adenocarcinoma, mucinous adenocarcinoma, intramucosal adenocarcinoma in the setting of a high-grade tubulovillous adenoma, synchronous colon/prostate adenocarcinoma, malignant melanoma, signet ring cell carcinoma, gastrointestinal stromal tumor, endometriosis, and adenocarcinoma diagnosed by the examination of colonoscopic biopsy specimens that showed complete regression with neoadjuvant therapy, respectively. Conclusions When evaluating specimens from patients with colorectal carcinoma, pathological evaluation, which is one of the most fundamental pillars in managing patients with cancer, must be performed carefully and meticulously. Each pathological parameter should be evaluated carefully and clinicians and pathologists should evaluate these cases together.
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Affiliation(s)
- Ceren Canbey Göret
- Department of Surgical Pathology, Health Sciences University, Sancaktepe Research and Education Hospital, Istanbul, Turkey
| | - Nuri Emrah Göret
- Department of General Surgery, Health Sciences University, Kartal Research and Education Hospital, Istanbul, Turkey
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58
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Brimo F, Downes MR, Jamaspishvili T, Berman D, Barkan GA, Athanazio D, Abro S, Visram K, Yilmaz A, Solanki S, Hahn E, Siemens R, Kassouf W, Trpkov K. Prognostic pathological factors in radical cystectomy after neoadjuvant chemotherapy. Histopathology 2018; 73:732-740. [PMID: 29776013 DOI: 10.1111/his.13654] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Abstract
AIMS We undertook a systematic evaluation of the prognostic value of numerous histological factors in 165 radical cystectomies (RCs) of patients with invasive urothelial carcinoma (UC) who underwent surgery after neoadjuvant chemotherapy (NAC). METHODS AND RESULTS Tumour regression grade (TRG) and therapy-related stromal and epithelial changes were also recorded. Locally advanced disease (≥pT2 and/or pN+) was present in 64% of patients, 22% had no evidence of residual carcinoma (pT0 + pN0), and 28% had no evidence of residual muscle-invasive carcinoma (≤pT1 + N0). TRG1, TRG2 and TRG3 were found in 32%, 15% and 50% of patients, respectively. Histological variants of UC were reported in 25% of cases. The most common therapy-related stromal change was fibroblastic reaction (78%), and the most common epithelial change in residual UC was smudgy and poorly preserved chromatin (28%). Prominent stromal and epithelial changes were noted in 41% and 5% of RCs, respectively. Progression was found in 45% of patients, and cancer-related deaths occurred in 30%. Multivariate analysis showed that the only independent prognostic parameters for progression were T stage, N stage, lymphovascular invasion, and margin status. Similarly, only T stage, N stage and margin status correlated with cancer-related deaths. Neither TRG nor any of the stromal-related or epithelial-related variables correlated with outcome. CONCLUSIONS We confirm that the traditional and routinely reported histological parameters in RC post-NAC remain the most powerful prognosticators of disease course. The significance of TRG in the bladder remains unconfirmed.
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Affiliation(s)
- Fadi Brimo
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | | | | | | | | | | | - Elan Hahn
- Queens University, Kingston, ON, Canada
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59
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D'Journo XB. Clinical implication of the innovations of the 8 th edition of the TNM classification for esophageal and esophago-gastric cancer. J Thorac Dis 2018; 10:S2671-S2681. [PMID: 30345104 DOI: 10.21037/jtd.2018.03.182] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Epidemiology of esophageal cancer and esophagogastric junction (EGJ) has deeply changed for the past two decades with a dramatically increase of adenocarcinoma whereas squamous cell carcinoma (SCC) has slowly decreased. Moreover, the two histological types differ in a number of features including risks factors, tumor location, tumor biology and outcomes. In acknowledgement of these differences, the newest 8th edition of the American Joint Committee on Cancer (AJCC) tumor, node and metastasis (TNM) staging classification of epithelial cancers of the esophagus and EGJ has refined this histology-specific disease stage with incorporation of new anatomic and non-anatomic categories. Based on data-driven of patients collected through the Worldwide Esophageal Cancer Collaboration (WECC) group, the 8th edition database encompasses a six-continent cohort of 22,654 patients among 33 institutions including patients treated with surgery alone and, for the first time, patients treated after neoadjuvant treatment. Anatomic categories include T descriptors (tumor invasion), N descriptors (regional lymph node invasion) and M descriptors (distant site). Non anatomic categories include grade differentiation (G descriptors) and tumor location (L descriptors). Category descriptors are currently assessed by endoscopy with biopsy, by endoscopy ultrasound fine-needle aspiration (EUS-FNA), by thoracic-abdominal-pelvic computed tomography (CT) and whole body flurodeoxyglucose positron emission tomography (FDG-PET) fused with CT. The new 8th edition considers separate and temporally related cancer classification based on the treatment strategy: clinical cTNM (before any treatment), pathologic pTNM (after surgery alone) and postneoadjuvant pathologic ypTNM (after neoadjuvant treatment followed by surgery). The 8th edition permits a more robust and reliable random forest-based machine learning analysis. Refinement of each T, N, M categories and subcategories makes the 8th edition more accurate and more adaptable to the current practice including neoadjuvant regimen. The main objective of this review is to examine the current staging of esophageal cancer and the new aspects of the 8th edition with its applications to clinical practice.
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Affiliation(s)
- Xavier Benoit D'Journo
- Department of Thoracic surgery, North Hospital, Aix-Marseille University, 13915 Marseille, France
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60
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Antunes J, Viswanath S, Brady JT, Crawshaw B, Ros P, Steele S, Delaney CP, Paspulati R, Willis J, Madabhushi A. Coregistration of Preoperative MRI with Ex Vivo Mesorectal Pathology Specimens to Spatially Map Post-treatment Changes in Rectal Cancer Onto In Vivo Imaging: Preliminary Findings. Acad Radiol 2018; 25:833-841. [PMID: 29371120 DOI: 10.1016/j.acra.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to develop and quantitatively evaluate a radiology-pathology fusion method for spatially mapping tissue regions corresponding to different chemoradiation therapy-related effects from surgically excised whole-mount rectal cancer histopathology onto preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS This study included six subjects with rectal cancer treated with chemoradiation therapy who were then imaged with a 3-T T2-weighted MRI sequence, before undergoing mesorectal excision surgery. Excised rectal specimens were sectioned, stained, and digitized as two-dimensional (2D) whole-mount slides. Annotations of residual disease, ulceration, fibrosis, muscularis propria, mucosa, fat, inflammation, and pools of mucin were made by an expert pathologist on digitized slide images. An expert radiologist and pathologist jointly established corresponding 2D sections between MRI and pathology images, as well as identified a total of 10 corresponding landmarks per case (based on visually similar structures) on both modalities (five for driving registration and five for evaluating alignment). We spatially fused the in vivo MRI and ex vivo pathology images using landmark-based registration. This allowed us to spatially map detailed annotations from 2D pathology slides onto corresponding 2D MRI sections. RESULTS Quantitative assessment of coregistered pathology and MRI sections revealed excellent structural alignment, with an overall deviation of 1.50 ± 0.63 mm across five expert-selected anatomic landmarks (in-plane misalignment of two to three pixels at 0.67- to 1.00-mm spatial resolution). Moreover, the T2-weighted intensity distributions were distinctly different when comparing fibrotic tissue to perirectal fat (as expected), but showed a marked overlap when comparing fibrotic tissue and residual rectal cancer. CONCLUSIONS Our fusion methodology enabled successful and accurate localization of post-treatment effects on in vivo MRI.
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61
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Verbeke C, Häberle L, Lenggenhager D, Esposito I. Pathology assessment of pancreatic cancer following neoadjuvant treatment: Time to move on. Pancreatology 2018; 18:467-476. [PMID: 29843972 DOI: 10.1016/j.pan.2018.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023]
Abstract
Neoadjuvant treatment has increasingly become an integral part of the multimodal management of patients with pancreatic cancer. In patients who are able to undergo surgery following preoperative therapy, tumour regression grading remains the diagnostic gold standard for the histomorphological assessment of the effect of neoadjuvant treatment. In recent years, however, there has been growing concern about inherent flaws of tumour regression grading systems as well as their imprecise and impractical criteria that result in divergence of practice and lack of interobserver agreement. Furthermore, existing tumour regression systems differ in their defining criteria and thresholds, leading to incomparability of data. In this review, the principles and limitations of the main existing tumour regression systems are discussed, and potential alternative assessment approaches and novel markers are presented.
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Affiliation(s)
- Caroline Verbeke
- Dept of Pathology, Institute of Clinical Medicine, University of Oslo, Norway; Dept of Pathology, Oslo University Hospital, Norway.
| | - Lena Häberle
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Germany
| | - Daniela Lenggenhager
- Dept of Pathology, Institute of Clinical Medicine, University of Oslo, Norway; Dept of Pharmacology, Institute of Clinical Medicine, University of Oslo, Norway; Institute of Pathology and Molecular Pathology, University of Zürich and University Hospital Zürich, Switzerland
| | - Irene Esposito
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Germany.
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Kong JC, Guerra GR, Warrier SK, Lynch AC, Michael M, Ngan SY, Phillips W, Ramsay G, Heriot AG. Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis. Colorectal Dis 2018; 20:574-585. [PMID: 29582537 DOI: 10.1111/codi.14106] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/01/2018] [Indexed: 02/08/2023]
Abstract
AIM The current standard of care for locally advanced rectal cancer involves neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision. There is a spectrum of response to neoadjuvant therapy; however, the prognostic value of tumour regression grade (TRG) in predicting disease-free survival (DFS) or overall survival (OS) is inconsistent in the literature. METHOD This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was undertaken using Ovid MEDLINE, Embase and Google Scholar. Inclusion criteria were Stage II and III locally advanced rectal cancer treated with long-course CRT followed by radical surgery. The aim of the meta-analysis was to assess the prognostic implication of each TRG for rectal cancer following neoadjuvant CRT. Long-term prognosis was assessed. The main outcome measures were DFS and OS. A random effects model was performed to pool the hazard ratio (HR) from all included studies. RESULTS There were 4875 patients from 17 studies, with 775 (15.9%) attaining a pathological complete response (pCR) and 719 (29.9%) with no response. A significant association with OS was identified from a pooled-estimated HR for pCR (HR = 0.47, P = 0.002) and nonresponding tumours (HR = 2.97; P < 0.001). Previously known tumour characteristics, such as ypN, lymphovascular invasion and perineural invasion, were also significantly associated with DFS and OS, with estimated pooled HRs of 2.2, 1.4 and 2.3, respectively. CONCLUSION In conclusion, the degree of TRG was of prognostic value in predicting long-term outcomes. The current challenge is the development of a high-validity tests to predict pCR.
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Affiliation(s)
- J C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G R Guerra
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Craig Lynch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - M Michael
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - S Y Ngan
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - W Phillips
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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63
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Davarzani N, Hutchins GGA, West NP, Hewitt LC, Nankivell M, Cunningham D, Allum WH, Smyth E, Valeri N, Langley RE, Grabsch HI. Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy - results from the MRC OE02 oesophageal cancer trial. Histopathology 2018; 72:1180-1188. [PMID: 29465751 PMCID: PMC5969086 DOI: 10.1111/his.13491] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/14/2018] [Indexed: 12/19/2022]
Abstract
AIMS Neoadjuvant chemotherapy (NAC) remains an important therapeutic option for advanced oesophageal cancer (OC). Pathological tumour regression grade (TRG) may offer additional information by directing adjuvant treatment and/or follow-up but its clinical value remains unclear. We analysed the prognostic value of TRG and associated pathological factors in OC patients enrolled in the Medical Research Council (MRC) OE02 trial. METHODS AND RESULTS Histopathology was reviewed in 497 resections from OE02 trial participants randomised to surgery (S group; n = 244) or NAC followed by surgery [chemotherapy plus surgery (CS) group; n = 253]. The association between TRG groups [responders (TRG1-3) versus non-responders (TRG4-5)], pathological lymph node (LN) status and overall survival (OS) was analysed. One hundred and ninety-five of 253 (77%) CS patients were classified as 'non-responders', with a significantly higher mortality risk compared to responders [hazard ratio (HR) = 1.53, 95% confidence interval (CI) = 1.05-2.24, P = 0.026]. OS was significantly better in patients without LN metastases irrespective of TRG [non-responders HR = 1.87, 95% CI = 1.33-2.63, P < 0.001 versus responders HR = 2.21, 95% CI = 1.11-4.10, P = 0.024]. In multivariate analyses, LN status was the only independent factor predictive of OS in CS patients (HR = 1.93, 95% CI = 1.42-2.62, P < 0.001). Exploratory subgroup analyses excluding radiotherapy-exposed patients (n = 48) showed similar prognostic outcomes. CONCLUSION Lymph node status post-NAC is the most important prognostic factor in patients with resectable oesophageal cancer, irrespective of TRG. Potential clinical implications, e.g. adjuvant treatment or intensified follow-up, reinforce the importance of LN dissection for staging and prognostication.
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Affiliation(s)
- Nasser Davarzani
- GROW School for Oncology and Developmental BiologyDepartment of PathologyMaastricht University Medical CentreMaastrichtthe Netherlands
- Department of Data Science and Knowledge EngineeringMaastricht UniversityMaastrichtthe Netherlands
| | - Gordon G A Hutchins
- Section of Pathology and Tumour BiologyLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - Nicholas P West
- Section of Pathology and Tumour BiologyLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - Lindsay C Hewitt
- GROW School for Oncology and Developmental BiologyDepartment of PathologyMaastricht University Medical CentreMaastrichtthe Netherlands
| | | | - David Cunningham
- Gastrointestinal and Lymphoma UnitRoyal Marsden HospitalLondonUK
| | | | - Elizabeth Smyth
- Gastrointestinal and Lymphoma UnitRoyal Marsden HospitalLondonUK
| | - Nicola Valeri
- Gastrointestinal and Lymphoma UnitRoyal Marsden HospitalLondonUK
- Department of Molecular PathologyThe Institute of Cancer ResearchLondonUK
| | - Ruth E Langley
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - Heike I Grabsch
- GROW School for Oncology and Developmental BiologyDepartment of PathologyMaastricht University Medical CentreMaastrichtthe Netherlands
- Section of Pathology and Tumour BiologyLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
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64
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Kano K, Aoyama T, Yoshikawa T, Maezawa Y, Nakajima T, Hayashi T, Yamada T, Sato T, Oshima T, Rino Y, Masuda M, Cho H, Ogata T. The Negative Survival Impact of Infectious Complications After Surgery is Canceled Out by the Response of Neoadjuvant Chemotherapy in Patients with Esophageal Cancer. Ann Surg Oncol 2018; 25:2034-2043. [PMID: 29748890 DOI: 10.1245/s10434-018-6504-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to investigate whether postoperative infectious complications (ICs) are a risk factor for the prognosis in esophageal cancer patients who receive neoadjuvant chemotherapy by stratifying the response to neoadjuvant chemotherapy. METHODS The present study retrospectively examined patients who received neoadjuvant chemotherapy followed by esophagectomy between January 2011 and September 2015. Risk factors for overall survival (OS) were examined by Cox proportional hazard analyses. Pathological responders to neoadjuvant chemotherapy were defined as those with a tumor disappearance of more than one-third of the initial tumor. Postoperative ICs were defined using the Clavien-Dindo classification. RESULTS Of the 111 patients examined, 45 (40.5%) developed postoperative ICs. A pathological response to neoadjuvant chemotherapy was observed in 54 (48.6%) patients. The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for the OS (hazard ratio [HR] 2.359; 95% confidence interval [CI] 1.057-5.263, p = 0.036). In the subset analysis, postoperative ICs were a marginally significant independent risk factor for OS in the nonresponders (HR 2.862; 95% CI 0.942-8.696, p = 0.063) but not in the responders (HR 0.867; 95% CI 0.122-6.153, p = 0.886). CONCLUSIONS These results suggested that the negative survival impact of postoperative ICs can be canceled out in esophageal cancer patients who respond to neoadjuvant chemotherapy.
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Affiliation(s)
- Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
| | - Yukio Maezawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tetsushi Nakajima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Tsutomu Hayashi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
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65
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Neves Filho EHC, Pires APB, de Sant'Ana RO, Rabenhorst SHB, Hirth CG, da Cunha MDPSS. The association among HER2, MET and FOXP3 expression and tumor regression grading in gastric adenocarcinoma. APMIS 2018; 126:389-395. [PMID: 29696715 DOI: 10.1111/apm.12840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022]
Abstract
Although the introduction of the perioperative chemotherapy on the management of gastric cancer has improved patients survival, heterogeneity of clinical outcomes has been evidenced in parallel to different histopathological regression pattern of gastric cancer cells. Thus, this study evaluated the tumor regression grading (TRG) in a series of post-treatment gastric tumors and its associations with HER2, MET, and FOXP3 expression. Material of 54 gastric cancer samples was available for TRG evaluation and immunohistochemistry. We found that total and subtotal pathologic response were significantly associated to the intestinal subtype (p = 0.04) and that well-differentiated tumors were significantly correlated with total or partial response (p = 0.019). Although not associated with the TRG, FOXP3 expression in gastric tumors was associated to poorly differentiated tumors (p = 0.03), to the diffuse and mixed subtypes together (p = 0.04) and to the presence of vascular infiltration (p = 0.04), while HER2 overexpression was associated to better differentiated cases (p = 0.04) and to the absence of vascular infiltration (p = 0.02). MET expression, however, showed no association with the analyzed clinicopathological factors. This study highlights the role of tissue differentiation on pathological response to neoadjuvant chemotherapy in gastric cancer and shows no impact between FOXP3, HER2 and MET expression in terms of TRG.
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66
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Duzgun O, Sarici IS, Gokcay S, Ates KE, Yılmaz MB. Effects of nivolumab in peritoneal carcinamatosis of malign melanoma in mouse model. Acta Cir Bras 2018; 32:1006-1012. [PMID: 29319729 DOI: 10.1590/s0102-865020170120000002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/19/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the efficacy of nivolumab and comparison with dacarbazine (DTIC) on peritoneal carcinomatosis of malignant melanoma in mouse model. METHODS Mouse skin melanoma cells was injected under the capsule of the peritoneal surface in the left side of the abdomen. On postoperative day ten, mouses randomised into three groups. Group 1: Control, Group 2: HIPEC (Hyperthermic intraperitoneal chemotherapy) with DTIC and Group 3: HIPEC with Nivolumab. After the sacrification on postoperative day fifteen, peritoneum evaluated macroscopically and histopathologically by using peritoneal regression grading score (PRGS). RESULTS In the 15th day exploration, all animals developed extensive intraperitoneal tumor growth in Group 1. In Group 2 and Group 3 median tumor size was 0.7±0.3cm and 0.3±0.2cm respectively (p: 0.023). Peritoneal carcinomatosis index (PCI) were significantly lower in Group 3 than other groups (p: 0.019). The lowest total tumor nodules in group 3 was 4 ± 2. The PGRS score was found significantly lower in Group 3 than other groups (p: 0.03). Lymphocytic response rate was found higher in the Group 3. CONCLUSIONS It has been found that nivolumab significantly better than DTIC on peritoneal metastases of malign melanoma in mouse models. Nivolumab treatment gives promising results with pathological evidence in the treatment of metastatic disease of malignant melanoma.
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Affiliation(s)
- Ozgul Duzgun
- MD, Department of Surgical Oncology, Umraniye Training and Research Hospital, Istanbul, Turkey. Conception, design, scientific, and intellectual content of the study; technical procedures
| | - Inanc Samil Sarici
- MD, Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey. Statistical analysis, manuscript writing, final approval
| | - Serkan Gokcay
- MD, Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey. Interpretation of data, critical revision
| | - Kivilcim Eren Ates
- MD, Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey. Histopathological examinations
| | - Mehmet Bertan Yılmaz
- Associate Professor, Department of Medical Biology, Faculty of Medicine, Cukurova University, Adana, Turkey. Critical revision
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67
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Repetto O, De Re V, De Paoli A, Belluco C, Alessandrini L, Canzonieri V, Cannizzaro R. Identification of protein clusters predictive of tumor response in rectal cancer patients receiving neoadjuvant chemo-radiotherapy. Oncotarget 2018; 8:28328-28341. [PMID: 28423701 PMCID: PMC5438653 DOI: 10.18632/oncotarget.16053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/27/2017] [Indexed: 12/26/2022] Open
Abstract
Preoperative neoadjuvant chemoradiotherapy (nCRT) is the gold standard in locally advanced rectal cancer, only 10–30% of patients achieving benefits. Currently, there is a need of a reliable selection of markers for the identification of poor or non-responders prior to therapy. In this work, we compared protein profiles before therapy of patients differing in their responses to nCRT to find novel predictive markers of response to therapy. Patients were grouped into 3 groups according to their tumor regression grading (TRG) after surgery: 'TRG 1–2′, good responders, 'TRG 3′ and 'TRG 4′, poor responders. Paired surgical specimens of rectal cancer and healthy (histologically confirmed) rectal tissues from 15 patients were analysed before nCRT by two dimensional difference in gel electrophoresis followed by mass spectrometry. Thirty spots were found as differentially expressed (p < 0.05). Among them, 3 spots (spots 471, 683 and 684) showed an increased amount of protein in poor responders compared with good responders, and they were more tumor associated compared with healthy tissues. Proteins of these spots were identified as fibrinogen ß chain fragment D, actin isoforms, B9 and B5 serpins, cathepsin D isoforms and peroxiredoxin-4. In an independent validation set of 20 rectal carcinomas we validated the increased fibrinogen ß chain abundance before nCRT in poor responders by immunoblotting. In conclusion, we propose a risk-stratification tool in predicting the response to nCRT treatment in rectal cancer based on the quantity of these proteins.
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Affiliation(s)
- Ombretta Repetto
- Facility of Bio-Proteomics, Immunopathology and Cancer Biomarkers, IRCCS CRO National Cancer Institute, Aviano, Italy
| | - Valli De Re
- Facility of Bio-Proteomics, Immunopathology and Cancer Biomarkers, IRCCS CRO National Cancer Institute, Aviano, Italy
| | - Antonino De Paoli
- Radiation Oncology, IRCCS CRO National Cancer Institute, Aviano, Italy
| | - Claudio Belluco
- Surgical Oncology, IRCCS CRO National Cancer Institute, Aviano, Italy
| | | | | | - Renato Cannizzaro
- Renato Cannizzaro, Gastroenterology, IRCCS CRO National Cancer Institute, Aviano, Italy
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68
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Kröll D, Noser L, Erdem S, Storni F, Arnold D, Dislich B, Zlobec I, Candinas D, Seiler CA, Langer R. Application of the 8th edition of the AJCC yTNM staging system shows improved prognostication in a single center cohort of esophageal carcinomas. Surg Oncol 2018; 27:100-105. [DOI: 10.1016/j.suronc.2017.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/22/2017] [Accepted: 12/29/2017] [Indexed: 01/08/2023]
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69
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Abstract
In the World Health Organization (WHO) classification, adenocarcinoma of esophagus comprises preinvasive type (dysplasia), adenocarcinoma, adenoid cystic carcinoma, adenosquamous carcinoma, and mucoepidermoid carcinoma. For adenocarcinoma, it is important to determine the grading of the cancer and histological variants such as signet ring adenocarcinoma. In the current day management of esophageal adenocarcinoma by neoadjuvant therapy, the histology of the cancer and the lymph nodal status may change after the therapy. Tumor regression grading systems could be used to assess the response to the neoadjuvant therapy in esophageal adenocarcinoma.
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Affiliation(s)
- Alfred K Lam
- Cancer Molecular Pathology of School of Medicine, Griffith University, Gold Coast, Australia.
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70
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Jarosch A, Sommer U, Bogner A, Reißfelder C, Weitz J, Krause M, Folprecht G, Baretton GB, Aust DE. Neoadjuvant radiochemotherapy decreases the total amount of tumor infiltrating lymphocytes, but increases the number of CD8+/Granzyme B+ (GrzB) cytotoxic T-cells in rectal cancer. Oncoimmunology 2017; 7:e1393133. [PMID: 29308324 DOI: 10.1080/2162402x.2017.1393133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022] Open
Abstract
Although neoadjuvant radiochemotherapy (nRCTx) is an established oncological treatment in patients with advanced rectal cancer, little is known about its effects on the tumor microenvironment. Quantity and composition of tumor infiltrating lymphocytes (TILs) are known to influence patients' prognosis but nRCTx-induced modifications are still unclear. We determined the composition of the immune cell infiltrate in rectal cancer after nRCTx and its influence on tumor regression, local recurrence rate and survival. We investigated density and composition of tumor infiltrating CD3+ and CD8+ T-cells and the quantity and ratio of CD8+/GrzB+ T-cells to CD8+ T-cells in 130 rectal cancers after nRCTx compared to a cohort of 30 primarily resected rectal cancers. Furthermore, we analyzed 22 pretherapeutic rectal cancer biopsies, later treated with nRCTx and surgery to evaluate nRCTx-induced modifications of the tumor microenvironment. The total numbers of CD3+ and CD8+ T-cells in tumor stroma (p < 0.001) and tumor epithelium (p < 0.001 CD3; 0.002 CD8) were significantly lower in rectal cancers after nRCTx compared to primarily resected cases, while the ratio of CD8+/GrzB+ T-cells to CD8+ T-cells was significantly increased in the nRCTx cohort (p < 0.001). In multivariate analyses, CD8+/GrzB+ T-cells in the tumor stroma were significantly associated with high regression grade and a lower likelihood of local recurrence (p = 0.029). nRCTx modifies the tumor microenvironment of rectal cancer leading to a total decrease of TILs, but a relative increase in CD8+/GrzB+ T-cells in the tumor stroma. CD8+/GrzB+ T-cells may contribute to local tumor control and the better outcome.
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Affiliation(s)
- Armin Jarosch
- Institute of Pathology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden
| | - Ulrich Sommer
- Institute of Pathology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden
| | - Andreas Bogner
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden
| | - Christoph Reißfelder
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany
| | - Jürgen Weitz
- Institute of Pathology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany
| | - Mechthild Krause
- National Center for Tumor Diseases (NCT) partner site Dresden.,Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology, Dresden, Germany
| | - Gunnar Folprecht
- Medical Department I, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany
| | - Gustavo B Baretton
- Institute of Pathology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany.,Tumor and normal tissue bank of Universitäts KrebsCentrum (UCC), University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Daniela E Aust
- Institute of Pathology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT) partner site Dresden.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Dresden, Germany.,Tumor and normal tissue bank of Universitäts KrebsCentrum (UCC), University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
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71
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Saigí M, Oliva M, Aliste L, Calvo M, Hormigo G, Serra Ò, Boladeras A, Farran L, Robles J, Creus G, Paúles MJ, Gornals JB, de Lama E, Borràs JM, Sala N, Galán M. Clinical relevance of histologic subtypes in locally advanced esophageal carcinoma treated with pre-operative chemoradiotherapy: Experience of a monographic oncologic centre. PLoS One 2017; 12:e0184737. [PMID: 28931046 PMCID: PMC5607166 DOI: 10.1371/journal.pone.0184737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022] Open
Abstract
Background Locally advanced esophageal carcinoma (LAEC) represents less than 30% of all diagnosed esophageal carcinoma worldwide. The standard of care for resectable tumours consists of preoperative chemoradiotherapy (CRT) followed by surgery. Despite the curative intent, the prognosis is still poor mainly due to relapse. A multidisciplinary approach is required in order to optimize the therapeutic strategy and follow-up. Differences in outcomes between the two main histological subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC), have been reported. Nevertheless, the heterogeneity in trials design and data available have hampered the achievement of clear conclusions. The purpose of this study is to report the outcomes from a cohort of patients with LAEC treated with a multidisciplinary approach and to remark the differences observed between the two main histologic subtypes and their clinical implications. Methods We retrospectively reviewed 100 patients diagnosed with LAEC that were treated with preoperative CRT at our institution and integrated centres. Histopathological characteristics and toxicities during treatment were recorded. Patterns of recurrence at the first relapse were analysed. Survival curves were plotted using the Kaplan Meier method and multivariate Cox proportional hazards models were used. Results Among the patients who received preoperative CRT, 83% underwent surgery. The median overall survival (mOS) was 31.7 months, 26.9 months for ADC and 45.5 for SCC (p-value = 0.33). In the multivariate Cox regression analysis, ypN+ was the only factor that negatively influenced in OS (OR = 4.1, p-value = 0.022). Patterns of recurrence differed according to histologic subtype. Distant relapse was more frequent in ADC (62%), whereas locoregional relapse was higher in SCC (50%) (p-value = 0.027). Second line therapeutic strategies could be offered to 50% of those patients who relapsed. Conclusions Differences in outcomes and recurrence pattern could be observed between the two main histologic subtypes of LAEC. A better molecular characterization, adapted therapeutic regimens and follow up strategies should be adopted in order to improve survival of these patients.
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Affiliation(s)
- Maria Saigí
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Marc Oliva
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Aliste
- Evaluation Unit, Cancer Plan, Department of Health, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Mariona Calvo
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gloria Hormigo
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Òlbia Serra
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Boladeras
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Radiation Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Leandre Farran
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Digestive Surgery Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Robles
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Nuclear Medecine Department, Institut del Diagnòstic Imatge (IDI), Hospital Universitari Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Gloria Creus
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Clinical Nutrition Unit, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ma José Paúles
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joan B. Gornals
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Gastroenterology Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eugenia de Lama
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Radiology Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Ma Borràs
- Department of Clinical Sciences, University of Barcelona, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program and Translational Research Laboratory, Institut Català d’Oncologia (ICO)-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Maica Galán
- Department of Medical Oncology, Institut Català Oncologia (ICO), IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroesophageal Tumours Functional Unit (UTEG), Institut Català d’Oncologia- Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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72
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Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy. Virchows Arch 2017; 472:175-186. [PMID: 28918544 DOI: 10.1007/s00428-017-2232-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023]
Abstract
Neoadjuvant therapy has been successfully introduced in the treatment of locally advanced gastrointestinal malignancies, particularly esophageal, gastric, and rectal cancers. The effects of preoperative chemo- or radiochemotherapy can be determined by histopathological investigation of the resection specimen following this treatment. Frequent histological findings after neoadjuvant therapy include various amounts of residual tumor, inflammation, resorptive changes with infiltrates of foamy histiocytes, foreign body reactions, and scarry fibrosis. Several tumor regression grading (TRG) systems, which aim to categorize the amount of regressive changes after cytotoxic treatment in primary tumor sites, have been proposed for gastroesophageal and rectal carcinomas. These systems primarily refer to the amount of therapy-induced fibrosis in relation to the residual tumor (e.g., the Mandard, Dworak, or AJCC systems) or the estimated percentage of residual tumor in relation to the previous tumor site (e.g., the Becker, Rödel, or Rectal Cancer Regression Grading systems). TRGs provide valuable prognostic information, as in most cases, complete or subtotal tumor regression after neoadjuvant treatment is associated with better patient outcomes. This review describes the typical histopathological findings after neoadjuvant treatment, discusses the most commonly used TRG systems for gastroesophageal and rectal carcinomas, addresses the limitations and critical issues of tumor regression grading in these tumors, and describes the clinical impact of TRG.
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Agnes A, Estrella JS, Badgwell B. The significance of a nineteenth century definition in the era of genomics: linitis plastica. World J Surg Oncol 2017; 15:123. [PMID: 28679451 PMCID: PMC5498981 DOI: 10.1186/s12957-017-1187-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/22/2017] [Indexed: 02/08/2023] Open
Abstract
Background Linitis plastica due to gastric adenocarcinoma is a condition with a long history, but still lacks a standardized definition and is commonly confused with Borrmann type IV, Lauren diffuse, and signet-cell type gastric cancer. The absence of a clear definition is a problem when investigating its biological characteristics and role as a possible independent factor for prognosis. Nevertheless, the biological behavior for linitis plastica, which is unique, may be valuable in risk stratification and have implications for treatment. A definition of linitis plastica based on molecular or genomic criteria could represent a useful starting point for investigating new targeted therapies. Main body This literature review of linitis plastica will focus on the current classifications for gastric cancer, illustrating how the concept of linitis plastica relates to them in most cases and identifying a clear and reproducible definition. Moreover, the review will highlight the diagnostic challenges associated with linitis plastica, its prognostic implications, and the therapeutic options available. Future perspectives for its management are also addressed. Conclusion Linitis plastica is a carcinoma with a scirrhous stroma, involving the submucosal and muscular layers of the stomach even in the absence of mucosal alteration. In most cases, the primary cancer cells are signet-ring cells or scattered cells in the context of a poorly differentiated carcinoma. Diagnosis is challenging. Staging should be thorough, including diagnostic laparoscopy in all cases due to the high incidence of peritoneal involvement. The prognostic significance of linitis plastica is still controversial. Curative-intent surgery, when feasible, should be performed, with a multimodality treatment approach. Cancer-stroma interactions are important features of this disease, and represent attaining potential target for future therapies. Future pathologic assessments of gastric cancer should report the stromal reaction in order to allow better characterization of the tumor.
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Affiliation(s)
- Annamaria Agnes
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Zschaeck S, Hofheinz F, Zöphel K, Bütof R, Jentsch C, Schmollack J, Löck S, Kotzerke J, Baretton G, Weitz J, Baumann M, Krause M. Increased FDG uptake on late-treatment PET in non-tumour-affected oesophagus is prognostic for pathological complete response and disease recurrence in patients undergoing neoadjuvant radiochemotherapy. Eur J Nucl Med Mol Imaging 2017; 44:1813-1822. [PMID: 28600646 DOI: 10.1007/s00259-017-3742-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/24/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Early side effects including oesophagitis are potential prognostic factors in patients undergoing radiochemotherapy (RCT) for locally advanced oesophageal cancer (LAEC). We assessed the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake within irradiated non-tumour-affected oesophagus (NTO) during restaging positron emission tomography (PET) as a surrogate for inflammation/oesophagitis. METHODS This retrospective evaluation included 64 patients with LAEC who had completed neoadjuvant RCT and had successful oncological resection. All patients underwent FDG PET/CT before and after RCT. In the restaging PET scan maximum and mean standardized uptake values (SUVmax, SUVmean) were determined in the tumour and NTO. Univariate Cox regression with respect to overall survival, local control, distant metastases and treatment failure was performed. Independence of clinically relevant parameters was tested in a multivariate Cox regression analysis. RESULTS Increased FDG uptake, measured in terms of SUVmean in NTO during restaging was significantly associated with complete pathological remission (p = 0.002) and did not show a high correlation with FDG response of the tumour (rho < 0.3). In the univariate analysis, increased SUVmax and SUVmean in NTO was associated with improved overall survival (p = 0.011, p = 0.004), better local control (p = 0.051, p = 0.044), a lower rate of treatment failure (p < 0.001 for both) and development of distant metastases (p = 0.012, p = 0.001). In the multivariate analysis, SUVmax and SUVmean in NTO remained a significant prognostic factor for treatment failure (p < 0.001, p = 0.004) and distant metastases (p = 0.040, p = 0.011). CONCLUSIONS FDG uptake in irradiated normal tissues measured on restaging PET has significant prognostic value in patients undergoing neoadjuvant RCT for LAEC. This effect may potentially be of use in treatment personalization.
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Affiliation(s)
- Sebastian Zschaeck
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. .,German Cancer Consortium (DKTK), Dresden, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Frank Hofheinz
- PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Klaus Zöphel
- German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Rebecca Bütof
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christina Jentsch
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Julia Schmollack
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany
| | - Steffen Löck
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Biostatistics and Modeling in Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Jörg Kotzerke
- German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Gustavo Baretton
- German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Department of Pathology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Weitz
- German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Baumann
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Institute of Radiooncology, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Mechthild Krause
- Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Institute of Radiooncology, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
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van der Kaaij RT, Snaebjornsson P, Voncken FE, van Dieren JM, Jansen EP, Sikorska K, Cats A, van Sandick JW. The prognostic and potentially predictive value of the Laurén classification in oesophageal adenocarcinoma. Eur J Cancer 2017; 76:27-35. [DOI: 10.1016/j.ejca.2017.01.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/11/2017] [Accepted: 01/29/2017] [Indexed: 12/25/2022]
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Patients unfit for neoadjuvant therapy may still undergo resection of locally advanced esophageal or esophagogastric junctional cancer with acceptable oncological results. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e09. [PMID: 29177210 PMCID: PMC5673116 DOI: 10.1097/ij9.0000000000000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text. Neoadjuvant chemotherapy (NA) is routinely offered to patients undergoing resection for locally advanced (≥cT3Nx or cTxN+) esophageal or esophagogastric junctional (EGJ) cancer in the United Kingdom. Patients with comorbidity precluding the use of NA can be considered for resection yet the effect of omitting NA on survival is unclear.
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77
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Neves Filho EHC, de Sant'Ana RO, Nunes LVSC, Pires APB, da Cunha MDPSS. Histopathological regression of gastric adenocarcinoma after neoadjuvant therapy: a critical review. APMIS 2017; 125:79-84. [DOI: 10.1111/apm.12642] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/02/2016] [Indexed: 01/07/2023]
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78
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Tripathi P, Rao SX, Zeng MS. Clinical value of MRI-detected extramural venous invasion in rectal cancer. J Dig Dis 2017; 18:2-12. [PMID: 28009094 DOI: 10.1111/1751-2980.12439] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/10/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022]
Abstract
Extramural venous invasion (EMVI) is associated with a poor prognosis and a poor overall survival rate in rectal cancer. It can independently predict local and distant tumor recurrences. Preoperative EMVI detection in rectal cancer is useful for determining the treatment strategy. EMVI status is beneficial for the post-treatment evaluation and analysis of rectal cancer. Magnetic resonance imaging (MRI) is a non-invasive diagnostic modality with no radiation effects. High-resolution MRI can detect EMVI with high accuracy. In addition, MRI results are equal to or even better than pathological results in the detection of medium to large EMVI in rectal cancer. MRI-detected EMVI (mrEMVI) can be used as a potential biomarker that facilitates treatment methods. This review highlights the importance of MRI before and after rectal cancer treatment. In addition, we analyze the prognostic correlation between mrEMVI and circulating tumor cells (CTC) in rectal cancer. This article may help shed light on the significance of mrEMVI.
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Affiliation(s)
- Pratik Tripathi
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Sheng Xiang Rao
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Meng Su Zeng
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
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Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol 2016; 17:1697-1708. [PMID: 27776843 DOI: 10.1016/s1470-2045(16)30531-9] [Citation(s) in RCA: 460] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Docetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma, but has not yet been evaluated in the context of resectable patients. Here we report findings from the phase 2 part of the phase 2/3 FLOT4 trial, which compared histopathological regression in patients treated with a docetaxel-based triplet chemotherapy versus an anthracycline-based triplet chemotherapy before surgical resection. METHODS In this randomised, open-label, phase 2/3 study, eligible participants were recruited from 28 German oncology centres. Patients with resectable gastric or gastro-oesophageal junction cancer who had clinical stage cT2 or higher, nodal positive (cN+) disease, or both were randomly assigned (1:1) to either three preoperative and three postoperative 3-week cycles of intravenous epirubicin 50 mg/m2 on day 1, intravenous cisplatin 60 mg/m2 on day 1, and either fluorouracil 200 mg/m2 as continuous intravenous infusion or capecitabine 1250 mg/m2 orally (two doses of 625 mg/m2 per day) on days 1 to 21 (ECF/ECX group) or four preoperative and four postoperative 2-week cycles of docetaxel 50 mg/m2, intravenous oxaliplatin 85 mg/m2, intravenous leucovorin 200 mg/m2, and fluorouracil 2600 mg/m2 as a 24 h infusion, all on day 1 (FLOT group). Randomisation was done centrally with an interactive web-response system based on a sequence generated with blocks (block size 2) stratified by Eastern Cooperative Oncology Group performance status, location of primary tumour, age, and nodal status. No masking was done. Central assessment of pathological regression was done according to the Becker criteria. The primary endpoint was pathological complete regression (tumour regression grade TRG1a) and was analysed in the modified intention-to-treat population, defined as all patients who were randomly assigned to treatment excluding patients who had surgery but did not provide resection specimens for central evaluation. The study (including the phase 3 part) has completed enrolment, but follow-up is ongoing and this is an interim analysis. The trial is registered with ClinicalTrials.gov, number NCT01216644. FINDINGS Between Aug 18, 2010, and Aug 10, 2012, 300 patients (152 patients in the ECF/ECX group; 148 patients in the FLOT group) were enrolled into the phase 2 part of the study, 265 of whom (137 in the ECF/ECX group; 128 in the FLOT group) were assessable on a modified intention-to-treat basis. 119 (93%) of 128 patients in the FLOT group and 126 (92%) of 137 patients in the ECF/ECX group were given all planned preoperative cycles of treatment. FLOT was associated with significantly higher proportions of patients achieving pathological complete regression than was ECF/ECX (20 [16%; 95% CI 10-23] of 128 patients vs eight [6%; 3-11] of 137 patients; p=0·02). 44 (40%) of 111 patients in the ECF/ECX group and 30 (25%) of 119 patients in the FLOT group had at least one serious adverse event involving a perioperative medical or surgical complication. The most common non-surgical grade 3-4 adverse events were neutropenia (52 [38%] of 137 patients in the ECF/ECX group vs 67 [52%] of 128 patients in the FLOT group), leucopenia (28 [20%] vs 36 [28%]), nausea (23 [17%] vs 12 [9%]), infection (16 [12%] vs 15 [12%]), fatigue (19 [14%] vs 11 [9%]), and vomiting (13 [10%] vs four [3%]). INTERPRETATION Perioperative FLOT was active and feasible to administer, and might represent an option for patients with locally advanced, resectable gastric or gastro-eosophageal junction adenocarcinoma. FUNDING None.
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Wong J. Impact of pathologic tumor response in the treatment of gastric cancer. Transl Gastroenterol Hepatol 2016; 1:71. [PMID: 28138637 PMCID: PMC5244616 DOI: 10.21037/tgh.2016.09.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/02/2023] Open
Affiliation(s)
- Joyce Wong
- Department of Surgery, Lenox Hill Hospital, Manhattan, NY, USA
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81
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Dreussi E, Cecchin E, Polesel J, Canzonieri V, Agostini M, Boso C, Belluco C, Buonadonna A, Lonardi S, Bergamo F, Gagno S, De Mattia E, Pucciarelli S, De Paoli A, Toffoli G. Pharmacogenetics Biomarkers and Their Specific Role in Neoadjuvant Chemoradiotherapy Treatments: An Exploratory Study on Rectal Cancer Patients. Int J Mol Sci 2016; 17:ijms17091482. [PMID: 27608007 PMCID: PMC5037760 DOI: 10.3390/ijms17091482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/11/2016] [Accepted: 08/18/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Pathological complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) is still ascribed to a minority of patients. A pathway based-approach could highlight the predictive role of germline single nucleotide polymorphisms (SNPs). The primary aim of this study was to define new predictive biomarkers considering treatment specificities. Secondary aim was to determine new potential predictive biomarkers independent from radiotherapy (RT) dosage and cotreatment with oxaliplatin. Methods: Thirty germ-line SNPs in twenty-one genes were selected according to a pathway-based approach. Genetic analyses were performed on 280 LARC patients who underwent fluoropyrimidine-based CRT. The potential predictive role of these SNPs in determining pathological tumor response was tested in Group 1 (94 patients undergoing also oxaliplatin), Group 2 (73 patients treated with high RT dosage), Group 3 (113 patients treated with standard RT dosage), and in the pooled population (280 patients). Results: Nine new predictive biomarkers were identified in the three groups. The most promising one was rs3136228-MSH6 (p = 0.004) arising from Group 3. In the pooled population, rs1801133-MTHFR showed only a trend (p = 0.073). Conclusion: This exploratory study highlighted new potential predictive biomarkers of neoadjuvant CRT and underlined the importance to strictly define treatment peculiarities in pharmacogenetic analyses.
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Affiliation(s)
- Eva Dreussi
- Experimental and Clinical Pharmacology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Erika Cecchin
- Experimental and Clinical Pharmacology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Vincenzo Canzonieri
- Pathology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Marco Agostini
- First Surgical Clinic Section, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova 35128, Italy.
- Nano-Inspired Biomedicine Laboratory, Institute of Pediatric Research-Città della Speranza, Corso Stati Uniti 4, Padova 35127, Italy.
- Department of Nanomedicine, The Methodist Hospital Research Institute, 6670 Bertner Avenue, Houston, TX 77030, USA.
| | - Caterina Boso
- Radiation Oncology, Istituto Oncologico Veneto-IRCCS, Padova 35128, Italy.
| | - Claudio Belluco
- Surgical Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Angela Buonadonna
- Medical Oncology B, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33801, Italy.
| | - Sara Lonardi
- Medical Oncology 1, Istituto Oncologico Veneto-IRCCS, Padova 35128, Italy.
| | - Francesca Bergamo
- Medical Oncology 1, Istituto Oncologico Veneto-IRCCS, Padova 35128, Italy.
| | - Sara Gagno
- Experimental and Clinical Pharmacology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Elena De Mattia
- Experimental and Clinical Pharmacology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Salvatore Pucciarelli
- First Surgical Clinic Section, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova 35128, Italy.
| | - Antonino De Paoli
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano 33081, Italy.
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Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AFC, Lampis A, Hahne JC, Rugge M, Peckitt C, Nankivell M, Langley R, Ghidini M, Braconi C, Wotherspoon A, Grabsch HI, Valeri N. Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial. J Clin Oncol 2016; 34:2721-7. [PMID: 27298411 PMCID: PMC5019747 DOI: 10.1200/jco.2015.65.7692] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial. MATERIALS AND METHODS Pathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS. RESULTS Three hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P < .001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P < .001). CONCLUSION Lymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate.
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Affiliation(s)
- Elizabeth C Smyth
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matteo Fassan
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - David Cunningham
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - William H Allum
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alicia F C Okines
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Lampis
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jens C Hahne
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Massimo Rugge
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Clare Peckitt
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthew Nankivell
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruth Langley
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michele Ghidini
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chiara Braconi
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrew Wotherspoon
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Heike I Grabsch
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicola Valeri
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands.
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Hüscher CGS, Tierno SM, Romeo V, Lirici MM. Technologies, technical steps, and early postoperative results of transanal TME. MINIM INVASIV THER 2016; 25:247-56. [PMID: 27387893 DOI: 10.1080/13645706.2016.1206024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION First described in 1982, TME overcomes most of the concerns regarding adequate local control after anterior rectal resection. TME requires close sharp dissection along the so-called Heald's plane down to the levators, with distal dissection often cumbersome. In recent years, Transanal TME was introduced with the aim to improve distal rectal dissection and quality of mesorectal excision. MATERIAL AND METHODS A prospective, non-randomized study, started in 2013, is currently ongoing in two Italian Centers. Study objectives were assessing the safety of TaTME and TME quality. TaTME technique and technologies as performed in these centers and cumulative results at ≤30 postoperative days of the first 102 patients are reported. RESULTS Early postoperative morbidity and mortality rates were 33.3% (34 pts, 16 Clavien-Dindo I + II and 18 Clavien-Dindo III + IV + V), and 1.96% (two deaths), respectively. The quality of mesorectal excision according to Quirke was: complete in 97.1% and nearly complete in 2.9% of the cases. CONCLUSIONS The results confirm the effectiveness of TaTME, especially regarding the quality of the mesorectal dissection. Open questions regarding standardization, anatomical landmarks, indications, morbidity (with special regard to local infection and sepsis), learning curve and oncological outcomes require further answers from larger studies and RCTs before definitive validation of this procedure. .
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Affiliation(s)
| | | | - Valentina Romeo
- b Department of Surgery San Giovanni Hospital , Rome , Italy
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Solass W, Sempoux C, Detlefsen S, Carr NJ, Bibeau F. Peritoneal sampling and histological assessment of therapeutic response in peritoneal metastasis: proposal of the Peritoneal Regression Grading Score (PRGS). Pleura Peritoneum 2016; 1:99-107. [PMID: 30911613 PMCID: PMC6328069 DOI: 10.1515/pp-2016-0011] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Multimodal therapeutic strategies have improved the outcome of peritoneal metastases (PM). However, objective assessment of therapy response remains difficult in PM, since radiological studies have a poor accuracy for low-volumetric disease. There is an obvious need for a histological gold standard allowing assessment of tumor response to treatment in PM. Content: We propose to perform peritoneal punch biopsies with a diameter of 3 to 5 mm in all four abdominal quadrants. We propose a four-tier Peritoneal Regression Grading Score (PRGS), defined as Grade 1: complete response (absence of tumor cells), Grade 2: major response (major regression features, few residual tumor cells), Grade 3: minor response (some regressive features but predominance of residual tumor cells), Grade 4: no response (tumor cells without any regressive features). Acellular mucin and infarct-like necrosis should be regarded as regression features. We recommend reporting the mean and the worst value of the regression grades obtained. When complete tumor response is suspected intraoperatively, a peritoneal cytology should be sampled. Summary: A generic, unique score for the assessment of histological tumor response to chemotherapy in PM makes sense because of the clinical impact of histological response to therapy and because the organ of metastasis (peritoneum) is the same. By adopting PRGS, different centers will be able to use a uniform terminology and grading that will allow meaningful comparison of their results. Outlook: PRGS has now to be validated in several gastrointestinal and gynecological cancer types and may be useful both in clinical and research settings.
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Affiliation(s)
- Wiebke Solass
- Institute of Pathology, Medical School Hanover, Hanover, Germany
| | - Christine Sempoux
- Department of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Norman J. Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom
| | - Frédéric Bibeau
- Department of Pathology, National Networks of Rare Periteoneal Tumors (RENAPE) and of digestive peritoneal carcinomatosis (BIG-REBNAPE), Institute du Cancer de Montpellier, Montpellier, France
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Chuong MD, Frakes JM, Figura N, Hoffe SE, Shridhar R, Mellon EA, Hodul PJ, Malafa MP, Springett GM, Centeno BA. Histopathologic tumor response after induction chemotherapy and stereotactic body radiation therapy for borderline resectable pancreatic cancer. J Gastrointest Oncol 2016; 7:221-7. [PMID: 27034789 DOI: 10.3978/j.issn.2078-6891.2015.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND While clinical outcomes following induction chemotherapy and stereotactic body radiation therapy (SBRT) have been reported for borderline resectable pancreatic cancer (BRPC) patients, pathologic response has not previously been described. METHODS This single-institution retrospective review evaluated BRPC patients who completed induction gemcitabine-based chemotherapy followed by SBRT and surgical resection. Each surgical specimen was assigned two tumor regression grades (TRG), one using the College of American Pathologists (CAP) criteria and one using the MD Anderson Cancer Center (MDACC) criteria. Overall survival (OS) and progression free survival (PFS) were correlated to TRG score. RESULTS We evaluated 36 patients with a median follow-up of 13.8 months (range, 6.1-24.8 months). The most common induction chemotherapy regimen (82%) was GTX (gemcitabine, docetaxel, capecitabine). A median SBRT dose of 35 Gy (range, 30-40 Gy) in 5 fractions was delivered to the region of vascular involvement. The margin-negative resection rate was 97.2%. Improved response according to MDACC grade trended towards superior PFS (P=061), but not OS. Any neoadjuvant treatment effect according to MDACC scoring (IIa-IV vs. I) was associated with improved OS and PFS (both P=0.019). We found no relationship between CAP score and OS or PFS. CONCLUSIONS These data suggest that the increased pathologic response after induction chemotherapy and SBRT is correlated with improved survival for BRPC patients.
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Affiliation(s)
- Michael D Chuong
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Jessica M Frakes
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Nicholas Figura
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Sarah E Hoffe
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Ravi Shridhar
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Eric A Mellon
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Pamela J Hodul
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Mokenge P Malafa
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Gregory M Springett
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
| | - Barbara A Centeno
- 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA
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McNamara MJ, Rybicki LA, Sohal D, Allende DS, Videtic GMM, Rodriguez CP, Stephans KL, Murthy SC, Raja S, Raymond D, Ives DI, Bodmann JW, Adelstein DJ. The relationship between pathologic nodal disease and residual tumor viability after induction chemotherapy in patients with locally advanced esophageal adenocarcinoma receiving a tri-modality regimen. J Gastrointest Oncol 2016; 7:196-205. [PMID: 27034786 DOI: 10.3978/j.issn.2078-6891.2015.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A complete pathologic response to induction chemo-radiotherapy (CRT) has been identified as a favorable prognostic factor for patients with loco-regionally advanced (LRA) adenocarcinoma (ACA) of the esophagus and gastro-esophageal junction (E/GEJ). Nodal involvement at the time of surgery has been found to be prognostically unfavorable. Less is known, however, about the prognostic import of less than complete pathologic regression and its relationship to residual nodal disease after induction chemotherapy. METHODS Between February 2008 and January 2012, 60 evaluable patients with ACA of the E/GEJ enrolled in a phase II trial of induction chemotherapy, surgery, and post-operative CRT. Eligibility required a clinical stage of T3-T4 or N1 or M1a (AJCC 6(th)). Induction chemotherapy with epirubicin 50 mg/m(2) d1, oxaliplatin 130 mg/m(2) d1, and fluorouracil 200 mg/m(2)/day continuous infusion for 3 weeks, was given every 21 days for three courses and was followed by surgical resection. Adjuvant CRT consisted of 50-55 Gy at 1.8-2.0 Gy/d and two courses of cisplatin (20 mg/m(2)/d) and fluorouracil (1,000 mg/m(2)/d) over 4 days during weeks 1 and 4 of radiotherapy. Residual viability (RV) was defined as the amount of remaining tumor in relation to acellular mucin pools and scarring. RESULTS Of the 60 evaluable patients, 54 completed induction therapy and underwent curative intent surgery. The Kaplan-Meier projected 3-year overall survival (OS) for patients with pathologic N0 (n=20), N1 (n=12), N2 (n=13), and N3 (n=9) disease is 73%, 57%, 35%, and 0% respectively (P<0.001). The Kaplan-Meier projected 3-year OS of patients with low (0-25%, n=19), intermediate (26-75%, n=26), and high (>75%, n=9) residual tumor viability was 67%, 42%, and 17% respectively (P=0.004). On multivariable analysis (MVA), both the pN descriptor and RV were independently prognostic for OS. In patients with less nodal dissemination (N0/N1), RV was prognostic for OS [3-year OS 85% (0-25% viable) vs. 51% (>25% viable), P=0.028]. Outcomes were poor, however, for patients with advanced nodal disease (N2/N3) regardless of RV [3-year OS 20% (0-25% viable) vs. 21% (>25% viable), P=0.55]. CONCLUSIONS RV and the pN descriptor after induction chemotherapy are independent pathologic prognostic factors for OS in patients with LRA ACA of the E/GEJ. Patients with extensive nodal disease, however, have poor outcomes irrespective of residual tumor viability.
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Affiliation(s)
- Michael J McNamara
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Lisa A Rybicki
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Davendra Sohal
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniela S Allende
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gregory M M Videtic
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Cristina P Rodriguez
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kevin L Stephans
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Siva Raja
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel Raymond
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Denise I Ives
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Joanna W Bodmann
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - David J Adelstein
- 1 Hematology and Oncology, Taussig Cancer Institute, 2 Quantitative Health Sciences, 3 Department of Pathology, 4 Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA ; 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA ; 6 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Wang HJ, Solanki S, Traboulsi S, Kassouf W, Brimo F. Neoadjuvant chemotherapy-related histologic changes in radical cystectomy: assessment accuracy and prediction of response. Hum Pathol 2016; 53:35-40. [PMID: 27321168 DOI: 10.1016/j.humpath.2016.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/26/2016] [Accepted: 02/10/2016] [Indexed: 12/28/2022]
Abstract
We evaluated the spectrum of histologic changes associated with neoadjuvant chemotherapy (NAC) and compared them with those resulting from transurethral resection (TUR). Twenty-five patients who received NAC were divided based on both their preoperative clinical/radiographic findings (clinical stage, hydronephrosis, palpable mass) and the cystectomy (RC) findings into NAC respondents (advanced clinical stage and <pT2+pN0), possible NAC respondents (non-advanced clinical stage and <pT2+pN0), and NAC nonrespondents (≥pT2and/or ≥pN1). In addition, 14 patients who received TUR alone and had <pT2+pN0 on RC were included. Presence/absence of the following histologic features was assessed: fibrosis/myofibroblastic reaction, hyalinization in the bladder wall, inflammatory reaction, calcification, foreign-body giant cells, necrosis, sheets of foamy macrophages, and fibrosis/hyalinization/necrosis in the lymph nodes (LNs). Overall, there was a significant histologic overlap between all groups. However, patients who received NAC had a significantly higher likelihood of showing hyalinization and less giant cells and inflammatory reaction than did those who received TUR only. Moreover, the only significantly different histologic features in NAC respondents versus TUR respondents were hyalinization and LN changes, with those 2 features in 25% and 0% of the possible NAC respondents group, respectively. Lastly, there was no significant difference in the possible NAC respondent group in comparison to the TUR-only arm. It appears that TUR and NAC result in overlapping histologic changes. In cases with no/minimal residual disease on RC, it is difficult to attribute the changes to NAC effect only, except if (1) hyalinization of the bladder wall or LN changes are present, or (2) if the preoperative clinical stage was beyond what could be resected by TUR.
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Affiliation(s)
- Hui Jun Wang
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Shraddha Solanki
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Samer Traboulsi
- Department of Urology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1.
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Editorial Comment. J Urol 2016; 195:891-2. [PMID: 26777242 DOI: 10.1016/j.juro.2015.10.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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89
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McCluggage WG, Judge MJ, Clarke BA, Davidson B, Gilks CB, Hollema H, Ledermann JA, Matias-Guiu X, Mikami Y, Stewart CJR, Vang R, Hirschowitz L. Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR). Mod Pathol 2015; 28:1101-22. [PMID: 26089092 DOI: 10.1038/modpathol.2015.77] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
A comprehensive pathological report is essential for optimal patient management, cancer staging and prognostication. In many countries, proforma reports are used but these vary in their content. The International Collaboration on Cancer Reporting (ICCR) is an alliance formed by the Royal College of Pathologists of Australasia, the Royal College of Pathologists of the United Kingdom, the College of American Pathologists, the Canadian Partnership Against Cancer and the European Society of Pathology, with the aim of developing an evidence-based reporting data set for each cancer site. This will reduce the global burden of cancer data set development and reduplication of effort by different international institutions that commission, publish and maintain standardised cancer reporting data sets. The resultant standardisation of cancer reporting will benefit not only those countries directly involved in the collaboration but also others not in a position to develop their own data sets. We describe the development of a cancer data set by the ICCR expert panel for the reporting of primary ovarian, fallopian tube and peritoneal carcinoma and present the 'required' and 'recommended' elements to be included in the report with an explanatory commentary. This data set encompasses the recent International Federation of Obstetricians and Gynaecologists staging system for these neoplasms and the updated World Health Organisation Classification of Tumours of the Female Reproductive Organs. The data set also addresses issues about site assignment of the primary tumour in high-grade serous carcinomas and proposes a scoring system for the assessment of tumour response to neoadjuvant chemotherapy. The widespread implementation of this data set will facilitate consistent and accurate data collection, comparison of epidemiological and pathological parameters between different populations, facilitate research and hopefully will result in improved patient management.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Meagan J Judge
- Royal College of Pathologists of Australasia, Sydney, NSW, Australia
| | - Blaise A Clarke
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ben Davidson
- 1] Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway [2] Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Blake Gilks
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Harry Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Colin J R Stewart
- 1] Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia [2] School for Women's and Infant's Health, University of Western Australia, Crawley, WA, Australia
| | - Russell Vang
- Department of Pathology (Division of Gynecologic Pathology), The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lynn Hirschowitz
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, UK
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Germline and somatic genetic predictors of pathological response in neoadjuvant settings of rectal and esophageal cancers: systematic review and meta-analysis. THE PHARMACOGENOMICS JOURNAL 2015; 16:249-65. [PMID: 26122021 DOI: 10.1038/tpj.2015.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/10/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
Oncologists have pointed out an urgent need for biomarkers that can be useful for clinical application to predict the susceptibility of patients to preoperative therapy. This review collects, evaluates and combines data on the influence of reported somatic and germline genetic variations on histological tumor regression in neoadjuvant settings of rectal and esophageal cancers. Five hundred and twenty-seven articles were identified, 204 retrieved and 61 studies included. Among 24 and 14 genetic markers reported for rectal and esophageal cancers, respectively, significant associations in meta-analyses were demonstrated for the following markers. In rectal cancer, major response was more frequent in carriers of the TYMS genotype 2 R/2 R-2 R/3 R (rs34743033), MTHFR genotype 677C/C (rs1801133), wild-type TP53 and KRAS genes. In esophageal cancer, successful therapy appeared to correlate with wild-type TP53. These results may be useful for future research directions to translate reported data into practical clinical use.
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91
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Li L, Chen Z, Wang X, Zhuo S, Li H, Jiang W, Guan G, Chen J. Assessment of colloid response by nonlinear optical microscopy after preoperative radiochemotherapy for rectal carcinoma. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:051009. [PMID: 25436512 DOI: 10.1117/1.jbo.20.5.051009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
Colloid response is a type of tumor response that occurs after preoperative radiochemotherapy for rectal carcinoma. Given its important influence on survival, the colloid response should be considered when estimating histopathological reactions. Here, multiphoton microscopy (MPM) was applied to evaluate the colloid response ex vivo. This study demonstrated that MPM has the capability to visualize the colloid response in the absence of labels and can, in particular, identify rare residual carcinomatous cells in mucin pools. These results highlight the potential of this nonlinear optical technique as a diagnostic tool for tumor response after neoadjuvant treatment.
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Affiliation(s)
- Lianhuang Li
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China
| | - Zhifen Chen
- Fujian Medical University, The Affiliated Union Hospital, Department of Colorectal Surgery, Fuzhou 350001, China
| | - Xingfu Wang
- Fujian Medical University, The First Affiliated Hospital, Department of Pathology, Fuzhou 350001, China
| | - Shuangmu Zhuo
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China
| | - Hongsheng Li
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China
| | - Weizhong Jiang
- Fujian Medical University, The Affiliated Union Hospital, Department of Colorectal Surgery, Fuzhou 350001, China
| | - Guoxian Guan
- Fujian Medical University, The Affiliated Union Hospital, Department of Colorectal Surgery, Fuzhou 350001, China
| | - Jianxin Chen
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China
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Li LH, Chen ZF, Wang XF, Zhuo SM, Li HS, Jiang WZ, Guan GX, Chen JX. Multiphoton microscopy for tumor regression grading after neoadjuvant treatment for colorectal carcinoma. World J Gastroenterol 2015; 21:4210-4215. [PMID: 25892870 PMCID: PMC4394081 DOI: 10.3748/wjg.v21.i14.4210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/10/2015] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility of using multiphoton microscopy (MPM) to assess a tumor regression grading (TRG) system.
METHODS: Fresh specimens from seven patients with colorectal carcinoma undergoing neoadjuvant radiochemotherapy at the Fujian Medical University Union Hospital were obtained immediately after proctectomy. Specimens were serially sectioned (10 µm thickness) and used for MPM or stained with hematoxylin and eosin for comparison. Sections were imaged by MPM using 810 nm excitation, and images were collected in two wavelength channels corresponding to second-harmonic generation (SHG) and two-photon excited fluorescence (TPEF) signals. The ratio of these signal intensities was used to distinguish fibrosis from normal mucosal and serosal tissues.
RESULTS: TRG of specimens assessed by MPM were in complete agreement with histologic grading performed by a consulting pathologist. SHG and TPEF images clearly revealed collagen fibers and fragmented elastic fibers in the muscularis propria specimens following neoadjuvant radiochemotherapy. Additionally, blood vessel hyperplasia was observed as thickening and fibrosis of the intima and media, which was accompanied by minimal inflammatory cell infiltration. Furthermore, the SHG/TPEF ratio in stromal fibrosis (4.15 ± 0.58) was significantly higher than those in the normal submucosal (2.31 ± 0.52) and serosal (1.47 ± 0.10) tissues (P < 0.001 for both). Analysis of emission spectra from cancerous tumor cells revealed two peaks corresponding to nicotinamide adenine dinucleotide hydrogen and flavin adenine dinucleotide signals; the ratio of these values was 1.19 ± 0.02, which is close to a normal metabolic state.
CONCLUSION: MPM can be used to perform real-time diagnosis of tumor response after neoadjuvant treatment, and can be applied to evaluate TRG.
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Allum WH, Bonavina L, Cassivi SD, Cuesta MA, Dong ZM, Felix VN, Figueredo E, Gatenby PAC, Haverkamp L, Ibraev MA, Krasna MJ, Lambert R, Langer R, Lewis MPN, Nason KS, Parry K, Preston SR, Ruurda JP, Schaheen LW, Tatum RP, Turkin IN, van der Horst S, van der Peet DL, van der Sluis PC, van Hillegersberg R, Wormald JCR, Wu PC, Zonderhuis BM. Surgical treatments for esophageal cancers. Ann N Y Acad Sci 2015; 1325:242-68. [PMID: 25266029 DOI: 10.1111/nyas.12533] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the role of the nurse in preparation of esophageal resection (ER); the management of patients who develop high-grade dysplasia after having undergone Nissen fundoplication; the trajectory of care for the patient with esophageal cancer; the influence of the site of tumor in the choice of treatment; the best location for esophagogastrostomy; management of chylous leak after esophagectomy; the optimal approach to manage thoracic esophageal leak after esophagectomy; the choice for operational approach in surgery of cardioesophageal crossing; the advantages of robot esophagectomy; the place of open esophagectomy; the advantages of esophagectomy compared to definitive chemoradiotherapy; the pathologist report in the resected specimen; the best way to manage patients with unsuspected positive microscopic margin after ER; enhanced recovery after surgery for ER: expedited care protocols; and long-term quality of life in patients following esophagectomy.
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Affiliation(s)
- William H Allum
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Li L, Chen Z, Wang X, Li H, Jiang W, Zhuo S, Guan G, Chen J. Detection of morphologic alterations in rectal carcinoma following preoperative radiochemotherapy based on multiphoton microscopy imaging. BMC Cancer 2015; 15:142. [PMID: 25885576 PMCID: PMC4373096 DOI: 10.1186/s12885-015-1157-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 03/03/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preoperative radiochemotherapy improves outcomes in patients with locally advanced rectal carcinoma, and has been used increasingly in patient management. However, there is a strong clinical need to assess tumor response to neoadjuvant treatment, and a non-invasive technique that allows the precise identification of morphologic changes in tumors would be of considerable clinical interest. METHODS In this study, we used multiphoton microscopy (MPM) to detect morphologic alterations in rectal adenocarcinomas in patients treated with preoperative radiochemotherapy. RESULTS MPM was able to identify histopathologic alterations in rectal cancer following preoperative radiochemotherapy, and allowed the qualitative assessment of treatment efficacy and feasibility in relation to dose or strategy. CONCLUSION These findings may provide the groundwork for evaluating tumor response to neoadjuvant treatment, thus allowing the tailoring of effective treatment doses and strategies.
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Affiliation(s)
- Lianhuang Li
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, 350007, China.
| | - Zhifen Chen
- Department of Colorectal Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou, 350001, China.
| | - Xingfu Wang
- Department of Pathology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, China.
| | - Hongsheng Li
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, 350007, China.
| | - Weizhong Jiang
- Department of Colorectal Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou, 350001, China.
| | - Shuangmu Zhuo
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, 350007, China.
| | - Guoxian Guan
- Department of Colorectal Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou, 350001, China.
| | - Jianxin Chen
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, 350007, China.
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Peng YF, Yu WD, Pan HD, Wang L, Li M, Yao YF, Zhao J, Gu J. Tumor regression grades: Potential outcome predictor of locally advanced rectal adenocarcinoma after preoperative radiotherapy. World J Gastroenterol 2015; 21:1851-1856. [PMID: 25684951 PMCID: PMC4323462 DOI: 10.3748/wjg.v21.i6.1851] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/29/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze tumor regression grade (TRG) for prognosis of locally advanced rectal adenocarcinoma (LARA) treated with preoperative radiotherapy.
METHODS: One hundred and ninety patients with clinical stage II/III LARA were studied. All patients underwent radical surgery (between 2004 and 2010) after 30-Gy/10-fraction preoperative radiotherapy (pre-RT). All 190 patients received a short course of pre-RT and were reassessed for disease recurrence and survival; the slides of surgical specimens were reviewed and classified according to Mandard TRG. We compared patients with good response (Mandard TRG1 or TRG2) vs patients with bad/poor response (Mandard TRG3-5). Outcomes evaluated were 5-year overall survival (OS), 5-year disease-free survival (DFS), and local, distant and mixed recurrence. Fisher’s exact test or χ2 test, log-rank test and proportional hazards regression analysis were used to calculate the probability that Mandard TRG was associated with patient outcomes.
RESULTS: One hundred and sixty-six of 190 patients (87.4%) were identified as Mandard bad responders (TRG3-5). High Mandard grade was correlated with tumor height (41.7% < 6 cm vs 58.3% ≥ 6 cm, P = 0.050), ypT stage (75% ypT0-2 vs 25% ypT3-4, P = 0.000), and ypN stage (75% ypN0 vs 25% ypN1, P = 0.031). In univariate survival analysis, Mandard grade bad responders had significantly worse OS and DFS than good responders (TRG1/2) (OS, 83.1% vs 96.4%, P = 0.000; DFS, 72.3% vs 92.0%, P = 0.002). In multivariate survival analysis, Mandard bad responders had significantly worse DFS than Mandard good responders (DFS 3.8 years (95%CI: 1.2-12.2 years, P = 0.026).
CONCLUSION: Mandard grade good responders had a favorable prognosis. TRG may be a potential predictor for DFS in LARA after pre-RT.
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96
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Verbeke C, Löhr M, Karlsson JS, Del Chiaro M. Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties. Cancer Treat Rev 2015; 41:17-26. [PMID: 25434282 DOI: 10.1016/j.ctrv.2014.11.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 12/22/2022]
Abstract
An increasing number of studies investigate the use of neoadjuvant treatment for ductal adenocarcinoma of the pancreas. While a strong rationale supports this approach, study results are difficult to interpret and compare due to marked variance in multiple aspects of study design and performance. Divergence in pathology examination and reporting as a cause for heterogeneity and incomparability of study results has not been brought into this discussion yet, despite the fact that several key outcome measures for neoadjuvant treatment are pathology-based. This article discusses areas of controversy and difficulty regarding the evaluation of the extent of residual tumour tissue, grading of tumour regression and assessment of the margins, and explains the important clinical implications of the present uncertainty and divergence in pathology practice.
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Affiliation(s)
- C Verbeke
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden; Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden.
| | - M Löhr
- Gastrocentrum, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden.
| | - J Severin Karlsson
- Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden.
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden.
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97
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Assessment of tumor regression of esophageal adenocarcinomas after neoadjuvant chemotherapy: comparison of 2 commonly used scoring approaches. Am J Surg Pathol 2014; 38:1551-6. [PMID: 25140894 DOI: 10.1097/pas.0000000000000255] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Histopathologic determination of tumor regression provides important prognostic information for locally advanced gastroesophageal carcinomas after neoadjuvant treatment. Regression grading systems mostly refer to the amount of therapy-induced fibrosis in relation to residual tumor or the estimated percentage of residual tumor in relation to the former tumor site. Although these methods are generally accepted, currently there is no common standard for reporting tumor regression in gastroesophageal cancers. We compared the application of these 2 major principles for assessment of tumor regression: hematoxylin and eosin-stained slides from 89 resection specimens of esophageal adenocarcinomas following neoadjuvant chemotherapy were independently reviewed by 3 pathologists from different institutions. Tumor regression was determined by the 5-tiered Mandard system (fibrosis/tumor relation) and the 4-tiered Becker system (residual tumor in %). Interobserver agreement for the Becker system showed better weighted κ values compared with the Mandard system (0.78 vs. 0.62). Evaluation of the whole embedded tumor site showed improved results (Becker: 0.83; Mandard: 0.73) as compared with only 1 representative slide (Becker: 0.68; Mandard: 0.71). Modification into simplified 3-tiered systems showed comparable interobserver agreement but better prognostic stratification for both systems (log rank Becker: P=0.015; Mandard P=0.03), with independent prognostic impact for overall survival (modified Becker: P=0.011, hazard ratio=3.07; modified Mandard: P=0.023, hazard ratio=2.72). In conclusion, both systems provide substantial to excellent interobserver agreement for estimation of tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas. A simple 3-tiered system with the estimation of residual tumor in % (complete regression/1% to 50% residual tumor/>50% residual tumor) maintains the highest reproducibility and prognostic value.
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98
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Al-Haddad S, Chang AC, De Hertogh G, Grin A, Langer R, Sagaert X, Salemme M, Streutker CJ, Soucy G, Tripathi M, Upton MP, Vieth M, Villanacci V. Adenocarcinoma at the gastroesophageal junction. Ann N Y Acad Sci 2014; 1325:211-25. [DOI: 10.1111/nyas.12535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sahar Al-Haddad
- Department of Laboratory Medicine and Pathobiology; St. Michael's Hospital; Toronto Canada
| | - Andrew C. Chang
- Section of Thoracic Surgery; University of Michigan Medical Center; Ann Arbor Michigan
| | - Gert De Hertogh
- Department of Morphology and Molecular Pathology; University Hospitals of K.U. Leuven; Leuven Belgium
| | | | - Rupert Langer
- Institute of Pathology; University of Bern; Bern Switzerland
| | - Xavier Sagaert
- Department of Morphology and Molecular Pathology; University Hospitals of K.U. Leuven; Leuven Belgium
| | | | - Catherine J. Streutker
- Department of Laboratory Medicine and Pathobiology; St. Michael's Hospital; Toronto Canada
| | - Geneviève Soucy
- Département de Pathologie - Pathologie Gastro-intestinale; Centre Hospitalier de l'Université de Montréal; Montréal Canada
| | - Monika Tripathi
- Department of Cellular Pathology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Melissa P. Upton
- Department of Pathology; University of Washington; Seattle Washington
| | - Michael Vieth
- Institute of Pathology; Klinikum Bayreuth; Bayreuth Germany
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Desenlaces del manejo no quirúrgico posterior a neoadyuvancia del cáncer localmente avanzado de recto. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rccan.2014.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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100
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Glimelius B. Optimal Time Intervals between Pre-Operative Radiotherapy or Chemoradiotherapy and Surgery in Rectal Cancer? Front Oncol 2014; 4:50. [PMID: 24778990 PMCID: PMC3985002 DOI: 10.3389/fonc.2014.00050] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/02/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In rectal cancer therapy, radiotherapy or chemoradiotherapy (RT/CRT) is extensively used pre-operatively to (i) decrease local recurrence risks, (ii) allow radical surgery in non-resectable tumors, and (iii) increase the chances of sphincter-saving surgery or (iv) organ-preservation. There is a growing interest among clinicians and scientists to prolong the interval from the RT/CRT to surgery to achieve maximal tumor regression and to diminish complications during surgery. METHODS The pros and cons of delaying surgery depending upon the aim of the pre-operative RT/CRT are critically evaluated. RESULTS Depending upon the clinical situation, the need for a time interval prior to surgery to allow tumor regression varies. In the first and most common situation (i), no regression is needed and any delay beyond what is needed for the acute radiation reaction in surrounding tissues to wash out can potentially only be deleterious. After short-course RT (5Gyx5) with immediate surgery, the ideal time between the last radiation fraction is 2-5 days, since a slightly longer interval appears to increase surgical complications. A delay beyond 4 weeks appears safe; it results in tumor regression including pathologic complete responses, but is not yet fully evaluated concerning oncologic outcome. Surgical complications do not appear to be influenced by the CRT-surgery interval within reasonable limits (about 4-12 weeks), but this has not been sufficiently explored. Maximum tumor regression may not be seen in rectal adenocarcinomas until after several months; thus, a longer than usual delay may be of benefit in well responding tumors if limited or no surgery is planned, as in (iii) or (iv), otherwise not. CONCLUSION A longer time interval after CRT is undoubtedly of benefit in some clinical situations but may be counterproductive in most situations. After short-course RT, long-term results from the clinical trials are not yet available to routinely recommend an interval longer than 2-5 days, unless the tumor is non-resectable at diagnosis.
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Affiliation(s)
- Bengt Glimelius
- Department of Radiology, Oncology and Radiation Science, Uppsala University , Uppsala , Sweden
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