251
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Fraum TJ, Owen JW, Fowler KJ. Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging. Clin Colon Rectal Surg 2016; 29:205-15. [PMID: 27582645 DOI: 10.1055/s-0036-1584288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of PET with the high soft tissue contrast of MRI. The addition of PET/MRI to the clinical staging armamentarium has the potential to provide comprehensive state-of-the-art colorectal cancer staging in a single examination.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Joseph W Owen
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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252
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Yao X, Yang SX, Song XH, Cui YC, Ye YJ, Wang Y. Prognostic significance of computed tomography-detected extramural vascular invasion in colon cancer. World J Gastroenterol 2016; 22:7157-7165. [PMID: 27610025 PMCID: PMC4988302 DOI: 10.3748/wjg.v22.i31.7157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare disease-free survival (DFS) between extramural vascular invasion (EMVI)-positive and -negative colon cancer patients evaluated by computed tomography (CT).
METHODS: Colon cancer patients (n = 194) undergoing curative surgery between January 2009 and December 2013 were included. Each patient’s demographics, cancer characteristics, EMVI status, pathological status and survival outcomes were recorded. All included patients had been routinely monitored until December 2015. EMVI was defined as tumor tissue within adjacent vessels beyond the colon wall as seen on enhanced CT. Disease recurrence was defined as metachronous metastases, local recurrence, or death due to colon cancer. Kaplan-Meier analyses were used to compare DFS between the EMVI-positive and -negative groups. Cox’s proportional hazards models were used to measure the impact of confounding variables on survival rates.
RESULTS: EMVI was observed on CT (ctEMVI) in 60 patients (30.9%, 60/194). One year after surgery, there was no statistically significant difference regarding the rates of progressive events between EMVI-positive and -negative patients [11.7% (7/60) and 6.7% (9/134), respectively; P = 0.266]. At the study endpoint, the EMVI-positive patients had significantly more progressive events than the EMVI-negative patients [43.3% (26/60) and 14.9% (20/134), respectively; odds ratio = 4.4, P < 0.001]. Based on the Kaplan-Meier method, the cumulative 1-year DFS rates were 86.7% (95%CI: 82.3-91.1) and 92.4% (95%CI: 90.1-94.7) for EMVI-positive and EMVI-negative patients, respectively. The cumulative 3-year DFS rates were 49.5% (95%CI: 42.1-56.9) and 85.8% (95%CI: 82.6-89.0), respectively. Cox proportional hazards regression analysis revealed that ctEMVI was an independent predictor of DFS with a hazard ratio of 2.15 (95%CI: 1.12-4.14, P = 0.023).
CONCLUSION: ctEMVI may be helpful when evaluating disease progression in colon cancer patients.
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253
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Arredondo J, Baixauli J, Pastor C, Chopitea A, Sola JJ, González I, A-Cienfuegos J, Martínez P, Rodriguez J, Hernández-Lizoain JL. Mid-term oncologic outcome of a novel approach for locally advanced colon cancer with neoadjuvant chemotherapy and surgery. Clin Transl Oncol 2016; 19:379-385. [PMID: 27496023 DOI: 10.1007/s12094-016-1539-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery. METHODS AND PATIENTS Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied. RESULTS Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65-82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8-79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2-63.7 %) (p < 0.005) of SUVmax (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p 25-p 75: 27.3-57.8) 3-5 year actuarial RFS was 88.9-85.6 %, respectively. Five-year actuarial OS was 95.3 %. CONCLUSION Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.
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Affiliation(s)
- J Arredondo
- Department of General Surgery, Complejo Asistencial Universitario de León, c/Altos de Nava s/n, 24008, León, Spain.
| | - J Baixauli
- Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - C Pastor
- Department of General Surgery, Fundación Jiménez-Díaz, Madrid, Spain
| | - A Chopitea
- Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - J J Sola
- Department of Pathology, Hospital San Pedro, Logroño, Spain
| | - I González
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - J A-Cienfuegos
- Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Martínez
- Department of General Surgery, Centro Médico de Asturias, Oviedo, Spain
| | - J Rodriguez
- Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
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Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2016; 207:984-995. [PMID: 27490941 DOI: 10.2214/ajr.15.15785] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to determine the accuracy of CT in the detection of tumor invasion beyond the bowel wall and nodal involvement of colon carcinomas. A literature search was performed to identify studies describing the accuracy of CT in the staging of colon carcinomas. Studies including rectal carcinomas that were inseparable from colon carcinomas were excluded. Publication bias was explored by using a Deeks funnel plot asymmetry test. A hierarchic summary ROC model was used to construct a summary ROC curve and to calculate summary estimates of sensitivity, specificity, and diagnostic odds ratios (ORs). CONCLUSION On the basis of a total of 13 studies, pooled sensitivity, specificity, and diagnostic ORs for detection of tumor invasion beyond the bowel wall (T3-T4) were 90% (95% CI, 83-95%), 69% (95% CI, 62-75%), and 20.6 (95% CI, 10.2-41.5), respectively. For detection of tumor invasion depth of 5 mm or greater (T3cd-T4), estimates from four studies were 77% (95% CI, 66-85%), 70% (95% CI, 53-83%), and 7.8 (95% CI, 4.2-14.2), respectively. For nodal involvement (N+), 16 studies were included with values of 71% (95% CI, 59-81%), 67% (95% CI, 46-83%), and 4.8 (95% CI, 2.5-9.4), respectively. Two studies using CT colonography were included with sensitivity and specificity of 97% (95% CI, 90-99%) and 81% (95% CI, 65-91%), respectively, for detecting T3-T4 tumors. CT has good sensitivity for the detection of T3-T4 tumors, and evidence suggests that CT colonography increases its accuracy. Discriminating between T1-T3ab and T3cd-T4 cancer is challenging, but data were limited. CT has a low accuracy in detecting nodal involvement.
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255
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Atsushi I, Mitsuyoshi O, Kazuya Y, Syuhei K, Noriyuki K, Masashi M, Akira W, Kentaro S, Nobuyuki K, Natsuko S, Jun W, Yasushi I, Chikara K, Itaru E. Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study. World J Gastroenterol 2016; 22:5237-5245. [PMID: 27298566 PMCID: PMC4893470 DOI: 10.3748/wjg.v22.i22.5237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/20/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer (CRC) at multiple Japanese institutions.
METHODS: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group’s department of gastroenterological surgery. Among them, 234 patients with stage II/III disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic factors.
RESULTS: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASA-PS (HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/dL (HR = 2.96, P = 0.007), T4 tumor (HR = 2.73, P = 0.002) and R1 resection (HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers (HR = 6.28, P = 0.009), a T4 tumor (HR = 3.46, P = 0.011) and R1 resection (HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive CRC.
CONCLUSION: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC.
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256
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Hunter C, Blake H, Jeyadevan N, Abulafi M, Swift I, Toomey P, Brown G. Local staging and assessment of colon cancer with 1.5-T magnetic resonance imaging. Br J Radiol 2016; 89:20160257. [PMID: 27226219 DOI: 10.1259/bjr.20160257] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE: The aim of this study was to assess the accuracy of 1.5-T MRI in the pre-operative local T and N staging of colon cancer and identification of extramural vascular invasion (EMVI). METHODS: Between 2010 and 2012, 60 patients with adenocarcinoma of the colon were prospectively recruited at 2 centres. 55 patients were included for final analysis. Patients received pre-operative 1.5-T MRI with high-resolution T2 weighted, gadolinium-enhanced T1 weighted and diffusion-weighted images. These were blindly assessed by two expert radiologists. Accuracy of the T-stage, N-stage and EMVI assessment was evaluated using post-operative histology as the gold standard. RESULTS: Results are reported for two readers. Identification of T3 disease demonstrated an accuracy of 71% and 51%, sensitivity of 74% and 42% and specificity of 74% and 83%. Identification of N1 disease demonstrated an accuracy of 57% for both readers, sensitivity of 26% and 35% and specificity of 81% and 74%. Identification of EMVI demonstrated an accuracy of 74% and 69%, sensitivity 63% and 26% and specificity 80% and 91%. CONCLUSION: 1.5-T MRI achieved a moderate accuracy in the local evaluation of colon cancer, but cannot be recommended to replace CT on the basis of this study. ADVANCES IN KNOWLEDGE: This study confirms that MRI is a viable alternative to CT for the local assessment of colon cancer, but this study does not reproduce the very high accuracy reported in the only other study to assess the accuracy of MRI in colon cancer staging.
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Affiliation(s)
- Chris Hunter
- 1 Department of Surgery and Cancer, Imperial College, London, UK
| | - Helena Blake
- 2 Department of Gastrointestinal Radiology, Croydon University Hospital, London, UK
| | - Nelesh Jeyadevan
- 2 Department of Gastrointestinal Radiology, Croydon University Hospital, London, UK
| | - Muti Abulafi
- 3 Department of Colorectal Surgery, Croydon University Hospital, London, UK
| | - Ian Swift
- 3 Department of Colorectal Surgery, Croydon University Hospital, London, UK
| | - Paul Toomey
- 4 Department of Colorectal Surgery, Epsom and St Helier University Hospitals, London, UK
| | - Gina Brown
- 5 Department of Gastrointestinal Radiology, The Royal Marsden Hospital, London, UK
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257
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Wood P, Peirce C, Mulsow J. Non-surgical factors influencing lymph node yield in colon cancer. World J Gastrointest Oncol 2016; 8:466-473. [PMID: 27190586 PMCID: PMC4865714 DOI: 10.4251/wjgo.v8.i5.466] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
There are numerous factors which can affect the lymph node (LN) yield in colon cancer specimens. The aim of this paper was to identify both modifiable and non-modifiable factors that have been demonstrated to affect colonic resection specimen LN yield and to summarise the pertinent literature on these topics. A literature review of PubMed was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens. The terms used for the search were: LN, lymphadenectomy, LN yield, LN harvest, LN number, colon cancer and colorectal cancer. Both non-modifiable and modifiable factors were identified. The review identified fifteen non-surgical factors: (13 non-modifiable, 2 modifiable) which may influence LN yield. LN yield is frequently reduced in older, obese patients and those with male sex and increased in patients with right sided, large, and poorly differentiated tumours. Patient ethnicity and lower socioeconomic class may negatively influence LN yield. Pre-operative tumour tattooing appears to increase LN yield. There are many factors that potentially influence the LN yield, although the strength of the association between the two varies greatly. Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.
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258
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Jalil O, Claydon L, Arulampalam T. Review of Neoadjuvant Chemotherapy Alone in Locally Advanced Rectal Cancer. J Gastrointest Cancer 2016; 46:219-36. [PMID: 26133151 DOI: 10.1007/s12029-015-9739-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, the standard management of locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy followed by resection. Despite the significant improvement in local recurrence, survival benefits are not gained due to distant failure and radiotherapy-associated toxicity. Compliance to adjuvant chemotherapy after preoperative chemoradiotherapy is also poor. Neoadjuvant chemotherapy alone followed by surgery may be an alternative. The objective of this review is to determine the efficacy of neoadjuvant chemotherapy alone in operable LARC. MATERIALS AND METHODS Electronic databases searched (from database inception-December 2013) were Medline, PubMed, Embase, Scopus, Cochrane library, and the Clinical Trials Register. Specific journals were also hand searched. The selection criteria were studies published in English investigating stage II-III non-metastatic rectal cancer patients treated with neoadjuvant chemotherapy (oral, intravenous or rectal route) followed by curative resection. The primary outcome measure was tumour response. Secondary outcome measures included acute toxicity, operative morbidity, R0 resection, local recurrence, overall survival (OS) and disease-free survival (DFS). RESULTS One randomised phase III trial, six single-arm phase II trials and one retrospective case series study were eligible for inclusion. Six studies administered fluoropyrimidine-based multiple agent regimens and two studies administered fluorouracil-based monotherapy. The studies with multiple agents and stronger chemotherapy regimens (intravenous and/or oral) followed by delayed surgery showed better tumour response rates. The overall objective response rate was good and ranged from 62.5 to 93.7 %. Pathological complete response ranged from 3.8 to 33.3 %. The R0 resection and compliance rates were also high ranging from 90 to 100 % and 72 to 100 %, respectively. Grade 3-4 toxicities ranged from 2.3 to 39 %. Four- to 5-year OS and DFS ranged from 67.2 to 91 % and 60.5 to 84 %, respectively. CONCLUSION This review demonstrates that neoadjuvant chemotherapy could be affectively administered in LARC and could provide a good alternative to chemoradiotherapy in moderate-risk rectal cancers without compromising short- and long-term outcomes.
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Affiliation(s)
- Omer Jalil
- Department of General and Colorectal Surgery, Colchester Hospital University, Turner Road, Colchester, CO4 5JL, UK,
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259
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Abstract
The optimal management of rectal cancer is achieved through a shared multidisciplinary decision making process with accurate staging by imaging being critical for treatment planning. Good quality, high-resolution MRI has become the imaging gold standard as it allows consistent staging and stratification of patients into distinct prognostic groups according to MR-findings. Imaging features other than T and N have been proven to influence patient outcomes, and increasingly these features are taken into consideration when determining treatment options: distance of tumour to the potential circumferential margin (CRM), presence of tumour within the extramural rectal vessels (EMVI), discontinuous tumour deposits (N1c), relationship to the intersphincteric plane in low rectal tumours and to pelvic compartments in advanced disease. The presence or absence of proven adverse MR features should be included in the MRI report and shared with the patient when treatment choices are offered. MRI enables the identification of high risk tumours where the use of neoadjuvant therapy is justified and is a robust method of identifying patients with a strong likelihood of complete response after preoperative treatment.
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Affiliation(s)
- Svetlana Balyasnikova
- />Colorectal Imaging Group, The Royal Marsden Hospital, NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK
- />Imperial College London, London, SW7 2AZ UK
- />The N. N. Blokhin Russian Cancer Research Center, Kashirskoye Shosse 24, Moscow, 15478 Russia
- />The State Scientific Center of Coloproctology, ul. Saliama Adilia 2, Moscow, 123423 Russia
| | - Gina Brown
- />Colorectal Imaging Group, The Royal Marsden Hospital, NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK
- />Imperial College London, London, SW7 2AZ UK
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260
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In Deciphering the Future of Adjuvant Treatment in Colon Cancer, the Journey Matters More than the Achievements. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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261
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Sammartino P, Biacchi D, Cornali T, Cardi M, Accarpio F, Impagnatiello A, Sollazzo BM, Di Giorgio A. Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Indian J Surg Oncol 2016; 7:215-24. [PMID: 27065712 DOI: 10.1007/s13193-016-0497-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/20/2016] [Indexed: 12/20/2022] Open
Abstract
An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.
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Affiliation(s)
- Paolo Sammartino
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Daniele Biacchi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Tommaso Cornali
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Maurizio Cardi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Fabio Accarpio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Alessio Impagnatiello
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Bianca Maria Sollazzo
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Angelo Di Giorgio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
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262
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Sjövall A, Blomqvist L, Egenvall M, Johansson H, Martling A. Accuracy of preoperative T and N staging in colon cancer--a national population-based study. Colorectal Dis 2016; 18:73-9. [PMID: 26291535 DOI: 10.1111/codi.13091] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/18/2015] [Indexed: 02/06/2023]
Abstract
AIM To select patients for neoadjuvant therapy in colon cancer, there is a need to improve pre-therapeutic locoregional staging. There are now data showing that the TN stage can be adequately assessed by preoperative CT in dedicated centres. In Sweden the use of preoperative CT of the abdomen for staging of the primary tumour is increasing. The aim of this study was to determine to what extent the preoperatively reported radiological TN stage correlates with the histopathological TN stage in an entire population. METHOD Data were collected on the preoperative cTN stage according to the radiologist and postoperative pTN stage according to the pathologist on all patients operated on for colon cancer in Sweden 2007-2010. The correlation between cTN stage and pTN stage was calculated using kappa statistics. RESULTS T stage was compared in 4373 patients with cT and pT stage. The correlation coefficient was 0.44, indicating fair agreement. The cN and pN correlation coefficient was 0.28, indicating a slight correlation. There was no difference in correlation related to age, gender, tumour location, body mass index or emergent vs elective surgery. A slight difference was seen between different geographical regions. CONCLUSION Preoperative CT in an unselected population does not result in an accurate cTN staging as previously reported from dedicated centres. To achieve adequate preoperative cTN staging nationally, the education of radiologists and optimization of the radiological method will be necessary.
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Affiliation(s)
- A Sjövall
- Department of Molecular Medicine and Surgery, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Blomqvist
- Department of Molecular Medicine and Surgery, Department of Radiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Egenvall
- Department for Clinical Sciences, Intervention and Technology, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - H Johansson
- Department of Oncology and Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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263
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Liu F, Yang L, Wu Y, Li C, Zhao J, Keranmu A, Zheng H, Huang D, Wang L, Tong T, Xu J, Zhu J, Cai S, Xu Y. CapOX as neoadjuvant chemotherapy for locally advanced operable colon cancer patients: a prospective single-arm phase II trial. Chin J Cancer Res 2016; 28:589-597. [PMID: 28174487 PMCID: PMC5242445 DOI: 10.21147/j.issn.1000-9604.2016.06.05] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this prospective, single-arm phase II trial was to confirm the safety and efficacy of neoadjuvant chemotherapy (NAC) using oxaliplatin plus capecitabine (CapOX) for patients with operable locally advanced colon cancer (CC). METHODS Patients with computed tomography-defined T4 or lymph node-positive CCs were enrolled. After radiological staging, patients were treated with at least 2 cycles of NAC consisting of 130 mg/m2 oxaliplatin on d 1, plus 1,000 mg/m2 capecitabine twice daily for 14 d every 3 weeks, followed by surgery, and then with the rest cycles of adjuvant chemotherapy. Radiological response was evaluated after 2 cycles of NAC. Tumor response, treatment toxicity, and surgical complications were recorded. The pathological response to therapy was evaluated according to the tumor regression grade (TRG) score. The primary endpoint was pathologic tumor response. This trial is registered in ClinicalTrials.gov (No: NCT02415829). RESULTS Forty-seven patients were enrolled in the study. Forty-two patients completed the planned treatments. The total radiological response rate was 68% (32/47), including complete and partial response rates of 2% (1/47) and 66% (31/47), respectively. Stable disease was observed in 32% (15/47) and progressive disease was observed in none. Complete pathologic response, major regression, and at least moderate regression were achieved in 1 (2%), 2 (4%), and 29 (62%) patients, respectively. Four patients developed grade 3 treatment toxicities. One patient with wound infection occurred after operation (1/47, 2%). There was no treatment-related death. CONCLUSIONS Our results suggest that NAC with CapOX is an effective and safe treatment option for patients with locally advanced CCs.
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Affiliation(s)
- Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Li Yang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yuchen Wu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Cong Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiang Zhao
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Adili Keranmu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongtu Zheng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Dan Huang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Lei Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Tong Tong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Junyan Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Ji Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Malmstrøm ML, Săftoiu A, Vilmann P, Klausen TW, Gögenur I. Endoscopic ultrasound for staging of colonic cancer proximal to the rectum: A systematic review and meta-analysis. Endosc Ultrasound 2016; 5:307-314. [PMID: 27803903 PMCID: PMC5070288 DOI: 10.4103/2303-9027.191610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives: Treatment of colonic cancer patients is highly dependent on the depth of tumor invasion (T-stage) as well as the extension of lymph node involvement (N-stage). We aimed to systematically review the accuracy of endoscopic ultrasound (EUS) for staging of colonic cancer proximal to the rectum. Patients and Methods: Men and women with colonic adenocarcinomas were included in the study. EUS staging was compared to histopathology as the gold standard. Outcome measures were T- and N-staging accuracies. Articles were searched in PubMed, Web of Science, The Cochrane Library, and EMBASE. Results: Six studies were identified comparing EUS staging of colonic cancer to histopathology. The pooled-staging sensitivity and specificity were 0.90 and 0.98 for T1 tumors, 0.67 and 0.96 for T2 tumors, and 0.97 and 0.83 for T3/T4 tumors, respectively. Sensitivity and specificity for N + disease were 0.59 and 0.78, respectively. Conclusions: EUS is a feasible method for T-staging of cancers of the colon proximal to the rectum. The accuracy of lymph node staging needs to be verified by prospective multicenter studies including larger patient populations.
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Affiliation(s)
- Marie Louise Malmstrøm
- Department of Surgery, Endoscopy Unit, Herlev University Hospital, Herlev, Denmark, Romania
| | - Adrian Săftoiu
- Department of Surgery, Endoscopy Unit, Herlev University Hospital, Herlev, Denmark, Romania; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Peter Vilmann
- Department of Surgery, Endoscopy Unit, Herlev University Hospital, Herlev, Denmark, Romania
| | | | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark, Romania
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265
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Zhou H, Song Y, Jiang J, Niu H, Zhao H, Liang J, Su H, Wang Z, Zhou Z, Huang J. A pilot phase II study of neoadjuvant triplet chemotherapy regimen in patients with locally advanced resectable colon cancer. Chin J Cancer Res 2016; 28:598-605. [PMID: 28174488 PMCID: PMC5242454 DOI: 10.21147/j.issn.1000-9604.2016.06.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective This study aims to investigate the feasibility, safety and efficacy of triplet regimen of neoadjuvant chemotherapy in patients with locally advanced resectable colon cancer. Methods Patients with clinical stage IIIb colon cancer received a perioperative triple chemotherapy regimen (oxaliplatin 85 mg/m2 and irinotecan 150 mg/m2, combined with folinic acid 200 mg, 5-fluorouracil 500 mg bolus and then 2,400 mg/m2 by 44 h infusion or capecitabine 1 g/m2 or S-1 40–60 mg b.i.d orally d 1–10, repeated at 2-week intervals) for 4 cycles. Complete mesocolic excision was scheduled 2–6 weeks after completion of neoadjuvant treatment and followed by a further 6 cycles of FOLFOXIRI or XELOX. Primary outcome measures of this stage II trial were feasibility, safety, tolerance and efficacy of neoadjuvant treatment.
Results All 23 patients received neoadjuvant chemotherapy and underwent surgery. Twenty-one patients (91.3%) had reductions in tumor volume after neoadjuvant treatment, and 13 patients (56.5%) had grade 3–4 toxicity. No patients had severe complications from surgery. Preoperative therapy resulted in significant down-staging of T-stage and N-stage compared with the baseline clinical stage including one pathological complete response. Conclusions Neoadjuvant triple chemotherapy has high activity and acceptable toxicity and perioperative morbidity, and is feasible, tolerable and effective for locally advanced resectable colon cancer.
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Affiliation(s)
| | | | | | | | - Hong Zhao
- Department of Abdominal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021, China
| | | | - Hao Su
- Department of Colorectal Surgery
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266
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Gollins S, Sebag-Montefiore D. Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer. Clin Oncol (R Coll Radiol) 2015; 28:146-151. [PMID: 26645661 DOI: 10.1016/j.clon.2015.11.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/15/2022]
Abstract
Improved surgical technique plus selective preoperative radiotherapy have decreased rectal cancer pelvic local recurrence from, historically, 25% down to about 5-10%. However, this improvement has not reduced distant metastatic relapse, which is the main cause of death and a key issue in rectal cancer management. The current standard is local pelvic treatment (surgery ± preoperative radiotherapy) followed by adjuvant chemotherapy, depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline magnetic resonance imaging, downstaging long-course preoperative chemoradiation (LCPCRT) is generally used. However, for non-CRM-threatened disease, varying approaches are currently adopted in the UK, including straight to surgery, short-course preoperative radiotherapy and LCPCRT. Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating preoperative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full-dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse. Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy-based schedules. Although several measures of neoadjuvant treatment response assessment based on imaging or pathology are promising predictive biomarkers for long-term survival, none has been validated in prospective phase III studies. The phase III setting will enable this, also providing translational opportunities to examine molecular predictors of response and survival.
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Affiliation(s)
- S Gollins
- North Wales Cancer Treatment Centre, Bodelwyddan, Denbighshire, UK.
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267
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Jakobsen A, Andersen F, Fischer A, Jensen LH, Jørgensen JCR, Larsen O, Lindebjerg J, Pløen J, Rafaelsen SR, Vilandt J. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial. Acta Oncol 2015; 54:1747-53. [PMID: 25920359 DOI: 10.3109/0284186x.2015.1037007] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy has proven valuable in several tumors, but it has not been elucidated in colon cancer. The present phase II trial addressed the issue in high-risk patients selected by computed tomography (CT) scan. MATERIAL AND METHODS Patients with resectable colon cancer fulfilling the following criteria were offered inclusion; Histopathological verification of adenocarcinoma, T3 tumor on CT scan with extramural tumor invasion > 5 mm or T4 tumor, age ≥ 18 years, PS ≤ 2, adequate hematology, and informed consent. Patients with KRAS, BRAF or PIK3CA mutation or unknown mutational status received three cycles of capecitabine 2000 mg/m(2) days 1-14 q3w and oxaliplatin 130 mg iv day 1 q3w. Wild-type patients received the same chemotherapy supplemented with panitumumab 9 mg/kg iv q3w. After the operation, patients fulfilling the international criteria for adjuvant chemotherapy, i.e. high-risk stage II and III patients, received five cycles of the same chemotherapy without panitumumab. Patients not fulfilling the criteria were offered follow-up only. The primary endpoint was the fraction of patients not fulfilling the criteria for adjuvant chemotherapy (converted patients). Secondary endpoints were recurrence rate, disease-free survival (DFS), and toxicity. RESULTS The study included 77 patients. The conversion rate was 42% in the wild-type group compared to 51% in patients with a mutation. The cumulative recurrence rate in converted versus unconverted patients was 6% versus 32% (p = 0.005) translating into a three-year DFS of 94% versus 63% (p = 0.005). CONCLUSION Neoadjuvant chemotherapy in colon cancer is feasible and the results suggest that a major part of the patients can be spared adjuvant chemotherapy. Validation in a randomized trial is warranted.
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Affiliation(s)
- Anders Jakobsen
- a Department of Oncology , Vejle Hospital , Vejle , Denmark
- i Institute for Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - Fahimeh Andersen
- e Department of Oncology , Hillerød Hospital , Hillerød , Denmark
| | - Anders Fischer
- h Department of Surgical Gastroenterology , Herlev Hospital , Herlev , Denmark
| | - Lars H Jensen
- a Department of Oncology , Vejle Hospital , Vejle , Denmark
| | | | - Ole Larsen
- g Department of Oncology , Herlev Hospital , Herlev , Denmark
| | - Jan Lindebjerg
- b Department of Pathology , Vejle Hospital , Vejle , Denmark
| | - John Pløen
- a Department of Oncology , Vejle Hospital , Vejle , Denmark
| | - Søren R Rafaelsen
- c Department of Radiology , Vejle Hospital , Vejle , Denmark
- i Institute for Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - Jesper Vilandt
- f Department of Surgery , Hillerød Hospital , Hillerød , Denmark
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268
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Khan MAS, Hakeem AR, Scott N, Saunders RN. Significance of R1 resection margin in colon cancer resections in the modern era. Colorectal Dis 2015; 17:943-53. [PMID: 25808496 DOI: 10.1111/codi.12960] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/23/2015] [Indexed: 02/08/2023]
Abstract
AIM Circumferential resection margin involvement (R1) in rectal cancer is a predictive factor for poor prognosis. The aim of this study was to confirm the prognostic significance of R1 in colon cancer resection and to establish whether the introduction of laparoscopic colorectal surgery influenced this. METHOD Prospectively collected data on a patient pathway data manager for sequential patients with colon cancer treated at our specialist unit from January 2005 to December 2010 were analysed. There were 1110 colonic resections (elective 865; emergency 245). A circumferential resection margin involvement of < 1 mm was considered positive. RESULTS The total R1 rate was 13.3% (elective 10.4%; emergency 23.6%; P < 0.001). Other statistically significant risk factors for an R1 resection included tumour perforation (P < 0.001), poorly differentiated carcinoma (P < 0.001), T4 tumour (P < 0.001), vascular invasion (P < 0.001), lymph node metastasis (P < 0.001), distant metastasis (P < 0.001) and palliative resection (P < 0.001). Over half of the elective resections were undertaken laparoscopically (486/865; 56.2%). When compared with elective open resection (379/865; 43.8%), the R1 rate was similar (P = 0.491) with similar disease-free survival (DFS) and overall survival (OS). The overall relapse rate was 18.9% in R0 and 55.5% in R1 resections (P < 0.001). Kaplan-Meier survival analysis showed significant improvements in DFS and OS in R0 over R1 patients. CONCLUSION The R1 margin in colon cancer resection is an important marker for advanced disease and a prognostic factor for DFS and OS. The introduction of laparoscopic surgery has not influenced the outcome in our unit despite a complex case mix.
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Affiliation(s)
- M A S Khan
- John Goligher Unit of Coloproctology, Leeds, UK
| | - A R Hakeem
- John Goligher Unit of Coloproctology, Leeds, UK
| | - N Scott
- Department of Pathology, St James's Hospital, Leeds, UK
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269
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Glynne-Jones R, Hava N, Goh V, Bosompem S, Bridgewater J, Chau I, Gaya A, Wasan H, Moran B, Melcher L, MacDonald A, Osborne M, Beare S, Jitlal M, Lopes A, Hall M, West N, Quirke P, Wong WL, Harrison M. Bevacizumab and Combination Chemotherapy in rectal cancer Until Surgery (BACCHUS): a phase II, multicentre, open-label, randomised study of neoadjuvant chemotherapy alone in patients with high-risk cancer of the rectum. BMC Cancer 2015; 15:764. [PMID: 26493588 PMCID: PMC4619031 DOI: 10.1186/s12885-015-1764-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/10/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In locally advanced rectal cancer (LARC) preoperative chemoradiation (CRT) is the standard of care, but the risk of local recurrence is low with good quality total mesorectal excision (TME), although many still develop metastatic disease. Current challenges in treating rectal cancer include the development of effective organ-preserving approaches and the prevention of subsequent metastatic disease. Neoadjuvant systemic chemotherapy (NACT) alone may reduce local and systemic recurrences, and may be more effective than postoperative treatments which often have poor compliance. Investigation of intensified NACT is warranted to improve outcomes for patients with LARC. The objective is to evaluate feasibility and efficacy of a four-drug regimen containing bevacizumab prior to surgical resection. METHODS/DESIGN This is a multi-centre, randomized phase II trial. Eligible patients must have histologically confirmed LARC with distal part of the tumour 4-12 cm from anal verge, no metastases, and poor prognostic features on pelvic MRI. Sixty patients will be randomly assigned in a 1:1 ratio to receive folinic acid + flurourcil + oxaliplatin (FOLFOX) + bevacizumab (BVZ) or FOLFOX + irinotecan (FOLFOXIRI) + BVZ, given in 2 weekly cycles for up to 6 cycles prior to TME. Patients stop treatment if they fail to respond after 3 cycles (defined as ≥ 30 % decrease in Standardised Uptake Value (SUV) compared to baseline PET/CT). The primary endpoint is pathological complete response rate. Secondary endpoints include objective response rate, MRI tumour regression grade, involved circumferential resection margin rate, T and N stage downstaging, progression-free survival, disease-free survival, overall survival, local control, 1-year colostomy rate, acute toxicity, compliance to chemotherapy. DISCUSSION In LARC, a neoadjuvant chemotherapy regimen - if feasible, effective and tolerable would be suitable for testing as the novel arm against the current standards of short course preoperative radiotherapy (SCPRT) and/or fluorouracil (5FU)-based CRT in a future randomised phase III trial. TRIAL REGISTRATION Clinical trial identifier BACCHUS: NCT01650428.
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Affiliation(s)
- R Glynne-Jones
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
| | - N Hava
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - V Goh
- Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - S Bosompem
- Pharmacy, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - J Bridgewater
- University College, London Cancer Institute, 72 Huntley St., London, WC1E 6AA, UK
| | - I Chau
- Department of Medical Oncology, Royal Marsden Hospital, London & Surrey, UK
| | - A Gaya
- Radiotherapy Department, Guys and St Thomas's Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - H Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - B Moran
- Department of Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - L Melcher
- Radiotherapy Department, Beatson Oncology Centre, 1053 Great Western Rd, Glasgow G12 0YN, UK
| | - A MacDonald
- Radiotherapy Department, North Middlesex Hospital, Sterling Way, London N18 1QX, UK
| | - M Osborne
- Radiotherapy Department, Royal Devon & Exeter Hospital, Barrack Rd, Exeter, Devon EX2 5DW, UK
| | - S Beare
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M Jitlal
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - A Lopes
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M Hall
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - N West
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - P Quirke
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Wai-Lup Wong
- Department of Radiology, Paul Strickland Scanner Centre, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M Harrison
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
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270
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Musiienko AM, Alzahrani S, Simpson JAD, Warrier S, Lynch AC, Heriot AG. Preoperative chemoradiation for an ascending colon tumour: novel approach to achieve a complete resection. ANZ J Surg 2015; 88:E342-E344. [PMID: 26471798 DOI: 10.1111/ans.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anton M Musiienko
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Saleh Alzahrani
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Satish Warrier
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Craig Lynch
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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271
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272
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Glynne-Jones R, Hall M. Radiotherapy and locally advanced rectal cancer. Br J Surg 2015; 102:1443-5. [DOI: 10.1002/bjs.9930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 01/13/2023]
Abstract
Blanket use of radiotherapy unwarranted
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Affiliation(s)
- R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, HA6 2RN, UK
| | - M Hall
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, HA6 2RN, UK
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273
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Wei Q, Huang X, Fu B, Liu J, Zhong L, Yang Q, Zhao T. IMP3 expression in biopsy specimens of colorectal cancer predicts lymph node metastasis and TNM stage. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:11024-11032. [PMID: 26617820 PMCID: PMC4637635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
IMP3 is associated with lymph node metastasis and TNM stage and is a good independent prognostic biomarker for colorectal cancer (CRC). However, the expression status and clinical implication of IMP3 in biopsy specimens have not yet been studied. We aim to address whether the presence of IMP3 expression in preoperative biopsies of CRC could predict lymph node metastasis and TNM stage. In this study, we examined IMP3 expression in paired biopsy and resection specimens of 71 CRC and analyzed the correlation of IMP3 expression with clinicopathological parameters. In the biopsy specimens, IMP3 positive expression was observed in 56 of 71 cases (78.9%) whereas negative expression was observed in 15 of 71 cases (21.1%). In the resection specimens, IMP3 positive expression was detected in 83.1% cases (59/71) whereas negative expression was detected in 16.9% cases (12/71). The absolute concordance rate between biopsy and resection specimens was 90.1% (64/71). The Spearman correlation test documented the existence of a strong linear correlation between the percentage of IMP3-positive cells in the biopsy and resection specimen (r = 0.629; P < 0.001). IMP3 expression in resection specimens was significantly related to histological grade (P = 0.043), T classification (P = 0.035), lymph node metastasis (P = 0.023), TNM stage (P = 0.007), tumor border (P = 0.049) and tumor budding (P = 0.012). IMP3 expression in biopsy specimens was significantly related to lymph node metastasis (P = 0.004), TNM stage (P = 0.005) and tumor budding (P = 0.001). In conclusion, IMP3 expression in biopsy specimens could be used to predict lymph node metastasis and TNM stage in CRC patients.
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Affiliation(s)
- Qingzhu Wei
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Xiaoping Huang
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Bo Fu
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Jianghuan Liu
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Ling Zhong
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Qiao Yang
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
| | - Tong Zhao
- Department of Pathology, The Third Affiliated Hospital of Southern Medical UniversityGuangzhou, Guangdong, China
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274
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Folkesson J, Martling A, Kodeda K. Current considerations in colorectal cancer surgery. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Colorectal cancer is one of the most common cancers in the world. The last decades improvement in survival in all stages of the disease has been achieved. Many factors contributes to this improvement; earlier diagnosis, better pre-operative staging, neoadjuvant radiochemotherapy, better surgical method and approach, introduction of pre- and post-operative multidisciplinary team conferences and adjuvant chemotherapy. Currently, new modalities are developing; robotics and organ preserving through wait-and-watch will give colorectal surgeons even more treatment options. This article highlights important aspects of colorectal cancer management now and in the future.
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Affiliation(s)
- Joakim Folkesson
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden
| | - Anna Martling
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Karl Kodeda
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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275
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Sugarbaker PH, Sammartino P, Tentes AA. Eradication of minimal residual disease in the perioperative period in primary colon cancer. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Colon adenocarcinoma is a disease process with a risk of local and regional treatment failure. This review seeks to identify the subset of patients with advanced primary disease who are at high risk for minimal residual disease after resection. These are the patients who may benefit from perioperative chemotherapy treatment that will improve the clearance of a small number of cancer cells disseminated prior to or at the time of the adenocarcinoma cancer resection. The selection factors for identifying these patients at high risk for local recurrence and peritoneal metastases and the special treatments they require are presented in this manuscript.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Paolo Sammartino
- Department of Surgery ‘Pietro Valdoni 6’, Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00155, Rome, Italy
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Wiegering A, Kunz M, Hussein M, Klein I, Wiegering V, Uthe FW, Dietz UA, Jurowich C, Bley T, Dandekar T, Germer CT, Ritter C. Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy. Int J Colorectal Dis 2015; 30:1067-73. [PMID: 25997602 DOI: 10.1007/s00384-015-2265-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Neoadjuvant therapy could improve oncological outcome of patients suffering from colon cancer. An accurate staging method is needed to define suitable patients. The aim of this retrospective study was to validate the value of CT for identifying patients with local advanced (T3/4) or nodal-positive colon cancer. METHODS AND MATERIAL Preoperative abdominal CT scans of 210 patients with colon cancer were evaluated by two radiologists independently for the T stage and N stage. Results were compared to pathology. Patients were stratified according to the guidelines for rectal cancer into patients with low risk (T0/1/2 and N0) or high risk (T3/4 or N+). RESULTS Inter-observer correlation was high with over 90 %. Overall sensitivity T stage was 93.0 % and for N stage 76.9 %. Using CT scan to identify local advanced (T3/4 or N+) tumors, the consensus sensitivity was 94.9 %, the specificity 53.6 %, the positive predictive value (PPV) 92.8 %, and the negative predictive value (NPV) 62.5 %. CONCLUSION Computer tomography represents an effective tool for identifying patients with colon cancer suitable for neoadjuvant therapy according to the guidelines for rectal cancer.
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Affiliation(s)
- Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany,
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Choi AH, Nelson RA, Schoellhammer HF, Cho W, Ko M, Arrington A, Oxner CR, Fakih M, Wong J, Sentovich SM, Garcia-Aguilar J, Kim J. Accuracy of computed tomography in nodal staging of colon cancer patients. World J Gastrointest Surg 2015; 7:116-22. [PMID: 26225194 PMCID: PMC4513434 DOI: 10.4240/wjgs.v7.i7.116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/06/2015] [Accepted: 06/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To predict node-positive disease in colon cancer using computed tomography (CT). METHODS American Joint Committee on Cancer stage I-III colon cancer patients who underwent curavtive-intent colectomy between 2007-2010 were identified at a single comprehensive cancer center. All patients had preoperative CT scans with original radiology reports from referring institutions. CT images underwent blinded secondary review by a surgeon and a dedicated abdominal radiologist at our institution to identify pericolonic lymph nodes (LNs). Comparison of outside CT reports to our independent imaging review was performed in order to highlight differences in detection in actual clinical practice. CT reviews were compared with final pathology. Results of the outside radiologist review, secondary radiologist review, and surgeon review were compared with the final pathologic exam to determine sensitivity, specificity, positive and negative predictive values, false positive and negative rates, and accuracy of each review. Exclusion criteria included evidence of metastatic disease on CT, rectal or appendiceal involvement, or absence of accompanying imaging from referring institutions. RESULTS From 2007 to 2010, 64 stageI-III colon cancer patients met the eligibility criteria of our study. The mean age of the cohort was 68 years, and 26 (41%) patients were male and 38 (59%) patients were female. On final pathology, 26 of 64 (40.6%) patients had node-positive (LN+) disease and 38 of 64 (59.4%) patients had node-negative (LN-) disease. Outside radiologic review demonstrated sensitivity of 54% (14 of 26 patients) and specificity of 66% (25 of 38 patients) in predicting LN+ disease, whereas secondary radiologist review demonstrated 88% (23 of 26) sensitivity and 58% (22 of 38) specificity. On surgeon review, sensitivity was 69% (18 of 26) with 66% specificity (25 of 38). Secondary radiology review demonstrated the highest accuracy (70%) and the lowest false negative rate (12%), compared to the surgeon review at 67% accuracy and 31% false negative rate and the outside radiology review at 61% accuracy and 46% false negative rate. CONCLUSION CT LN staging of colon cancer has moderate accuracy, with administration of NCT based on CT potentially resulting in overtreatment. Active search for LN+ may improve sensitivity at the cost of specificity.
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Karoui M, Rullier A, Luciani A, Bonnetain F, Auriault ML, Sarran A, Monges G, Trillaud H, Le Malicot K, Leroy K, Sobhani I, Bardier A, Moreau M, Brindel I, Seitz JF, Taieb J. Neoadjuvant FOLFOX 4 versus FOLFOX 4 with Cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a multicentre randomised controlled phase II trial--the PRODIGE 22--ECKINOXE trial. BMC Cancer 2015; 15:511. [PMID: 26156156 PMCID: PMC4497499 DOI: 10.1186/s12885-015-1507-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 06/19/2015] [Indexed: 02/08/2023] Open
Abstract
Background In patients with high risk stage II and stage III colon cancer (CC), curative surgery followed by adjuvant FOLFOX-4 chemotherapy has become the standard of care. However, for 20 to 30 % of these patients, the current curative treatment strategy of surgical excision followed by adjuvant chemotherapy fails either to clear locoregional spread or to eradicate distant micrometastases, leading to disease recurrence. Preoperative chemotherapy is an attractive concept for these CCs and has the potential to impact upon both of these causes of failure. Optimum systemic therapy at the earliest possible opportunity may be more effective at eradicating distant metastases than the same treatment given after the delay and immunological stress of surgery. Added to this, shrinking the primary tumor before surgery may reduce the risk of incomplete surgical excision, and the risk of tumor cell shedding during surgery. Methods/Design PRODIGE 22 - ECKINOXE is a multicenter randomized phase II trial designed to evaluate efficacy and feasibility of two chemotherapy regimens (FOLFOX-4 alone and FOLFOX-4 + Cetuximab) in a peri-operative strategy in patients with bulky CCs. Patients with CC deemed as high risk T3, T4 and/or N2 on initial abdominopelvic CT scan are randomized to either colectomy and adjuvant chemotherapy (control arm), or 4 cycles of neoadjuvant chemotherapy with FOLFOX-4 (for RAS mutated patients). In RAS wild-type patients a third arm testing FOLFOX+ cetuximab has been added prior to colectomy. Patients in the neoadjuvant chemotherapy arms will receive postoperative treatment for 4 months (8 cycles) to complete their therapeutic schedule. The primary endpoint of the study is the histological Tumor Regression Grade (TRG) as defined by Ryan. The secondary endpoints are: treatment strategy safety (toxicity, primary tumor related complications under chemotherapy, peri-operative morbidity), disease-free and recurrence free survivals at 3 years, quality of life, carcinologic quality and completeness of the surgery, initial radiological staging and radiological response to neoadjuvant chemotherapy, and the correlation between histopathological and radiological response. Taking into account a 50 % prevalence of CC without RAS mutation, accrual of 165 patients is needed for this Phase II trial. Trial Registration NCT01675999 (ClinicalTrials.gov)
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Affiliation(s)
- Mehdi Karoui
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, University Institute of Cancerology (Paris VI), Pierre & Marie Curie University (Paris VI), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,FFCD (Fédération Francophone de Cancérologie Digestive), Dijon, France.
| | - Anne Rullier
- Department of Pathology, Pellegrin University Hospital, Bordeaux, France.
| | - Alain Luciani
- Assistance Publique-Hôpitaux de Paris, Department of Radiology, Henri Mondor University Hospital, Paris XII university, Créteil, France.
| | - Franck Bonnetain
- Department of Medical Oncology and public health, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France.
| | - Marie-Luce Auriault
- Assistance Publique-Hôpitaux de Paris, Department of Pathology, Henri Mondor University Hospital, Créteil, France.
| | - Antony Sarran
- Department of Radiology, Institut Paoli Calmettes, Marseille, France.
| | - Geneviève Monges
- Department of Pathology, Institut Paoli Calmettes, Marseille, France.
| | - Hervé Trillaud
- Department of Radiology, St André University Hospital, Bordeaux, France.
| | - Karine Le Malicot
- FFCD (Fédération Francophone de Cancérologie Digestive), Dijon, France.
| | - Karen Leroy
- Assistance Publique-Hôpitaux de Paris, Department of Pathology, Henri Mondor University Hospital, Créteil, France.
| | - Iradj Sobhani
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Henri Mondor University Hospital, Créteil, France.
| | - Armelle Bardier
- Assistance Publique-Hôpitaux de Paris, Department of Pathology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Marie Moreau
- FFCD (Fédération Francophone de Cancérologie Digestive), Dijon, France.
| | - Isabelle Brindel
- Assistance Publique-Hôpitaux de Paris, Département de la Recherche Clinique et du Développement (DRCD), Paris, France.
| | | | - Julien Taieb
- FFCD (Fédération Francophone de Cancérologie Digestive), Dijon, France. .,Assistance Publique-Hôpitaux de Paris, Department of Digestive Oncology, European Georges Pompidou - Paris Descartes University, Paris, France.
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Tanis PJ, Paulino Pereira NR, van Hooft JE, Consten ECJ, Bemelman WA. Resection of Obstructive Left-Sided Colon Cancer at a National Level: A Prospective Analysis of Short-Term Outcomes in 1,816 Patients. Dig Surg 2015; 32:317-24. [PMID: 26159388 DOI: 10.1159/000433561] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS The prematurely closed Stent-In II trial in patients with left-sided obstructive colon cancer may have influenced clinical decision making in The Netherlands. The aim of this study was to evaluate treatment of left-sided malignant colon obstruction at a population level since then. METHODS Short-term outcomes of all patients who underwent resection for left-sided obstructive colon cancer between 2009 and 2012 were assessed based on a prospective national registry. RESULTS In total, 1,816 evaluable patients were included; acute resection was performed in 1,485 (81.8%), and endoscopic stent or decompressing stoma followed by resection in 196 (10.8%) and 135 (7.4%), respectively. The use of endoscopic stenting significantly decreased from 18% (2009) to 6% (2012). Overall 30-day or in-hospital mortality rate was 6.9, 5.6, and 3.7%, respectively (p = 0.107). Mortality rate after acute resection was 2.9% in patients <70 [corrected] years, but mortality rates up to 32.2% were observed in high-risk elderly patients. CONCLUSION Acute resection as first choice treatment seems justified for patients <70 [corrected] years of age given a mortality rate of 3%. For the elderly frail patients, mortality rates over 30% after acute resection stress the need for alternative treatment strategies.
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Affiliation(s)
- Pieter J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Suenaga M, Fujimoto Y, Matsusaka S, Shinozaki E, Akiyoshi T, Nagayama S, Fukunaga Y, Oya M, Ueno M, Mizunuma N, Yamaguchi T. Perioperative FOLFOX4 plus bevacizumab for initially unresectable advanced colorectal cancer (NAVIGATE-CRC-01). Onco Targets Ther 2015; 8:1111-8. [PMID: 26056475 PMCID: PMC4445787 DOI: 10.2147/ott.s83952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Perioperative chemotherapy combined with surgery for liver metastases is considered an active strategy in metastatic colorectal cancer (CRC). However, its impact on initially unresectable, previously untreated advanced CRC, regardless of concurrent metastases, remains to be clarified. METHODS A Phase II study was conducted to evaluate the safety and efficacy of perioperative FOLFOX4 plus bevacizumab for initially unresectable advanced CRC. Patients with previously untreated advanced colon or rectal cancer initially diagnosed as unresectable advanced CRC (TNM stage IIIb, IIIc, or IV) but potentially resectable after neoadjuvant chemotherapy (NAC) were studied. Preoperatively, patients received six cycles of NAC (five cycles of neoadjuvant FOLFOX4 plus bevacizumab followed by one cycle of FOLFOX4 alone). The interval between the last dose of bevacizumab and surgery was at least 5 weeks. Six cycles of adjuvant FOLFOX4 plus bevacizumab were given after surgery. The completion rate of NAC and feasibility of curative surgery were the primary endpoints. RESULTS An interim analysis was performed at the end of NAC in the 12th patient to assess the completion rate of NAC. The median follow-up time was 56 months. The characteristics of the patients were as follows: sex, eight males and four females; tumor location, sigmoid colon in three, ascending colon in one, and rectum (above the peritoneal reflection) in eight; stage, III in eight and IV in four (liver or lymph nodes). All patients completed six cycles of NAC. There were no treatment-related severe adverse events or deaths. An objective response to NAC was achieved in nine patients (75%), and no disease progression was observed. Eleven patients underwent curative tumor resection, including metastatic lesions. In December 2012, this Phase II study was terminated because of slow registration. CONCLUSION Perioperative FOLFOX4 plus bevacizumab is well tolerated and has a promising response rate leading to curative surgery, which offers a survival benefit in initially unresectable advanced CRC with concurrent metastatic lesions.
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Affiliation(s)
- Mitsukuni Suenaga
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiya Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Matsusaka
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masatoshi Oya
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuyuki Mizunuma
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiharu Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Abstract
PURPOSE Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage. METHODS We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen. RESULTS Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs. CONCLUSION WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer.
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283
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Balar AV, Milowsky MI. Neoadjuvant therapy in muscle-invasive bladder cancer: a model for rational accelerated drug development. Urol Clin North Am 2015; 42:217-24, viii-ix. [PMID: 25882563 DOI: 10.1016/j.ucl.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the advent of cisplatin-based combination therapy in the management of muscle-invasive and advanced bladder cancer, there has been little progress in improving outcomes for patients. Novel therapies beyond cytotoxic chemotherapy are needed. The neoadjuvant paradigm lends to acquiring ample pretreatment and posttreatment tumor tissue as a standard of care, which enables comprehensive biomarker analyses to better understand mechanisms of both response and resistance, which will aid drug development. This article discusses the evolution of neoadjuvant therapy as standard treatment and the role it may serve toward the development of novel therapies.
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Affiliation(s)
- Arjun V Balar
- Genitourinary Cancers Program, Perlmutter NYU Cancer Center, 160 East 34th Street, 8th Floor, New York, NY 10016, USA.
| | - Matthew I Milowsky
- Genitourinary Oncology, Urologic Oncology Program, UNC Lineberger Comprehensive Cancer Center, 3rd Floor Physician's Office Building, 170 Manning Drive, Chapel Hill, NC 27599, USA
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284
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Chong TW, Balch GC, Kehoe SM, Margulis V, Saint-Cyr M. Reconstruction of Large Perineal and Pelvic Wounds Using Gracilis Muscle Flaps. Ann Surg Oncol 2015; 22:3738-44. [DOI: 10.1245/s10434-015-4435-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Indexed: 11/18/2022]
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285
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Slesser AAP, Khan F, Chau I, Khan AZ, Mudan S, Tekkis PP, Brown G, Rao S. The effect of a primary tumour resection on the progression of synchronous colorectal liver metastases: an exploratory study. Eur J Surg Oncol 2015; 41:484-92. [PMID: 25638603 DOI: 10.1016/j.ejso.2014.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 12/16/2022] Open
Abstract
AIM The objective of this study was to determine the effect of an upfront primary tumour resection on the progression of synchronous colorectal liver metastases. MATERIALS AND METHODS Patients with synchronous colorectal liver metastases referred between 2005 and 2010 were identified. Patients were analysed according to the following two groups: 1) an upfront primary tumour resection and 2) neo-adjuvant chemotherapy. A univariate and multivariate analysis was performed to identify factors significantly contributing to progressive disease. Cox regression analysis was undertaken to determine the effect of management on overall survival (OS) and time to tumour progression (TTP). RESULTS A total of 116 patients with synchronous colorectal liver metastases were identified of which 49 patients received an upfront primary tumour resection and 67 received neo-adjuvant chemotherapy. Liver resections were performed in 18 (36.7%) and 14 (20.9%) of the patients in the upfront and neo-adjuvant groups respectively (P 0.06). On multivariate analysis, an upfront primary tumour resection significantly affected progressive disease (p < 0.001, OR 5.67; 95% CI 2.71-11.79). An upfront tumour resection was not a significant predictor of overall survival (P = 0.83; HR 1.10; 95% CI 0.48-2.52). CONCLUSION Our findings suggest that an upfront primary tumour resection in patients with synchronous colorectal liver metastases results in progressive disease. These preliminary findings need to be validated in a future multi-centre independent study.
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Affiliation(s)
- A A P Slesser
- Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK
| | - F Khan
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - I Chau
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - A Z Khan
- Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK
| | - S Mudan
- Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK
| | - P P Tekkis
- Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK
| | - G Brown
- Department of Radiology, The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK; Division of Medicine, Imperial College London, UK.
| | - S Rao
- Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
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Lee SL, Dempsey-Hibbert NC, Vimalachandran D, Wardle TD, Sutton P, Williams JHH. Targeting Heat Shock Proteins in Colorectal Cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-3-319-17211-8_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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287
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Dahl O, Pfeffer F. Twenty-five years with adjuvant chemotherapy for colon cancer--a continuous evolving concept. Acta Oncol 2015; 54:1-4. [PMID: 25263079 DOI: 10.3109/0284186x.2014.958533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Olav Dahl
- Section of Oncology, Institute of Clinical Science, MOF, University of Bergen and Department of Oncology, Haukeland University Hospital , Haukeland , Norway
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Chen CY, Hsu JS, Jaw TS, Wu DC, Shih MCP, Lee CH, Kuo CH, Chen YT, Lai ML, Liu GC. Utility of the iodine overlay technique and virtual nonenhanced images for the preoperative T staging of colorectal cancer by dual-energy CT with tin filter technology. PLoS One 2014; 9:e113589. [PMID: 25469775 PMCID: PMC4254464 DOI: 10.1371/journal.pone.0113589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/12/2014] [Indexed: 01/28/2023] Open
Abstract
Objectives To evaluate the diagnostic accuracy and the potential radiation dose reduction of dual-energy CT (DECT) for tumor (T) staging of colorectal cancer (CRC) using iodine overlay (IO) and virtual nonenhanced (VNE) images. Materials and Methods This retrospective study included 103 consecutive patients who underwent nonenhanced CT and enhanced DECT for preoperative CRC staging. Enhanced weighted-average (WA), IO and VNE images were reconstructed from enhanced 80 kVp and Sn140 kVp scans. Two radiologists assessed image qualities of the true nonenhanced (TNE) and VNE images. For T-staging, another two radiologists independently interpreted all scans in two separate reading sessions: in the first session, only images derived from the single phase DECT acquisition (IO and VNE images) were read. In the second reading session after 30 to 50 (average:42) days, the same assessment was again performed with the TNE and enhanced WA images thereby simulating conventional dual-phase single-energy CT. The tumor node metastasis (TNM) system was used for staging with histopathologic reports as gold standard. Analysis of variance was used for statistical analysis. Results The signal-to-noise ratios (SNRs) of the tumors and normal reference tissues showed significant correlation between the TNE and VNE images (P<0.01). The mean iodine overlay value (48.4 HU±12.2) and enhancement (49.4 HU±11.8) value of CRCs had no significant difference (P = 0.52).The mean image noise on TNE (5.0±1.1) and VNE (5.3±1.1) images were similar (P = 0.07). The quantitative qualities of the VNE images were mildly inferior to the TNE images. Overall accuracy of T-stage CRC when using single-phase acquisition was slightly better than the dual-phase acquisition (90.3% vs 87.4%) (P = 0.51). The mean dose of the single-phase DECT acquisition was 6.2mSv comparing with 14.3mSv of dual-phase. Conclusion Single-phase DECT using IO and VNE images yields a high accuracy in T-staging of CRCs. Thereby, the radiation exposure of the patients can be reduced.
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Affiliation(s)
- Chiao-Yun Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jui-Sheng Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Lai Lai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gin-Chung Liu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- * E-mail:
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Huang L, Li TJ, Zhang JW, Liu S, Fu BS, Liu W. Neoadjuvant chemotherapy followed by surgery versus surgery alone for colorectal cancer: meta-analysis of randomized controlled trials. Medicine (Baltimore) 2014; 93:e231. [PMID: 25526442 PMCID: PMC4603078 DOI: 10.1097/md.0000000000000231] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Effects of neoadjuvant chemotherapy (NAC) on colorectal cancer (CRC) have been largely studied, while its survival and surgical benefits remain controversial. This study aimed to perform a meta-analysis of randomized controlled trials (RCTs), comparing efficacy and safety of NAC plus surgery with surgery alone (SA) for CRC. We searched systematically databases of MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing NAC and surgery with SA for treating CRC. References of relevant articles and reviews, conference proceedings, and ongoing trial databases were also screened. Primary outcomes included overall and disease-free survivals, total and perioperative mortalities, recurrence, and metastasis. Meta-analysis was performed where possible comparing parameters using relative risks (RRs). Safely analysis was then performed. Outcomes for stages II and III tumors were also meta-analyzed, respectively. Our study was conducted according to intention-to-treat analysis. A total of 6 RCTs comparing NAC (n=1393) with SA (n=1358) published from 2002 to 2012 were identified. Compared with SA, NAC tended to reduce overall recurrences (21.86% vs 25.15%, RR: 0.70, 95% confidence interval [CI]: 0.32-1.56, P=0.09), and prevent vascular invasion (32.30% vs 43.12%, RR: 0.73, 95% CI: 0.53-1.00, P=0.05); and significantly lowered distant metastasis (15.58% vs 23.80%, RR: 0.66, 95% CI: 0.50-0.86, P=0.002), especially liver metastasis rate (13.00% vs 18.25%, RR: 0.71, 95% CI: 0.51-0.99, P=0.04), and associated with higher incidence of ypT0-2 cases upon resection (13.04% vs 6.42%, RR: 2.36, 95% CI: 1.02-5.44, P=0.04). All other parameters were comparable. NAC-related side-effects were generally mild. NAC mainly benefited patients with stage III disease. NAC could prevent recurrence and metastasis, associates with better tumor stages upon resection, and potentially impedes vascular invasion among CRC patients. NAC does not contribute to significant survival benefits for CRC, and compares favorably with SA in tumor-free resection rates, nodal status upon resection, and postsurgical complications. This level 1a evidence does not support NAC to obviously outweigh SA in terms of survival and surgical benefits for CRC currently.
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Affiliation(s)
- Lei Huang
- From the Guangdong Provincial Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China (LH, TJL, WL); Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China (LH); Organ Transplantation Center, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China (BSF, JWZ)
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Zhou Z, Nimeiri HS, Benson AB. Preoperative chemotherapy for locally advanced resectable colon cancer - a new treatment paradigm in colon cancer? ANNALS OF TRANSLATIONAL MEDICINE 2014; 1:11. [PMID: 25332956 DOI: 10.3978/j.issn.2305-5839.2013.01.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/05/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Zheng Zhou
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL. 60611, USA
| | - Halla S Nimeiri
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL. 60611, USA
| | - Al B Benson
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL. 60611, USA
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291
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Killeen S, Mannion M, Devaney A, Winter DC. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 2014; 16:577-94. [PMID: 24655722 DOI: 10.1111/codi.12616] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/09/2014] [Indexed: 12/12/2022]
Abstract
AIM Complete mesocolic excision (CME) and extended lympha-denectomy (EL) have been proposed as safe procedures for improving colon cancer survival outcomes. The aim of this study was to evaluate the evidence regarding oncological outcomes, morbidity and mortality after such techniques for colon cancer. METHOD A systematic review of the literature was conducted to evaluate evidence regarding oncological outcomes, morbidity and mortality after CME or EL. Three major databases (PubMed, MEDLINE and the Cochrane Library) were searched. The review included original articles reporting outcomes after CME or EL from January 1950 to July 2012. RESULTS Twenty-one, predominately retrospective, studies involving 5246 patients (mean age 68.2 years, 56.5% men) were included. Reporting of outcomes was inconsistent. Median follow up was 60 months. The operative mortality rate was 3.2% and the cumulative morbidity rate was 21.5%. The weighted mean local recurrence rate and the 5-year overall and disease-free survival rates were 4.5%, 58.1% and 77.4%, respectively. CONCLUSION The available data for CME and EL have numerous fundamental limitations that prohibit adoption. Contemporary controlled studies are required before universal recommendation.
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Affiliation(s)
- S Killeen
- Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
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292
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Risk/benefit profile of panitumumab-based therapy in patients with metastatic colorectal cancer: evidence from five randomized controlled trials. Tumour Biol 2014; 35:10409-18. [PMID: 25053599 DOI: 10.1007/s13277-014-2354-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/14/2014] [Indexed: 12/18/2022] Open
Abstract
This study aims to evaluate the risk and benefit profiles of panitumumab-based therapy (PBT) in patients with metastatic colorectal cancer (mCRC). Relevant randomized controlled trials were identified by searching PubMed, Medline, EMBASE and Cochrane Library. Data on progression-free survival (PFS), overall survival (OS), all grade and severe (grade ≥3) adverse events were extracted and pooled to calculate hazard ratios (HRs) and risk ratios (RRs) with 95 % confidence intervals (CIs). Number needed to treat (NNT) for PFS and number needed to harm (NNH) for significantly changed toxicities were calculated. A total of 4,155 patients were included in the analysis. PBT significantly improved PFS (HRrandom = 0.66, 95 % CI = 0.45-0.95) but not OS (HRfixed = 0.93, 95 % CI = 0.83-1.04) when used in the subsequent-line setting. The effect on PFS was more evident in patients with wild-type KRAS (HRrandom = 0.64, 95 % CI = 0.47-0.87) and the NNT for PFS is 11 to 23at 1 year. PBT did not benefit patients when used in the first-line setting. In addition, PBT significantly increased the risk of skin toxicity, infections, diarrhea, dehydration, mucositis, hypokalemia, fatigue, hypomagnesemia, pulmonary embolism and paronychia. The NNHs for skin toxicity, diarrhea, infection, hypokalemia and mucositis are less than 23. In conclusion, when used in the subsequent-line setting, PBT can improve the disease progression, especially in mCRC patients with wild-type KRAS. Regarding the adverse events associated with the PBT, close monitoring and necessary preparations are recommended during the therapy.
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293
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Differentiation of poorly differentiated colorectal adenocarcinomas from well- or moderately differentiated colorectal adenocarcinomas at contrast-enhanced multidetector CT. ACTA ACUST UNITED AC 2014; 40:1-10. [DOI: 10.1007/s00261-014-0176-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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294
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Eveno C, Lefevre JH, Svrcek M, Bennis M, Chafai N, Tiret E, Parc Y. Oncologic results after multivisceral resection of clinical T4 tumors. Surgery 2014; 156:669-75. [PMID: 24953279 DOI: 10.1016/j.surg.2014.03.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 03/26/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard operative management of colorectal cancer (CRC) with adherent adjacent organs is en bloc resection to obtain clear resection margins. We analyzed early and long-term outcomes after multivisceral resection for clinically suspected T4 CRC and identified factors predicting survival. METHODS All patients operated on for clinically suspected T4 CRC between 2000 and 2010 were identified retrospectively. Data concerning demographics, surgery, pathologic examination and oncologic outcome were analyzed. RESULTS One hundred fifty-two patients underwent partial or total en bloc resection of ≥1 adherent organ. An R0 resection was achieved in 136 patients (89.5%). Malignant invasion of the adherent organ was histologically confirmed in 98 patients (64.5%). Five-year overall survival and disease-free survival rates were 77.4% and 58.1%, respectively. On univariate analysis, margin positivity, pT4 stage, and lymph node invasion were predictors of a worse disease-free survival. The presence of liver metastases and concomitant hepatectomy were both factors of poor overall and disease-free survival. On multivariate analysis, resection of ≥2 adjacent organs was a predictor of better overall survival. This finding may be explained by the significantly higher rate of tumors with microsatellite instability (MSI) in the group with resection of multiple organs. CONCLUSION The oncologic outcome of multivisceral resection for clinically suspected colorectal T4 tumors was good, especially in MSI patients and patients without liver metastases. The number of organs requiring resection should not contraindicated radical surgery as in this study it was associated with a good prognosis.
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Affiliation(s)
- Clarisse Eveno
- Department of Digestive Surgery (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Jeremie H Lefevre
- Department of Digestive Surgery (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France.
| | - Magali Svrcek
- Department of Pathology (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Malika Bennis
- Department of Pathology (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Najim Chafai
- Department of Digestive Surgery (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Emmanuel Tiret
- Department of Digestive Surgery (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Yann Parc
- Department of Digestive Surgery (AP-HP), Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
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295
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Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study. ACTA ACUST UNITED AC 2014; 39:941-8. [DOI: 10.1007/s00261-014-0150-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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296
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297
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Buczacki SJA, Davies RJ. The confounding effects of tumour heterogeneity and cellular plasticity on personalized surgical management of colorectal cancer. Colorectal Dis 2014; 16:329-31. [PMID: 24661415 DOI: 10.1111/codi.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/16/2014] [Indexed: 12/14/2022]
Affiliation(s)
- S J A Buczacki
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.
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298
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Arredondo J, Martínez P, Baixauli J, Pastor C, Rodríguez J, Pardo F, Rotellar F, Chopitea A, Hernández-Lizoáin JL. Analysis of surgical complications of primary tumor resection after neoadjuvant treatment in stage IV colon cancer. J Gastrointest Oncol 2014; 5:148-53. [PMID: 24772343 DOI: 10.3978/j.issn.2078-6891.2014.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Assess the surgical complications of primary tumor resection in stage IV colon cancer patients previously treated with neoadjuvant chemotherapy. METHODS Between July 2001 and September 2010, 67 consecutive patients received preoperative chemotherapy. Clinical and surgical complications were obtained from the medical records. This study was retrospective in design. RESULTS All patients were affected with liver metastasis, and 29.8% had metastasis in additional organs. Three different schemes of preoperative chemotherapy were employed, based on FOLFIRI, XELOXIRI or XELOX plus cetuximab. Eighteen patients (26.8%) reported some side effects to the chemotherapy, without contraindicating any intervention. All patients underwent colon surgery and within those, eight patients (11.9%), underwent liver surgery simultaneously. Median hospital admission was 8 [3-29] days. The perioperative complication rate was 16.2%, when the estimated physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) was 58.3%. There was not perioperative mortality, despite the mortality prediction for Portsmouth-POSSUM (P-POSSUM) being 5.07%. No differences were observed between the chemotherapy regimen (P=0.72) or the kind of the surgery-simple or combined (P=0.58). CONCLUSIONS Neoadjuvant chemotherapy as a systemic treatment for stage IV colon cancer does not indicate surgery contraindication nor increases postoperative morbimortality by a significant amount.
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Affiliation(s)
- Jorge Arredondo
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Patricia Martínez
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Jorge Baixauli
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Carlos Pastor
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Javier Rodríguez
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Fernando Pardo
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Fernando Rotellar
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - Ana Chopitea
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
| | - José Luís Hernández-Lizoáin
- 1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain
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299
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Arredondo J, González I, Baixauli J, Martínez P, Rodríguez J, Pastor C, Ribelles MJ, Sola JJ, Hernández-Lizoain JL. Tumor response assessment in locally advanced colon cancer after neoadjuvant chemotherapy. J Gastrointest Oncol 2014; 5:104-11. [PMID: 24772338 DOI: 10.3978/j.issn.2078-6891.2014.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preoperative chemotherapy followed by radical surgery is a novel therapeutic approach for locally advanced colon cancer (LACC). Neoadjuvant strategies require highly accurate diagnostic tests for a proper selection of candidate patients, allowing a low risk of overtreatment. This paper assesses the radiological, metabolic and pathological findings induced by preoperative oxaliplatin and fluoropyrimidines-based chemotherapy in LACC. METHODS Forty-four consecutive patients with a confirmed diagnosis of LACC who received neoadjuvant chemotherapy and colon surgery were included. All patients were staged at baseline and before surgery. Clinical diagnosis consisted of physical examination, endoscopy with biopsy and computed tomography (CT) scan. In selected cases, a positron emission tomography/CT (PET/CT) scan was also performed. Accuracy and correlations between CT scan findings and pathologic report was assayed for T stage, N stage and TN stage. This study is retrospective in design. RESULTS After chemotherapy, a statistical significant tumor volume reduction of 62.5% was achieved by CT-scan (P<0.001; Wilcoxon test) and a 38.9% decrease of standard uptake value (SUVmax) was observed on PET/CT (P=0.004). No progressive disease was reported during neoadjuvant treatment. Accuracy for T and N classification was 62% and 87%, respectively. Accuracy for TN stage was 77%, with 13.6% and 9.1% of the patients being under or overstaged, respectively. Pathologic stage II and III disease was observed in 29/44 (65.9%) and 15/44 (34.1%) of the patients, respectively. Pathologic complete response was achieved in three patients. CONCLUSIONS Oxaliplatin/fluorpyrimidine neoadjuvant chemotherapy induces major tumour shrinkage at both the pathological and radiological levels. The CT scan shows a high accuracy and a low overstaged rate in LACC patients treated by means of a neoadjuvant approach.
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Affiliation(s)
- Jorge Arredondo
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ignacio González
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Baixauli
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Patricia Martínez
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Rodríguez
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carlos Pastor
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Jesús Ribelles
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jesús Javier Sola
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José Luís Hernández-Lizoain
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
More than 1·2 million patients are diagnosed with colorectal cancer every year, and more than 600,000 die from the disease. Incidence strongly varies globally and is closely linked to elements of a so-called western lifestyle. Incidence is higher in men than women and strongly increases with age; median age at diagnosis is about 70 years in developed countries. Despite strong hereditary components, most cases of colorectal cancer are sporadic and develop slowly over several years through the adenoma-carcinoma sequence. The cornerstones of therapy are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from greater than 90% in patients with stage I disease to slightly greater than 10% in patients with stage IV disease. Screening has been shown to reduce colorectal cancer incidence and mortality, but organised screening programmes are still to be implemented in most countries.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
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