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Vesa V, Jaana M, Ia K, Anu C, Heikki M, Raija R, Annika Å, Eetu H. Short-course preoperative radiotherapy increases pelvic fracture risk in rectal cancer. Clin Transl Radiat Oncol 2023; 42:100656. [PMID: 37457020 PMCID: PMC10339188 DOI: 10.1016/j.ctro.2023.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/10/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Pelvic insufficiency fractures (PIFs) are adverse events associated with chemoradiotherapy (CRT) administered preoperatively in rectal cancer, with incidences of 0-33.6% reported in the literature. Data on PIFs after 5 × 5 Gy fractionated short-course radiotherapy (SCRT) using highly conformal radiotherapy techniques such as volumetric modulated arc therapy (VMAT) is limited. Methods The Turku University Hospital colorectal cancer database was searched for patients operated on for stage I-III rectal cancer during the years 2014-2018. The hospital's routine follow-up includes a 2-year computed tomography (CT) scan, which was systemically re-evaluated to detect PIFs. Only radiotherapy delivered using VMAT and image-guided approaches was included. Baseline demographics, tumor data, and dose-volume data were collected to identify risk factors for PIFs. Results Median time to CT scan was 24 months. Among the 164 patients analyzed, the 2-year PIF incidence was 22.2% for SCRT (n = 12/54, OR 9.1 (CI95% 1.9-42.9), p = 0.004), 9.1% for CRT (n = 4/44, OR 3.2 (CI95% 0.6-18.3), p = 0.13) and 3.0% (n = 2/66, reference) for those operated on without radiotherapy. The PIF incidence was not explained by differences in dose-volume data in either the SCRT or CRT groups. Fracture risk was higher in women, up to 50% after SCRT. Conclusions Every fifth patient treated with SCRT and rectal surgery presented with a PIF. Critical bony structures to be avoided during radiotherapy contouring could not be identified. Clinicians, especially those involved with the follow-up of rectal cancer, should be aware of this potentially debilitating and surprisingly common adverse event.
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Affiliation(s)
- Väliaho Vesa
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
| | - Mäkitalo Jaana
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
- Department of Medical Physics, Turku University Hospital, Hämeentie 11, Turku 20521, Finland
| | - Kohonen Ia
- Medicity Research Laboratory, University of Turku, Tykistökatu 6A, Turku 20520, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Hämeentie 11, Turku 20521, Finland
| | - Carpelan Anu
- Department of Digestive Surgery, Turku University Hospital and University of Turku, Kiinamyllynkatu 4–8, Turku 20521, Finland
| | - Minn Heikki
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
| | - Ristamäki Raija
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
| | - Ålgars Annika
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
| | - Heervä Eetu
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, Turku 20521, Finland
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Carpelan A, Elamo E, Karvonen J, Varpe P, Elamo S, Vahlberg T, Grönroos J, Huhtinen H. Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different lars severity groups. Scand J Surg 2021; 110:414-419. [PMID: 32552563 PMCID: PMC8551436 DOI: 10.1177/1457496920930142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Low anterior resection syndrome is common after anterior resection for rectal cancer. Its severity can be tested with the low anterior resection syndrome score. We have translated the low anterior resection syndrome score to Finnish, and the aim of this study is to validate the translation. MATERIALS AND METHODS The translated Finnish low anterior resection syndrome score and European Organisation for Research and Treatment of Cancer quality-of-life questionnaire-C30 and QLQ-CR29 questionnaires were sent to 159 surviving patients operated with anterior resection for rectal adenocarcinoma between 2007 and 2014 in a tertiary referral center. Psychometric properties of the translation were evaluated in comparison to quality-of-life scales and in different risk factor groups. RESULTS In the study, 104 (65%) patients returned the questionnaires. Of these, 56 (54%) had major low anterior resection syndrome, 26 (25%) had minor low anterior resection syndrome, and 22 (21%) had no low anterior resection syndrome. Patients with major low anterior resection syndrome had a significantly lower quality of life and more defecatory symptoms as assessed with the European Organisation for Research and Treatment of Cancer questionnaires compared with those with no low anterior resection syndrome. Patients operated with total mesorectal excision had significantly higher low anterior resection syndrome scores compared with those operated with partial mesorectal excision (median/interquartile range 32/15 and 29/11, respectively, p = 0.037). The test-retest validity of the translation was good with an intraclass correlation coefficient of 0.77 (95% confidence interval 0.51-0.90). CONCLUSIONS The Finnish low anterior resection syndrome score is a valid test in the assessment of postoperative bowel function and its impact on the quality of life. It can be implemented to use during regular follow-up visits of Finnish-speaking rectal cancer patients.
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Affiliation(s)
- Anu Carpelan
- Department of Digestive Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Eeva Elamo
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Jukka Karvonen
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Pirita Varpe
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Sami Elamo
- Department of Orthopaedics, Satakunta Central Hospital, Pori, Finland and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Juha Grönroos
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Heikki Huhtinen
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
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Heervä E, Väliaho V, Salminen T, Nieminen L, Carpelan A, Kurki S, Sundström J, Huhtinen H, Rantala A, Carpén O, Minn H, Österlund P, Ålgars A, Ristamäki R. An easily adaptable validated risk score predicts cancer-specific survival in stage II colon cancer. Acta Oncol 2020; 59:1503-1507. [PMID: 33044880 DOI: 10.1080/0284186x.2020.1831062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Eetu Heervä
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Vesa Väliaho
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tapio Salminen
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Lasse Nieminen
- Department of Pathology, Fimlab Laboratories, Tampere University, Tampere, Finland
- Department of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anu Carpelan
- Department of Digestive Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Jari Sundström
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Heikki Huhtinen
- Department of Digestive Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Arto Rantala
- Department of Digestive Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Olli Carpén
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pathology and Research Program in Systems Oncology, University of Helsinki and Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Minn
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pia Österlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Annika Ålgars
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
- Medicity Research Laboratory, University of Turku, Turku, Finland
| | - Raija Ristamäki
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
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CDX2 Loss With Microsatellite Stable Phenotype Predicts Poor Clinical Outcome in Stage II Colorectal Carcinoma. Am J Surg Pathol 2020; 43:1473-1482. [PMID: 31490234 DOI: 10.1097/pas.0000000000001356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Current risk factors in stage II colorectal carcinoma are insufficient to guide treatment decisions. Loss of CDX2 has been shown to associate with poor clinical outcome and predict benefit for adjuvant chemotherapy in stage II and III colorectal carcinoma. The prognostic relevance of CDX2 in stage II disease has not been sufficiently validated, especially in relation to clinical risk factors, such as microsatellite instability (MSI) status, BRAF mutation status, and tumor budding. In this study, we evaluated the protein expression of CDX2 in tumor center and front areas in a tissue microarrays material of stage II colorectal carcinoma patients (n=232). CDX2 expression showed a partial or total loss in respective areas in 8.6% and 10.9% of patient cases. Patients with loss of CDX2 had shorter disease-specific survival when scored independently either in tumor center or tumor front areas (log rank P=0.012; P=0.012). Loss of CDX2 predicted survival independently of other stage II risk factors, such as MSI status and BRAF mutation status, pT class, and tumor budding (hazard ratio=5.96, 95% confidence interval=1.55-22.95; hazard ratio=3.70, 95% confidence interval=1.30-10.56). Importantly, CDX2 loss predicted inferior survival only in patients with microsatellite stable, but not with MSI-high phenotype. Interestingly, CDX2 loss associated with low E-cadherin expression, tight junction disruption, and high expression of ezrin protein. The work demonstrates that loss of CDX2 is an independent risk factor of poor disease-specific survival in stage II colorectal carcinoma. Furthermore, the study suggests that CDX2 loss is linked with epithelial-to-mesenchymal transition independently of tumor budding.
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