Comparison of the effectiveness of integrative immunomodulatory treatments and conventional therapies on the survival of selected gastrointestinal cancer patients

In the last decade, the use of immunomodulating treatments (IMT) at integrative oncology providers (IOP) increased. IMTs are used to modulate the tumor microenvironment, which might lead to increased response-to-treatment, and the indication of immune checkpoint inhibitors might also be widened. The efficacy and safety of IMTs in advanced/metastatic gastrointestinal cancers were compared with conventional chemo(radio)therapy (CT). 21 colorectal- (CRC), 14 pancreatic- (PC), 5 cholangiocellular- (CCC), 5 gastric- (GC) and 4 esophageal cancer (EC) patients received IMT. IMT and CT were compared in CRC and PC. CT was administered at an academic oncology center. After the initiation of IMT, a median survival of ~ 20 (CRC, PC and EC) and ~ 10 months (CCC and GC) was observed. Of the IMTs, locoregional modulated electro-hyperthermia had the most positive effect on overall survival (HR: 0.3055; P = 0.0260), while fever-inducing interleukin-2, and low-dose ipilimumab showed a positive tendency. IMT was superior to CT in PC (HR: 0.1974; P = 0.0013), while modest effect was detected in CRC (HR: 0.7797; P = 0.4710). When the whole study population was analyzed, IMTs showed minimal effect on patient survival, still CT had the greatest effect if introduced as early as possible (HR: 0.0624; P < 0.0001). The integrative IMTs in the presented form have mild impact on gastrointestinal cancer patients' survival, however, we observed its benefit in PC, which warrants further investigations.

Influence of the duration of type 2 diabetes mellitus on colorectal cancer outcomes

Type 2 diabetes mellitus (T2DM) is a progressive disease, which affects colorectal cancer (CRC) survival. However, data on the relationship between CRC survival and T2DM duration is scarce and controversial. A retrospective observational study was conducted. Sub-cohorts were created based on the duration of T2DM as follows, ≤ or > 5/10/15/20 years. 204 of the 817 (24.95%) included study participants had T2DM at any point of CRC. 160 of the 204 CRC + T2DM patients had detailed T2DM duration data. At the time of CRC diagnosis, 85, 50, 31, and 11 patients had T2DM for > 5/10/15/20 years, respectively, which increased to 110, 71, 45, and 17 during the course of the study. Despite constant glycated hemoglobin values throughout the study, shorter overall and disease-specific survival times were observed for the > 5/10/15 years cohorts and longitudinal survival modeling techniques confirmed the significant effect of T2DM duration in all cohorts. While in the first 3 years after CRC diagnosis, the best survival was found for the ≤ 5 years cohort, all diabetes cohorts had the same survival thereafter. T2DM duration affected CRC survival significantly, therefore, a closer follow-up of this sub-populations is suggested.

Long-term results of radiologic placement of a central vein access device

OBJECTIVE

We describe our long-term experience with radiologic implantation of the Peripheral Access System (PAS) Port venous access device. Technical efficacy and complications are documented and compared with surgical and radiologic series involving other long-term venous access devices.

SUBJECTS AND METHODS

Fifty-two PAS-Port catheters were implanted in 51 patients during a 30-month period. All procedures took place in the angiography suite and were performed by interventional radiologists with imaging guidance. Patients were followed up through the oncology clinic or the clinic that originally referred the patient. The durability of the catheter was evaluated, and complications were recorded during the study period.

RESULTS

Fifty-two ports have been indwelling for a total of 18,357 patient-days. The mean time of implantation was 372 days, with a range of 30-825 days. Technical success in implanting the device was 100%. Device-related sepsis occurred in one patient (2%), superficial thrombophlebitis in one patient (2%), skin site dehiscence in one patient (2%), and deep vein thrombosis in one patient (2%). No instances of catheter occlusion occurred, and all catheters retained the ability to aspirate blood throughout their use. The overall complication rate was 8% (0.22/1000 patient days).

CONCLUSION

Radiologic placement of this device is safe and effective. It offers many patients a superior alternative to surgically implanted chest wall ports. Complications are fewer, and chances for technical success are greater. In circumstances where cosmesis is deemed highly important, the PAS-Port device may be preferable to tunneled venous access catheters.