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Joseph K, Al Habsi Z, Abraham A, Elangovan A, Ghosh S, Pham T, Shreekumar D, Ramji Z, Paulson K, Tankel K, Usmani N, Severin D, Schiller D, Wong C, Mulder K, Karachiwala H, Doll C, King K, Nijjar T. A population-based analysis of the impact of 1 vs. 2 doses of mitomycin on patterns of failure of anal cancer patients treated with concurrent chemoradiotherapy. Radiother Oncol 2024; 196:110219. [PMID: 38479443 DOI: 10.1016/j.radonc.2024.110219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE We report the impact of 1 vs. 2 doses of mitomycin-C (MMC) based chemoradiation (CRT) on patterns of treatment failure and long-term patient outcomes in anal squamous cell carcinoma (ASCC) and the predictors for locoregional failure (LRF) and distant metastasis (DM). METHODS In this population-based study, we identified all patients with anal cancer in our province treated radically with radiation and concurrent 5-Fluorouracil (5FU) and 1 vs. 2 doses of MMC between the years 2000-2019. The primary outcomes analyzed were locoregional recurrence (LRR), disease free survival (DFS), ASCC cancer-specific survival (ASCC-CSS) and overall survival (OS). RESULTS 451 patients were identified. 272 (60%) patients received 1 cycle of MMC (MMC1) and 179 (40%) received 2 cycles (MMC2) as part of the CRT regimen. The median follow-up was 57 (36-252) and 97 (38-239) months for MMC1 and MMC2, respectively. Cox Regression analysis showed stage IIIb and IIIc were associated with worse locoregional recurrence free survival (RFS) (HR=2.851, p=<0.001) and distant RFS (HR=3.391, p=<0.001). Similarly, stage IIIb and IIIc patients had poorer DFS (HR 3.439, p=<0.001), ASCC-SS (HR 3.729, p=<0.001) and OS (2.230, p=<0.001). The use of MMC2 showed a positive impact on improved ASCC-SS (HR 0.569, p=0.029) and distant RFS (HR 0.555, p=0.040) in patients with stage IIIb and IIIc. CONCLUSIONS Our analysis showed that 1 vs. 2 cycles of MMC along with 5FU and radiation is associated with comparable treatment outcomes in general. However, in patients with stage IIIb and IIIc cancer, 2 doses of MMC were associated with improved ASCC-SS and distant DFS.
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Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada.
| | - Zainab Al Habsi
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Aswin Abraham
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada.
| | - Arun Elangovan
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
| | - TruongMinh Pham
- Cancer Research & Analytics, Alberta health services, Edmonton, Alberta, Canada
| | | | | | - Kim Paulson
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Diane Severin
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Dan Schiller
- Department of Surgical Oncology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Clarence Wong
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen Mulder
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Hatim Karachiwala
- Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Corinne Doll
- Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Karen King
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
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Boarini LR, Sobrado CW, Mota GR, Villa LL, de Albuquerque IC, Queiroz NSF, Facanali CBG, Nadal SR, Cecconello I. Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV in the anorectal fistula tract. A comparative study. Clinics (Sao Paulo) 2023; 78:100219. [PMID: 37257365 PMCID: PMC10244904 DOI: 10.1016/j.clinsp.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND & AIMS Perianal fistulizing Crohn's disease is the main risk factor for anal cancer in patients with inflammatory bowel disease. Whether this occurs due to a higher frequency of human papillomavirus remains unclear. The authors aimed to evaluate the prevalence of HPV and high-risk HPV in patients with perianal Crohn's disease, compared with a control group. METHODS The authors conducted a two-center cross-sectional study in which perianal fistulizing Crohn's disease patients were matched for age and sex with patients with anorectal fistula without Crohn's disease. Biopsy specimens were obtained from fistulous tracts during examination under anesthesia for both groups. The samples were sent for HPV detection and genotyping using the INNO-LiPA test. RESULTS A total of 108 subjects (54 in each group) were recruited. The perianal fistulizing Crohn's disease group showed a statistically higher frequency of HPV in the fistulous tract than the control group (33.3% vs. 16.7%; p = 0.046). Separate analyses on high-risk types demonstrated that there was a numerically higher frequency of HPV in the perianal fistulizing Crohn's disease group. In multiple logistic regression, patients with perianal fistulizing Crohn's disease were found to have a chance of HPV 3.29 times higher than patients without Crohn's disease (OR = 3.29; 95% CI 1.20‒9.01), regardless of other variables. The types most frequently identified in the perianal fistulizing Crohn's disease group were HPV 11 (12.96%) and HPV 16 (9.26%). CONCLUSION Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV than in patients with anorectal fistula without Crohn's disease.
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Affiliation(s)
- Lucas Rodrigues Boarini
- Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carlos Walter Sobrado
- Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giana Rabello Mota
- Centro de Investigação Translacional em Oncologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luisa Lina Villa
- Centro de Investigação Translacional em Oncologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Natalia Sousa Freitas Queiroz
- Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Ivan Cecconello
- Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Principe DR, Cataneo JL, Timbers KE, Koch RM, Valyi-Nagy K, Mellgren A, Rana A, Gantt G. Leukocyte subtyping predicts for treatment failure and poor survival in anal squamous cell carcinoma. BMC Cancer 2022; 22:697. [PMID: 35751111 PMCID: PMC9229146 DOI: 10.1186/s12885-022-09742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anal squamous cell carcinoma (SCC) generally carries a favorable prognosis, as most tumors are highly sensitive to standard of care chemoradiation. However, outcomes are poor for the 20–30% of patients who are refractory to this approach, and many will require additional invasive procedures with no guarantee of disease resolution. Methods To identify the patients who are unlikely to respond to the current standard of care chemoradiation protocol, we explored a variety of objective clinical findings as a potential predictor of treatment failure and/or mortality in a single center retrospective study of 42 patients with anal SCC. Results Patients with an increase in total peripheral white blood cells (WBC) and/or neutrophils (ANC) had comparatively poor clinical outcomes, with increased rates of death and treatment failure, respectively. Using pre-treatment biopsies from 27 patients, tumors with an inflamed, neutrophil dominant stroma also had poor therapeutic responses, as well as reduced overall and disease-specific survival. Following chemoradiation, we observed uniform reductions in nearly all peripheral blood leukocyte subtypes, and no association between peripheral white blood cells and/or neutrophils and clinical outcomes. Additionally, post-treatment biopsies were available from 13 patients. In post-treatment specimens, patients with an inflamed tumor stroma now demonstrated improved overall and disease-specific survival, particularly those with robust T-cell infiltration. Conclusions Combined, these results suggest that routinely performed leukocyte subtyping may have utility in risk stratifying patients for treatment failure in anal SCC. Specifically, pre-treatment patients with a high WBC, ANC, and/or a neutrophil-dense tumor stroma may be less likely to achieve complete response using the standard of care chemoradiation regimen, and may benefit from the addition of a subsequent line of therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09742-7.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Surgery, University of Illinois at Chicago, IL, Chicago, USA
| | - Jose L Cataneo
- Department of Surgery, University of Illinois at Chicago, IL, Chicago, USA
| | - Kaytlin E Timbers
- Department of Surgery, University of Illinois at Chicago, IL, Chicago, USA
| | - Regina M Koch
- Department of Surgery, University of Illinois at Chicago, IL, Chicago, USA
| | - Klara Valyi-Nagy
- Department of Pathology, University of Illinois at Chicago, IL, Chicago, USA
| | - Anders Mellgren
- Department of Surgery, Division of Colorectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ajay Rana
- Department of Surgery, University of Illinois at Chicago, IL, Chicago, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Gerald Gantt
- Department of Surgery, Division of Colorectal Surgery, University of Illinois at Chicago, Chicago, IL, USA.
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Plotzker RE, Barnell GM, Wiley DJ, Stier EA, Jay N. Provider Preferences for Anal Cancer Prevention Screening: Results of the International Anal Neoplasia Society Survey. Tumour Virus Res 2022; 13:200235. [PMID: 35183808 PMCID: PMC9006639 DOI: 10.1016/j.tvr.2022.200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
Objective This study explores provider preferences regarding anal cancer screening indications, initiation age, tools, and referral threshold to high resolution anoscopy (HRA). Methods International Anal Neoplasia Society affiliates were invited to complete an online survey. Options for initiation age and tools were delineated by sub-groups. HRA referral thresholds separately queried recommendations by patient immune status. Results One hundred forty respondents participated. Although consensus was lacking with regard to specific screening initiation age, more respondents recommended younger initiation ages for men who have sex with men (MSM) living with HIV (LWH) compared with MSM not LWH (p < 0.01). “No age threshold” ranged 44-55% among sub-groups with lower genital tract disease. Cytology and digital anorectal exam (DARE) were the most frequently selected tools for all sub-groups (ranges 77-90% and 74-86%, respectively). HRA was recommended significantly more frequently for MSM LWH (58%) and patients with vulvar cancer (52%) compared to others (p < 0.01). “Any [test] abnormality” was more often selected as indication for HRA for immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology test result (29%, 36% respectively). Conclusion Cytology and DARE were preferred screening tools; screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidelines are needed and may lead to more consistent screening practices.
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Affiliation(s)
- Rosalyn E Plotzker
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
| | - Gregory M Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, 3600 Broadway, Suite 38, Oakland, CA 94611, USA.
| | - Dorothy J Wiley
- UCLA School of Nursing, 700 Tiverton Avenue, Factor Building Room #4242, Los Angeles, CA 90095-6918 USA.
| | - Elizabeth A Stier
- Boston University School of Medicine, Boston Medical Center, 771 Albany Street, Dowling 4, Boston, MA 02118 USA.
| | - Naomi Jay
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
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Brim H, Mirabello L, Bass S, Ford DH, Carethers JM, Ashktorab H. Association of Human Papillomavirus Genotype 16 Lineages With Anal Cancer Histologies Among African Americans. Gastroenterology 2021; 160:922-924. [PMID: 33075347 PMCID: PMC8844882 DOI: 10.1053/j.gastro.2020.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Hassan Brim
- Departments of Internal Medicine, Surgery, and Pathology, Howard University College of Medicine, Washington DC.
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sara Bass
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland; and
| | - Debra H. Ford
- Departments of Internal Medicine, Surgery, and Pathology, Howard University College of Medicine, Washington DC
| | - John M. Carethers
- Departments ofInternal Medicine and Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Hassan Ashktorab
- Departments of Internal Medicine, Surgery, and Pathology, Howard University College of Medicine, Washington DC
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Wiley R, Shelal Z, Bernard C, Urbauer D, Toy E, Ramondetta L. Human Papillomavirus: From Basic Science to Clinical Management for Preclinical Medical Students. MedEdPORTAL 2018; 14:10787. [PMID: 30800987 PMCID: PMC6354799 DOI: 10.15766/mep_2374-8265.10787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) is associated with 30,000 cancer diagnoses a year, but the HPV vaccination is administered less frequently than other vaccinations. Future providers are a potential target for improving rates, and this flipped classroom module was developed to educate future vaccinators on HPV virology, vaccination, and clinical management. METHODS Designed as a clinical correlation for a basic science curriculum on introductory virology and immunology, this weeklong module consisted of a 1-hour lecture and case presentation, assigned articles, and a 90-minute wrap-up session including individual and group quizzes over the assigned material, a group clinical application exercise, and a 20-minute lecture on the case and real-world applications. A pre-/posttest survey was done on general knowledge of HPV, satisfaction with education, and willingness to recommend vaccination for HPV. RESULTS This module was designed for first-year students, 491 of whom have performed well in it. Pre-/posttest surveys of 243 students indicated that they significantly improved their knowledge of HPV (from 66.3% premodule to 86.3% postmodule, p <.001) and their satisfaction with medical education on vaccination-related topics, as well as increasing their willingness to recommend vaccination (from 58% premodule to 100% postmodule, p <.001). DISCUSSION This module is an effective and satisfactory way to teach first-year medical students about HPV and HPV vaccination and improves reported willingness to recommend vaccination. With limited resources available to effectively teach HPV vaccination to preclinical medical students, this module fills a gap.
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Affiliation(s)
- Rachel Wiley
- Resident, Obstetrics and Gynecology Residency Program, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston
| | - Zeena Shelal
- Senior Coordinator, Clinical Studies, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center
| | - Carolyn Bernard
- Senior Systems Analyst, Office of Health Policy, The University of Texas MD Anderson Cancer Center
| | - Diana Urbauer
- Principal Statistical Analyst, Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Eugene Toy
- Assistant Dean for Educational Programs, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston
| | - Lois Ramondetta
- Professor, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center
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Dapper H, Oechsner M, Hirche C, Münch S, Sauter C, Borm K, Peeken JC, Combs SE, Habermehl D. Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the "true" (deep) ano-inguinal lymphatic drainage of anal cancer patients. Radiat Oncol 2018; 13:227. [PMID: 30466454 PMCID: PMC6249729 DOI: 10.1186/s13014-018-1174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/06/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction The ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Currently, there are no recommendations for an inclusion of the ‘true’ AILD in the clinical target volume (CTV) of definitive chemoradiation for anal cancer patients. To estimate the relevance of inguinal recurrence, we compared the incidental dose to the AILD in anal cancer (AC) patients who were treated either with Volumetric Arc Therapy – Intensity Modulated Radiation Therapy (VMAT-IMRT) or conventional 3D-radiation technique. Methods One VMAT-IMRT-plans and one 3D-plans were calculated on the same target volumes and identical dose prescription in ten patients. We defined the volume of the AILD on the planning CT-scans based on the information of new fluorescence methods. Furthermore, we defined several anatomical subvolumes of interest inside the AILD. We examined and compared absolute and relative dosimetric parameters of the AILD and different anatomical subunits. Results The Dmean of the AILD was 40 Gy in the 3D-group and 38 Gy in the IMRT-group. Dmean and Dmedian as well as the V30Gy of the AILD and all subvolumes of the caudal AILD were significant higher using 3D-RT compared to IMRT. Even though the absolute differences were small, in the caudal aspect of the ano-inguinal lymphatic drainage the V30Gy could be more than 10% less with VMAT-IMRT. Conclusions 3D-RT was slightly superior to IMRT in terms of dose coverage of the AILD. However, the absolute differences were very small. Some relevant caudal parts of the AILD received an insufficient dose for treating potential micrometastases. Particularly in high-risk situations, this may lead to inguinal recurrence and therefore the true deep AILD should be included into the target volume in high risk patients.
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Affiliation(s)
- Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Hirche
- Department for Hand-, Plastic and Reconstructive Surgery, Burn Centre, BG-Trauma Centre Ludwigshafen/Rhine, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christina Sauter
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kai Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute for innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany.,Deutsches Konsortium für translationale Krebsforschung (DKTK), Partner SiTe Munich, Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute for innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
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Ashktorab H, Kupfer SS, Brim H, Carethers JM. Racial Disparity in Gastrointestinal Cancer Risk. Gastroenterology 2017; 153:910-923. [PMID: 28807841 PMCID: PMC5623134 DOI: 10.1053/j.gastro.2017.08.018] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/25/2017] [Accepted: 08/05/2017] [Indexed: 12/13/2022]
Abstract
Cancer from the gastrointestinal tract and its associated excretory organs will occur in more than 300,000 Americans in 2017, with colorectal cancer responsible for >40% of that burden; there will be more than 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to the incidence and mortality of these cancers exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in non-Hispanic whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among blacks. Liver cancer has been most frequent among Asian/Pacific Islanders, chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene-environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas, and colorectum show the highest rates among blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socioeconomic and health care access, treatment, and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biologic and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, Howard University,Department of Cancer Center, Howard University
| | - Sonia S. Kupfer
- Division of Gastroenterology, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine, Department of Human Genetics and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
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Granata V, Fusco R, Reginelli A, Roberto L, Granata F, Rega D, Rotondo A, Grassi R, Izzo F, Petrillo A. Radiological assessment of anal cancer: an overview and update. Infect Agent Cancer 2016; 11:52. [PMID: 27752279 PMCID: PMC5062854 DOI: 10.1186/s13027-016-0100-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/27/2016] [Indexed: 12/27/2022] Open
Abstract
Anal cancer is uncommon neoplasm with an incidence of 2 new cases per 100,000 per year in the USA, accounting approximately 0.4 % of all tumors and 2.5 % of gastrointestinal malignancies. An early detection of the anal cancer is crucial for the patient management, whereas the diagnosis at an early stage allows conservative management with sphincter sparing, on the contrary a delays in diagnosis might lead to an advance cancer stage at presentation with worst survival. According to National Comprehensive Cancer Network (NCCN) Anal Carcinoma guidelines the patients should be subjected to a careful clinical examination, including a digital rectal examination (DRE), an anoscopic examination, and palpation of inguinal nodes. The guidelines recommended for the assessment of T stage, only a clinical examination, while the role of imaging techniques, as Magnetic Resonance imaging (MRI) is limited to the identification of regional nodes. Instead, the endoanal ultrasound (EAUS) is not recommended. This paper presents an overview and some updates about 3D EAUS and MRI in detection, staging and assessment post therapy of anal cancer patients.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Roberta Fusco
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luca Roberto
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Francesco Granata
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Daniela Rega
- Department of Colorectal Surgical Oncology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Francesco Izzo
- Department of Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
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Shah SB, Pickham D, Araya H, Kamal A, Pineda CE, Ghole S, Shih L, Kong C, Pai R, Welton M. Prevalence of Anal Dysplasia in Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2015; 13:1955-61.e1. [PMID: 26044314 DOI: 10.1016/j.cgh.2015.05.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/23/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although the prevalence of anal dysplasia is higher in some immunosuppressed populations, the prevalence in patients with inflammatory bowel disease (IBD) is unknown. We examined the prevalence of abnormal anal cytology among IBD patients, and its relation to the human papilloma virus (HPV). METHODS Adults with IBD and age-matched healthy controls (HC) were recruited. IBD patients were categorized as nonimmunosuppressed (IBD-N) or immunosuppressed (IBD-I). Anal Papanicolaou tests were performed for HPV testing and classification by a cytopathologist as follows: negative, atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, cancer, or unsatisfactory. RESULTS A total of 270 subjects (100 IBD-I, 94 IBD-N, and 76 HC) were recruited. ASC-US were detected in 19 subjects, with a trend toward a higher prevalence among IBD subjects compared with HC (8.8% vs 2.6%; P = .10). The prevalence did not differ with respect to immunosuppression. Crohn's disease (CD) subjects had a higher prevalence of ASC-US compared with others with IBD (P = .02). Among those with CD, female sex and disease duration longer than 10 years were risk factors. There were no cases of low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or anal cancer in the cohort. HPV was present in 5.3% and 1.5% of subjects with and without ASC-US, respectively (P = .26). CONCLUSIONS Although there was a trend toward abnormal anal Papanicolaou tests in IBD subjects compared with HC, there was no difference based on immunosuppression. The presence of HPV did not correlate with abnormal anal cytology. Risk factors associated with this increased trend include female CD subjects and those with a longer duration of CD. ClinicalTrials.gov number: NCT01860963; https://clinicaltrials.gov/ct2/show/NCT01860963.
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Affiliation(s)
- Shamita B Shah
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, California.
| | - Danielle Pickham
- Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Hiwot Araya
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Ahmad Kamal
- Division of Gastroenterology, Santa Clara Valley Medical Center, San Jose, California
| | - Carlos E Pineda
- Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Saif Ghole
- Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Lauren Shih
- Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Christina Kong
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Reet Pai
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Mark Welton
- Surgery-Colorectal Surgery, Stanford University School of Medicine, Stanford, California
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