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Le Scodan R, Ghannam Y, Kirova Y, Bourgier C, Richard Tallet A. Radiation therapy of the primary tumour and oligometastatic sites in patients with breast cancer with synchronous metastases: A literature review. Cancer Radiother 2024; 28:3-14. [PMID: 38065784 DOI: 10.1016/j.canrad.2023.08.007] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/04/2024]
Abstract
De novo metastatic breast cancer represents 5 to 8% of all breast cancers (2500 new cases per year in France). Systemic treatment is the cornerstone of treatment, whereas radiation therapy usually has a palliative intent. Advances in systemic and local treatments (surgery and radiation therapy) have substantially improved overall survival. In the recent breast cancer statistics in the United States, the 5-year relative survival for patients diagnosed during 2012-2018 was 29% for stage IV (Breast Cancer Statistics). Thus, an increasing proportion of metastatic breast cancers present a prolonged complete response to systemic therapy, which raises the question of the impact of local treatment on patient survival. Radiation therapy has shown its value for early breast cancer, but its place in the local management of the primary tumour or oligometastatic sites for de novo metastatic breast cancer remains under debate. This article is a literature review assessing the role of radiation therapy directed to the primary tumour and oligometastatic sites of breast cancer in patients with synchronous metastases, in order to highlight clinicians in their therapeutic decision.
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Affiliation(s)
- R Le Scodan
- Institut de cancérologie et radiothérapie brétillien (ICRB), hôpitaux privés rennais, centre hospitalier privé Saint-Grégoire, Vivalto, Saint-Grégoire, France.
| | - Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, Angers, France
| | - Y Kirova
- Département de radiothérapie, institut Curie, Paris, France
| | - C Bourgier
- Université de Montpellier, Montpellier, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, institut régional du cancer Montpellier (ICM), Montpellier, France
| | - A Richard Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), Inserm UMR 1068, Marseille, France
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Brouwer OR, Albersen M, Parnham A, Protzel C, Pettaway CA, Ayres B, Antunes-Lopes T, Barreto L, Campi R, Crook J, Fernández-Pello S, Greco I, van der Heijden MS, Johnstone PAS, Kailavasan M, Manzie K, Marcus JD, Necchi A, Oliveira P, Osborne J, Pagliaro LC, Garcia-Perdomo HA, Rumble RB, Sachdeva A, Sakalis VI, Zapala Ł, Sánchez Martínez DF, Spiess PE, Tagawa ST. European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. Eur Urol 2023:S0302-2838(23)02638-6. [PMID: 36906413 DOI: 10.1016/j.eururo.2023.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Penile cancer is a rare disease but has a significant impact on quality of life. Its incidence is increasing, so it is important to include new and relevant evidence in clinical practice guidelines. OBJECTIVE To provide a collaborative guideline that offers worldwide physician and patient guidance for the management of penile cancer. EVIDENCE ACQUISITION Comprehensive literature searches were performed for each section topic. In addition, three systematic reviews were conducted. Levels of evidence were assessed, and a strength rating for each recommendation was assigned according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. EVIDENCE SYNTHESIS Penile cancer is a rare disease but its global incidence is increasing. Human papillomavirus (HPV) is the main risk factor for penile cancer and pathology should include an assessment of HPV status. The main aim of primary tumour treatment is complete tumour eradication, which has to be balanced against optimal organ preservation without compromising oncological control. Early detection and treatment of lymph node (LN) metastasis is the main determinant of survival. Surgical LN staging with sentinel node biopsy is recommended for patients with a high-risk (≥pT1b) tumour with cN0 status. While (inguinal) LN dissection remains the standard for node-positive disease, multimodal treatment is needed in patients with advanced disease. Owing to a lack of controlled trials and large series, the levels of evidence and grades of recommendation are low in comparison to those for more common diseases. CONCLUSIONS This collaborative penile cancer guideline provides updated information on the diagnosis and treatment of penile cancer for use in clinical practice. Organ-preserving surgery should be offered for treatment of the primary tumour when feasible. Adequate and timely LN management remains a challenge, especially in advanced disease stages. Referral to centres of expertise is recommended. PATIENT SUMMARY Penile cancer is a rare disease that significantly impacts quality of life. While the disease can be cured in most cases without lymph node involvement, management of advanced disease remains challenging. Many unmet needs and unanswered questions remain, underlining the importance of research collaborations and centralisation of penile cancer services.
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Mathonnet A, Dabakuyo S, Philip CA, Jankowski C, Cortet M. [How is our practice of mastectomy? Analysis based on population data in a French department]. Gynecol Obstet Fertil Senol 2022; 50:770-776. [PMID: 36183985 DOI: 10.1016/j.gofs.2022.09.009] [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] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this research was to study the evolution of the mastectomy rate in patients with breast cancer between 1998 and 2015, based on population data from the Côte d'Or breast cancer registry of the FRANCIM network ("France cancer incidence and mortality"). METHODS In this study on population register we included patients who had presented a primary breast cancer (invasive cancer and/or carcinoma in situ [CIS]) between 1998 and 2015 in the Côte d'Or department. We estimated the annual proportions of mastectomies, then calculated their evolution trends over this period. RESULTS Between 1998 and 2015, 7093 patients were included. The overall proportion of mastectomies was stable at 28% and did not respond to a time trend (Sen's slope of 0.2% per year; P=0.289). There was an increase in the proportion of lobular carcinomas (slope at 0.3% per year; P <0.05), with a rising proportion of mastectomy for lobular carcinomas (slope at 0.6% per year; P<0.05) but decreasing for ductal (slope at -0.8% per year; P<0.05). The proportion of mastectomy was stable for plurifocal cancers but the proportion of plurifocal cancers increased over time (slope at 0.8% per year; P<0.05). CONCLUSION Therefore, mastectomy remained a stable practice over the 18 years of analysis in the Côte d'Or region. However, this overall stability is the result of variations in the profiles of diagnosed cancers and surgical practices.
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Affiliation(s)
- A Mathonnet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France.
| | - S Dabakuyo
- Registre des cancers du sein et des cancers gynécologiques de Côte d'Or, unité de recherche en epidémiologie et qualité de vie, Inserm U1231, Georges François Leclerc Centre-UNICANCER, Dijon, France
| | - C-A Philip
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
| | - C Jankowski
- Service de chirurgie oncologique, centre de lutte contre le cancer Georges-François Leclerc, Dijon, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
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Reher D, Fehrenbach U, Kayser A, Pape UF, Henes FO, Cremer B, Hörsch D, Izbicki J, Lohse AW, Rinke A, Schrader J. Localization Defines Streptozotocin/5-FU Response in Primary Pancreatic Neuroendocrine Tumours. Neuroendocrinology 2022; 112:595-605. [PMID: 34515157 DOI: 10.1159/000518895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/06/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Incidence of pancreatic neuroendocrine tumours (pNETs) is on the rise. The only curative treatment is surgical resection in localized or oligo-metastatic disease. However, patients may present with locally advanced or unresectable primary tumours. So far, no conversion therapy to achieve resectability has been established, which is partly due to lack of data on primary tumour response to therapies. Here, we specifically evaluate the primary tumour response to streptozocin/5-FU in a large cohort of metastatic pNET patients. METHODS Five ENETS centres in Germany contributed 84 patients to the study cohort for retrospective analysis. RESULTS Overall response rate (ORR) in primary tumours was 34% and disease control rate (DCR) 88%. ORR was different in metastases at 44% and DCR at 70%. Partial remission in primary tumours was more frequent among those located in pancreatic tail than that in pancreatic head (49% vs. 14%, p = 0.03). Correspondingly, metastases from tumours originating from pancreatic tail responded more frequently than metastases originating from pancreatic head (88.5% vs. 41.7%, p = 0.005). The median PFS of the primary tumours was longer than that in metastases (31 months vs. 16 months; p = 0.04). Considerable downsizing of the primary tumour was rare and occurred primarily in tumours located in the pancreatic tail. CONCLUSION STZ/5-FU can achieve disease stabilization in a high proportion of metastatic pNET patients. In the majority of cases however it does not induce substantial downsizing of the primary tumour, thus possibly limiting its potential as conversion chemotherapy. Furthermore, the difference in response rate observed between different primary tumour locations warrants further exploration.
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Affiliation(s)
- Dominik Reher
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité University Medicine Center Berlin, Berlin, Germany
| | - Antonin Kayser
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Mitte, Charité University Medicine Center Berlin, Berlin, Germany
| | - Ulrich-Frank Pape
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Mitte, Charité University Medicine Center Berlin, Berlin, Germany
- Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Frank Oliver Henes
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Cremer
- Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO-ABCD), University Hospital Cologne, Cologne, Germany
| | - Dieter Hörsch
- Klinik für Innere Medizin, Gastroenterologie und Endokrinologie, Zentrum für Neuroendokrine Tumore Bad Berka - ENETS Center of Excellence, Bad Berka, Germany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Wilhelm Lohse
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps-University, Marburg, Germany
| | - Jörg Schrader
- First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Szychot E, Morgenstern D, Chopra M, Sorrentino S, Arthurs O, Sebire N, Arfeen F, Brodkiewicz A, Humphries P, Biassoni L. Clinical impact of primary tumour 123ImIBG response to induction chemotherapy in children with high-risk neuroblastoma. Int J Clin Oncol 2021; 27:253-261. [PMID: 34626287 DOI: 10.1007/s10147-021-02039-y] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 50% children with high-risk neuroblastoma (HR-NBL) experience disease progression, which we hypothesise is due to non-response of primary tumour to treatment. Current imaging techniques are unable to characterise response in primary tumour (necrotic versus viable tissue) at diagnosis or follow-up. OBJECTIVES Compare clinico-histological characteristics between primary 123ImIBG-avid tumours that became entirely 123ImIBG-non-avid (responders) after induction chemotherapy (IC) versus primary 123ImIBG-avid tumour that remained 123ImIBG-avid (non-responders). METHODS Retrospective review of clinico-radiological data of children diagnosed with 123ImIBG-avid HR-NBL at our centre (2005-2016). Patients received Rapid COJEC IC and two additional courses of TVD if metastatic response was inadequate. Primary tumour 123ImIBG response was assessed qualitatively as positive, negative or intermediate at diagnosis and after IC. Post-surgical histopathology slices were marked considering percentage of viable tissue. RESULTS Sixteen of 61 patients showed complete primary tumour 123ImIBG response, 20 partial response, while 25 no response. There was no statistically significant difference between clinical demographics of complete responders and group of non- or partial responders. Mean percentage of viable tumour cells was higher in non-responders than in complete responders (44.6% vs 20.6%; p = 0.05). Five-year EFS was significantly higher in complete responders than non-responders (43 ± 15% vs 7 ± 6%; p < 0.005). CONCLUSIONS 123ImIBG response in primary HR-NBL correlates with amount of necrotic tissue, skeletal metastatic 123ImIBG response and outcome. An entirely 123ImIBG non-avid tumour can still harbour viable tumour cells. Therefore, our findings do not support utility of primary tumour 123ImIBG response in decision making regarding residual tumour surgery. Combining both, primary and metastatic 123ImIBG response will improve interpretability of clinical trial results.
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Affiliation(s)
- Elwira Szychot
- Clinical Studies, The Institute of Cancer Research, Sutton, UK. .,Oak Centre for Children and Young People, Royal Marsden Hospital, Sutton, SM2 5PT, UK. .,Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland.
| | - Daniel Morgenstern
- Departments of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Hospital for Sick Children, Toronto, Canada
| | - Mark Chopra
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stefania Sorrentino
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Unit of Paediatric Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Owen Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil Sebire
- Department of Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Farrukh Arfeen
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrzej Brodkiewicz
- Department of Paediatrics, Child's Nephrology, Dialysis Therapy and Acute Poisoning, Szczecin, Poland
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Boevé L, Hulshof MCCM, Verhagen PCMS, Twisk JWR, Witjes WPJ, de Vries P, van Moorselaar RJA, van Andel G, Vis AN. Patient-reported Quality of Life in Patients with Primary Metastatic Prostate Cancer Treated with Androgen Deprivation Therapy with and Without Concurrent Radiation Therapy to the Prostate in a Prospective Randomised Clinical Trial; Data from the HORRAD Trial. Eur Urol 2020; 79:188-197. [PMID: 32978014 DOI: 10.1016/j.eururo.2020.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND A survival benefit was demonstrated for patients with low-volume metastatic prostate cancer (mPCa) when local radiotherapy was added to androgen deprivation therapy (ADT). OBJECTIVE To determine the effect of ADT combined with external beam radiotherapy (EBRT) to the prostate on health-related quality of life (HRQoL) of patients with primary bone mPCa. DESIGN, SETTING, AND PARTICIPANTS The HORRAD trial is a multicentre randomised controlled trial recruiting 432patients with primary bone mPCa between 2004 and 2014. INTERVENTION Patients were randomised to ADT with EBRT or to ADT alone. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients completed two validated HRQoL questionnaires (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire Core Module (QLQ-C30) and EORTC Quality of Life Questionnaire Prostate Module [QLQ-PR25]) at baseline and at 3, 6, 12, and24 mo after the initiation of treatment. The effect of both treatments was evaluated based on mixed-effect models. RESULTS AND LIMITATIONS Patient characteristics and HRQoL scores at baseline were similar in both arms. At baseline, 98% of patients completed the questionnaires, compared with 58% at 24 mo. Patients reported significantly more diarrhoea (difference between the groups 10.8; 95% confidence interval [CI] 7.3-14.2), bowel symptoms (4.5; 95% CI 2.1-6.8), and urinary symptoms (11.9; 95% CI 8.9-14.8) after EBRT and ADT compared with ADT alone (all between-arm difference p < 0.001). Urinary complaints levelled at 6 mo. At 2 yr, only bowel symptom scores were significantly different (8.0; 95% CI 4.8-11.1, p ≤ 0.001), but 68% of patients in the radiotherapy group did not report clinically relevant worsening of their bowel symptom scores. CONCLUSIONS Patients with bone mPCa reported temporary modest urinary and bowel symptoms after combined treatment with EBRT of the prostate and ADT compared with ADT alone. For some patients (22%), deterioration of bowel functions remains at 2 yr, whereas general HRQoL does not deteriorate.. PATIENT SUMMARY This study investigated the effect of radiotherapy to the prostate added to hormonal therapy on patient-reported health-related quality of life (HRQoL) in patients with primary bone metastatic prostate cancer. Most patients reported only temporary urinary and bowel symptoms. In 22% of patients, bowel symptoms remained at 2 yr, whereas general HRQoL did not deteriorate.
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Affiliation(s)
- Liselotte Boevé
- Department of Urology, OLVG, Amsterdam, The Netherlands; Department of Urology, Amsterdam UMC, Location VU university Medical Center (VUmc), Amsterdam, The Netherlands.
| | - Maarten C C M Hulshof
- Department of Radiotherapy, Amsterdam UMC, location Academic Medical Center (AMC), Amsterdam, The Netherlands
| | | | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VU university Medical Center (VUmc), Amsterdam, The Netherlands
| | | | - Peter de Vries
- Department of Urology, Zuyderland, Heerlen, The Netherlands
| | - R Jeroen A van Moorselaar
- Department of Urology, Amsterdam UMC, Location VU university Medical Center (VUmc), Amsterdam, The Netherlands
| | | | - André N Vis
- Department of Urology, Amsterdam UMC, Location VU university Medical Center (VUmc), Amsterdam, The Netherlands
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Laville A, Coutte A, Blanchard P, Sun R, Deutsch E, Latorzeff I. [Treatment of primary disease for synchronous metastatic prostate cancer]. Cancer Radiother 2020; 24:547-553. [PMID: 32855028 DOI: 10.1016/j.canrad.2020.06.011] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
Abstract
The management of early metastatic prostate cancer is based on systemic treatment by androgen deprivation therapy with or without chemotherapy or next-generation anti-androgen therapies. Local treatment of the prostate was initially used only to alleviate local symptoms. However, local radiotherapy of the prostate has been the subject of retrospective and prospective studies in patients with better prognostic factors, particularly in oligometastatic status. The results of these studies support that prostate radiotherapy can prolong the survival of patients with a low metastatic burden. This article states the biological bases, the main published and future published studies aimed to embed this strategy to optimize therapeutic management.
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Affiliation(s)
- A Laville
- Département de radiothérapie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Département de radiothérapie, CHU d'Amiens, 1, rue du Professeur-Christian-Cabrol, 80050, France.
| | - A Coutte
- Département de radiothérapie, CHU d'Amiens, 1, rue du Professeur-Christian-Cabrol, 80050, France
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - R Sun
- Département de radiothérapie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Deutsch
- Département de radiothérapie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Inserm, UMR 1030 « radiosensibilité des tumeurs et tissus sains », 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - I Latorzeff
- Département de radiothérapie-oncologie, bâtiment Atrium, clinique Pasteur, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
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Ghannam Y, Bourgier C, Legouté F, Gonzalez-Moya A, Lizée T, Trémolières P, Hennequin C. [Treatment of primary disease with irradiation in case of de novo metastatic breast cancer]. Cancer Radiother 2020; 24:567-575. [PMID: 32814669 DOI: 10.1016/j.canrad.2020.06.008] [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] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022]
Abstract
Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France.
| | - C Bourgier
- Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier IRCM, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Inserm, U1194, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - F Legouté
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - A Gonzalez-Moya
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - P Trémolières
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris, France
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Bingham G, Shetye A, Suresh R, Mirnezami R. Impact of primary tumour location on colorectal liver metastases: A systematic review. World J Clin Oncol 2020; 11:294-307. [PMID: 32728532 PMCID: PMC7360521 DOI: 10.5306/wjco.v11.i5.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide. Despite significant advances in screening, surgical management and adjuvant therapies, average 5-year survival seldom exceeds 60% in most developed nations. Metastatic disease represents the primary cause of mortality in patients with CRC, and the liver is the most common location for distant tumour spread. Up to 25% of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40% will develop metachronous disease in the course of follow-up. It has been suggested that primary tumour location [right side versus left side, primary tumour location (PTL)] can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms. This suggestion is not universally accepted and there have been conflicting reports in the literature to date.
AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases (CRCLM).
METHODS MEDLINE, EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria.
RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review. In 21 out of 38 studies that provided data on overall survival, a statistically significant improvement in overall survival was reported in patients with left sided primary tumours. These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference. Eight studies noted a similar trend towards improved disease-free or progression-free survival. Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL; for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC.
CONCLUSION Taken together, the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC. The mechanisms responsible for this variation remain poorly understood, but are likely to relate to molecular, histological and embryological differences, as well as inherent differences in therapeutic sensitivity.
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Affiliation(s)
- George Bingham
- Department of General Surgery, St. Thomas’s Hospital, Lambeth, London SE1 7EH, United Kingdom
| | - Alysha Shetye
- Department of Colorectal Surgery, Royal Free Hospital, Hampstead, London NW3 2QG, United Kingdom
| | - Reena Suresh
- Department of General Surgery, St. Thomas’s Hospital, Lambeth, London SE1 7EH, United Kingdom
| | - Reza Mirnezami
- Department of Colorectal Surgery, Royal Free Hospital, Hampstead, London NW3 2QG, United Kingdom
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Bandurska-Luque A, Löck S, Haase R, Richter C, Zöphel K, Perrin R, Appold S, Krause M, Steinbach J, Kotzerke J, Hofheinz F, Zips D, Baumann M, Troost EG. Correlation between FMISO-PET based hypoxia in the primary tumour and in lymph node metastases in locally advanced HNSCC patients. Clin Transl Radiat Oncol 2019; 15:108-112. [PMID: 30834349 PMCID: PMC6384311 DOI: 10.1016/j.ctro.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/05/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 02/07/2023] Open
Abstract
We investigated correlation between hypoxia in the primary tumour and LN before and during RCTx. The Correlation between primary tumour and LN hypoxia is stronger in patients with large LN compared to the entire cohort. We advise to perform a comprehensive evaluation of hypoxia in the primary tumour and LN.
Purpose This secondary analysis of the prospective study on repeat [18F]fluoromisonidazole (FMISO)-PET in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) assessed the correlation of hypoxia in the primary tumour and lymph node metastases (LN) prior to and during primary radiochemotherapy. Methods This analysis included forty-five LN-positive HNSCC patients having undergone FMISO-PET/CTs at baseline, and at week 1, 2 and 5 of radiochemotherapy. The quantitative FMISO-PET/CT parameters maximum standardised uptake value (SUVmax, corrected for partial volume effect) and peak tumour-to-background ratio (TBRpeak) were estimated in the primary tumour as well as in index and large LN, respectively. Statistical analysis was performed using the Spearman correlation coefficient ρ. Results In 15 patients with large LN (FDG-PET positive volume >5 ml), there was a significant correlation between the hypoxia measured in the primary tumour and the large LN at three out of four time-points using the TBRpeak (baseline: ρ = 0.57, p = 0.006; week 2: ρ = 0.64, p = 0.003 and week 5: ρ = 0.68, p = 0.001). For the entire cohort (N = 45) only assessed prior to the treatment, there was a statistically significant, though weak correlation between FMISO-SUVmax of the primary tumour and the index LN (ρ = 0.36, p = 0.015). Conclusions We observed a significant correlation between FMISO-based hypoxia in the primary tumour and large lymph node(s) in advanced stage HNSCC patients. However, since most patients only had relatively small hypoxic lymph node metastases, a comprehensive assessment of the primary tumour and lymph node hypoxia is essential.
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Affiliation(s)
- Anna Bandurska-Luque
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Corresponding author at: Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
| | - Steffen Löck
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Haase
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Christian Richter
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Klaus Zöphel
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Rosalind Perrin
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Steffen Appold
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mechthild Krause
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- National Center for Tumor Diseases, Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Jörg Steinbach
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Rossendorf, Germany
- Faculty of Chemistry and Food Chemistry, Technische Universität Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Frank Hofheinz
- Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard Karls Universität Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, Germany
| | - Michael Baumann
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases, Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Esther G.C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- National Center for Tumor Diseases, Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
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Petrelli F, Ghidini A, Cabiddu M, Tomasello G, De Stefani A, Bruschieri L, Vitali E, Ghilardi M, Borgonovo K, Barni S, Trevisan F. Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis. Lung Cancer 2018; 126:194-200. [PMID: 30527187 DOI: 10.1016/j.lungcan.2018.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/07/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) has a discrete number of distant lesions (<5) that can be amenable to radical treatment. The treatment of the primary lung tumour in such stage IV cases is still debated. We conducted a systematic review and meta-analysis to evaluate the outcome of these patients and the added benefit in terms of overall survival (OS) and progression-free survival (PFS) when radical treatment of the primary tumour with radiotherapy (RT) was delivered. PubMed, EMBASE and Cochrane Library were systematically searched to identify relevant studies published up to July 2018. Prospective trials and retrospective series comparing RT vs no RT to the primary NSCLC in the presence of oligometastases were included. Hazard ratios (HRs) for OS and PFS were aggregated according to a fixed or random effect model. Twenty-one studies for a total of 924 synchronous oligometastatic NSCLC were analysed. Median OS and PFS were 20.4 and 12 months. Pooled 1-2-3 and 5-year OS were 70.3%, 43.5%, 29.3% and 20.2% respectively. Overall survival was improved with the addition of thoracic RT (HR = 0.44, 95%CI 0.32-0.6; P < 0.001). Similarly, RT added to the primary tumour increased PFS (HR = 0.42, 95%CI 0.33-0.55; P < 0.001). The only variable associated with the median OS was the year of publication with most recent series associated with a better outcome. In patients with oligometastatic NSCLC and disease controlled with ablative therapy of distant metastases, a consolidation with radical RT to the primary tumour is associated with better survival and could be considered as a treatment modality in selected cases.
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Affiliation(s)
- Fausto Petrelli
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy.
| | | | - Mary Cabiddu
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | | | | | - Mara Ghilardi
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Karen Borgonovo
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Sandro Barni
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
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Correa RJM, Ahmad B, Warner A, Johnson C, MacKenzie MJ, Pautler SE, Bauman GS, Rodrigues GB, Louie AV. A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma. Radiat Oncol 2018; 13:47. [PMID: 29558966 PMCID: PMC5859400 DOI: 10.1186/s13014-018-0992-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/06/2018] [Accepted: 03/06/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cytoreductive nephrectomy is thought to improve survival in metastatic renal cell carcinoma (mRCC). As many patients are ineligible for major surgery, we hypothesized that SABR could be a safe alternative. METHODS In this dose-escalation trial, inoperable mRCC patients underwent SABR targeting the entire affected kidney. Toxicity (CTCAE v3.0), quality of life (QoL), renal function, and tumour response (RECIST v1.0) were assessed. RESULTS Twelve patients of mostly intermediate (67%) or poor (25%) International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic class, median KPS of 70%, and median tumour size of 8.7 cm (range: 4.8-13.8) were enrolled in successive dose cohorts of 25 (n = 3), 30 (n = 6), and 35 Gy (n = 3) in 5 fractions. SABR was well tolerated with 3 grade 3 events: fatigue (2) and bone pain (1). QoL decreased for physical well-being (p = 0.016), but remained unchanged in other domains. SABR achieved a median tumour size reduction of - 17.3% (range: + 5.3 to - 54.4) at 5.3 months. All patients progressed systemically and median OS was 6.7 months. Crude median follow-up was 5.8 months. CONCLUSIONS In non-operable mRCC patients, renal-ablative SABR to 35 Gy in 5 fractions yielded acceptable toxicity, renal function preservation, and stable QoL. SABR merits further prospective investigation as an alternative to cytoreductive nephrectomy. TRIAL REGISTRATION ClinicalTrials.gov NCT02264548. Registered July 22 2014 - Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT02264548.
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Affiliation(s)
- Rohann J M Correa
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Belal Ahmad
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Craig Johnson
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Mary J MacKenzie
- Department of Medical Oncology, London Regional Cancer Program, London, Canada
| | - Stephen E Pautler
- Division of Urology, Western University, London, Canada.,Division of Surgical Oncology, Western University, London, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada. .,Department of Epidemiology and Biostatistics, Western University, London, Canada.
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Tiemeier GL, Brown JM, Pratap SE, McCarthy C, Kastrenopoulou A, Bradley K, Wilson S, Orosz Z, Gibbons CLMH, Oppermann U, Athanasou NA. Pleomorphic liposarcoma of bone: a rare primary malignant bone tumour. Clin Sarcoma Res 2018; 8:2. [PMID: 29449935 PMCID: PMC5807841 DOI: 10.1186/s13569-018-0089-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Liposarcoma is an extremely rare primary bone sarcoma. CASE PRESENTATION We report a case of primary pleomorphic liposarcoma that arose in an 18 year old male in the metaphysis of the left tibia. Plain radiographs showed a partly sclerotic lesion and MR imaging a heterogeneous tumour predominantly isointense on T1- and high-signal on T2-weighted sequences with focal areas of increased T1 signal that suppressed with fat saturation. PET/CT showed marked FDG uptake (SUV = 17.1) in the primary tumour as well as a metastasis in the right distal femur and multiple small pulmonary metastases. Histologically, the tumour was a pleomorphic liposarcoma containing large tumour cells with vacuolated cytoplasm and hyperchromatic pleomorphic nuclei as well as numerous lipoblasts and scattered brown fat-like cells. Tumour cells strongly expressed FABP4/aP2, a marker of adipocyte differentiation, and UCP1, a marker of brown fat, but not S100. The case was treated with neoadjuvant MAP chemotherapy, resulting in extensive (> 95%) necrosis in the primary tumour and almost complete resolution of the femoral and pulmonary metastases. CONCLUSIONS Pleomorphic liposarcoma can present as a sclerotic primary malignant bone tumour; markers of adipose differentiation are useful in histological diagnosis and neoadjuvant MAP chemotherapy results in significant tumor necrosis.
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Affiliation(s)
- G. L. Tiemeier
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - J. M. Brown
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - S. E. Pratap
- Sarcoma Service, Nuffield Orthopaedic Centre, Oxford, UK
| | - C. McCarthy
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford, UK
| | - A. Kastrenopoulou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - K. Bradley
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - S. Wilson
- Sarcoma Service, Nuffield Orthopaedic Centre, Oxford, UK
| | - Z. Orosz
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | | | - U. Oppermann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - N. A. Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
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Dupré A, Malik HZ, Jones RP, Diaz-Nieto R, Fenwick SW, Poston GJ. Influence of the primary tumour location in patients undergoing surgery for colorectal liver metastases. Eur J Surg Oncol 2017; 44:80-86. [PMID: 29183640 DOI: 10.1016/j.ejso.2017.10.218] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/26/2017] [Accepted: 10/22/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The prognosis of patients undergoing liver resection for colorectal liver metastases (CLM) seems to be altered when the primary tumour is right-sided. However, data are lacking and conflicting. We aimed to evaluate the influence of the primary tumour location on oncologic outcomes following such surgery. METHODS We retrospectively analysed prospectively collected data from 376 consecutive patients who underwent liver surgery for CLM between June 2010 and August 2015. We compared the outcomes of patients with right colon tumours and those with left colorectal tumours. The splenic flexure was used as the cut-off point to determine the anatomic primary site. RESULTS Among the 364 patients eligible, 74 (20.3%) had a right-sided primary tumour. These patients were older, had a poorer American Society of Anaesthesiologists status and had fewer node-positive primary tumours. The CLM characteristics were similar between both groups. Median PFS was not significantly different between the two groups at 9.9 months, as well as the pattern of recurrence. Median OS was shorter for patients with right-sided primary tumour (34.6 versus 45.3 months, p = 0.035). Similar results were observed when patients with rectal tumour were excluded from analysis (34.6 vs. 47.5 months, p = 0.007). Primary tumour site was an independent prognosis factor in multivariate analysis. CONCLUSION Right-sided location of the primary tumour is associated with worse OS after surgery for CLM, but seems to have no influence on PFS, and on the pattern of recurrence.
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Affiliation(s)
- Aurélien Dupré
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK; Centre Léon Bérard, Department of Surgical Oncology, Lyon, F-69008, France.
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Robert P Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK; School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - Rafael Diaz-Nieto
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
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Grellety T, Lucchesi C, Hostein I, Auzanneau C, Khalifa E, Soubeyran I, Italiano A. High-depth sequencing of paired primary and metastatic tumours: Implications for personalised medicine. Eur J Cancer 2017; 84:250-256. [PMID: 28841542 DOI: 10.1016/j.ejca.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Next-generation sequencing of large panel of genes had been associated with clinical benefit in a significant proportion of patients with advanced cancer. However, the molecular profile of the primary tumour from the initial surgical specimen might significantly differ from the molecular profile in a tumour sample obtained from a biopsy of a metastatic site. PATIENTS AND METHODS We compare the genetic profile of primary tumours and paired metastases by using a large panel of cancer genes. Training and validation set including a total of 152 primary and metastatic tumour pairs were sequenced (up to 429 genes) focussing on variants described in the Catalogue of Somatic Mutations in Cancer (COSMIC). RESULTS Training and validation set including a total of 152 primary and metastatic tumour pairs were sequenced focussing on variants described in COSMIC. Agreement rate between the couples of primary and metastasis on COSMIC variants was 65% (24/37) and 43% (49/115) in the training and validation cohort, respectively. That rose to 74% (20/27) and 58% (42/73) when focussing on targetable mutations. In five cases, the discordance was related to appearance of secondary resistance mutation, giving a targetable refined agreement rate of 67% (67/100). CONCLUSION Up to 40% of paired primary tumour/metastases have discordant molecular profile. Liquid biopsies may overcome, in the near future, the limits of tumour tissue genotyping.
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Affiliation(s)
- T Grellety
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France; National Institute of Health and Medical Research, INSERM U1218, Institut Bergonié, Bordeaux, France
| | - C Lucchesi
- National Institute of Health and Medical Research, INSERM U1218, Institut Bergonié, Bordeaux, France
| | - I Hostein
- Department of Pathology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France
| | - C Auzanneau
- Department of Pathology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France
| | - E Khalifa
- Department of Pathology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France
| | - I Soubeyran
- Department of Pathology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France.
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Courtois S, Durán RV, Giraud J, Sifré E, Izotte J, Mégraud F, Lehours P, Varon C, Bessède E. Metformin targets gastric cancer stem cells. Eur J Cancer 2017; 84:193-201. [PMID: 28822889 DOI: 10.1016/j.ejca.2017.07.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023]
Abstract
Gastric cancer is the third leading cause of cancer-related deaths worldwide and has still a poor prognosis. Therefore, new therapeutic strategies are needed: among them, targeting cancer stem cells (CSCs) could offer new opportunities. The aim of our study was to evaluate the anti-tumoural effect of metformin on gastric cancer in vitro and in vivo and especially, to determine whether this molecule could target the gastric CSCs. Metformin effects were evaluated on the proliferation and tumourigenic properties of the gastric CSCs from patient-derived primary tumour xenografts (PDXs) and cancer cell lines (MKN45, AGS and MKN74) in vitro in conventional 2 dimensional (2D) and in 3 dimensional (3D) culture systems, in which only CSCs are able to form tumourspheres and in mouse xenograft models in vivo. Metformin induced a cell cycle arrest, which decreased cell proliferation in the 2D cultures. In a 3D culture system, metformin decreased the number of tumourspheres, revealing its capacity to target the CSCs. This effect was confirmed by the study of the expression of CSC markers (CD44 and Sox2) and differentiation markers (Kruppel-like factor 4 and MUC5AC), which were decreased or increased in response to metformin, respectively. Finally, in vivo treatment of PDXs with metformin led to a tumour growth delay and decreased the self-renewal ability of the CSCs. These results suggest that the use of metformin could represent an efficient strategy to inhibit tumour growth by targeting gastric CSCs.
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Millan M, Delgado A, Caicedo LA, Arrunategui AM, Meneses CA, Villegas JI, Serrano O, Caicedo L, Duque M, Echeverri GJ. Liver Angiosarcoma: Rare tumour associated with a poor prognosis, literature review and case report. Int J Surg Case Rep 2016; 28:165-168. [PMID: 27718433 PMCID: PMC5061303 DOI: 10.1016/j.ijscr.2016.09.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/30/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
Liver Angiosarcoma is rare and aggressive tumour that requires surgical management. Partial Hepatectomy is the ideal surgical management for Liver Angiosarcoma. Liver transplant does not improve the survival of Liver Angiosarcoma patients.
Introduction Liver angiosarcoma is a very uncommon tumour of mesenchymal origin, representing between 0.1–2% of all primary tumours of the liver, affecting mainly men in their sixth or seventh decade of life, with a high mortality in the first years (Chaudhary et al., 2015). Literature reports of its surgical treatment vary from a total or partial hepatectomy with or without liver transplant. Presentation of case A 37 year old male, with a 7 year history of a fatty liver, was found to have a 12 cm diameter tumour in a cirrhotic liver, during an abdominal Computed Tomography (CT) scan. Patient was asymptomatic with negative tumour markers, yet tumour liver biopsy revealed a Liver Angiosarcoma with positive immunohistochemistry for neoplastic cells CD31 and CD34. Patient was deemed candidate for a partial hepatectomy of the affected liver segments which was done without complications and no evidence of other tumour lesions was found during surgery. Patient continued oncologic management with ongoing chemotherapy. Discusion Liver Angiosarcoma, although rare, persists with a high mortality due to its aggressive nature. Never the less liver transplantation, although proven to be an effective treatment for many pathologies that culminate in liver failure, fails to improve patients’ survival and prognosis, when compared to partial hepatectomy as surgical management to for liver Angiosarcoma, Conclusion Partial hepatectomy as surgical management, followed by adjuvant therapy, for Liver Angiosarcoma continues to prove favourable results and prognosis compared to Liver Transplantation.
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Affiliation(s)
- Mauricio Millan
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Alejandro Delgado
- Centro de Investigaciones Clínicas, Fundación Valle del Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Luis A Caicedo
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | | | | | - Jorge I Villegas
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Oscar Serrano
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Liliana Caicedo
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Mauricio Duque
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Gabriel J Echeverri
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
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Wilkinson KJ, Chua W, Ng W, Roohullah A. Management of asymptomatic primary tumours in stage IV colorectal cancer: Review of outcomes. World J Gastrointest Oncol 2015; 7:513-523. [PMID: 26691885 PMCID: PMC4678398 DOI: 10.4251/wjgo.v7.i12.513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 09/23/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare outcomes for patients presenting with stage IV colorectal cancer and an asymptomatic primary tumour, undergoing primary tumour resection (PTR) plus palliative chemotherapy vs primary chemotherapy up-front.
METHODS: A literature search was conducted using MEDLINE and EMBASE. The primary outcome was overall survival. Secondary outcomes included perioperative mortality, morbidity and delayed surgical intervention rates in patients undergoing PTR and subsequent complication rates in patients with an un-resected primary tumour. Tertiary outcomes included impact on systemic treatment and identification of prognostic factors relevant for survival in this cohort.
RESULTS: Twenty non-randomised studies met the inclusion criteria. Eleven studies included comparative overall survival data. Three studies showed an overall survival advantage for PTR, 7 studies showed no statistically significant advantage, and 1 study showed a significant worsening in survival in the surgical group. The perioperative mortality rate ranged from 0% to 8.5%, and post-operative morbidity rate from 10% to 35%, mainly minor complications that did not preclude subsequent chemotherapy. The rate of delayed primary-tumour related symptoms, most commonly obstruction, in patients with an un-resected primary tumour ranged from 3% to 46%. The strongest independent poor prognostic factor was extensive hepatic metastases, in addition to poor performance status, M1b stage and non-use of modern chemotherapy agents.
CONCLUSION: Based on the current literature, both PTR and up front chemotherapy appear appropriate initial management strategies, with a trend towards an overall survival advantage with PTR. The procedure has a low post-operative mortality, and most complications are transient and minor. The results of recruiting randomised trials are eagerly anticipated.
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Vignot S, Lefebvre C, Frampton GM, Meurice G, Yelensky R, Palmer G, Capron F, Lazar V, Hannoun L, Miller VA, André F, Stephens PJ, Soria JC, Spano JP. Comparative analysis of primary tumour and matched metastases in colorectal cancer patients: evaluation of concordance between genomic and transcriptional profiles. Eur J Cancer 2015; 51:791-9. [PMID: 25797355 DOI: 10.1016/j.ejca.2015.02.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Focal and temporal tumour heterogeneity can represent a major challenge for biology-guided therapies. This study proposes to investigative molecular discrepancies between primary colorectal cancer (CRC) samples and matched metastases. EXPERIMENTAL DESIGN Surgical samples from primary and matched metastatic tissues from 13 CRC patients along with their adjacent normal tissue were evaluated. A mutational analysis was performed using a targeted Next Generation Sequencing assay (Foundation Medicine) with a focus on known recurrent somatic mutations as surrogate of key oncogenic events. Gene expression analysis was also performed to investigate transcriptional discrepancies. RESULTS Among the 26 samples, 191 mutations were identified including mutations in APC (13 pts), TP53 (11 pts), and KRAS (7 pts). Global concordance rate for mutations was 78% between primary and metastatic tumours and raised to 90% for 12 known recurrent mutations in CRC. Differential gene expression analysis revealed a low number of significantly variant transcripts between primary and metastatic tumours once the tissue effect was taken into account. Only two pathways (ST_ADRENERGIC, PID_REELINPATHWAY) were differentially up-regulated in metastases among 17 variant pathways. A common profile in primary and metastatic tumours revealed conserved pathways mostly involved in cell cycle regulation. Only two pathways were significantly down regulated compared to normal control, including regulation of autophagy (KEGG_REGULATION_OF_AUTOPHAGY). CONCLUSION These results suggest that profiles of primary tumour can identify key alterations present in matched CRC metastases at first metastatic progression. Gene expression analysis identified mainly conserved pathways between primary tumour and matched liver metastases.
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Affiliation(s)
- Stéphane Vignot
- Oncologie Hématologie, Hôpitaux de Chartres, Chartres Le Coudray, France; INSERM U981, Gustave Roussy, Villejuif Grand Paris, France
| | | | | | - Guillaume Meurice
- Unité de Génomique Fonctionnelle, Gustave Roussy, Villejuif Grand Paris, France
| | | | | | | | - Vladimir Lazar
- Unité de Génomique Fonctionnelle, Gustave Roussy, Villejuif Grand Paris, France
| | | | | | - Fabrice André
- INSERM U981, Gustave Roussy, Villejuif Grand Paris, France
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Agrawal R, Kumar M, Agrawal L, Agrawal KK. A huge primary ovarian leiomyoma with degenerative changes-an unusual. J Clin Diagn Res 2013; 7:1152-4. [PMID: 23905126 DOI: 10.7860/jcdr/2013/5313.3060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 11/14/2012] [Accepted: 03/28/2013] [Indexed: 11/24/2022]
Abstract
Primary ovarian leiomyoma is a rare benign tumour of the ovary, which is seen in women who are aged between 20 years to 65 years. Ovarian leiomyomas can be confused with other spindle cell tumours which display gross anatomical and histological similarities. A case of a primary leiomyoma of the ovary in a pre-menopausal female is being presented here, due to its huge size and unusual presentation.
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Affiliation(s)
- Ranjan Agrawal
- Department of Pathology, Rohilkhand Medical College Hospital , Bareilly, UP, India
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Abstract
There are still debates regarding the appropriate primary treatment policy for asymptomatic primary colorectal lesions in cases of unresectable metastatic colorectal cancer. Even though there are patients with asymptomatic primary tumors when starting chemotherapy, those patients may still undergo surgery due to complications related to primary tumors in the middle of chemotherapy; therefore, controversy exists regarding surgical resection of primary colorectal lesions in cases where symptoms are absent when making a diagnosis. Thus, based on the published literature, we discuss opinions that prefer first-line surgery for primary tumors as well as opinions favoring first-line chemotherapy for treating unresectable synchronous metastatic colorectal cancer. Although the upfront chemotherapy including targeted agents is suggested as an effective treatment in recent years, the first line surgery has been a preferred treatment for decades. The first line surgery is beneficial to prolong the survival duration given the retrospective analysis of randomized trial data. So far, no prospective comparison study has only focused on the first-line treatment modality; thus, future clinical studies focusing on the survival duration and the quality of life should be performed as soon as possible. Furthermore, at this point, multidisciplinary team approaches would be helpful in finding the appropriate therapy. Regardless of symptoms, the performance status and the tumor burden should be taken into consideration as well. In case of surgical resection, minimally invasive surgery, such as laparoscopic surgery, is recommended.
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Affiliation(s)
- Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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22
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Abstract
There are still debates regarding the appropriate primary treatment policy for asymptomatic primary colorectal lesions in cases of unresectable metastatic colorectal cancer. Even though there are patients with asymptomatic primary tumors when starting chemotherapy, those patients may still undergo surgery due to complications related to primary tumors in the middle of chemotherapy; therefore, controversy exists regarding surgical resection of primary colorectal lesions in cases where symptoms are absent when making a diagnosis. Thus, based on the published literature, we discuss opinions that prefer first-line surgery for primary tumors as well as opinions favoring first-line chemotherapy for treating unresectable synchronous metastatic colorectal cancer. Although the upfront chemotherapy including targeted agents is suggested as an effective treatment in recent years, the first line surgery has been a preferred treatment for decades. The first line surgery is beneficial to prolong the survival duration given the retrospective analysis of randomized trial data. So far, no prospective comparison study has only focused on the first-line treatment modality; thus, future clinical studies focusing on the survival duration and the quality of life should be performed as soon as possible. Furthermore, at this point, multidisciplinary team approaches would be helpful in finding the appropriate therapy. Regardless of symptoms, the performance status and the tumor burden should be taken into consideration as well. In case of surgical resection, minimally invasive surgery, such as laparoscopic surgery, is recommended.
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Affiliation(s)
- Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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