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Roesel R, Deantonio L, Bernardi L, Garo ML, Majno-Hurst P, Vannelli A, Cefalì M, Palmarocchi MC, Valli MC, Pesola G, Cristaudi A, De Dosso S. Neo-Adjuvant Treatment in Primary Resectable Pancreatic Cancer: A Systematic Review and PRISMA-Compliant Updated Metanalysis of Oncological Outcomes. Cancers (Basel) 2023; 15:4627. [PMID: 37760596 PMCID: PMC10526896 DOI: 10.3390/cancers15184627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Despite advances in treatment, the prognosis of resectable pancreatic adenocarcinoma remains poor. Neoadjuvant therapy (NAT) has gained great interest in hopes of improving survival. However, the results of available studies based on different treatment approaches, such as chemotherapy and chemoradiotherapy, showed contrasting results. The aim of this systematic review and meta-analysis is to clarify the benefit of NAT compared to upfront surgery (US) in primarily resectable pancreatic adenocarcinoma. METHODS A PRISMA literature review identified 139 studies, of which 15 were finally included in the systematic review and meta-analysis. All data from eligible articles was summarized in a systematic summary and then used for the meta-analysis. Specifically, we used HR for OS and DFS and risk estimates (odds ratios) for the R0 resection rate and the N+ rate. The risk of bias was correctly assessed according to the nature of the studies included. RESULTS From the pooled HRs, OS for NAT patients was better, with an HR for death of 0.80 (95% CI: 0.72-0.90) at a significance level of less than 1%. In the sub-group analysis, no difference was found between patients treated with chemoradiotherapy or chemotherapy exclusively. The meta-analysis of seven studies that reported DFS for NAT resulted in a pooled HR for progression of 0.66 (95% CI: 0.56-0.79) with a significance level of less than 1%. A significantly lower risk of positive lymph nodes (OR: 0.45; 95% CI: 0.32-0.63) and an improved R0 resection rate (OR: 1.70; 95% CI: 1.23-2.36) were also found in patients treated with NAT, despite high heterogeneity. CONCLUSIONS NAT is associated with improved survival for patients with resectable pancreatic adenocarcinoma; however, the optimal treatment strategy has yet to be defined, and further studies are required.
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Affiliation(s)
- Raffaello Roesel
- Department of Visceral Surgery, Hospital of Lugano (EOC), 6900 Lugano, Switzerland (P.M.-H.); (A.C.)
| | - Letizia Deantonio
- Radiation Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (L.D.); (M.C.V.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Lorenzo Bernardi
- Department of Visceral Surgery, Hospital of Lugano (EOC), 6900 Lugano, Switzerland (P.M.-H.); (A.C.)
| | | | - Pietro Majno-Hurst
- Department of Visceral Surgery, Hospital of Lugano (EOC), 6900 Lugano, Switzerland (P.M.-H.); (A.C.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Alberto Vannelli
- Department of General Surgery, Ospedale Valduce, 22100 Como, Italy;
| | - Marco Cefalì
- Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (M.C.); (M.C.P.); (G.P.)
| | - Maria Celeste Palmarocchi
- Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (M.C.); (M.C.P.); (G.P.)
| | - Maria Carla Valli
- Radiation Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (L.D.); (M.C.V.)
| | - Guido Pesola
- Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (M.C.); (M.C.P.); (G.P.)
| | - Alessandra Cristaudi
- Department of Visceral Surgery, Hospital of Lugano (EOC), 6900 Lugano, Switzerland (P.M.-H.); (A.C.)
| | - Sara De Dosso
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), EOC, 6500 Bellinzona, Switzerland; (M.C.); (M.C.P.); (G.P.)
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2
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Goel M, Gupta AM, Patkar S, Parray AM, Shetty N, Ramaswamy A, Patil P, Chopra S, Ostwal V, Kulkarni S, Engineer R, Mehta S. Towards standardization of management of gallbladder carcinoma with obstructive jaundice: Analysis of 113 cases over 10 years at a single institution. J Surg Oncol 2021; 124:572-580. [PMID: 34106475 DOI: 10.1002/jso.26564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/29/2021] [Revised: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no defined treatment pathways. METHODS Retrospective analysis of all surgically treated GBC patients from January 2010 to December 2019 was performed for evaluating etiology of obstructive jaundice, resectability, postoperative morbidity, mortality, disease-free survival (DFS) and overall survival (OS). RESULTS Out of 954 patients, 521 patients (54.61%) were locally advanced gallbladder carcinoma (LAGBC: Stage III and IV) and 113 patients (11.84%) had jaundice at presentation. Thirty-four (30%) patients had benign cause of obstructive jaundice. Median OS of the whole cohort (n=113) was 22 months (16.5-27.49 months) with resectability rate of 62% (70/113). Median OS of curative resection group (n=70) was 32 months and DFS was 25 months. Treatment completion was achieved in 30% (n= 21/70) patients with median OS of 46 months and median DFS of 27 months. Isolated bile duct infiltration subgroup fared the best with median OS of 74 months with a 5-year survival of 66.7%. CONCLUSION Surgical resection as a part of multimodality treatment improves survival in carefully selected locally advanced gallbladder cancer patients with jaundice. Early introduction of systemic therapy is the key in the management of this disease with aggressive tumor biology.
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Affiliation(s)
- Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit M Gupta
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amir M Parray
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Prachi Patil
- Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shaesta Mehta
- Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India
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Gillespie MA, Steele CW, Lannagan TR, Sansom OJ, Roxburgh CS. Pre-clinical modelling of rectal cancer to develop novel radiotherapy-based treatment strategies. Oncol Rev 2021; 15:511. [PMID: 34249240 PMCID: PMC8237517 DOI: 10.4081/oncol.2021.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Pre-operative chemoradiotherapy reduces local recurrence rates in locally advanced rectal cancer. 10-20% of patients undergo complete response to chemoradiotherapy, however, many patients show no response. The mechanisms underlying this are poorly understood; identifying molecular and immunological factors underpinning heterogeneous responses to chemoradiotherapy, will promote development of treatment strategies to improve responses and overcome resistance mechanisms. This review describes the advances made in pre-clinical modelling of colorectal cancer, including genetically engineered mouse models, transplantation models, patient derived organoids and radiotherapy platforms to study responses to chemoradiotherapy. Relevant literature was identified through the PubMed and MEDLINE databases, using the following keywords: rectal cancer; mouse models; organoids; neo-adjuvant treatment; radiotherapy; chemotherapy. By delineating the advantages and disadvantages of available models, we discuss how modelling techniques can be utilized to address current research priorities in locally advanced rectal cancer. We provide unique insight into the potential application of pre-clinical models in the development of novel neo-adjuvant treatment strategies, which will hopefully guide future clinical trials.
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Affiliation(s)
- Michael A. Gillespie
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Owen J. Sansom
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Campbell S.D. Roxburgh
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
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4
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Mozarowski P, Rasaiah B, Reed M, Lewis A, Walde N, Voutsadakis IA. Prognostic Role of Tumor Budding in Breast Cancer Patients Receiving Neo-Adjuvant Therapy. J Clin Med 2021; 10:jcm10040827. [PMID: 33670512 PMCID: PMC7922902 DOI: 10.3390/jcm10040827] [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: 12/23/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Isolated tumor cells or small clusters of tumor cells observed in the vicinity of the main tumor mass in pathology sections, termed tumor budding, are common in cancers and have been associated with prognosis in some settings. This study examined the clinical associations and treatment efficacy implications of tumor budding in breast cancer patients receiving neo-adjuvant therapy. Methods: Breast cancer patients that received neo-adjuvant therapy before definitive surgical treatment in a single cancer center over a 7-year period were included, and their records were reviewed. Data extracted included patient demographics, tumor characteristics and pathologic response to treatment at surgery. The initial breast cancer biopsy before any therapy was reviewed by two pathologists, and a hot spot area was evaluated for tumor budding (defined as 1 to 5 cancer cells observed detached from the main tumor mass). Results: Seventy-five patients who received neo-adjuvant therapy (73 received chemotherapy and 2 received hormonal therapy) were included. Tumor budding was observed in two-thirds of the patients. There were no significant differences in patient (age and menopause status) and tumor (stage, histology and molecular sub-type equivalent) characteristics between the group that had tumor budding and the group that did not have tumor budding in the pre-treatment biopsy. Likewise, no statistically significant differences were observed in the frequency of complete or partial responses between the two groups. Conclusion: In this cohort of breast cancer patients receiving neo-adjuvant therapy, tumor budding was frequent, but it was not associated with tumor characteristics or pathologic responses to treatment. The value of tumor budding as a prognostic factor in the neo-adjuvant setting within the general breast cancer population could not be confirmed, but such a value in specific sub-groups deserves further investigation, given the pathophysiologic rationale and data from other settings.
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Affiliation(s)
- Paul Mozarowski
- Department of Pathology, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada; (P.M.); (B.R.)
| | - Bhubendra Rasaiah
- Department of Pathology, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada; (P.M.); (B.R.)
| | - Melissa Reed
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada; (M.R.); (A.L.); (N.W.)
- Faculty of Medicine, University of Ottawa School of Medicine, Ottawa, ON KK1H 8M5, Canada
| | - Alexis Lewis
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada; (M.R.); (A.L.); (N.W.)
- Department of Biology, Algoma University, Sault Ste. Marie, ON P6A 2G4, Canada
| | - Natalie Walde
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada; (M.R.); (A.L.); (N.W.)
| | - Ioannis A. Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, ON P6B 0A8, Canada
- Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
- Correspondence:
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Meyer VM, Meuzelaar RR, Schoenaker Y, de Groot JW, de Boer E, Reerink O, de Vos tot Nederveen Cappel W, Beets GL, van Westreenen HL. Delayed Surgery after Neoadjuvant Treatment for Rectal Cancer Does Not Lead to Impaired Quality of Life, Worry for Cancer, or Regret. Cancers (Basel) 2021; 13:cancers13040742. [PMID: 33670120 PMCID: PMC7916848 DOI: 10.3390/cancers13040742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/17/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Rectal cancer patients with an initial (near) complete clinical response to neoadjuvant chemoradiotherapy can be repeatedly assessed to see if a complete response endures. Up to 75% of these patients are able to avoid surgery and its related complications. However, the remaining 25% who ‘fail’ will eventually have to undergo surgery. Although recent studies have shown that patients undergoing delayed surgery have promising surgical and oncological outcomes, it is not known how these patients fare in terms of quality of life. The aim of this study was to compare quality of life between these immediate and delayed surgery groups through validated questionnaires. Our study including 51 patients shows no difference in quality of life, worry for cancer, or decision regret. Therefore, from a quality of life perspective, this study supports a repeated response assessment strategy after chemoradiotherapy for rectal carcinoma to identify all complete responders. Abstract Non operative management of complete clinical responders after neoadjuvant treatment for rectal cancer enjoys an increasing popularity because of the increased functional outcome results. Even a near complete response can evolve in a cCR, and therefore further delaying response assessment is accepted. However, up to 40% of patients will develop a regrowth and will eventually require delayed surgery. It is presently unknown if and to what extent quality of life of these patients is affected, compared to patients who undergo immediate surgery. Between January 2015-May 2020, 200 patients were treated with neoadjuvant therapy of whom 94 received TME surgery. Fifty-one (59%) of 87 alive patients returned the questionnaires: 33 patients who underwent immediate and 18 patients who underwent delayed surgery. Quality of life was measured through the QLQ-C30, QLQ-CR29, and Cancer Worry Scale questionnaires. Regret to participate in repeated response assessment protocol was assessed through the Decision Regret Scale. Exploratory factor analysis (EFA) and a ‘known groups comparison’ was performed to assess QLQ questionnaires validity in this sample. Higher mean physical function scores (89.2 vs. 77.6, p = 0.03) were observed in the immediate surgery group, which lost significance after correction for operation type (p = 0.25). Arousal for men was higher in the delayed surgery group (20.0 vs. 57.1, p = 0.02). There were no differences between surgical groups for the other questionnaire items. Worry for cancer was lower in the delayed surgery group (10.8 vs. 14.0, p = 0.21). Regret was very low (12–16%). EFA reproduced most QLQ C-30 and CR29 subscales with good internal consistency. Quality of life is not impaired in patients undergoing delayed TME surgery after neoadjuvant treatment for rectal cancer. Moreover, there is very low regret and no increase in worry for cancer. Therefore, from a quality of life perspective, this study supports a repeated response assessment strategy after CRTx for rectal carcinoma to identify all complete responders.
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Affiliation(s)
- Vincent Maurice Meyer
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
- Correspondence:
| | - Richtje R Meuzelaar
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
| | - Yvonne Schoenaker
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
| | - Jan-Willem de Groot
- Department of Oncology, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands;
| | - Edwin de Boer
- Department of Radiology, Isala Hospitals, 8025 AB Zwolle, The Netherlands;
| | - Onno Reerink
- Department of Radiotherapy, Isala Hospitals, 8025 AB Zwolle, The Netherlands;
| | | | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Henderik L van Westreenen
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
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Ortega-Ruiz MA, Karabağ C, Garduño VG, Reyes-Aldasoro CC. Morphological Estimation of Cellularity on Neo-Adjuvant Treated Breast Cancer Histological Images. J Imaging 2020; 6:jimaging6100101. [PMID: 34460542 PMCID: PMC8321162 DOI: 10.3390/jimaging6100101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
This paper describes a methodology that extracts key morphological features from histological breast cancer images in order to automatically assess Tumour Cellularity (TC) in Neo-Adjuvant treatment (NAT) patients. The response to NAT gives information on therapy efficacy and it is measured by the residual cancer burden index, which is composed of two metrics: TC and the assessment of lymph nodes. The data consist of whole slide images (WSIs) of breast tissue stained with Hematoxylin and Eosin (H&E) released in the 2019 SPIE Breast Challenge. The methodology proposed is based on traditional computer vision methods (K-means, watershed segmentation, Otsu’s binarisation, and morphological operations), implementing colour separation, segmentation, and feature extraction. Correlation between morphological features and the residual TC after a NAT treatment was examined. Linear regression and statistical methods were used and twenty-two key morphological parameters from the nuclei, epithelial region, and the full image were extracted. Subsequently, an automated TC assessment that was based on Machine Learning (ML) algorithms was implemented and trained with only selected key parameters. The methodology was validated with the score assigned by two pathologists through the intra-class correlation coefficient (ICC). The selection of key morphological parameters improved the results reported over other ML methodologies and it was very close to deep learning methodologies. These results are encouraging, as a traditionally-trained ML algorithm can be useful when limited training data are available preventing the use of deep learning approaches.
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Affiliation(s)
- Mauricio Alberto Ortega-Ruiz
- Universidad del Valle de México, Departamento de Ingeniería, Campus Coyoacán, Ciudad de México 04910, Mexico
- Department of Electrical & Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK;
- Correspondence: (M.A.O.-R.); (C.C.R.-A.)
| | - Cefa Karabağ
- Department of Electrical & Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK;
| | - Victor García Garduño
- Departamento de Ingeniería en Telecomunicaciones, Facultad de Ingeniería, Universidad Nacional Autónoma de México, Av. Universidad 3000, Ciudad Universitaria, Coyoacán, Ciudad de México 04510, Mexico;
| | - Constantino Carlos Reyes-Aldasoro
- giCentre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK
- Correspondence: (M.A.O.-R.); (C.C.R.-A.)
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Huber J, Teber D, Hatiboglu G, Popeneciu V, Jakobi H, Hallscheidt P, Pahernik S, Hohenfellner M. Does a venous tumor thrombus exclude renal transitional cell carcinoma? Implications for neo-adjuvant treatment strategies. Anticancer Res 2014; 34:1031-1035. [PMID: 24511051] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series of five patients with VTT due to renal transitional cell carcinoma (TCC). Our study aimed to determine the incidence and clinical relevance of this entity. PATIENTS AND METHODS From our prospectively-maintained tumor database, we identified 102 patients with renal TCC according to postoperative histology and analyzed the incidence of VTT in renal TCC from 1990 to 2010. RESULTS Five out of 102 patients with TCC (5%) had a VTT. None of these five patients experienced gross haematuria and we presumed correct diagnosis preoperatively in one out of five patients. Univariate analysis revealed that TNM stage and resection status were inferior in the VTT group. All five patients from the VTT group died from their disease, with a median survival of 8.9 months. With regard to all diagnosed VTT, the effective incidence of vena cava involvement in RCC was 48-fold higher than in renal TCC. CONCLUSION A VTT is very suggestive of renal cell carcinoma. However, before neo-adjuvant treatment, the diagnosis should be assured whenever there is doubt.
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Affiliation(s)
- Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU of Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
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