SUMMARY The treatment philosophy for rectal cancer has changed a lot during the last three decades. In the 1970s it was more or less a pure surgical business and rectal cancer was considered radiation resistant. Owing to the unacceptable high local recurrence rates, surgery was changed (the total mesorectal excision technique) during the 1980s and treatment was, in many countries, concentrated to lager units. Moreover, the addition of adjuvant radiotherapy was tested during the same period in several randomized trials and demonstrated that the local recurrence rate could be reduced by 50%, provided the radiation dose was high enough. Since then, treatment has changed very rapidly with several interesting approaches, such as timing and type of radiotherapy, the place of chemotherapy, surgery with modern technique including laparoscopy; natural orifice transendoscopic surgery or robotics; and the whole idea of ‘wait-and-watch’ program. All of these new aspects are covered and discussed in the view of the s...
{"title":"New trends in rectal cancer treatment","authors":"A. Martling, L. Påhlman, K. Kodeda, J. Folkesson","doi":"10.2217/CRC.14.7","DOIUrl":"https://doi.org/10.2217/CRC.14.7","url":null,"abstract":"SUMMARY The treatment philosophy for rectal cancer has changed a lot during the last three decades. In the 1970s it was more or less a pure surgical business and rectal cancer was considered radiation resistant. Owing to the unacceptable high local recurrence rates, surgery was changed (the total mesorectal excision technique) during the 1980s and treatment was, in many countries, concentrated to lager units. Moreover, the addition of adjuvant radiotherapy was tested during the same period in several randomized trials and demonstrated that the local recurrence rate could be reduced by 50%, provided the radiation dose was high enough. Since then, treatment has changed very rapidly with several interesting approaches, such as timing and type of radiotherapy, the place of chemotherapy, surgery with modern technique including laparoscopy; natural orifice transendoscopic surgery or robotics; and the whole idea of ‘wait-and-watch’ program. All of these new aspects are covered and discussed in the view of the s...","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126957469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-24DOI: 10.2174/1876820201407010001
Anita I. Nasrallah, M. E. Sibai
Colon cancer is the cancer of the epithelial cells lining the colon. This type of cancer occurs in many people that are either genetically predisposed or exposed to risk factors. Colorectal cancer is mainly divided into different stages according to invasiveness and metastatic ability of the tumor. Many mutations are acquired, leading to this malignancy. Treatment of colorectal cancer range from surgery in early stages to palliative care in most advanced stages. In this minireview, we summarize the latest findings on colorectal cancer.
{"title":"Colorectal Cancer Causes and Treatments: A Minireview","authors":"Anita I. Nasrallah, M. E. Sibai","doi":"10.2174/1876820201407010001","DOIUrl":"https://doi.org/10.2174/1876820201407010001","url":null,"abstract":"Colon cancer is the cancer of the epithelial cells lining the colon. This type of cancer occurs in many people that are either genetically predisposed or exposed to risk factors. Colorectal cancer is mainly divided into different stages according to invasiveness and metastatic ability of the tumor. Many mutations are acquired, leading to this malignancy. Treatment of colorectal cancer range from surgery in early stages to palliative care in most advanced stages. In this minireview, we summarize the latest findings on colorectal cancer.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114689452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1876820201306010001
A. Mitselou, D. Arvanitis, Urania Skoufi, D. Tsironis, E. Lampri, Ioannis Nesseris, T. Vougiouklakis, E. Briassoulis, E. Ioachim
Background: Angiogenesis is a multistep process that depends on the balance of proangiogenic factors and in- hibitors as well as on interactions with the extracellular matrix. Thrombospondin-1 (TSP-1) is an endogenous inhibitor of angiogenesis encoded by THBS1 gene, whose promoter is activated by p53. Aim: To evaluate the relevance of TSP-1 in patients with colorectal cancer. Material and Methods: We examined the immunohistochemical expression of angiogenic agents (VEGF and CD34), pro- liferation associated indices, extracellular matrix components (tenascin, fibronectin, laminin, and collagen type IV), and the antiangiogenic agent TPS-1 in 97 patients with colorectal carcinoma (CRC) and correlated their expression levels with clinicopathological parameters. Results: TSP-1 was detected in the tumor cells, stroma and perivascular tissue. High and moderate tumor TSP-1 expres- sion was observed in 24.75%, weak in 19.6%, while 55.7% of the cases were negative. High stromal expression was ob- served in 40.2% and perivascular stain was noted in 31.95% of the cases. Stromal TSP-1 expression was correlated with tumor type and tumor grade (p=0.001, and p=0.041 respectively) and with ECM components expression: tenascin (p=0.053), fibronectin (p=0.063), collagen type IV (p=0.004) and laminin (p=0.0001). The relationship of TSP-1 expres- sion with tumor angiogenesis, growth fraction, p53 protein expression, and overall survival was not significant. Conclusions: Our data suggest that both tumor and stromal TSP-1 expression may not be a direct antiangiogenic factor, although it seems to be implicated in the remodeling of colorectal cancer tissue through interaction with other extracellu- lar matrix components.
{"title":"Association Between Thrombospondin-1, Angiogenesis Related Markers,and Extracellular Matrix Components with Colorectal Cancer Outcome","authors":"A. Mitselou, D. Arvanitis, Urania Skoufi, D. Tsironis, E. Lampri, Ioannis Nesseris, T. Vougiouklakis, E. Briassoulis, E. Ioachim","doi":"10.2174/1876820201306010001","DOIUrl":"https://doi.org/10.2174/1876820201306010001","url":null,"abstract":"Background: Angiogenesis is a multistep process that depends on the balance of proangiogenic factors and in- hibitors as well as on interactions with the extracellular matrix. Thrombospondin-1 (TSP-1) is an endogenous inhibitor of angiogenesis encoded by THBS1 gene, whose promoter is activated by p53. Aim: To evaluate the relevance of TSP-1 in patients with colorectal cancer. Material and Methods: We examined the immunohistochemical expression of angiogenic agents (VEGF and CD34), pro- liferation associated indices, extracellular matrix components (tenascin, fibronectin, laminin, and collagen type IV), and the antiangiogenic agent TPS-1 in 97 patients with colorectal carcinoma (CRC) and correlated their expression levels with clinicopathological parameters. Results: TSP-1 was detected in the tumor cells, stroma and perivascular tissue. High and moderate tumor TSP-1 expres- sion was observed in 24.75%, weak in 19.6%, while 55.7% of the cases were negative. High stromal expression was ob- served in 40.2% and perivascular stain was noted in 31.95% of the cases. Stromal TSP-1 expression was correlated with tumor type and tumor grade (p=0.001, and p=0.041 respectively) and with ECM components expression: tenascin (p=0.053), fibronectin (p=0.063), collagen type IV (p=0.004) and laminin (p=0.0001). The relationship of TSP-1 expres- sion with tumor angiogenesis, growth fraction, p53 protein expression, and overall survival was not significant. Conclusions: Our data suggest that both tumor and stromal TSP-1 expression may not be a direct antiangiogenic factor, although it seems to be implicated in the remodeling of colorectal cancer tissue through interaction with other extracellu- lar matrix components.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125650639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-10-10DOI: 10.2174/1876820201205010038
J. Parsons, Yola M. Zdanowicz, C. Brezden-Masley, A. Sheppard, A. Grenville, C. Kauffman, D. Jiang, N. Baxter, H. Bryant, David Klein
Background and Purpose: Colorectal cancer (CRC) is a significant cause of morbidity and mortality world- wide, and screening is widely accepted as a means of improving outcomes. However, screening uptake remains low amongst Canadians aged 50-74. The study's objective was to obtain national-level baseline data regarding Canadians' at- titudes towards and awareness of CRC screening. Methods: A telephone survey using random digit dialing methodology was conducted. A total of 2,444 respondents aged 50 -74 were surveyed regarding their attitudes, awareness and past screening behaviours related to cancer generally and CRC specifically. Logistic regression identified predictors of CRC screening participation. Results: While 80.9% of respondents were aware that screening tests for CRC exist, far more had heard of colonoscopy (87.2%) than fecal occult blood testing (FOBT, 42.8%). Only a minority (40.0 %) recognized that cancer screening occurs before symptom onset. The strongest predictor of CRC screening participation was having discussed it with their doctor (OR 6.81); yet only 29.0% recalled having such discussions. Belief that early detection increases one's chance of survival was positively associated with prior screening (OR 2.50), while belief that CRC screening was unnecessary in the absence of symptoms showed a negative association (OR 0.42). Conclusion: This study provides important national-level baseline data regarding Canadians' attitudes towards and aware- ness of CRC and its screening, and identifies factors associated with screening behaviour. The findings indicate important gaps in respondents' understanding regarding CRC screening. Potential interventions include public education to promote awareness of FOBT and optimal timing of screening, and greater support for physicians in promoting screening uptake.
{"title":"Canadians' Attitudes and Awareness Towards Colorectal Cancer Screen-ing: Results of a National Survey","authors":"J. Parsons, Yola M. Zdanowicz, C. Brezden-Masley, A. Sheppard, A. Grenville, C. Kauffman, D. Jiang, N. Baxter, H. Bryant, David Klein","doi":"10.2174/1876820201205010038","DOIUrl":"https://doi.org/10.2174/1876820201205010038","url":null,"abstract":"Background and Purpose: Colorectal cancer (CRC) is a significant cause of morbidity and mortality world- wide, and screening is widely accepted as a means of improving outcomes. However, screening uptake remains low amongst Canadians aged 50-74. The study's objective was to obtain national-level baseline data regarding Canadians' at- titudes towards and awareness of CRC screening. Methods: A telephone survey using random digit dialing methodology was conducted. A total of 2,444 respondents aged 50 -74 were surveyed regarding their attitudes, awareness and past screening behaviours related to cancer generally and CRC specifically. Logistic regression identified predictors of CRC screening participation. Results: While 80.9% of respondents were aware that screening tests for CRC exist, far more had heard of colonoscopy (87.2%) than fecal occult blood testing (FOBT, 42.8%). Only a minority (40.0 %) recognized that cancer screening occurs before symptom onset. The strongest predictor of CRC screening participation was having discussed it with their doctor (OR 6.81); yet only 29.0% recalled having such discussions. Belief that early detection increases one's chance of survival was positively associated with prior screening (OR 2.50), while belief that CRC screening was unnecessary in the absence of symptoms showed a negative association (OR 0.42). Conclusion: This study provides important national-level baseline data regarding Canadians' attitudes towards and aware- ness of CRC and its screening, and identifies factors associated with screening behaviour. The findings indicate important gaps in respondents' understanding regarding CRC screening. Potential interventions include public education to promote awareness of FOBT and optimal timing of screening, and greater support for physicians in promoting screening uptake.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116726979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-15DOI: 10.2174/1876820201205010028
Aich Ranen Kanti, Ray Amitabh, Das Chaitiparna, Bhattacharya Jibak, Gangopadhyay Subir
Neuroendocrine tumors have been studied for over a century and several advances have been made in under- standing of the pathophysiology, diagnostic methods, management, and underlying genetics. Advances in pathology and identification of serum markers have helped to identify subsets of tumors. Diagnostic modalities like somatostatin receptor scintigraphy (SRS) with CT fusion imaging, Endoscopic ultrasonography (EUS), PET scan and MRI have vastly im- proved the diagnosis of these tumors. The management of these tumors requires a multidisciplinary approach including endocrinology, interventional radiology, medical surgery, and medical & radiation oncology. The aggressive use of cura- tive and cytoreductive surgery, orthotopic liver transplantation as well as interventional radiological techniques including embolization, chemo-embolization, and radiofrequency ablation in conjunction with judicial use of somatostatin analogues for symptom control has become the frontline of treatment. For the vast majority of patients with unresectable metastatic disease, older chemotherapeutic agents have shown disappointing results, yet new regimens and new classes of drugs hold great promise. Clinicians need to be aware with the disease pattern, natural history and disease progression, which are characteristic of these tumors. A multidisciplinary approach is the evidence based logical approach to treat these diseases.
{"title":"Management of Gastro-intestinal Neuroendocrine Tumors with Liver Metastases: A Comprehensive Review","authors":"Aich Ranen Kanti, Ray Amitabh, Das Chaitiparna, Bhattacharya Jibak, Gangopadhyay Subir","doi":"10.2174/1876820201205010028","DOIUrl":"https://doi.org/10.2174/1876820201205010028","url":null,"abstract":"Neuroendocrine tumors have been studied for over a century and several advances have been made in under- standing of the pathophysiology, diagnostic methods, management, and underlying genetics. Advances in pathology and identification of serum markers have helped to identify subsets of tumors. Diagnostic modalities like somatostatin receptor scintigraphy (SRS) with CT fusion imaging, Endoscopic ultrasonography (EUS), PET scan and MRI have vastly im- proved the diagnosis of these tumors. The management of these tumors requires a multidisciplinary approach including endocrinology, interventional radiology, medical surgery, and medical & radiation oncology. The aggressive use of cura- tive and cytoreductive surgery, orthotopic liver transplantation as well as interventional radiological techniques including embolization, chemo-embolization, and radiofrequency ablation in conjunction with judicial use of somatostatin analogues for symptom control has become the frontline of treatment. For the vast majority of patients with unresectable metastatic disease, older chemotherapeutic agents have shown disappointing results, yet new regimens and new classes of drugs hold great promise. Clinicians need to be aware with the disease pattern, natural history and disease progression, which are characteristic of these tumors. A multidisciplinary approach is the evidence based logical approach to treat these diseases.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"313 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124440019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-18DOI: 10.2174/1876820201205010022
J. Zekri, A. Rizvi, J. Al-Maghrabi, B. Sadiq
Background: K-ras oncogene mutations are confirmed factor for lack of clinical benefit from antibodies target- ing EGFR in patients with colorectal cancer (CRC). Mutations are reported in 40% of CRC tumors in western patients. There is scarcity of data on population from Asia and the Middle East. Aims: This study investigates the frequency and impact of k-ras mutation and the association between clinico-pathological features and K-ras status in Saudi patients with CRC. Patients and Methods: Retrospective review of K-ras status, clinico-pathological characteristics and clinical outcome in 46 patients with CRC. Results: K-ras mutations were identified in 15/46 (32%) tumors, 87% at codon 12 and 13% at codon 13. Gender, site of tumor, stage at diagnosis, differentiation and lymphatic and vascular invasion were tested as potential risk predictors for K-ras status. Only gender was found to be a potential risk factor. Female gender compared to male posed higher signifi- cant chance of wild type status (RR=1.54, 65% CI: 1.07-2.2; P=0.034). K-ras status (mutant vs. wild) did not statistically significantly impact on clinical outcome as measured by development of relapsed disease (80% vs. 81%), median relapse free survival (17 vs. 11 months, P=0.256) and overall survival (not reached in both groups, P=0.59). Conclusion: This relatively small retrospective series shows that rate of K-ras mutation in Saudi patients with CRC is lower than reported in western Caucasian population but close to rates reported in neighboring Asian population. Muta- tions are less frequent in females. In these patients, K-ras mutation status did not significantly impact clinical outcome.
背景:K-ras癌基因突变是结直肠癌(CRC)患者中靶向EGFR抗体缺乏临床获益的确定因素。据报道，在西方患者中，40%的CRC肿瘤存在突变。亚洲和中东地区的人口数据缺乏。目的:本研究探讨沙特结直肠癌患者k-ras突变的频率和影响，以及k-ras状态与临床病理特征的关系。患者与方法:回顾性分析46例结直肠癌患者的K-ras状态、临床病理特征及临床转归。结果:在15/46(32%)的肿瘤中发现K-ras突变，其中密码子12和13分别占87%和13%。性别、肿瘤部位、诊断分期、分化、淋巴和血管浸润作为K-ras状态的潜在危险预测因素。研究发现，只有性别是潜在的风险因素。与男性相比，女性出现野生型状态的几率更高(RR=1.54, 65% CI: 1.07-2.2;P = 0.034)。K-ras状态(突变型与野生型)对临床结果的影响无统计学意义，包括复发疾病的发生(80% vs 81%)、中位无复发生存期(17 vs 11个月，P=0.256)和总生存期(两组均未达到，P=0.59)。结论:这一相对较小的回顾性研究表明，沙特阿拉伯结直肠癌患者的K-ras突变率低于西方高加索人群的报道，但接近邻近亚洲人群的报道。突变在女性中较少发生。在这些患者中，K-ras突变状态对临床结果没有显著影响。
{"title":"K-ras in Colorectal Cancer Tumors From Saudi Patients: Frequency, Clinco-pathological Association and Clinical Outcome","authors":"J. Zekri, A. Rizvi, J. Al-Maghrabi, B. Sadiq","doi":"10.2174/1876820201205010022","DOIUrl":"https://doi.org/10.2174/1876820201205010022","url":null,"abstract":"Background: K-ras oncogene mutations are confirmed factor for lack of clinical benefit from antibodies target- ing EGFR in patients with colorectal cancer (CRC). Mutations are reported in 40% of CRC tumors in western patients. There is scarcity of data on population from Asia and the Middle East. Aims: This study investigates the frequency and impact of k-ras mutation and the association between clinico-pathological features and K-ras status in Saudi patients with CRC. Patients and Methods: Retrospective review of K-ras status, clinico-pathological characteristics and clinical outcome in 46 patients with CRC. Results: K-ras mutations were identified in 15/46 (32%) tumors, 87% at codon 12 and 13% at codon 13. Gender, site of tumor, stage at diagnosis, differentiation and lymphatic and vascular invasion were tested as potential risk predictors for K-ras status. Only gender was found to be a potential risk factor. Female gender compared to male posed higher signifi- cant chance of wild type status (RR=1.54, 65% CI: 1.07-2.2; P=0.034). K-ras status (mutant vs. wild) did not statistically significantly impact on clinical outcome as measured by development of relapsed disease (80% vs. 81%), median relapse free survival (17 vs. 11 months, P=0.256) and overall survival (not reached in both groups, P=0.59). Conclusion: This relatively small retrospective series shows that rate of K-ras mutation in Saudi patients with CRC is lower than reported in western Caucasian population but close to rates reported in neighboring Asian population. Muta- tions are less frequent in females. In these patients, K-ras mutation status did not significantly impact clinical outcome.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130199492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-04-27DOI: 10.2174/1876820201205010015
Shikha Tarang, Jing Wang
The recepteur d'origine nantais (RON) is a member of MET family of receptor tyrosine kinase (RTKs), an overexpression of which has been observed in several cancers. The expression of RON gene is required during embryonic development and also plays critical roles in regulating macrophage inflammatory response. In CRC, the overexpression of moderate RON activity contributes to their oncogenic potential by regulating several key processes such as proliferation, motility and resistance to apoptosis. Interestingly, an aberrant RON expression is often associated with the generation of several splice variants with unique transforming activities. The targeting of RON signaling pathway by the use of mono- clonal antibodies and small-molecule inhibitors has shown promising therapeutic results in animal models. The present ar- ticle aims at summarizing the current understanding of RON kinase in CRC.
{"title":"RON - The Con in Colorectal Carcinoma","authors":"Shikha Tarang, Jing Wang","doi":"10.2174/1876820201205010015","DOIUrl":"https://doi.org/10.2174/1876820201205010015","url":null,"abstract":"The recepteur d'origine nantais (RON) is a member of MET family of receptor tyrosine kinase (RTKs), an overexpression of which has been observed in several cancers. The expression of RON gene is required during embryonic development and also plays critical roles in regulating macrophage inflammatory response. In CRC, the overexpression of moderate RON activity contributes to their oncogenic potential by regulating several key processes such as proliferation, motility and resistance to apoptosis. Interestingly, an aberrant RON expression is often associated with the generation of several splice variants with unique transforming activities. The targeting of RON signaling pathway by the use of mono- clonal antibodies and small-molecule inhibitors has shown promising therapeutic results in animal models. The present ar- ticle aims at summarizing the current understanding of RON kinase in CRC.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128244680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-03-08DOI: 10.2174/1876820201205010009
M. Calvanese, R. Manzo, M. Orditura, P. Murino, rizio Camma-rota, R. Franco, S. Falivene, A. Morra, P. Muto, V. Ravo
Background and Purpose: It is known that radiotherapy or chemotherapy alone don't represent a standard of care as adjuvant treatment for patients with advanced gastric cancer that underwent surgical resection. The purpose in the approach of this cancer is to find an adjuvant treatment that can affect overall survival. Phase 2 studies and randomized trials suggest that a multimodal approach with chemo radiotherapy (CT-RT) can improve overall survival. We analyze the feasibility and toxic effects of chemo radiotherapy (CT-RT) as a post surgical adjuvant treatment in a cohort of patients with high risk gastric cancer. Methods: We enrolled 48 patients with advanced gastric cancer (Stage III and IV, M0). These patients were submitted to surgical resection and all of them, within 6 weeks, underwent adjuvant chemotherapy with FOLFOX-4 (ie, a combination of folinic acid, fluorouracil, and oxaliplatin) for 8 cycles and concomitant radiotherapy (45 Gy in 25 daily fractions over 5 weeks). Radiotherapy started after the first 2 cycles of FOLFOX-4. Chemotherapy schedule was reduced by 25% during the period of the contemporary radiotherapy treatment. Results: All patients except one ended the combined adjuvant treatment. We observed severe hematologic adverse effects only in less than 10% of patients (4 patients); regarding gastrointestinal toxic effects they occurred in 33% of patients and specifically we noted G1-G3 grade toxicity and no G4 toxicity . Disease-free and overall survival at 1, 2, and 3 years was superior to in untreated patients. One to 3-years Median disease-free and overall survival rates were 27 months and 15 months respectively. Conclusions: A combined trial with chemo radiotherapy (CT-RT ) as adjuvant treatment represents an effective approach for patients with resected advanced gastric cancer.
{"title":"Postoperative Adjuvant Radiochemotherapy for Patients with Stage III or IV Gastric Cancer","authors":"M. Calvanese, R. Manzo, M. Orditura, P. Murino, rizio Camma-rota, R. Franco, S. Falivene, A. Morra, P. Muto, V. Ravo","doi":"10.2174/1876820201205010009","DOIUrl":"https://doi.org/10.2174/1876820201205010009","url":null,"abstract":"Background and Purpose: It is known that radiotherapy or chemotherapy alone don't represent a standard of care as adjuvant treatment for patients with advanced gastric cancer that underwent surgical resection. The purpose in the approach of this cancer is to find an adjuvant treatment that can affect overall survival. Phase 2 studies and randomized trials suggest that a multimodal approach with chemo radiotherapy (CT-RT) can improve overall survival. We analyze the feasibility and toxic effects of chemo radiotherapy (CT-RT) as a post surgical adjuvant treatment in a cohort of patients with high risk gastric cancer. Methods: We enrolled 48 patients with advanced gastric cancer (Stage III and IV, M0). These patients were submitted to surgical resection and all of them, within 6 weeks, underwent adjuvant chemotherapy with FOLFOX-4 (ie, a combination of folinic acid, fluorouracil, and oxaliplatin) for 8 cycles and concomitant radiotherapy (45 Gy in 25 daily fractions over 5 weeks). Radiotherapy started after the first 2 cycles of FOLFOX-4. Chemotherapy schedule was reduced by 25% during the period of the contemporary radiotherapy treatment. Results: All patients except one ended the combined adjuvant treatment. We observed severe hematologic adverse effects only in less than 10% of patients (4 patients); regarding gastrointestinal toxic effects they occurred in 33% of patients and specifically we noted G1-G3 grade toxicity and no G4 toxicity . Disease-free and overall survival at 1, 2, and 3 years was superior to in untreated patients. One to 3-years Median disease-free and overall survival rates were 27 months and 15 months respectively. Conclusions: A combined trial with chemo radiotherapy (CT-RT ) as adjuvant treatment represents an effective approach for patients with resected advanced gastric cancer.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"46 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129766332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-29DOI: 10.2174/1876820201205010005
S. Alasari, N. Kim
{"title":"[Poster] Unusual presentation of complicated diverticulitis at colostomy site","authors":"S. Alasari, N. Kim","doi":"10.2174/1876820201205010005","DOIUrl":"https://doi.org/10.2174/1876820201205010005","url":null,"abstract":"","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132611806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-13DOI: 10.2174/1876820201205010001
S. Alasari, Alaa S. Abduljabbar, N. Al‐Sanea, S. Alhomoud, L. Ashari, K. Balaraj
Serum Carcinoembryonic Antigen (CEA) levels are the most widely used tumor marker for colorectal cancer. Elevated serum CEA has been reported to be associated with an increased risk of relapse and poor patient outcome. Whether this marker would be altered with preoperative adjuvant treatment of rectal cancer prior to resection and can this alteration reflect any changes in the tumor have not been yet investigated. If so, this might guide us to predict curative from palliative resection and to correlate between the marker level and future tumor response to the adjuvant therapy. Aim: This review was undertaken to assess the effect of preoperative neoadjuvant therapy on serum CEA level and the re- lationship between these effect on CEA and changes of the tumor in CT scan in advanced rectal cancer patient before de- finitive surgery. Methods: Between January 2002 and October 2007, a retrospective review using the colorectal database for all rectal can- cer patients treated in King Faisal Specialist Hospital and Research Center was performed. All patients received preopera- tive long course radiotherapy alone, or combined with 5- fluorouracil. Serum CEA and CT scan was done for the patients before starting the neoadjuvant therapy, and repeated again prior to surgery. Surgical resection was planned 6 - 8 weeks following the completion of treatment. We determined the criteria of the tumor response in the CT scan findings and compared the results with the CEA level after the neoadjuvant therapy. Results: Out-off the 77 patients, 38 received radiotherapy alone, while 39 patients received chemoradiotherapy, CT scan was done for all patients in both groups (pre and post neoajuvent therapy). Patients divided into 2 groups based on the CT scan findings to: CT responder and CT non-responder patients. In the radiation only group, 21 (55 %) patients had raised CEA levels before the treatment, 18 (86%) of them showed a decrease in CEA with CT response, while 3(14%) patients' demonstrated further increase and CT non-response. 17(45%) patients with normal CEA. 15 (89%) of them showed normal CEA post treatment 12 (80%) of them showed CT response and 3 of them shows CT non-response. 2/17 (11%) patients showed further increase in CEA level and CT non-response as well. In the chemoradiotherapy group, 17 (43%) patients had high CEA level before the treatment. 16 (95%) of them showed a decrease in CEA and CT response while 1(5%) patient showed increase in CEA level and CT non-response post treat- ment. 22/39(57%) showed normal CEA where all of them remained in normal level post treatment and only 1 patient (5%) showed CT non-response. All patients with CEA and CT scan response are operable patients and we can consider them for curative resection, while all patients with CEA and CT scan non response are non operable or can get a palliative treatment due to ( metastasis or carcinomatosis). 4 patients of normal CEA post treatment CT scan shows ( increase in thickening and s
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