1,720,982 research outputs found
Reply to Letter to the Editor 'Weekly oxaliplatin and pre-operative radiotherapy as a new neoadjuvant therapy for locally advanced rectal cancer', by T. Watanabe et al. (Ann Oncol 2006; 17 : 1173)
No full textLong-Term oncologic results and complications after preoperative chemoradiotherapy for rectal cancer: a Single-Institution experience after a median Follow-Up of 95 months.
No full textBackground
This study sought to evaluate the long-term outcome and complications, and occurrence of second malignancy after preoperative chemoradiotherapy (pCRT) for rectal cancer.
Methods
One hundred twenty-three consecutive patients (78 men, 45 women) with locally advanced mid-low rectal cancer underwent pCRT between 1994 and 2002. Patients were followed up by one surgeon with a standard protocol, and data were prospectively recorded in a dedicated database. No patient was lost to follow-up. Complications were defined as late if they occurred >6 months after surgery. Overall and disease-free survival were calculated by the Kaplan-Meier method.
Results
Of 123 patients, 111 underwent an R0 procedure. The rate of pathologic complete response was 16% (n = 20 patients). At a median follow-up of 95 (range, 56–160) months, 50 late complications occurred in 41 patients, 21 of whom required surgery. In seven cases, the complications were clearly CRT related and were significantly associated with the total dose of radiation delivered (P < .05). The estimated 5- and 10-year overall survival was 76% and 67%, respectively. The estimated 5- and 10-year disease-free survival was 83% and 82%, respectively. In 18 of 19 patients who experienced recurrence (local, n = 3; distant, n = 16), it occurred within 48 months from surgery. The most frequent site of metastasis as first site of recurrence was the lung (9 of 19). The most frequent second primary malignancy was lung cancer (3 of 8).
Conclusions
Despite satisfactory oncological outcome, late morbidity after pCRT is relevant and related to the radiotherapy dose used. Most recurrences and second malignancies were located in the lung
Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET/CT) and metabolic features in advanced rectal cancer: additional information at initial staging and after neoadjuvant therapy
No full textAim: PET/CT has been provided to be useful in staging of colorectal cancer for
detecting extra‐hepatic disease in high risk patients and for examine for postoperative
recurrence of disease. We aimed to evaluate the additional information
provided by FDG PET/CT from qualitative and quantitative analysis in patients with
advanced rectal cancer. Materials and methods: at our Institution, we prospectively
evaluated 30 patients (21 males; mean age: 65±12 years) with rectal cancer, who
underwent FDG PET/CT for initial staging. PET/CT findings and the maximum
standardized uptake value (SUVmax) obtained by the analysis of the images were
compared with clinical stage of disease and with response to neoadjuvant
treatment (chemotherapy plus radiotherapy). A patient‐based analysis was used. A
p value <0.05 was considered statistically significant. Results: at initial staging, 3
(10%) patients were at stage I, 6 (20%) at stage II, 14 (47%) at stage III and finally 7
(23%) at stage IV. PET/CT correctly staged 11 patients, in particular in 4 patients
localized visceral secondary metastases, whereas in the remnant 15 patients understaged
the lymph node involvement. In these latter patients, SUVmax at primary
lesion was 21±8 (range: 9‐36). SUVmax of primary lesion was similar among the
different stage of disease (25±13, 17±6, 21±7 e 19±10, respectively at stage I, II, III e
IV; ANOVA test p=0.551). After neoadjuvant therapy, 17 (57%) patients have had a
complete or partial response to treatment, while 6 patients had not. The value of
SUVmax at primary lesion was similar between responder and no‐responder subset
(19±7 vs. 25±11; t‐Student test p=0.131). Conclusions: PET/CT can yield useful
information for the initial evaluation of rectal cancer, in particular for the distant
metastases. From our results, we did not find any correlation between metabolic
aggressiveness and responsiveness to neoadjuvant therapy, but a larger study
population is warranted to confirm this finding
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Determining therapeutic approaches in the elderly with rectal cancer
No full textBACKGROUND: To evaluate the toxicity and feasibility of pelvic radiotherapy (RT) and/or surgery in elderly patients with locally advanced low-lying rectal cancer.
PATIENTS AND METHODS: From November 1999 to November 2005, 51 patients aged >or=70 years who underwent RT for locally advanced low-lying rectal cancer were retrospectively examined. Variables considered were age, co-morbidities (evaluated according to the Charlson score and the Cumulative Illness Rating Scale-Geriatric [CIRS-G] score) and surgery versus no surgery.
RESULTS: The median age was 80 years (range 70-94 years) and the male : female ratio was 33 : 18. A total of 5.9% of patients were considered 'fit', 72.5% had one or more CIRS-G grade 1 or 2 co-morbidities and 21.6% had one or more CIRS-G grade 3 co-morbidities. 54.9% of patients underwent surgery and 45.1% underwent RT. Only 9 of 21 (42.8%) patients who underwent radical resection received the full course of adjuvant RT and only seven (50%) of all patients treated with RT alone received the full dose of therapy. Patients with one or more CIRS-G grade 3 co-morbidities reported similar numbers of grade 1-2 toxicities as patients with one or more CIRS-G grade 2 co-morbidities.
CONCLUSION: Notwithstanding the small number of patients analysed, the findings of this study indicate that elderly patients with rectal cancer and mild co-morbidities could probably receive the same treatment as fit elderly patients, given that tolerability appeared to be similar in both categories of patients. Neither age nor co-morbidities should be considered reasons to deny the patient the possible benefits of receiving complete treatment. Moreover, Multidimensional Geriatric Assessment should always be undertaken to help clinicians make better decisions about treatment. Further prospective trials are needed to confirm these results
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Neoadjuvant treatment for rectal cancer in fit and vulnerable patients older than 70 years
No full textRectal cancer adjuvant chemotherapy: When is more useful?
Full text linkTHE AIM of the study was to evaluate time-to-progression (TTP) of rectal cancer in a group of patients receiving adjuvant chemotherapy (CHT) after combined neoadjuvant treatment. A secondary end-point was to identify the possible influence of clinical TNM (cTNM) or pathological TNM (pTNM) on TTP and overall survival (OS).
PATIENTS AND METHODS: From January 2000 to December 2005, 101 consecutive rectal cancer patients who had been neoadjuvantly treated and had underne adjuvant CHT were retrospectively examined. The variables considered were age, gender and clinical and pathological effect of CHT administration.
RESULTS: The mean age was 59 years (29-78 years) and the male:female ratio, 61:40. Forty-two patients had a lower (< or =5 cm from the anal verge), 54 a middle (from 6 to 10 cm) and 5 a higher (=10 cm) rectal lesion. All the patients had received the full course of neoadjuvant radiotherapy (RT) while 26.7% patients had received a reduced number of neoadjuvant CHT cycles. All the patients had undergone surgery and had received adjuvant chemotherapy which was completed in only 77.2% of the cases. Tumour down-staging and complete remissions were reported in 75.2% and 14.8% of cases, respectively. TTP and OS at 3 years were 81.2% and 91.1%, respectively. Out of locally recurrent patients, 77.8% were N+ (p=0.0026) at the pathological evaluation.
CONCLUSION: In our series, neither administration of oxaliplatin-based adjuvant chemotherapy (p=0.44) nor age > or =70 years (p=0.51), clinical stage III (p=0.67), tumour down-staging (p=0.44) and achievement of pCR (p=0.66) appeared to have a significant impact on TTP; only pN+ (patients "not responders" to a neoadjuvant CHT-RT) influenced local relapse requiring more accurate postoperative treatment and confirming the literature data about the utility of adjuvant therapy in stage III diseas
A haplotype of the methylenetetrahydrofolate reductase gene predicts poor tumor response in rectal cancer patients receiving preoperative chemoradiation
No full textObjective: The objective of the present study was to evaluate whether germline methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms as well as polymorphisms in the thymidylate synthase gene promoter, namely the variable number tandem repeat polymorphism (TS VNTR) and the intrarepeat G to C single nucleotide polymorphism (TS SNP), are predictive markers of tumor regression in rectal cancer patients following preoperative chemoradiotherapy.
Basic methods: Blood samples from 125 patients with primary adenocarcinoma of the mid-low rectum who received 5-fluorouracil-based chemotherapy and external beam radiotherapy (median dose 48.4 Gy), 125 patients (women n=45, men n=80; median age 60 years, range 31-79 years) were genotyped. Response to preoperative treatment was evaluated employing the Tumor Regression Grade criteria. On the basis of the pathologic response, patients were classified as responders (TRG 1-2, n=48) and non-responders (TRG 3-5, n=74). Three patients were excluded because of insufficient data.
Main results: Among the polymorphic variants examined, the MTHFR 677T-1298A haplotype was, upon univariate analysis, the only variable found associated with tumor regression (P=0.004). Moreover, at multivariate analysis, the MTHFR 677T-1298A haplotype was an independent predictor of tumor regression. Patients not carrying the MTHFR 677T-1298A haplotype (odds ratio 0.29, 95% confidence interval 0.13-0.64, P=0.002) displayed a higher response rate than patients with the MTHFR 677T-1298A haplotype.
Conclusions: Unlike TS VNTR and SNP polymorphisms, MTHFR 677T-1298A haplotype in genomic DNA has the potential to be a predictive marker of tumor response in rectal cancer patients submitted to preoperative chemoradiotherap
- …
