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National Cancer Institute®
Ultima Vez Modificado: 1 de febrero del 2002
UI - 11591974
AU - Wood TF; Spirt M; Rangel D; Shen P; Tsioulias GJ; Morton DL; Bilchik AJ
TI - Lymphatic mapping improves staging during laparoscopic colectomy for cancer.
SO - Surg Endosc 2001 Jul;15(7):715-9
AD - The John Wayne Cancer Institute, Saint John's Health Center, Department of Surgical Oncology, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
BACKGROUND: Recently, lymphatic mapping (LM) of the sentinel lymph node (SN) has been coupled with ultrastaging methods to diagnose nodal micrometastases from colorectal cancer (CRC). We have developed a technique for LM at the time of laparoscopic colon resection (LCR). early-stage CRC underwent laparoscopic LM and LCR. The primary tumor/polyp site was visualized through a colonoscope and either tattooed preoperatively with a carbon dye (India ink), or stained intraoperatively by peritumoral injection of isosulfan blue dye. Immediately after intraoperative injection of blue dye, efferent lymphatic channels were visualized through the laparoscope and followed to the SN. Each blue-stained SN was marked with a suture or clip. RESULTS: In all 11 cases, laparoscopic LM identified between one and three SN draining the primary tumor. LM added ~15-20 min to the operating time. The SN correctly reflected the nodal status of the entire specimen in all cases. In the one node-positive case, micrometastases were found only in an SN and only after cytokeratin immunohistochemistry (CK-IHC). In four cases, LM demonstrated unexpected primary lymphatic drainage that prompted an increase in the margins of resection. CONCLUSIONS: LM during laparoscopic colectomy for CRC may be useful to mark the primary tumor site and to demonstrate lymphatic drainage that can alter the margins of resection. Focused examination of SN identifies occult micrometastases that up-stage CRC.
UI - 11765410
AU - Perevoshchikov AG; Prorokov VV; Zalit NIu; Knysh VI; Barkanov AI;
TI - Anan'ev VS [Morphological aspects of intense preoperative hypoxyradiotherapy in combined treatment of patients with sigmoid colon carcinoma]
SO - Arkh Patol 2001 Sep-Oct;63(5):25-30
AD - N. N. Blokhin Cancer Research Center, 115478, Moscow.
Morphological study has confirmed the advantage of using doses of single radiation doses 5 Gy (total dose 25 Gy) and inhalation of a hypoxic gas mixture vs other methods of treatment. The study of radiation pathomorphosis showed significants devitalization of the tumor cells realized clinically with a fall in the number of postoperative recurrences and metastases.
UI - 11772141
AU - McGavin JK; Goa KL
TI - Capecitabine: a review of its use in the treatment of advanced or metastatic colorectal cancer.
SO - Drugs 2001;61(15):2309-26
AD - Adis International Limited, Auckland, New Zealand. email@example.com
Capecitabine is an orally administered fluoropyrimidine which is selectively activated in tumour tissue to the active moiety fluorouracil and is cytotoxic through inhibition of DNA synthesis. In patients with advanced or metastatic colorectal cancer, first-line therapy with intermittent capecitabine achieved significantly higher objective tumour response rates than therapy with fluorouracil plus leucovorin in pooled analysis. Response rates were also higher in patients pretreated in the adjuvant setting and whose primary site of metastasis was the lung. However, no significant differences between the two treatment groups were seen in the time to disease progression, time to treatment failure or overall survival. Preliminary data suggest response may be improved by combining capecitabine with other anticancer therapies such as oxaliplatin, irinotecan and radiotherapy. Capecitabine in therapeutic dosage regimens generally has acceptable tolerability. Diarrhoea and hand-and-foot syndrome are the major dose-limiting toxicities associated with capecitabine therapy, with adverse effects generally of a gastrointestinal nature. Overall, diarrhoea, stomatitis, nausea and alopecia were significantly less common with capecitabine than with bolus fluorouracil and leucovorin. In addition, capecitabine recipients experienced significantly less myelosuppression, although more capecitabine recipients discontinued therapy because of adverse events. Importantly, patients spent less time in hospital after capecitabine than after bolus fluorouracil and leucovorin therapy, and the oral route of administration of capecitabine is likely to be preferred. In conclusion, capecitabine has shown superior tumour response and less myelosuppression, although more grade 3 hand-and-foot syndrome, in comparison with the 'Mayo Clinic' regimen of fluorouracil therapy, but is unlikely to improve survival. Significantly, its oral route of administration is likely to be preferred by patients. Future strategies to improve patient response may involve selection of those patients likely to respond best to capecitabine, through determination of relevant enzyme levels and combination of capecitabine with various antineoplastic agents. Data on the effect of the drug on quality of life would help establish its role. In the meantime, capecitabine appears to offer an effective and more convenient alternative to fluorouracil as first-line monotherapy for the treatment of metastatic colorectal cancer.
UI - 11816480
AU - Nozoe Y; Ogata Y; Miyagi Y; Nakagawa M; Matono K; Sasatomi T; Araki Y;
TI - Shirouzu K [Efficacy of postoperative adjuvant chemotherapy for colorectal cancer]
SO - Gan To Kagaku Ryoho 2002 Jan;29(1):67-72
AD - Dept. of Surgery, Kurume University Hospital.
We attempted postoperative adjuvant chemotherapy for stage II or III colorectal cancer. To investigate the efficacy of the adjuvant chemotherapy, we retrospectively reviewed all 293 colorectal cancer patients who underwent curative resection between 1990 and 1996 in Kurume University Hospital. The patients were divided into two groups according to whether or not they received postoperative adjuvant chemotherapy. Patients in Group 1 (n = 156) underwent resection followed by administration of oral fluorouracil. Some also received intravenous 5-FU or MMC after surgery. Patients in Group 2 (n = 95) underwent surgery alone. The disease-free survival rate in Group 1 was significantly higher than that in Group 2, but only for those with rectal cancer, with no significant difference for those with colon cancer. The results were also analyzed according to tumor stage, degree of lymphatic and venous invasion, and histological grading. Findings were similar between the two groups for those with stage II, stage IIIa, a low grade of lymphatic and venous invasion, and well-differentiated adenocarcinoma. Postoperative adjuvant chemotherapy in colorectal cancer might reduce the risk of recurrence, particularly in cases of rectal cancer. However, postoperative adjuvant chemotherapy was insufficient for those with highly advanced cancer or a biologically aggressive tumor.
UI - 11730992
AU - Jung H; Beck-Bornholdt HP; Svoboda V; Alberti W; Herrmann T
TI - Quantification of late complications after radiation therapy.
SO - Radiother Oncol 2001 Dec;61(3):233-46
AD - Institute of Biophysics and Radiobiology, University of Hamburg, Hamburg, Germany.
BACKGROUND: An increasing number of patients survive cancer after having received radiation therapy. Therefore, the occurrence of late normal tissue complications among long-term survivors is of particular concern. METHODS: Sixty-three patients treated by radical surgery and irradiation for rectal carcinoma were subjected to an unconventional sandwich therapy. Preoperative irradiation was given in four fractions of 5 Gy each applied within 2 or 3 days; postoperative irradiation consisted mostly of 15 x 2 Gy (range, 20-40 Gy). A considerable proportion of these patients developed severe late complications (Radiother Oncol 53 (1999) 177). The data allowed a detailed analysis of complication kinetics, leading to a new model which was tested using data from the literature. RESULTS: Data on late complications were obtained for eight different organs with a follow-up of up to 10 years. For the various organs, the percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by exponential regression. From the fit, the parameter p(a) was obtained, which is the percentage of patients at risk in a given year of developing a complication in a given organ during that year. The rate p(a) remained about constant with time. Following sandwich therapy, the annual incidence of complications in the bladder, ileum, lymphatic and soft tissue, and ureters was about the same (p(a)=10-14%/year), whereas complications in bone or dermis occurred at lower rates (4.7 or 7.5%/year, respectively). DISCUSSION: Numerous data sets collected from published reports were analyzed in the same way. Many of the data sets studied were from patients in a series where there was a high incidence of late effects. Three types of kinetics for the occurrence of late effects after radiotherapy were identified: Type 1, purely exponential kinetics; Type 2, exponential kinetics, the slope of which decreased exponentially with time; Type 3, curves composed of two components, a fast initial decline followed by an exponential decrease. For each kind of kinetics, provided that the dose distribution is not too heterogeneous, the incidence of late effects appears to occur at exponential or approximately exponential kinetics, even many years after treatment. This implies that a random process might be involved in the occurrence of late radiation sequelae. CONCLUSIONS: There might be a lifelong risk of developing late complications, of which patients and clinicians should be aware. It appears worthwhile to try to identify, in follow-up examinations of patients after radiation therapy, what kind of processes might be involved in triggering subclinical residual injury to develop into a clinically manifest late effect.
UI - 11776626
AU - Wang L; Yu Z; Qian T
TI - [Radiotherapy for early anal cancer: a report of 27 cases]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):455-7
AD - Cancer Istitute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021.
OBJECTIVE: To evaluate the results of radiotherapy for early stage anal cancer. METHODS: During 1960 through 1993, 27 patients with stage T1-2N0 anal cancer were treated by radiotherapy alone. Seven cases received pelvic irradiation plus local field boost, 20 cases received local field irradiation alone. Kaplan-Meier method was used in survival analysis. RESULTS: The overall 5-year survival rate in this series of patients was 79.1%. Eighteen of the 27 cases had their anal functions preserved. Local recurrence occurred in 7 cases and regional lymph node metastasis in one case. Five of them were salvaged, two by surgery and three by irradiation. CONCLUSION: Radiotherapy alone for early anal cancer is effective. Anal function is preserved in about two-thirds of the patients so treated. Local treatment failure can be salvaged by surgery or radiotherapy.
UI - 11578913
AU - Schwartzberg LS
TI - Clinical experience with edrecolomab: a monoclonal antibody therapy for colorectal carcinoma.
SO - Crit Rev Oncol Hematol 2001 Oct;40(1):17-24
AD - firstname.lastname@example.org
Edrecolomab (monoclonal antibody 17-1A) is a murine monoclonal antibody that recognizes the human tumor-associated antigen Ep-CAM (otherwise known as 17-1A). It is being developed for the adjuvant treatment of colorectal cancer. In a study of 189 patients with resected stage III colorectal cancer, treatment with edrecolomab resulted in a 32% increase in overall survival compared with no treatment (P<0.01) and decreased the tumor recurrence rate by 23% (P<0.04). In terms of safety, edrecolomab was well tolerated. Based on these study results, edrecolomab is currently under investigation in large multicenter phase III studies both as monotherapy and in combination with 5-fluorouracil-based chemotherapy versus chemotherapy alone for the treatment of stage III colon cancer. Although these studies are still ongoing, an interim analysis of safety data indicated that the combination of edrecolomab with chemotherapy is well tolerated. In addition, edrecolomab monotherapy demonstrated a favorable safety profile compared with chemotherapy. Edrecolomab is also currently being tested in large multicenter adjuvant phase III studies in stage II/III rectal cancer and stage II colon cancer. Edrecolomab represents a novel therapeutic approach and has the potential to become a treatment of choice as monotherapy in stage II colon cancer and in combination with chemotherapy in stage II/III rectal and stage III colon cancer.
UI - 11677939
AU - Yamamoto S; Watanabe M; Hasegawa H; Kitajima M
TI - Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1248-51
AD - Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
BACKGROUND/AIMS: Laparoscopic colorectal surgery for advanced colorectal carcinoma still remains controversial because of the technical difficulties in lymph node dissection, which is a routine procedure for advanced colorectal carcinoma, and uncertainty regarding the oncologic outcome after laparoscopic colectomy. This study reviewed the results of laparoscopic colectomy with lymph node dissection in patients with advanced colorectal carcinoma performed at our hospital. METHODOLOGY: The oncologic outcomes of 48 patients with advanced colorectal carcinoma who underwent laparoscopic colectomy between 1993 and 1998 were compared with those of 48 matched patients who underwent conventional open surgery during the same period or immediately before the introduction of laparoscopic surgery. RESULTS: The median follow-up for the laparoscopic group and the open colectomy group was 41 and 68 months, respectively. No port site recurrence occurred in the laparoscopic group, and the medium-term disease-free rate, overall survival rate, as well as the patterns of recurrence were comparable in the two groups. CONCLUSIONS: Oncologic outcome of laparoscopic colectomy at a minimum of two years was not compromised compared with conventional open surgery even in advanced carcinoma. However, information regarding true oncologic outcome will require careful long-term follow-up.
UI - 11677961
AU - Secco GB; Ravera G; Bonfante P; Gianquinto D; Baldi E; Canaletti M;
TI - Ferraris R Prognostic indicators of local recurrence in patients operated for rectal cancer.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1346-50
AD - DICMI, Sezione di Semeiotica Chirurgica I, University of Genoa School of Medicine, Genoa, Italy.
BACKGROUND/AIMS: To identify subgroups of patients at high risk of local relapse after curative surgery for rectal cancer. METHODOLOGY: multivariate methods. Median follow-up was 38 months. RESULTS: High and moderate grade (P = 0.0001), Size > or = 5 cm (P = 0.013), lymph nodes involvement (P = 0.002) and patients with locally advanced rectal cancer underwent extensive surgery and postoperative radiation significantly increased local relapse; whereas surgical procedure and experience of surgeons had no influence. CONCLUSIONS: The above-mentioned prognostic factors of rectal cancer that show a risk of local relapse 2- to 3.5-times higher than comparative conditions could be useful in identifying subgroups of patients at high risk for local recurrence. These patients should undergo a careful selection according to risk factors of relapse in order to increase local control of disease performing "optimal" primary surgery, effective postoperative radiation and tailored follow-up.
UI - 11677969
AU - Hsieh YH; Lin HJ; Tseng GY; Perng CL; Li AF; Chang FY; Lee SD
TI - Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1379-82
AD - Buddhish Tzu Chi Dalin General Hospital, Taiwan, ROC.
BACKGROUND/AIMS: Polyps of the gastrointestinal tract are usually removed due to their link to bleeding, obstruction and malignancy. However, complications may occur following polypectomy. The aim of this study was to assess whether submucosal epinephrine injection before polypectomy could reduce the incidence of bleeding and perforation. polyps of the gastrointestinal tract found in our endoscopic unit were randomized to receive submucosal epinephrine injection (epinephrine group) or no injection (control group) before polypectomy. In the epinephrine group, epinephrine (1:10,000) was injected surrounding the stalk of the polyp until the mucosa was blanched and bulged. The patients were observed for complications in the following month. RESULTS: A total of 120 patients with 151 sessile polyps were enrolled in this study. In the epinephrine group, 75 polyps (n = 68) were randomized to receive epinephrine injection before polypectomy. In the control group, 76 polyps (n = 61) underwent polypectomy without epinephrine injection. In both groups, there was no significant difference in clinical features including the sizes of the polyps and their stalks, the location of polyps and the pathological diagnosis. There were a total of nine episodes of post-polypectomy hemorrhage, two in the epinephrine group and seven in the control group (2/75 vs. 7/76) (P = 0.07). One case in the epinephrine group experienced delayed bleeding (4 days later). Immediate hemorrhage occurred less in the epinephrine group than that in the control group (1/75 vs. 7/76, P = 0.03). There was one case of perforation in each group. CONCLUSIONS: Epinephrine injection prior to polypectomy is effective in preventing immediate bleeding.
UI - 11793596
AU - Lutz MP; Adler G
TI - [Chemotherapy of colorectal carcinoma]
SO - Internist (Berl) 2001 Dec;42(12):1567-8, 1571-6, 1578-82
AD - Abteilung Innere Medizin I, Medizinische Universitatsklinik und Poliklinik, Universitatsklinikum, Robert-Koch-Strasse 8, 89070 Ulm.
UI - 11781283
AU - Suleiman S; Rex DK; Sonnenberg A
TI - Chemoprevention of colorectal cancer by aspirin: a cost-effectiveness analysis.
SO - Gastroenterology 2002 Jan;122(1):78-84
AD - Department of Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
BACKGROUND & AIMS: The aim of the study is to compare the cost-effectiveness of aspirin and colonoscopy in the prevention of colorectal cancer. METHODS: A Markov process is used to follow a hypothetical cohort of 100,000 subjects aged 50 years until death. Four strategies are compared: (1) no intervention, (2) colonoscopy once per 10 years and every 3 years in subjects with polyps, (3) chemoprevention with 325 mg of daily aspirin, and (4) combination of the second and third strategies. The various strategies are compared calculating incremental cost-effectiveness ratios (ICERs). RESULTS: The expected number of colorectal cancers is 5904 per 100,000 subjects. Colonoscopy prevents 4428 colorectal cancers and saves 7951 life-years at an ICER of $10,983 per life-year saved compared with no intervention. Aspirin prevents 2952 colorectal cancers and saves 5301 life-years at an ICER of $47,249 per life-year saved compared with no intervention. The cost of aspirin therapy plus management of aspirin-related complications was reported to be $172 per year per patient. Varying the annual aspirin-related costs between $50 and $200 results in ICER changes between $4617 and $57,080, with the 2 strategies breaking even at $70. Applying aspirin chemoprevention plus colonoscopy screening concomitantly yields an ICER of $227,607 per life-year saved compared with screening colonoscopy alone. CONCLUSION: As compared with colonoscopy once per 10 years, the use of aspirin to prevent colorectal cancer saves fewer lives at higher costs. The high complication cost and the lower efficacy of aspirin render screening colonoscopy a more cost-effective strategy to prevent colorectal cancer.
UI - 11771442
AU - Nelson H
TI - Laparoscopic colectomy for colon cancer--a trial update.
SO - Swiss Surg 2001;7(6):248-51
AD - Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. email@example.com
OBJECTIVES: A prospective randomized trial was designed to test the hypothesis that disease-free survival and overall survival are equivalent regardless of whether patients receive laparoscopic assisted colectomy (LAC) or open colectomy. Secondary and tertiary aims will test the safety of LAC and the impact of LAC on quality of life and costs, respectively. METHODS: 1200 patients will be accrued and randomly assigned to LAC or open colectomy. Consenting adults with primary colon cancer without previous or concurrent malignancies and with tumors considered resectable for cure are eligible for enrollment. Patients will be followed postoperatively for evidence of recurrence and for survival and perioperatively for morbidity, mortality, quality of life, and cost end points. RESULTS: Over 800 patients have been enrolled to date. Early trial results are available for 408 patients, 203 open and 205 LAC. As anticipated, patients are evenly distributed within the two treatment arms according to age, gender, and anesthesia risk (ASA classification). In the open arm, the mean age is 69 with 52 percent females, 87 percent ASA I/II and 13 percent ASA III. In the laparoscopic arm, the mean age is 67, with 48 percent females, 87 percent ASA I/II, and 13 percent ASA III. A total of 160 right and 117 sigmoid colectomies have been performed. Extent of resection data is also available and all parameters tested show no difference between the LAC and open cases: for the laparoscopic vs open colectomy, total bowel length 26 cm vs 27 cm; proximal margins 12 cm vs 11 cm; distal margins 10 cm vs 12 cm; mesenteric length 9 cm vs 8 cm. Similarly, the number of nodes resected for laparoscopic colectomy is essentially the same (mean 12 lymph nodes) to that for open surgery (mean 13 nodes). CONCLUSIONS: Although this study is ongoing; preliminary results suggest that open and LAC provide for the same extent of resection. The quality of life portion of the study is now complete and data will soon be available.
UI - 11771444
AU - Link KH; Staib L; Kornmann M; Formentini A; Schatz M; Suhr P; Messer P;
TI - Rottinger E; Beger HG; Forschungsgruppe Onkologie Gastrointestinale Tumoren Surgery, radio- and chemotherapy for multimodal treatment of rectal cancer.
SO - Swiss Surg 2001;7(6):256-74
AD - Department General and Visceral Surgery, University Hospital Ulm, Germany.
The possibilities and results of multimodal treatment in rectal cancer were reviewed with respect to the results of surgical treatment only. Based on the results of 4 studies, reducing local relapse rates and increasing long term survival rates significantly, postoperative radiochemotherapy (RCT) + chemotherapy (CT) should remain the recommended standard for R0 resected UICC II and III rectal cancers. The addition of RT to adjuvant CT reduces local relapses without significant impact on survival (NSABP R-02). Vice versa, the addition of CT to RT or an improved CT in the RCT-concept prolongs survival. Preoperative neoadjuvant radiotherapy (RT) reduced local relapse rates in 9 studies, and extended survival in one study that evaluated all eligible patients. Preoperative RT reduced local relapse rates in addition to total mesorectal excision (TME) but did not extend survival. The preoperative RCT + CT downstages resectable and nonresectable tumors and induces a higher sphincter preservation rate. Phase III data justifying its routine use in all UICC II + III stages are not yet available. This treatment may be routinely applied in nonresectable primary tumors or local relapses. Preoperative RCT (or RT) may evolve as standard, if the patient selection is improved and postoperative morbidity and long term toxicity reduced. Intraoperative RT could be added to this concept or be used together with preoperative/postoperative RT at the same indications. Postoperative adjuvant RT reduced local relapses significantly in a single trial, and no impact on survival time is reported. Since postoperative RT is inferior to preoperative RT, this treatment cannot be recommended, if RT is chosen as a single treatment modality in adjunction to surgery. The results of local tumor excisions may be improved with pre- or postoperative RCT + CT. In the future, multimodal treatment of rectal cancer might be more effective, if individualized according to prognostic factors.
UI - 11771445
AU - Spencer MP
TI - Transanal excision for T1 and T2 rectal cancer--efficacy of local resection vs. adjuvant therapy. Extended abstract.
SO - Swiss Surg 2001;7(6):275-7
AD - Department of Surgery, Division of Colon and Rectal Surgery, University of Minnesota, USA.
The principal goal in the management of any patient with rectal cancer is to provide the optimum chance for cure while maintaining their quality of life. Treatment options over the past century have reflected our ability to provide safe surgical care and, more recently, a greater understanding of tumor biology. Prior to the introduction of the abdominoperineal resection (APR) that was reported in the Lancet in 1908 by Sir Ernest Miles, perineal excision was the accepted approach for nearly all rectal cancer. Unfortunately, inconsistent surgical outcomes and high local recurrence even in Miles personal experience promoted alternative treatment. The acceptance of APR and subsequently low anterior resection reduced recurrence and improved long-term survival but often with the cost of decreased quality of life. A recent review by McCall et al. report disease specific recurrence at 8.5 percent, 16.3 percent and 28.6 percent for cancer stages I, II and III respectively with an overall reported recurrence rates following APR ranging from 10 to 29 percent. Reported five-year survival rates range 78 to 100 percent for stage I, 45 to 73 percent for stage II and 22 to 66 percent for stage III. The wide variations in recurrence and survival rates likely reflect differences in tumor size, proximity to the anal canal, depth of penetration in the rectal wall and unfavorable histologic characteristics. An additional confounding variable in the management of rectal cancer has been the use of adjuvant therapy do in part to the timing and dose/fractionation differences utilized. Given the variation in outcomes with APR and ongoing concerns regarding morbidity and quality of life issues associated with radical resection, many centers have revisited local therapy as a means of managing select patients with distal rectal cancers. These therapies include transanal and transcoccygeal excision as well as endocavitary radiation and even fulguration. It is the belief of many surgeons that our ability to more accurately stage patients preoperatively and add adjuvant therapy when indicated will improve our success with local excision.
UI - 11771446
AU - Metzger U; Schnider A
TI - Prophylactic surgery in families with familial adenomatous polyposis (FAP) and in colitis.
SO - Swiss Surg 2001;7(6):278-80
AD - Department of Surgery, City-Hospital Triemli, Zurich.
Colorectal cancer is the second most common cause of death from malignant tumors in western countries with approximately 3800 new cases/year in Switzerland. For individuals known to be at high risk for the development of colorectal cancer, screening, chemoprevention and/or prophylactic surgery are the only tools to avoid unnecessary premature death from this disease. With modern molecular and/or genetic testing the risk of developing colorectal cancer can be more precisely estimated on an individualized basis. These individuals need to be enrolled in strong surveillance programs and are clear candidates for prophylactic surgery. The risk of prophylactic surgery (morbidity, mortality, quality of life following surgery) must be clearly weighted against the increasing risk of cancer. These patients should be treated in experienced centers for colorectal surgery in close connection with a genetic testing and counseling team, a molecular laboratory and a psychological support group.
UI - 11802206
AU - Liang JT; Huang KC; Cheng YM; Hsu HC; Cheng AL; Hsu CH; Yeh KH; Wang SM;
TI - Chang KJ P53 overexpression predicts poor chemosensitivity to high-dose 5-fluorouracil plus leucovorin chemotherapy for stage IV colorectal cancers after palliative bowel resection.
SO - Int J Cancer 2002 Feb 1;97(4):451-7
AD - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Our study aims to further clarify the prognostic significance of p53 for our study, based on appropriate eligibility criteria. The patients were nonrandomly allocated to 2 treatment groups of either with or without high-dose 5-fluorouracil plus leucovorin chemotherapy (HDFL: 5-Fu: 2,600 mg/m(2) leucovorin 300 mg/m maximum 500 mg). Each treatment group was further divided into 2 subgroups according to the status of p53 overexpression. Therefore, 4 subgroups were allocated in our study and were designated as p53 (overexpression) HDFL (+), n = 65; p53 (normal) HDFL (+), n = 37; p53 (overexpression) HDFL (-), n = 27; and p53 (normal) HDFL (-), n = 15, respectively. All patients were difference of the background clinicopathologic data of these 4 allocated subgroups of patients (p > 0.05). Multivariate analysis of various clinicopathologic factors of the whole group of patients indicated that age > or = 60 years, poor differentiation, mucin production, CEA > 100 ng/ml, p53 overexpression and without chemotherapy were the significant independent poor prognostic factors (p < 0.05). Survival analyses indicated that the patients of subgroup p53 (normal) HDFL (+) survived significantly longer than those of subgroup p53 (overexpression) HDFL (+), with mean survival time (95% confidence interval [CI]) of 20.24 (16.24-24.25) and 13.29 (10.98-15.60) months, respectively (p = 0.0043, log-rank test). In contrast, in patients without chemotherapy, the prognosis was poor regardless of their p53 status, with mean survival time (95% CI) of 6.85 (5.47-8.23) and 5.87 (4.48-7.26) months in p53 (overexpression) HDFL (-) and p53 (normal) HDFL (-) subgroups of patients, respectively (p = 0.2820, log-rank test). Cancers of normal p53 expression responded significantly better to HDFL (p < 0.05), with mean response rate (95% CI) being 65.57% (52.18-82.96%) in subgroup p53 (normal) HDFL (+) as compared to 35.38% (23.52-47.24%) in subgroup p53 (overexpression) HDFL (+). The toxicity to HDFL was similarly minimal between p53-normal and p53-overexpression patients (p > 0.05). We thus concluded that the poorer prognosis of stage IV colorectal cancers with p53 overexpression was associated with their poorer chemosensitivity rather than the more biologic aggressiveness. Copyright 2001 Wiley-Liss, Inc.
UI - 10968812
AU - Simmonds PC
TI - Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis. Colorectal Cancer Collaborative Group.
SO - BMJ 2000 Sep 2;321(7260):531-5
AD - CRC Wessex Medical Oncology Unit, University of Southampton, Southampton General Hospital, SO16 6YD, UK. firstname.lastname@example.org
OBJECTIVES: To determine the benefits and harms of palliative chemotherapy in patients with locally advanced or metastatic colorectal cancer and to compare the outcomes for elderly and younger patients. DESIGN: Meta-analysis of individual patient data and published summary statistics from trials for which individual patient data could not be obtained from the investigators. STUDIES: All randomised controlled trials comparing palliative chemotherapy with supportive care in patients with advanced colorectal cancer that were identified by computerised and hand searches of the literature, scanning references, and contacting investigators. MAIN OUTCOME MEASURES: Survival, disease progression, quality of life, and toxicity. RESULTS: 13 randomised controlled trials including a total of 1365 patients met the inclusion criteria. Meta-analysis of seven trials that provided individual patient data (866 patients) showed that palliative chemotherapy was associated with a 35% reduction in the risk of death (95% confidence interval 24% to 44%). This translates into an absolute improvement in survival of 16% at both six and 12 months and an improvement in median survival of 3.7 months. No age related differences were found in the effectiveness of chemotherapy, but elderly patients were under represented in trials. The overall quality of evidence relating to treatment toxicity, symptom control, and quality of life was poor. CONCLUSIONS: Chemotherapy is effective in prolonging time to disease progression and survival in patients with advanced colorectal cancer. The survival benefit may be underestimated in this analysis as some patients in the control arms received chemotherapy.
UI - 11159629
AU - Jeffrey DI
TI - Chemotherapy for advanced colorectal cancer. Patients need time to reflect on uncertainties surrounding palliative chemotherapy.
SO - BMJ 2001 Jan 27;322(7280):234
UI - 10963244
AU - Martling AL; Holm T; Rutqvist LE; Moran BJ; Heald RJ; Cedemark B
TI - Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project.
SO - Lancet 2000 Jul 8;356(9224):93-6
AD - Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
BACKGROUND: The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cancer. This, study investigated the potential for further improvement by introduction of the concept of total mesorectal excision (TME) to surgeons in Stockholm, Sweden. METHODS: Workshops started in 1994 and included 11 television-based demonstrations and two histopathology sessions. The study population consisted of all patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995-96 (TME project; n=447). Outcomes at 2 years were compared with those from the Stockholm I (n=790) and II (n=542) trials as historical controls. FINDINGS: For patients with curative abdominal resections, there were no differences between the Stockholm I (n=686), Stockholm II (n=481), and TME project (n=381) groups in 30-day mortality (30 [4%], six [1%], and 12 [3%]), anastomotic leakage (27 [10%], 18 [9%], and 23 [9%]), or all complications (204 [30%], 169 [35%], and 134 [35%]). This similarity was achieved despite a decrease in the proportion of abdominoperineal procedures from 55-60% to 27%. Local recurrence occurred in significantly fewer of the TME group than of the Stockholm I and II groups (21 [6%] vs 103 [15%] and 66 [14%], p<0.001) as did cancer-related death (35 [9%] vs 104 [15%] and 77 [16%], p<0.002). INTERPRETATION: A surgical teaching initiative had a major effect on cancer outcomes. The proportion of abdominoperineal procedures and the local recurrence rate decreased by more than 50% and there is already evidence of a decline in rectal-cancer mortality.
UI - 11772231
AU - Midgley R; Kerr D
TI - Conventional cytotoxic and novel therapeutic concepts in colorectal cancer.
SO - Expert Opin Investig Drugs 2001 Jun;10(6):1011-9
AD - CRC Institute for Cancer Studies, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2TT. UK. email@example.com
Colorectal cancer (CRC) is a major cause of death, particularly in the Western world, leading to 400,000 deaths each year. Of the patients, 30% have advanced disease at presentation, either locally or at distant sites and chemotherapy in this setting has an established role in improving survival and palliating symptoms. In addition, approximately 50% of those patients initially believed to be cured by surgery, subsequently relapse and die of their disease. Adjuvant chemotherapy administered for six months after surgery for Dukes C colon cancer improves absolute survival by 5-10%. However, the role of adjuvant chemotherapy in Dukes B colon or Dukes B/C rectal tumours is still controversial and is only recommended within the scope of a randomised clinical trial. Cytotoxic drug development for colorectal cancer has traditionally followed the established pathway of Phase I, Phase II and then Phase III trials in advanced disease, with subsequent translation into the adjuvant setting. For the purpose of this review current conventional chemotherapy for advanced CRC is described, followed by an explanation of newer developments that are predicated upon our increasing understanding of the molecular processes underpinning malignant transformation, invasion and metastasis. Paradigm shifts in trial design necessitated by a mechanistic approach to drug development are also discussed.
UI - 11778748
AU - Inoue H
TI - Endoscopic mucosal resection for the entire gastrointestinal mucosal lesions.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):459-78
AD - Department of Gastroenterology, Showa Northern Yokohama Hospital School of Medicine, Showa University, Japan. firstname.lastname@example.org
In general, mucosal cancer of the gastrointestinal tract has the lowest risk of lymph node metastasis, and is curatively managed by the EMR procedure.
UI - 11778753
AU - Kudo S; Tamegai Y; Yamano H; Imai Y; Kogure E; Kashida H
TI - Endoscopic mucosal resection of the colon: the Japanese technique.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):519-35
AD - Department of Gastroenterology, Showa Northern Yokohama Hospital School of Medicine, Showa University, Yokohama, Japan. Kudoemail@example.com
Early colorectal neoplasms, especially flat-type and depressed-type lesions, should be treated with an EMR technique. In general because depressed-type lesions, in contrast to flat-type or protruded-type lesions, tend to invade the submucosa rapidly, they ought to be treated by EMR at an early stage. Histopathologically in the case of lesions that only minimally invade the submucosa without vessel invasion (sm1a and sm1b without vessel invasion), a treatment can be completed with EMR. Massive submucosal invasive cancers ought to be resected by surgical treatment because of the risk of recurrence or metastasis. In addition, pit pattern diagnosis with magnifying colonoscopy is useful to determine a therapeutic method for colonic neoplasms. Lesions with the type VN pit pattern represent malignancy and usually invade the submucosa massively, so it is better to treat them surgically from the outset. Endoscopic mucosal resection should be conducted under fully controlled endoscopy to prevent complications. EMR is a superior therapeutic method and will be performed frequently in the future. It is necessary for colonoscopists to determine a suitable therapy for each colorectal neoplastic lesion. They also need to master the EMR technique in the correct manner.
UI - 11778754
AU - Waye JD
TI - Endoscopic mucosal resection of colon polyps.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):537-48, vii
AD - Department of Medicine, Mount Sinai Medical Center, New York, New York, USA. firstname.lastname@example.org
The term submucosal injection polypectomy (SIP) more accurately describes the technique used for removal of flat colonic polyps and is preferred, in the colon, to endoscopic mucosal resection (a procedure that usually uses a special suction-activated device). Using SIP, most polyps can be removed safely from any part of the colon. The methodology is described in detail and is within the capability of most colonoscopists.
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