Table of Contents
1
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.
2
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.
3
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. demail@adis.co.nz
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.
4
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.
5
UI - 11285948
AU - Greene FL
TI -
Standard setting for laparoscopic resection of colorectal cancer.
SO - Surg Endosc 2001 Feb;15(2):109
6
UI - 11605104
AU - Young-Fadok TM
TI -
Raising the bar. Laparoscopic resection of colorectal cancer.
SO - Surg Endosc 2001 Sep;15(9):911-2
7
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.
8
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.
9
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 - lschwartzberg@westclinic.com
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.
10
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.
11
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.
12
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.
13
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.
14
UI - 11781299
AU - Provenzale D
TI -
The cost-effectiveness of aspirin for chemoprevention of colorectal
cancer.
SO - Gastroenterology 2002 Jan;122(1):230-3
15
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.
16
UI - 11523001
AU - Cirocco WC
TI -
Lower endoscopy after curative colorectal cancer surgery: it's not just
cancer surveillance.
SO - Gastrointest Endosc 2001 Sep;54(3):421-2
17
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. nelson.heidi@mayo.edu
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.
18
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.
19
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.
20
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.
21
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.
22
UI - 10968797
AU - Michael M; Zalcberg JR
TI -
Chemotherapy for advanced colorectal cancer.
SO - BMJ 2000 Sep 2;321(7260):521-2
23
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. pds@soton.ac.uk
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.
24
UI - 11159618
AU - Kirollos MM
TI -
Chemotherapy for advanced color. Please aim for accuracy rather than
hard hitting headlines.
SO - BMJ 2001 Jan 27;322(7280):232-3
25
UI - 11159627
AU - Munday D
TI -
Chemotherapy for advanced colorectal cancer. Does the evidence or the
doctor have the greater influence?
SO - BMJ 2001 Jan 27;322(7280):233
26
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
27
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.
28
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. midgleyrs@cancer.bham.ac.uk
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.
29
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. haru.inoue@med.showa-u.ac.jp
In general, mucosal cancer of the gastrointestinal tract has the lowest
risk of lymph node metastasis, and is curatively managed by the EMR
procedure.
30
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. Kudo-s@synap.ne.jp
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.
31
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. jdwaye@aol.com
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.
32
UI - 11687740
AU - Chmielarz A; Kryj M; Wloch J; Poltorak S; Sacher A;
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