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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Colorectal Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- [Resection of liver metastasis: higher chance of survival]
- Chemotherapy for colon cancer in a well-defined French population: is it under- or over-prescribed?
- Prognostic significance of nodal disease following preoperative radiation for rectal adenocarcinoma.
- The impact of new technology on surgery for colorectal cancer.
- Bolus fluorouracil and leucovorin with oxaliplatin as first-line treatment in metastatic colorectal cancer.
- [Therapeutics of squamous cell cancer of the anus: specific aspects in HIV-infected subjects]
- [Anal canal squamous-cell carcinomas in HIV positive patients: clinical features, treatments and prognosis]
- Photodynamic effects of mTHPC on human colon adenocarcinoma cells: photocytotoxicity, subcellular localization and apoptosis.
- Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy.
- Phase II study of a weekly 8-hour 5-fluorouracil and leucovorin infusion for patients with advanced colorectal cancer: dose adjusted according to
- [Anastomosis dehiscence in anterior resection of the rectum with total excision of the mesorectum]
- [The surgeon as a prognostic factor in the treatment of cancer of the rectum]
- Celecoxib as adjunctive therapy for treatment of colorectal cancer.
- Tumour targeting of humanised cross-linked divalent-Fab' antibody fragments: a clinical phase I/II study.
- Predictive values of sex and tumour site for survival benefit from 5FU in colorectal cancer.
- [Evaluation of chemoradiotherapy for the treatment of rectal cancer]
- New therapies, new directions: advances in the systemic treatment of metastatic colorectal cancer.
- Phase II trial of irinotecan in combination with amifostine in patients with advanced colorectal carcinoma.
- Radiological palliation of malignant colonic obstruction.
- [Departmental review of surgical cases in the last 17 years: Colonic neoplasms]
- Surgically treated adenocarcinomas of the right side of the colon during a ten year period: a retrospective study.
- The variability of the clinical target volume for rectal cancer due to internal organ motion during adjuvant treatment.
- [More effective exenteration of small pelvis organs in colorectal cancer: is it possible?]
- Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled
- Local excision and postoperative radiation therapy for rectal adenocarcinoma.
- Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy.
- Aberrant methylation of the ATM promoter correlates with increased radiosensitivity in a human colorectal tumor cell line.
- Value and cost of follow-up after adjuvant treatment of patients with Dukes' C colonic cancer (Br J Surg 2001; 88: 101-6).
- A prospective randomised study of drains in infra-peritoneal rectal anastomoses.
- Abdominoperineal resection for locally recurrent rectal cancer.
- Lifestyle-related factors and colorectal polyps: preliminary results from a Norwegian follow-up and intervention study.
- Surgically treated adenocarcinomas of the right side of the colon during a ten year period: a retrospective study.
- Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study.
- Triplet combination with irinotecan plus oxaliplatin plus continuous-infusion fluorouracil and leucovorin as first-line treatment
- [Cancer of the rectum: complete resection of the mesorectum with or without preoperative radiotherapy]
- A rapid and systematic review of the evidence for the clinical effectiveness and cost-effectiveness of irinotecan, oxaliplatin and
- Laparoscopic versus open surgery for colorectal carcinoma: a prospective clinical trial involving 157 cases with a mean follow-up of 5 years.
- Experience with split-course external beam irradiation +/- chemotherapy and integrated Ir-192 high-dose-rate brachytherapy in the treatment of
- Use of minilaparotomy in the treatment of colonic cancer.
- In regard to Kapp et al.: experience with split-course external beam irradiation +/- chemotherapy and integrated (192)Ir high-dose-rate
- Use of minilaparotomy in the treatment of colonic cancer (Br J Surg 2001;88:831-6).
- Use of minilaparotomy in the treatment of colonic cancer (Br J Surg 2001;88:831-6).
- [The long-term evaluation of artificial myoplastic anus and artificial classical anus based on manometric and radiological examinations]
- Rectal cancer in Victoria in 1994: patterns of reported management.
- Audit of definitive colorectal surgery in patients with early and advanced colorectal cancer.
- Human colorectal malignancy and oral UFT.
- Induction of apoptosis by 1,4-phenylenebis(methylene)selenocyanate in cultured human colon cancer cells.
- Lamin B, caspase-3 activity, and apoptosis induction by a combination of HMG-CoA reductase inhibitor and COX-2 inhibitors: a novel approach in
- Effects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomes.
- Short-course preoperative radiation therapy for operable rectal cancer.
- [Colorectal endometriosis. Diagnosis and management]
- Survival from colorectal cancer in Victoria: 10-year follow up of the 1987 management survey.
- Clinical phase II study and pharmacological evaluation of rubitecan in non-pretreated patients with metastatic colorectal cancer-significant
- Review article: non-systemic chemotherapy in the treatment of colorectal cancer-portal vein, hepatic arterial and intraperitoneal approaches.
- [Radical resection of colorectal carcinoma in the oldest old]
- [Local recurrence and survival rate after rectal cancer operations and multimodal therapy]
Table of Contents
1
UI - 11851077
AU - de Jong KP; Slooff MJ
TI -
[Resection of liver metastasis: higher chance of survival]
SO - Ned Tijdschr Geneeskd 2002 Feb 2;146(5):196-9
AD - Academisch Ziekenhuis, afd. Hepato-Pancreato-Biliaire Chirurgie en
Levertransplantatie, Postbus 30.001, 9700 RB Groningen.
k.p.de.jong@chir.azg.nl
In patients with colorectal liver metastases, resection is the only
intentionally curative therapy. It is stated that follow-up after a
resection of primary colorectal malignancies does not favourably
influence patient outcome. However, follow-up can identify 12% of
patients with isolated liver metastases in whom liver resection should
be performed. One third of these patients can be cured by liver surgery.
In general, medical care is provided for lower chances of survival and
freedom of disease. Local ablative therapies are probably useful, but
need to be evaluated in a randomised trial. Tumour progression of
hepatocellular carcinomas in patients, during the long waiting time for
liver transplantation, necessitates the use of radiofrequency ablation.
Minimally invasive techniques for liver resections seem to be promising
but need to be evaluated before they can be more widely applied.
2
UI - 11876687
AU - Faivre-Finn C; Bouvier AM; Mitry E; Rassiat E; Clinard F; Faivre J
TI -
Chemotherapy for colon cancer in a well-defined French population: is it
under- or over-prescribed?
SO - Aliment Pharmacol Ther 2002 Mar;16(3):353-9
AD - Registre Bourguignon des Cancers Digestifs (INSERM EPI 106), Faculte de
Medecine, Dijon, France. jean.faivre@u-bourgogne.fr
BACKGROUND: It has been demonstrated that adjuvant chemotherapy in TNM
stage III and palliative chemotherapy are effective treatments for colon
cancer. AIM: To determine changes over a 10-year period in the practice
of adjuvant and palliative chemotherapy for colon cancer in a
well-defined French population. METHODS: Some 4093 patients with colon
adenocarcinoma diagnosed between 1989 and 1998 were studied. To estimate
the independent effect of the studied variables, a non-conditional
logistical regression was performed. RESULTS: The proportion of patients
with stage II disease treated with adjuvant chemotherapy increased from
2.3% (1989-90) to 20.5% (1997-98). The corresponding figures for stage
III patients were 7.1% and 54.9%. This increase was particularly marked
in younger patients, with 47.3% of stage II and 86.1% of stage III
patients under the age of 65 years being treated in the 1997-98 period,
compared with 4.9% and 24.4% of those over 75 years for the same period
(P < 0.0001). The use of palliative chemotherapy increased over time
from 13.6% (1989-90) to 38.9% (1997-98). Again, this increase was more
dramatic in the younger age group. CONCLUSIONS: The use of adjuvant
chemotherapy has increased for stage II disease despite the absence of
proven effectiveness. Both adjuvant and palliative chemotherapy are
still under-prescribed in patients over the age of 75 years.
3
UI - 12013294
AU - Rinkus KM; Russell GB; Levine EA
TI -
Prognostic significance of nodal disease following preoperative
radiation for rectal adenocarcinoma.
SO - Am Surg 2002 May;68(5):482-7
AD - Department of Surgery, Wake Forest University School of Medicine,
Winston-Salem, North Carolina 27157, USA.
The administration of preoperative radiation (Pre-Op) therapy for
adenocarcinoma of the rectum is evolving. The prognostic value of nodal
disease found after preoperative therapy is unclear. The purpose of this
study is to evaluate the impact of Pre-Op therapy on nodal staging and
thus prognosis in patients with operable cancer of the rectum.
Retrospective review of 292 cases revealed that 20% (N = 58) received
Pre-Op radiation and 33% (N = 97) received Post-Op radiation. Of the
Pre-Op group 66% received 5-fluorouracil-based chemotherapy
concomitantly (vs 48% Post-Op). Radiation dose averaged 50 Gy for both
groups. Node-positive disease was found after Pre-Op therapy at a
similar rate to that of Post-Op or surgery-only patients (45% vs 46%, P
= 0.95). Fewer nodes were found in Pre-Op resection specimens (6.8 vs
10.0 nodes/specimen, P = 0.003), which altered the fraction of positive
nodes (27% Pre-Op vs 18% Post-Op, P = 0.003). The N0 cases had better
survival than N+ in both Pre-Op (80% vs 34%, P = 0.0001) and Post-Op
(70% vs 40%, P = 0.02) groups. There was no significant difference in
survival between Pre-Op versus Post-Op. Pre-Op chemoradiation improved
patient survival over radiation alone and should be considered routinely
with radiation therapy for rectal cancer. Pre-Op radiotherapy decreases
the number of nodes recovered but does not influence the presence of
nodal metastasis. Nodal disease remains a strong prognostic indicator of
survival after Pre-Op radiation therapy.
4
UI - 11819841
AU - Makin GB; Breen DJ; Monson JR
TI -
The impact of new technology on surgery for colorectal cancer.
SO - World J Gastroenterol 2001 Oct;7(5):612-21
AD - University of Hull Academic Surgical Unit, Castle Hill Hospital, Castle
Road, Cottingham HU16 5JQ, United Kingdom.
Advances in technology continue at a rapid pace and affect all aspects
of life, including surgery. We have reviewed some of these advances and
the impact they are having on the investigation and management of
colorectal cancer. Modern endoscopes, with magnifying, variable
stiffness and localisation capabilities are making the primary
investigation of colonic cancer easier and more acceptable for
patients.Imaging investigations looking at primary, metastatic and
recurrent disease are shifting to digital data sets, which can be
stored, reviewed remotely, potentially fused with other modalities and
reconstructed as 3 dimensional (3D) images for the purposes of advanced
diagnostic interpretation and computer assisted surgery. They include
virtual colonoscopy, trans-rectal ultrasound, magnetic resonance
imaging, positron emission tomography and radioimmunoscintigraphy. Once
a colorectal carcinoma is diagnosed, the treatment options available are
expanding. Colonic stents are being used to relieve large bowel
obstruction, either as a palliative measure or to improve the patient's
overall condition before definitive surgery. Transanal endoscopic
microsurgery and minimally invasive techniques are being used with
similar outcomes and a lower mortality, morbidity and hospital stay than
open trans-abdominal surgery. Transanal endoscopic microsurgery allows
precise excision of both benign and early malignant lesions in the mid
and upper rectum. Survival of patients with inoperable hepatic
metastases following radiofrequency ablation is encouraging. Robotics
and telemedicine are taking surgery well into the 21(st) century.
Artificial neural networks are being developed to enable us to predict
the outcome for individual patients. New technology has a major impact
on the way we practice surgery for colorectal cancer.
5
UI - 12011134
AU - Ravaioli A; Marangolo M; Pasquini E; Rossi A; Amadori D; Cruciani G;
TI -
Tassinari D; Oliverio G; Giovanis P; Turci D; Zumaglini F; Nicolini M;
Panzini I
Bolus fluorouracil and leucovorin with oxaliplatin as first-line
treatment in metastatic colorectal cancer.
SO - J Clin Oncol 2002 May 15;20(10):2545-50
AD - Department of Oncology, Infermi Hospital, Via Settembrini 2, 47900
Rimini, Italy. aravaiol@austrn.net
PURPOSE: A phase II trial investigated the activity and toxicity of a
bolus administration schedule of oxaliplatin, fluorouracil (5-FU), and
leucovorin (LV) therapy in patients with untreated advanced colorectal
cancer. PATIENTS AND METHODS: Forty-five patients in this multicenter,
open, nonrandomized study received oxaliplatin 130 mg/m(2) on the first
day of each course and 5-FU and LV 350 mg/m(2) and 20 mg/m(2),
respectively, as a daily bolus for 5 days, every 21 days, for a maximum
of six courses. RESULTS: Partial responses occurred in 18 patients,
giving an intent-to-treat response rate of 40.0%. Median time to
response was 12.7 weeks; median duration of response was 18.4 weeks.
Median progression-free survival was 5.9 months; median survival was 14
months. The independent prognostic factors for improved overall survival
were good performance status and negative carcino-embryonic antigen
blood level. Incidences of adverse effects were reduced after the 5-FU
dose was reduced to 300 mg/m(2). Reversible neurologic toxicity occurred
in 44.4% of patients. CONCLUSION: Bolus administration of oxaliplatin,
5-FU, and LV as first-line therapy for untreated advanced colorectal
cancer is efficacious and safe. In addition to a more favorable safety
profile, the 300 mg/m(2) dosage offered improved dose-intensity compared
with the initial dosage.
6
UI - 11938065
AU - Bauer P; Etienney I
TI -
[Therapeutics of squamous cell cancer of the anus: specific aspects in
HIV-infected subjects]
SO - Gastroenterol Clin Biol 2002 Feb;26(2):147-9
7
UI - 11938066
AU - Vatra B; Sobhani I; Aparicio T; Girard PM; Puy Montbrun TD; Housset M;
TI -
Baillet F; Hecht F; Chossidow D; Soule JC
[Anal canal squamous-cell carcinomas in HIV positive patients: clinical
features, treatments and prognosis]
SO - Gastroenterol Clin Biol 2002 Feb;26(2):150-6
AD - FAMA de Colo-Proctologie, Hopital Bichat-Claude Bernard, Paris, France.
The prevalence of squamous-cell carcinoma of the anus seems to be
increasing in HIV positive patients. Clinical features and prognosis in
this population have not been well evaluated.AIMS: To assess the
prognosis of anal squamous-cell carcinoma in HIV positive patients as
well as clinical features and treatment procedures.METHODS: A series of
20 HIV positive patients presenting with invasive anal squamous-cell
carcinoma was retrospectively analyzed. Data have been compared to those
obtained from 24 randomly selected HIV negative patients who were
followed during the same periods in the same centers for anal carcinoma
with similar histopathological features.RESULTS: The follow-up ranged
from 10 to 172 months. No difference was observed between the two groups
concerning the clinical features leading to anal cancer diagnosis,
although HIV positive patients were younger. Anal cancer was more
frequently associated with lymph node metastasis in HIV positive (60%)
than in HIV negative (17%) patients, although its size was similar in
both groups. Radiotherapy was similarly performed in both groups, while
chemotherapy was administered less frequently in HIV positive than in
HIV negative patients (54% vs 25%). Immediate side effects and mortality
at 1 year follow-up were similar in both groups, whereas the objective
initial response to therapy (50% versus 88%), the remission rate with
anal conservation at 1 year follow-up (45% versus 88%), and the
mortality at 3 years were better in HIV negative patients.CONCLUSION:
The prognosis of anal squamous-cell carcinoma is poor in HIV positive
patients. This correlates with a more advanced tumor stage and an
alteration of systemic immunity status at the time of diagnosis and less
response rate to treatment. Detection of precancerous lesions and
treatment procedures should be evaluated in HIV infected patients.
8
UI - 12003131
AU - Leung WN; Sun X; Mak NK; Yow CM
TI -
Photodynamic effects of mTHPC on human colon adenocarcinoma cells:
photocytotoxicity, subcellular localization and apoptosis.
SO - Photochem Photobiol 2002 Apr;75(4):406-11
AD - School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong,
People's Republic of China. awnleung@hkbu.edu.hk
The photodynamic properties of meta-tetra(hydroxyphenyl)chlorin (mTHPC),
a promising second-generation photosensitizer, were investigated using a
human colon adenocarcinoma cell line (Colo 201 cells). The study on
photocytotoxicity using
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide reduction
assay showed that mTHPC was an effective photosensitizer on Colo 201
cells. The photocytotoxicity of mTHPC showed both drug and light
dose-dependent characteristics. To reach LD50, namely, the dose at which
50% of the cells were killed, only 0.45+/-0.15 microg/mL of mTHPC and 3
J/cm2 of light dose were required. The presence of 10% fetal calf serum
in culture medium significantly decreased the incorporation of mTHPC
into cells and resulted in the reduction of photodynamic efficacy. Using
confocal laser scanning microscopy, mTHPC was first shown to localize in
lysosomes rather than in mitochondria. Furthermore, nuclear stainings
demonstrated that photodynamic therapy with mTHPC induced apoptosis in
Colo 201 cells.
9
UI - 12025835
AU - Schell SR; Zlotecki RA; Mendenhall WM; Marsh RW; Vauthey JN; Copeland EM
TI -
3rd
Transanal excision of locally advanced rectal cancers downstaged using
neoadjuvant chemoradiotherapy.
SO - J Am Coll Surg 2002 May;194(5):584-90; discussion 590-1
AD - Department of Surgery, University of Florida College of Medicine,
Gainesville 32610-0286, USA.
BACKGROUND: Our institution has previously demonstrated a survival
advantage conferred by preoperative neoadjuvant therapy for locally
advanced rectal cancers. We now report our results using transanal
excision as definitive surgical therapy in a selected group of patients
who experienced significant downstaging of T3 rectal cancers after
neoadjuvant therapy. STUDY DESIGN: Seventy-four patients diagnosed with
locally advanced (T3) rectal cancers were treated with neoadjuvant
chemoradiotherapy. After neoadjuvant therapy, 11 (14.9%) patients who
had significant downstaging of their tumors were selected to undergo
transanal excision of their residual rectal cancers. Intraoperative
cryostat evaluation was used to confirm negative margin status, and all
patients were subsequently followed with routine endoscopy, transrectal
ultrasonography, and digital rectal examinations. RESULTS: Tumors were
located between 1 cm and 7 cm from the anal verge (mean 4.3 +/- 0.6 cm),
and were located in lateral, anterior, and posterior positions. Mean
followup was 55.2 +/- 8.9 months (median 47.9 months). Imaging studies
using CT, MRI, transrectal ultrasonography, or combination demonstrated
suspicious lymph nodes in three patients. After neoadjuvant therapy,
these lymph nodes were no longer demonstrated in two patients. There
were no local recurrences, nodal metastases, or operative mortalities.
One patient (9%) developed distant metastases (pulmonary nodules), and
remains alive 30 months after transanal excision. One patient (9%)
experienced sphincter laxity, which was successfully repaired, and is
now asymptomatic. One patient (9%) developed postoperative urgency that
resolved spontaneously. CONCLUSIONS: In patients who have initial bulky
(T3) lesions, and experience significant downstaging after neoadjuvant
chemoradiotherapy, transanal excision appears to be a safe and effective
treatment, preserving sphincter function and avoiding laparotomy.
10
UI - 11902493
AU - Yang TS; Hsu KC; Wang HM; Lin YC
TI -
Phase II study of a weekly 8-hour 5-fluorouracil and leucovorin infusion
for patients with advanced colorectal cancer: dose adjusted according to
its toxicity.
SO - Jpn J Clin Oncol 2001 Dec;31(12):610-5
AD - Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei,
Taiwan. tsyangss@ms27.hinet.net
BACKGROUND: 5-fluorouracil (5-FU) clearly behaves as two different drugs
according to the schedules for its administration. A weekly, 8-h 5-FU
continuous infusion (CI) regimen may produce a dual effect, because it
elicits both a high plasma 5-FU level and also a durable exposure to
5-FU, which may have the advantage of inhibiting both DNA synthesis and
RNA activities. The plasma 5-FU level, however, cannot be monitored in
most hospitals, so we initiated a pragmatic clinical trial with this
weekly 8-h 5-FU Cl regimen and adjusted the drug's dose according to the
detected toxicity. METHODS: The initial dose of 5-FU was 1200 mg/m2 and
this was escalated by 200 mg/m2 weekly, provided that no evidence of
significant (grade 2 or greater) toxicity became apparent. Twenty-six
median dose of 5-FU delivered was 1600 mg/m2. The major symptoms
precluding dose escalation were nausea and vomiting. Seven patients
demonstrated a partial response (26.9%), 11 patients revealed stable
disease (42.3%) and eight exhibited progressive disease (30.8%).
CONCLUSION: This weekly 8-h CI 5-FU protocol with the adjustment of dose
according to toxicity was not able to achieve the same 5-FU dose and
response rate as in previous studies with pharmacokinetic monitoring of
5-FU levels. However, with the concurrent administration of intensive
anti-emetic premedication, it is still possible to achieve adequate
plasma 5-FU levels by adjusting the 5-FU dose according to elicited
toxicity.
11
UI - 12038108
AU - Tersigni R; Alessandroni L; Baiano G; Cavallaro G; Palmieri I; Pantano
TI -
F; Tremiterra S
[Anastomosis dehiscence in anterior resection of the rectum with total
excision of the mesorectum]
SO - Chir Ital 2002 Mar-Apr;54(2):179-84
AD - Dipartimento di Scienze Chirurgiche Unita Operativa di Chirurgia
Generale 1a Flajani Azienda Ospedaliera San Camillo, Forlanini, Roma.
Anterior rectal resection with total mesorectal excision is currently
regarded as the operation of choice in patients with neoplasms of the
extraperitoneal rectum. This operation is associated with a significant
incidence of anastomotic dehiscence. Some authors, therefore, advise the
execution of a protective stoma. From 1987 to 2000, 241 patients with
rectal neoplasma were submitted to radical surgery: 183 to anterior
rectal resection (extraperitoneal neoplasms in 129 cases and
intraperitoneal neoplasms in 54) and 58 to a Miles operation. The total
incidence of anastomotic complications was 8.1% (15 patients). In 12
cases (6.5%) a clinical dehiscence was observed, while in 3 patients
(1.6%) an asymptomatic fistula was present. In the patients with
symptomatic dehiscence a colostomy was performed in 5 cases (42%), while
in 7 cases (58%) a conservative approach was adopted (total parenteral
nutrition and antibiotic therapy), with complete healing of the fistula.
The incidence of anastomotic complications was 9.3% in extraperitoneal
neoplasms and 5.6% in intraperitoneal localizations. In relation to the
anastomotic technique adopted, the incidence of dehiscences was 25%
after 8 Knight-Griffen anastomoses, 16% after 12 manual anastomoses and
7.3% after 163 end-to-end mechanical anastomoses (P = NS). The
percentage of anastomotic complications was greater in the period from
1995 to 1997, compared to the period from 1987 to 1994 (12.6% vs 3.8%, P
= NS), due to the routine execution of rectal resection in conjunction
with total mesorectal excision, particularly at the beginning of the
experience, in 1995. In the last 36 cases from 1998 on the incidence of
anastomotic complications was reduced to 8.3%, after the learning phase.
No related mortality was observed. On the basis of our experience and
the evidence reported in the international literature we do not think
the execution of a protective stoma is justified after low and ultra-low
colorectal anastomosis, except in selected cases.
12
UI - 12038109
AU - Cunsolo A; De Cataldis A; De Raffaele E
TI -
[The surgeon as a prognostic factor in the treatment of cancer of the
rectum]
SO - Chir Ital 2002 Mar-Apr;54(2):185-93
AD - Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti,
Universita degli Studi di Bologna.
The study of prognostic factors in neoplastic rectal surgery is enriched
with a new element, namely, the role of the surgeon. The aim of this
study was to evaluate whether this was true of our own experience. We
selected 118 patients with rectal cancer operated on with a radical
intent by two different surgeons and analyzed factors such as sex, age,
Dukes' stage, histological type, tumour length, differentiation and type
of operation. We studied these factors by univariate and multivariate
analysis in relation to local and distant recurrence and survival. We
found statistically significant correlations between distant recurrence
and tumour stage, differentiation and surgeon, but between local
recurrence and tumour stage only. Multivariate analysis showed
statistically significant correlations between distant recurrence and
tumour stage and differentiation, but between local recurrence and
tumour stage only. As regards survival, we found statistically
significant differences in relation to stage, histological type, and
differentiation. The role of the surgeon appeared to be important when
there are differences in experience, training and specialization.
13
UI - 11793634
AU - North GL
TI -
Celecoxib as adjunctive therapy for treatment of colorectal cancer.
SO - Ann Pharmacother 2001 Dec;35(12):1638-43
AD - School of Pharmacy, University of Montana, Missoula, MT, USA.
gnorth@northbay.org
OBJECTIVE: To describe the role of celecoxib as adjunctive therapy in
the treatment of familial adenomatous polyposis (FAP), an inherited
autosomal dominant predisposition syndrome for colorectal cancer. DATA
SOURCES: Literature was evaluated through MEDLINE search (1995-March
2000) and through secondary sources, using the search terms celecoxib,
cyclooxygenase-2 inhibitors, and familial adenomatous polyps. DATA
SYNTHESIS: Observational studies have found a decreased rate of
colorectal cancer in people who regularly took aspirin or other
nonsteroidal antiinflammatory drugs (NSAIDs). The Food and Drug
NSAID celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, for
adjunctive therapy in patients with FAP, based on a six-month,
randomized, controlled clinical trial. CONCLUSIONS: Aspirin and other
NSAIDs reduce the incidence of colorectal cancer in the general
population. Limited clinical studies in patients with FAP using
nonaspirin NSAIDs have shown a reduction in polyp burden. A current
clinical trial using celecoxib has also shown a reduction in polyp
burden in patients with FAP. The long-term clinical impact of using a
selective COX-2 inhibitor is not known, since celecoxib has not been
studied beyond six months in patients with FAP. By reducing the polyp
burden in FAP patients, celecoxib may be useful as adjunctive
chemotherapy, in addition to routine endoscopic surveillance and
surgery.
14
UI - 11986771
AU - Casey JL; Napier MP; King DJ; Pedley RB; Chaplin LC; Weir N; Skelton L;
TI -
Green AJ; Hope-Stone LD; Yarranton GT; Begent RH
Tumour targeting of humanised cross-linked divalent-Fab' antibody
fragments: a clinical phase I/II study.
SO - Br J Cancer 2002 May 6;86(9):1401-10
AD - Cancer Research UK Targeting and Imaging Group, Department of Oncology,
Royal Free and University College Medical School, University College
London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
Antibody engineering has made it possible to design antibodies with
optimal characteristics for delivery of radionuclides for tumour imaging
and therapy. A humanised divalent-Fab' cross-linked with a bis-maleimide
linker referred to as humanised divalent-Fab' maleimide was produced as
a result of this design process. It is a humanised divalent antibody
with no Fc, which can be produced in bacteria and has enhanced stability
compared with F(ab')(2). Here we describe a clinical study in patients
with colorectal cancer using humanised divalent-Fab' maleimide generated
from the anti-carcinoembryonic antigen antibody A5B7 radiolabelled with
iodine-131. Ten patients received an i.v. injection of
iodine-131-labelled A5B7 humanised divalent-Fab' maleimide, and positive
tumour images were obtained by gamma camera imaging in eight patients
with known lesions, and one previously undetected lesion was identified.
True negative results were obtained in two patients without tumour. Area
under the curve analysis of serial blood gamma counting and gamma camera
images showed a higher tumour to blood ratio compared to A5B7 mF(ab')(2)
used previously in the clinic, implying this new molecule may be
superior for radioimmunotherapy. MIRD dose calculations showed a
relatively high radiation dose to the kidney, which may limit the amount
of activity that could be administered in radioimmunotherapy. However
the reduction in immunogenicity was also a major advantage for A5B7
humanised divalent-Fab' maleimide over murine versions of this antibody
suggesting that humanised divalent-Fab' maleimide should be a useful
vehicle for repeated therapies. Copyright 2002 Cancer Research UK
15
UI - 11986790
AU - Iacopetta B
TI -
Predictive values of sex and tumour site for survival benefit from 5FU
in colorectal cancer.
SO - Br J Cancer 2002 May 6;86(9):1524-5; discussion 1525-6
16
UI - 12040673
AU - Koda K; Miyazaki M
TI -
[Evaluation of chemoradiotherapy for the treatment of rectal cancer]
SO - Gan To Kagaku Ryoho 2002 May;29(5):703-8
AD - Dept. of General Surgery, Graduate School of Medicine, Chiba University.
Chemoradiotherapy for the treatment of primary rectal cancers has been
regarded as an effective adjuvant for surgical procedures. It has been
expected to reduce local recurrence, increase the chance of
sphincter-preserving operation and improve survival. However, recent
advances in surgical technique for rectal cancers have reduced the local
recurrence rate to no more than 10%, where the question may arise of
whether adjuvant chemoradiotherapy is indeed necessary. Another matter
to be elucidated is why adjuvant chemoradiotherapy does not necessarily
improve overall survival for rectal cancers even when the local
recurrence rate is reduced. In the treatment of locally recurrent
lesions, either heavy ion radiotherapy or proton beam therapy is
expected to be an effective alternative to the surgical procedure.
17
UI - 11905784
AU - Holen KD; Saltz LB
TI -
New therapies, new directions: advances in the systemic treatment of
metastatic colorectal cancer.
SO - Lancet Oncol 2001 May;2(5):290-7
AD - Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer
Center, New York, NY 10021, USA.
Colorectal cancer is the second leading cause of cancer death and it is
clear that patients with metastatic disease have better quality of life
and survival when given treatment. Despite four decades of experience of
treating patients with fluorouracil, there remains considerable
controversy about the optimum dose and scheduling, as well as
biomodulation with leucovorin and methotrexate. However, irrespective of
the dose and schedule, overall survival times are poor--about 1 year.
Disappointingly, oral agents with similar mechanisms to fluorouracil do
not improve survival rates in comparison with fluorouracil and
leucovorin treatment. Irinotecan and oxaliplatin are newer agents that
have improved the response rates for patients with metastatic disease
when they are added to flurouracil and leucovorin. The combination of
irinotecan, fluorouracil, and leucovorin has also improved overall
survival. These are small advances in the fight against colorectal
cancer, and further drug development is necessary.
18
UI - 12001114
AU - Delioukina ML; Prager D; Parson M; Hecht JR; Rosen P; Rosen LS
TI -
Phase II trial of irinotecan in combination with amifostine in patients
with advanced colorectal carcinoma.
SO - Cancer 2002 Apr 15;94(8):2174-9
AD - University of California at Los Angeles Center for the Health Sciences
and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA.
BACKGROUND: Irinotecan is effective in patients with advanced colorectal
carcinoma in both first-line and salvage settings but its use can be
limited by serious side effects. Amifostine has been shown to reduce the
incidence of cisplatin-induced cumulative renal toxicity in patients
with advanced ovarian carcinoma and nonsmall cell lung carcinoma. In the
current pilot Phase II trial, the authors examined the potential role of
amifostine as a protective agent against irinotecan-induced diarrhea and
myelosuppression and evaluated an every-2-weeks regimen as an
alternative schedule for the administration of irinotecan in patients
with previously treated metastatic colorectal carcinoma. METHODS: All
patients received amifostine, 740 mg/m2, followed by irinotecan, 250
mg/m2, every 2 weeks. A 6-week cycle of chemotherapy (every 2 weeks for
3 treatments) was chosen to assess toxicity and response. The main
objective of the current study was to evaluate the impact of amifostine
on gastrointestinal and hematologic toxicity. RESULTS: A total of 22
patients entered the current study. Six of these 22 patients (27%) had
WHO Common Toxicity Criteria Grade 3 or 4 diarrhea, including 2 patients
(9%) with Grade 4 diarrhea. Eight of 22 patients (36.3%) developed Grade
3 or 4 neutropenia (Grade 4 in 4 of the 22 patients [18%]). Dose
reduction was required in 25% of the treatment cycles. Five of the 22
patients (23%) withdrew from the trial due to amifostine toxicity. Of
the 15 patients who were evaluable for response, 4 patients (26.6%) had
achieved a partial response and 9 (60%) had stable disease as their best
response.CONCLUSIONS: The combination of irinotecan with amifostine in
patients with previously treated metastatic colorectal carcinoma did not
appear to reduce irinotecan toxicity. Amifostine did not appear to
interfere with the cytotoxic effect of irinotecan. The results of the
current study did demonstrate efficacy and safety of the every-2-weeks
irinotecan schedule that was comparable to other established regimens
and these results support its feasibility as a reasonable alternative in
this disease setting. Copyright 2002 American Cancer Society.
19
UI - 12014929
AU - Aviv RI; Shyamalan G; Watkinson A; Tibballs J; Ogunbaye G
TI -
Radiological palliation of malignant colonic obstruction.
SO - Clin Radiol 2002 May;57(5):347-51
AD - Departments of Radiology, Royal Free Hospital, London, U.K.
PURPOSE: To evaluate the efficacy of colorectal stenting in the
palliation of irresectable malignant colonic obstruction. MATERIALS AND
METHODS: Fifteen patients underwent colorectal stenting for irresectable
colonic malignancy. Sixteen stents were placed successfully in 13
patients. Two stent insertions, one a proximal transverse colon lesion,
were unsuccessful. Twelve patients (80%) had clinical or radiological
features of imminent obstruction. Three patients were completely
obstructed. Eighty-six percent of lesions were within the rectosigmoid
colon. RESULTS: Technical and clinical success was 88%. Early, minor
complications occurred in two patients (13%). Late complications
included migration (13%) and ingrowth (19%). The median survival was 2
months (0.5-12 months). CONCLUSION: Stenting should be considered as
definitive treatment in the context of an inoperable malignant stricture
of the colon. It has low morbidity and a high technical and clinical
success rate and avoids emergency defunctioning surgery in high-risk
patients. Copyright 2002 The Royal College of Radiologists.
20
UI - 11989234
AU - Maehara Y; Kakechi Y; Emi Y; Sumiyoshi Y; Kimura K; Ikeda Y; Kitamura K;
TI -
Ono S; Adachi Y; Mori M; Hiramoto Y
[Departmental review of surgical cases in the last 17 years: Colonic
neoplasms]
SO - Fukuoka Igaku Zasshi 2002 Mar;93(3 Suppl):12-5
21
UI - 12016748
AU - Hilska M; Gronroos J; Collan Y; Laato M
TI -
Surgically treated adenocarcinomas of the right side of the colon during
a ten year period: a retrospective study.
SO - Ann Chir Gynaecol Suppl 2001;(215):45-9
AD - Department of Surgery, Turku University Central Hospital, Turku,
Finland. marja.hilska@tyks.fi
BACKGROUND AND AIMS: Colon cancer is one of the most common malignancies
in Finland. The purpose of the current study was to analyse the results
of surgical treatment of right-sided colon cancers operated in the 1980s
at Turku University Central Hospital. In addition, we compared the
results to those reported from earlier decades. MATERIAL AND METHODS:
One hundred and fifty-three patients with primary proximal colon cancer
were operated in 1981-1990. The results were analysed retrospectively
from patient records. RESULTS: The crude five-year survival rate of the
patients was 48%. The most crucial factor affecting survival was the
stage of spreading of the tumour. Obstructive tumours had a poorer
prognosis than non-obstructive ones. CONCLUSIONS: The results of
surgical treatment of proximal colon cancer were satisfactory at Turku
University Central Hospital and slightly better compared to earlier
reports.
22
UI - 12023155
AU - Nuyttens JJ; Robertson JM; Yan D; Martinez A
TI -
The variability of the clinical target volume for rectal cancer due to
internal organ motion during adjuvant treatment.
SO - Int J Radiat Oncol Biol Phys 2002 Jun 1;53(2):497-503
AD - Department of Radiation Oncology, William Beaumont Hospital, Royal Oak,
MI, USA.
PURPOSE: This study defined the clinical target volume (CTV) for the
adjuvant treatment of rectal cancer and applied this definition to
multiple CT scans obtained during the typical 5-week course of treatment
to measure the modification to the CTV due to internal organ motion that
would be needed to define the planning target volume (PTV). METHODS AND
MATERIALS: Ten patients with rectal cancer had weekly treatment planning
CT scans during adjuvant radiation therapy. All patients were given oral
contrast, placed prone on a rigid foam cradle with a depressed area for
small bowel exclusion, and instructed to have a full bladder. The CT
scans were registered according to the bones of the pelvis, and the CTV
was outlined on each CT slice. Movement of the CTV in all dimensions was
measured. The CT scan with the lowest and highest bladder volume for
each patient was used to calculate the CTV movement due to bladder
filling. RESULTS: The largest difference in the CTV occurred 10 cm
caudal to the anus, with a standard deviation of 1 cm. Bladder filling
displaced the anterior border of the CTV an average of 7 mm over a
cranial to caudal length of 2.5 cm. Other borders of the CTV were based
on muscle, bone, or major blood vessels and were stable. CONCLUSION:
Modification of the CTV to design a PTV can be unequal, with the largest
change at the anterior border of the inferior pelvis.
23
UI - 11810941
AU - Gotsadze DT
TI -
[More effective exenteration of small pelvis organs in colorectal
cancer: is it possible?]
SO - Khirurgiia (Mosk) 2001;(12):45-8
21 exenterations of small pelvis organs were performed from 1991 to 2000
for locally-spread cancer of the rectum. Temporary passage feces and
urine before radical operation was performed in 6 patients. 10 patients
underwent infralevator and 11 patients--supralevator exenteration of
small pelvis organs. Continent cypass of urine was carried out in all
the patients (in 2--delayed), and of feces--in 8 (in 2--delayed).
Substitution of the urinary bladder was performed in 11 patients,
formation of reservoir with "dry" urinostoma--in 10.
24
UI - 12044376
AU - Lobo DN; Bostock KA; Neal KR; Perkins AC; Rowlands BJ; Allison SP
TI -
Effect of salt and water balance on recovery of gastrointestinal
function after elective colonic resection: a randomised controlled
trial.
SO - Lancet 2002 May 25;359(9320):1812-8
AD - Section of Surgery, University Hospital, Queen's Medical Centre,
Nottingham, UK. dileep.lobo@nottingham.ac.uk
BACKGROUND: Low concentrations of albumin in serum and long gastric
emptying times have been returned to normal in dogs by salt and water
restriction, or a high protein intake. We aimed to determine the effect
of salt and water balance on recovery of gastrointestinal function after
elective colonic resection in human beings. METHODS: We randomly
allocated ten patients to receive postoperative intravenous fluids in
accordance present hospital practice (> or = 3 L water and 154 mmol
sodium per day) and ten to receive a restricted intake (< or = 2 L water
and 77 mmol sodium per day). All patients had no disease other than
colonic cancer. The primary endpoint was solid and liquid-phase gastric
emptying time, measured by dual isotope radionuclide scintigraphy on the
fourth postoperative day. Secondary endpoints included time to first
bowel movement and length of postoperative hospital stay. Analysis was
by intention to treat. FINDINGS: Median solid and liquid phase gastric
emptying times (T(50)) on the fourth postoperative day were
significantly longer in the standard group than in the restricted group
(175 vs 72.5 min, difference 56 [95% CI 12-132], p=0.028; and 110 vs
73.5 min, 52 [9-95], p=0.017, respectively). Median passage of flatus
was 1 day later (4 vs 3 days, 2 [1-2], p=0.001); median passage of stool
2.5 days later (6.5 vs 4 days, 3 [2-4], p=0.001); and median
postoperative hospital stay 3 days longer (9 vs 6 days, 3 [1-8],
p=0.001) in the standard group than in the restricted group. One patient
in the restricted group developed hypokalaemia, whereas seven patients
in the standard group had side-effects or complications (p=0.01).
INTERPRETATION: Positive salt and water balance sufficient to cause a 3
kg weight gain after surgery delays return of gastrointestinal function
and prolongs hospital stay in patients undergoing elective colonic
resection.
25
UI - 11992391
AU - Mendenhall WM; Morris CG; Rout WR; Zlotecki RA; Lind DS; Hochwald SN;
TI -
Schell SR; Copeland EM 3rd
Local excision and postoperative radiation therapy for rectal
adenocarcinoma.
SO - Int J Cancer 2001;96 Suppl():89-96
AD - Department of Radiation Oncology, University of Florida College of
Medicine, Gainesville, Florida 32610-0287, USA. mendewil@shands.ufl.edu
Sixty-seven patients with early-stage adenocarcinoma of the rectum who
had lesions thought to be unsuitable for either local excision alone or
endocavitary irradiation were treated with local excision followed by
postoperative radiation therapy. The purpose of this study was to
evaluate the effectiveness of local excision followed by radiation
therapy for treatment of rectal adenocarcinoma. The patients were
treated between 1974 and 1999; follow-up time was 6 to 273 months
(median, 65 months). All living patients had follow-up for at least 2
years. The indications for postoperative irradiation included equivocal
or positive margins, invasion of the muscularis propria,
endothelial-lined space invasion, poorly differentiated histology, and
perineural invasion. Cox proportional hazards regression analysis was
performed using six explanatory variables including tumor size,
configuration (exophytic vs. ulcerative), histologic differentiation,
pathologic T stage, endothelial-lined space invasion, and margin status.
The time interval between treatment and development of recurrent disease
was in the range of 11 to 48 months. The 5-year results were as follows:
local-regional control, 86%; ultimate local-regional control, 93%;
distant metastasis-free survival, 93%; absolute survival, 80%; and
cause-specific survival, 90%. When the Cox proportional hazards
regression analysis was performed for these endpoints, margin status
influenced absolute survival (P = 0.0074), cause-specific survival (P =
0.0405), and ultimate local-regional control (P = 0.0439). Tumor
configuration marginally influenced cause-specific survival (P =
0.0577). None of the variables had an influence on the endpoints'
local-regional control, ultimate local-regional control with sphincter
preservation, or distant metastasis. Five patients (7%) had severe
complications; no complication was fatal. Local excision and
postoperative radiation therapy results in a high probability of
local-regional control and survival for selected patients with
relatively early-stage rectal adenocarcinoma. Patients with ulcerative
tumors may have a lower likelihood of cause-specific survival. Copyright
2002 Wiley-Liss, Inc.
26
UI - 11985979
AU - van der Wal BC; Cleffken BI; Gulec B; Kaufman HS; Choti MA
TI -
Results of salvage abdominoperineal resection for recurrent anal
carcinoma following combined chemoradiation therapy.
SO - J Gastrointest Surg 2001 Jul-Aug;5(4):383-7
AD - Department of Surgery, Johns Hopkins Medical Institutions, 600 North
Wolfe Street, Baltimore, MD 21287-5614, U.S.A.
Combined chemotherapy and radiation therapy is the standard treatment
for epidermoid carcinoma of the anal canal. Failures are often not
associated with distant recurrence and are therefore potentially
amenable to salvage abdominoperineal resection. The aim of this study
was to review our experience with abdominoperineal resection following
failure of chemoradiation therapy for epidermoid carcinoma of the anus.
Between 1980 and 1998, 17 patients underwent salvage abdominoperineal
resection following failure of chemoradiation therapy. Four patients
were excluded from survival analysis because resection was performed
with palliative intent. Survival curves were based on the method of
Kaplan and Meier, and univariate analysis of predictive variables was
performed using the log-rank test. Twelve patients underwent
abdominoperineal resection for persistent disease and five patients for
recurrent disease. No operative deaths occurred, but local complications
including perineal wound infection and wound breakdown was seen in 8 of
17 patients and 6 of 17 patients, respectively. Patients undergoing
omental flap reconstruction (n = 3) or no pelvic reconstruction (n = 5)
had a higher incidence of perineal breakdown compared to those
undergoing muscle flap reconstruction (n = 9) (P <0.05). The median
follow-up time for the patients operated on with curative intent was 53
months. The 5-year actuarial survival was 47%. Potential prognostic
factors that were not found to have an impact on survival included
margin status of resection, sphincter invasion, and degree of
differentiation. Only pathologic tumor size greater than 5.0 cm (P
<0.001) and age over 55 years (P <0.05) adversely affected survival.
Selected patients with recurrent or persistent anal carcinoma following
chemoradiation therapy can be offered salvage abdominoperineal
resection. This operation is associated with a high incidence of local
wound complications, and muscle flap reconstruction should be considered
when possible. Prolonged survival can be achieved in some patients
following salvage resection for epidermoid carcinoma of the anal canal.
27
UI - 12032824
AU - Kim WJ; Vo QN; Shrivastav M; Lataxes TA; Brown KD
TI -
Aberrant methylation of the ATM promoter correlates with increased
radiosensitivity in a human colorectal tumor cell line.
SO - Oncogene 2002 May 30;21(24):3864-71
AD - Department of Biochemistry and Molecular Biology, LSU Health Sciences
Center, Louisiana State University, New Orleans, LA 70112, USA.
Recent findings suggest that DNA alkylating agents trigger cellular
responses that overlap those activated after ionizing radiation.
Moreover, activation of these responses is dependent upon a functional
mismatch repair (MMR) system. These developments led us to test if
MMR-deficient cells may be compromised in their ability to activate
appropriate cellular signaling pathways after ionizing radiation. An
initial experiment to address this notion was to determine the level of
radiosensitivity of several MMR-deficient cell lines derived from
patients with Hereditary Non-Polyposis Colorectal Cancer (HNPCC). While
two of the three HNPCC lines investigated show levels of
radiosensitivity consistent with that displayed by normal human
fibroblasts, HCT-116 cells display moderate radiosensitivity compared to
the other MMR-deficient lines. This increased sensitivity to ionizing
radiation correlates with lowered levels of ATM expression in HCT-116.
Analysis of genomic DNA from HCT-116 cells determined that these cells
possess aberrant methylation of multiple CpG dinucleotides within the
proximal promoter region of the ATM gene. The significance of this
finding is underscored by our observations that co-culturing HCT-116
cells with the DNA demethylating agent 5-azacytidine reverses promoter
methylation, promotes normal levels of ATM expression, and restores
normal radiosensitivity. The proximal ATM promoter is a approximately
520 bp region shared with the NPAT gene, and current evidence suggests
that this region functions as a bi-directional promoter. We found that,
unlike ATM, the methylation status of this intergenic region does not
effect the expression of the NPAT gene. In sum, these observations
indicate that the ATM gene is a novel target for epigentic silencing
through inappropriate methylation of its proximal promoter region.
28
UI - 11494981
AU - Menon VS
TI -
Value and cost of follow-up after adjuvant treatment of patients with
Dukes' C colonic cancer (Br J Surg 2001; 88: 101-6).
SO - Br J Surg 2001 Aug;88(8):1128-9
29
UI - 11862564
AU - Brown SR; Seow-Choen F; Eu KW; Heah SM; Tang CL
TI -
A prospective randomised study of drains in infra-peritone
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