MedWorm: Neoadjuvant Radiation Therapy

In Regard to “Thymidylate Synthase Gene Polymorphism Affects the Response to Preoperative 5-Fluorouracil Chemoradiation Therapy in Patients With Rectal Cancer” (Int J Radiat Oncol Biol Phys 2011;81:669–676)

International Journal of Radiation Oncology * Biology * Physics — Mon, 30 Jan 2012 09:33:53 +0100

To the Editor: When preparing a manuscript addressing TS genetic polymorphisms in the context of neoadjuvant radiochemotherapy in patients with locally advanced rectal cancer, we read with great interest the study by Hur and colleagues . Of course, predictive markers for efficiency of the applied therapy regimen would be of high clinical value, which is documented by the high interest this issue has in the literature. In view of published data and our own data in this field, we would like to add some comments: (Source: International Journal of Radiation Oncology * Biology * Physics)

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Castration Therapy of Prostate Cancer Results in Downregulation of HIF-1α Levels

International Journal of Radiation Oncology * Biology * Physics — Mon, 30 Jan 2012 09:33:53 +0100

Conclusions: Our data suggest that neoadjuvant castration decreases tumor cell hypoxia in prostate cancer, which may explain increased radiosensitivity after castration. (Source: International Journal of Radiation Oncology * Biology * Physics)

Value of three‐dimensional power Doppler to predict clinical and histological response to neoadjuvant chemotherapy in locally advanced cervical carcinoma

Ultrasound in Obstetrics and Gynecology — Fri, 27 Jan 2012 08:35:23 +0100

ConclusionFI is a potential marker for predicting both clinical and histological responses to chemotherapy in patients with locally advanced cervical carcinoma. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Advances in the management of high‐risk localised and metastatic prostate cancer

BJU International — Sat, 21 Jan 2012 12:44:16 +0100

• At the third annual Interactive Genitourinary Cancer Conference, held in Budapest from 30 April to 1 May 2011, the latest developments in the management of patients with high‐risk localised and metastatic prostate cancer were discussed.• Prostate cancer is the most common cancer in Western men and, for advanced disease, no curative agents are available.• For men with high‐risk localised disease there is debate about the best treatment approaches, with both radical prostatectomy and radiation therapy shown to improve outcomes.• These approaches have started to be augmented as new techniques and therapies are developed. For instance, radiation therapy combined with androgen deprivation therapy has been shown to be more efficacious than radiation therapy alone, and there...

Defined Clinical Classifications Are Associated with Outcome of Patients with Anatomically Resectable Pancreatic Adenocarcinoma Treated with Neoadjuvant Therapy

Annals of Surgical Oncology — Thu, 19 Jan 2012 07:00:34 +0100

Conclusions This system describes discrete clinical subgroups of patients with pancreatic cancer who have similar, potentially resectable tumor anatomy but heterogeneous physiology and cancer biology. It may be used with neoadjuvant therapy to predict outcomes, individualize treatment algorithms, and optimize survival. Content Type Journal ArticleCategory Pancreatic TumorsPages 1-9DOI 10.1245/s10434-011-2211-4Authors Ching-Wei D. Tzeng, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAJason B. Fleming, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAJeffrey E. Lee, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAL...

A observational study of the efficacy and safety of capecitabine versus bolus infusional 5-fluorouracil in pre-operative chemoradiotherapy for locally advanced rectal cancer

International Journal of Colorectal Disease — Thu, 19 Jan 2012 06:59:00 +0100

Conclusions In consideration of the better ypT0-2 downstaging rate, less severe toxicities, and no need for indwelling intravenous device on oral capecitabine regimen, the administration of oral capecitabine with RT may be a more favorable option in the neoadjuvant treatment for LARC. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00384-011-1377-3Authors Chin-Fan Chen, Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanMing-Yii Huang, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanChih-Jen Huang, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, ...

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Epithelial Malignant Pleural Mesothelioma After Extrapleural Pneumonectomy: Stratification of Survival With CT-Derived Tumor Volume

American Journal of Roentgenology — Thu, 19 Jan 2012 05:00:00 +0100

CONCLUSION. With control of prognostic covariates, CT-derived tumor volume can be used to stratify survival of patients with epithelial mesothelioma after extrapleural pneumonectomy and should be included in prognostic evaluation of patients for whom resection is being considered. (Source: American Journal of Roentgenology)

A Phase II Study of Gefitinib for Aggressive Cutaneous Squamous Cell Carcinoma of the Head and Neck.

Clinical Cancer Research — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS: Gefitinib, in the neoadjuvant setting, was active and well-tolerated in patients with aggressive CSCC, and did not interfere with definitive treatment. In view of the 18% CR rate we observed, EGFR TKIs should be further explored in the treatment of aggressive CSCC. PMID: 22261807 [PubMed - as supplied by publisher] (Source: Clinical Cancer Research)

Neoadjuvant Therapy of Pancreatic Cancer: The Emerging Paradigm?

The Oncologist — Mon, 16 Jan 2012 05:00:00 +0100

Authors: Lim KH, Chung E, Khan A, Cao D, Linehan D, Ben-Josef E, Wang-Gillam A Abstract AbstractPancreatic cancer remains one of the deadliest cancers due to difficulty in early diagnosis and its high resistance to chemotherapy and radiation. It is now clear that even patients with potentially resectable disease require multimodality treatment including chemotherapy and/or radiation to improve resectability and reduce recurrence. Tremendous efforts are currently being invested in refining preoperative staging to identify optimal surgical candidates, and also in developing various neoadjuvant or adjuvant regimens to improve surgical outcome. Although at present no studies have been done to directly compare the benefit of neoadjuvant versus adjuvant approaches, accumulating evidence ...

Detection of KRAS Codon 12 Mutations is not Associated with Concurrent Detection of TP53 Mutations in Patients With Rectal Cancer

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:55 +0100

Conclusions: Our study confirms that tumors with both KRAS and TP53 mutations are less likely to respond to CRT. in addition, our data suggests that tumors with KRAS codon 12 mutation are less likely to occur with TP53 gene mutation. the association of select genetic alterations may affect tumor response to neoadjuvant therapy. (Source: Journal of Surgical Research)

Accuracy of Histological Classification of Needle Biopsy/Aspirate Specimens in Patients With Non-Small Cell Lung Cancer (NSCLC)

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:22 +0100

Conclusions: Histological subclassification is important to guide therapy in NSCLC. Even in a tertiary referral cancer center, the rate of inaccuracy of histological subclassification based on limited biopsy material is significant, especially when neoadjuvant therapy is used. Clinicians managing patients with NSCLC need to recognize this discordance. Further research is needed to develop new biomarkers capable of using limited biopsy material to subclassify NSCLC accurately. (Source: Journal of Surgical Research)

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Thymoma and thymic carcinoma

General Thoracic and Cardiovascular Surgery — Thu, 12 Jan 2012 06:43:57 +0100

Abstract Thymic tumors comprise a heterogeneous group of neoplasms with a wide spectrum of clinical presentations. The evolution of the disease is often unpredictable, ranging from an indolent attitude to the possibility of intra- and extrathoracic spread. From the histological point of view, thymoma and thymic carcinoma are the most frequent subtypes and arise only from thymic epithelial cells. Other histological types are even more rare and are usually considered separately. A number of prognostic factors have been validated as predictors of outcome: staging, World Health Organization histological classification, diameter of the tumor, associated paraneoplastic syndromes, completeness of resection, and early onset of recurrence. Complete surgical resection is the key fac...

Quality of life issues in men undergoing androgen deprivation therapy: a review.

Asian Journal of Andrology — Mon, 09 Jan 2012 05:00:00 +0100

Authors: Casey RG, Corcoran NM, Larry Goldenberg S Abstract Androgen deprivation therapy (ADT) has been an essential treatment option for treating prostate cancer (PCa). The role for hormonal treatment initially was restricted to men with metastatic and inoperable, locally advanced disease. Now it has been extended to neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease. Fifty percent of PCa patients treated will receive ADT at some point. There is growing concern about the adverse effects and costs associated with more widespread ADT use. The adverse effects on quality of life (QoL), including physical, social and psychological well-being when men are androgen-depriv...

Salvage radiotherapy in patients with recurrent esophageal carcinoma

Strahlentherapie und Onkologie — Wed, 04 Jan 2012 16:50:43 +0100

Conclusion RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherpy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended. Content Type Journal ArticleCategory Original articlePages 1-7DOI 10.1007/s00066-011-0023-xAuthors K. Fakhrian, Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, GermanyN. Gami...

Radiation Sensitivity of Esophageal Adenocarcinoma: The Contribution of the RNA-Binding Protein RNPC1 and p21-Mediated Cell Cycle Arrest to Radioresistance.

Radiation Research — Tue, 03 Jan 2012 05:00:00 +0100

Authors: Hötte GJ, Lennon NL, Reynolds JV, Maher SG Abstract Radiation combined with chemotherapy (neo-CRT) is increasingly the standard of care for the treatment of esophageal cancer either as neoadjuvant therapy in multimodal protocols or as primary therapy. Unfortunately, ∼60% of patients demonstrate little or no response to neo-CRT. Accordingly, understanding the molecular mechanisms of resistance to therapy may underpin significant advances through the identification of nonresponders either before or early in treatment. We previously identified the RNPC1 gene, which is important in stabilizing p21, as being upregulated in the tumors of esophageal cancer patients who had a poor response to neo-CRT. We hypothesize that RNPC1 contributes to resistance to radiation therapy thro...

[Articles] Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial

The Lancet Oncology — Sun, 01 Jan 2012 05:00:00 +0100

We present a pre-planned preliminary safety analysis of side-effects in stages 1 and 2 of a randomised trial comparing standard and hypofractionated radiotherapy.MethodsWe did a multicentre, randomised study and recruited men with localised prostate cancer between Oct 18, 2002, and Aug 12, 2006, at 11 UK centres. Patients were randomly assigned in a 1:1:1 ratio to receive conventional or hypofractionated high-dose intensity-modulated radiotherapy, and all were given with 3–6 months of neoadjuvant androgen suppression. (Source: The Lancet Oncology)

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Phase II Trial of Neoadjuvant/adjuvant Imatinib Mesylate for Advanced Primary and Metastatic/recurrent Operable Gastrointestinal Stromal Tumors: Long-term Follow-up Results of Radiation Therapy Oncology Group 0132

Annals of Surgical Oncology — Wed, 28 Dec 2011 06:52:23 +0100

Conclusions This long-term analysis suggests a high percentage of patients experienced disease progression after discontinuation of 2-year maintenance imatinib therapy after surgery. Consideration should be given to studying longer treatment durations in intermediate- to high-risk GIST patients. Content Type Journal ArticleCategory Bone and Soft Tissue SarcomasPages 1-7DOI 10.1245/s10434-011-2190-5Authors Dian Wang, Medical College of Wisconsin, Milwaukee, WI, USAQiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA, USACharles D. Blanke, University of British Columbia and British Columbia Cancer Agency, Vancouver, BC, CanadaGeorge D. Demetri, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USAMichael C. Heinrich, Po...

Breast MR with special focus on DW-MRI and DCE-MRI.

Cancer Imaging — Mon, 26 Dec 2011 17:24:03 +0100

Authors: Petralia G, Bonello L, Priolo F, Summers P, Bellomi M Abstract The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its h...

Recommendations from an International Consensus Conference on the Current Status and Future of Neoadjuvant Systemic Therapy in Primary Breast Cancer

Annals of Surgical Oncology — Thu, 22 Dec 2011 16:37:01 +0100

Abstract The use of neoadjuvant systemic therapy (NST) for the treatment of primary breast cancer has constantly increased, especially in trials of new therapeutic regimens. In the 1980 s, NST was shown to substantially improve breast-conserving surgery rates and was first typically used for patients with inoperable locally advanced or inflammatory breast cancer. Investigators have since also used NST as an in vivo test for chemosensitivity by assessing pathologic complete response. Today, by using pathologic response and other biomarkers as intermediate end points, results from trials of new regimens and therapies that use NST are aimed to precede and anticipate the results from larger adjuvant trials. In 2003, a panel of representatives from various breast cancer cl...

Does the Timing of Esophagectomy After Chemoradiation Affect Outcome? [ORIGINAL ARTICLES: GENERAL THORACIC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions The timing of esophagectomy after neoadjuvant CXRT is not associated with perioperative complication, pathologic response, or overall survival. It may be reasonable to delay esophagectomy beyond 8 weeks for patients who have not yet recovered from chemoradiation. (Source: The Annals of Thoracic Surgery)

Racial and ethnic disparities in outcomes with radiation therapy for rectal adenocarcinoma

International Journal of Colorectal Disease — Fri, 09 Dec 2011 06:50:13 +0100

Conclusions To our knowledge, this is the first study examining the efficacy of radiation therapy for racial/ethnic groups with rectal cancer. Disparate outcomes were observed for the administration of radiation therapy for select racial/ethnic groups. The reasons for these disparities in outcomes should be investigated to better optimize radiation therapy for patients with rectal cancer. Content Type Journal ArticleCategory Original ArticlePages 1-13DOI 10.1007/s00384-011-1378-2Authors Wendy Lee, Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USARebecca Nelson, Department of Biostatistic, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USAYasir Akmal, Department of Surger...

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Wait-and-See Policy for Clinical Complete Responders After Chemoradiation for Rectal Cancer [Gastrointestinal Cancer]

Journal of Clinical Oncology — Thu, 08 Dec 2011 05:00:00 +0100

Conclusion A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery. The proposed selection criteria and follow-up could form the basis for future randomized studies. (Source: Journal of Clinical Oncology)

Triple-Negative Subtype Predicts Poor Overall Survival and High Locoregional Relapse in Inflammatory Breast Cancer.

The Oncologist — Tue, 06 Dec 2011 05:00:00 +0100

Conclusions. TN disease is associated with worse OS, DR, and LRR outcomes in IBC patients, indicating the need for developing new locoregional and systemic treatment strategies for patients with this aggressive subtype. PMID: 22147002 [PubMed - as supplied by publisher] (Source: The Oncologist)

Preoperative Radiation Therapy for Upper Rectal CancerT3,T4/Nx: Selectivity Essential.

Clinical Colorectal Cancer — Mon, 05 Dec 2011 05:00:00 +0100

Authors: Popek S, Tsikitis VL, Hazard L, Cohen AM Abstract This review explores the current available literature regarding the role of neoadjuvant therapy for upper locally advanced rectal cancers (≥10cm-15cm). Although there is a paucity of data evaluating the outcomes of preoperative chemoradiation for upper rectal cancers the authors suggest that T3N0 tumors will not likely benefit from radiation and that treatment of T4N0 should be individualized. PMID: 22154165 [PubMed - as supplied by publisher] (Source: Clinical Colorectal Cancer)

S0356: A Phase II Clinical and Prospective Molecular Trial With Oxaliplatin, Fluorouracil, and External-Beam Radiation Therapy Before Surgery for Patients With Esophageal Adenocarcinoma [Gastrointestinal Cancer]

Journal of Clinical Oncology — Tue, 29 Nov 2011 05:00:00 +0100

Conclusion Neoadjuvant oxaliplatin, PI-FU, and EBRT for esophageal adenocarcinoma is active and tolerable. Because the regimen failed to meet the primary end point, it does not define a new standard. However, future trials can be built on this platform to validate the role of ERCC-1 in determining the best systemic regimen for individual patients. (Source: Journal of Clinical Oncology)

Challenging the Feasibility and Clinical Significance of Current Guidelines on Lymph Node Examination in Rectal Cancer in the Era of Neoadjuvant Therapy [Gastrointestinal Cancer]

Journal of Clinical Oncology — Tue, 29 Nov 2011 05:00:00 +0100

Conclusion In a tertiary cancer center, the 12-LN threshold was not relevant and often not achievable in patients with RC treated with neoadjuvant therapy. Lower LN count after neoadjuvant treatment was not associated with understaging or inferior survival. Although we support the critical importance of careful pathologic examination and adequate nodal staging, we challenge the relevance of LN count both in clinical practice and as a quality indicator in RC. (Source: Journal of Clinical Oncology)

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Summaries: International Kidney Cancer Symposium

Kidney Cancer Association — Sun, 20 Nov 2011 21:48:07 +0100

Conclusion: there is no increased risk of doing the lymph node dissection early on. Dr. Eggener-CON Basics Lymph node dissections rarely done, even for large tumors, because there is no proven therapeutic or staging benefit for low risk patients. A Mayo study revealed no data showing therapeutic benefit in high risk patients. For clinically node negative high risk patients, there is staging value but no proven therapeutic benefit. Rate of positive nodes is associated with stage and grade; the higher the stage and grade, the more likely there will be positive nodes. A tumor > 10 cm with sarcomatoid features and tumor necrosis is also associated with positive nodes. Looking at several studies, t...

Monitoring the response to primary medical therapy for breast cancer using three- dimensional time-resolved optical mammography.

Technology in Cancer Research and Treatment — Sat, 19 Nov 2011 16:19:22 +0100

Authors: Enfield LC, Cantanhede G, Westbroek D, Douek M, Purushotham AD, Hebden JC, Gibson AP Abstract Primary medical therapy is used to reduce tumour size prior to surgery in women with locally advanced breast cancer. Optical tomography is a functional imaging technique using near- infrared light to produce three-dimensional breast images of tissue oxygen saturation and haemoglobin concentration. Its advantages include the ability to display quantitative physiological information, and to allow repeated scans without the hazards associated with exposure to ionising radiation. There is a need for a non-invasive functional imaging tool to evaluate response to treatment, so that non-responders can be given the opportunity to change their treatment regimen. Here, we evaluate the use o...

Dynamic contrast enhanced-MRI for the detection of pathological complete response to neoadjuvant chemotherapy for locally advanced rectal cancer

European Radiology — Sat, 19 Nov 2011 06:51:13 +0100

Conclusion After neoadjuvant chemotherapy in rectal cancer, MR perfusional characteristics have been identified that can aid in the distinction between incomplete response and pCR. Key Points • Dynamic contrast enhanced (DCE) MRI provides perfusion characteristics of tumours. • These objective quantitative measures may be more helpful than subjective imaging alone • Some parameters differed markedly between completely responding and incompletely responding rectal cancers. • Thus DCE-MRI can potentially offer treatment-altering imaging biomarkers. Content Type Journal ArticleCategory GastrointestinalPages 1-11DOI 10.1007/s00330-011-232...

Genomic alterations in rectal tumors and response to neoadjuvant chemoradiotherapy: an exploratory study

Radiation Oncology — Fri, 18 Nov 2011 05:00:00 +0100

Conclusions: This exploratory study suggests that an in depth characterization of chromosomal alterations by aCGH would provide useful predictive information on response to neoadjuvant chemoradiotherapy and could help to optimize therapy in rectal cancer patients.The data discussed in this study are available on the NCBI Gene Expression Omnibus [GEO: GSE25885]. (Source: Radiation Oncology)

New treatment paradigm for prostate cancer: abarelix initiation therapy for immediate testosterone suppression followed by a luteinizing hormone‐releasing hormone agonist

BJU International — Wed, 16 Nov 2011 05:00:00 +0100

CONCLUSIONS• Abarelix initiation therapy results in the desired effect of achieving rapid testosterone suppression; testosterone surges after subsequent LHRH agonist therapy are greatly abrogated or completely eliminated.• This treatment paradigm (abarelix initiation followed by agonist maintenance) obviates the need for an antiandrogen.• Abarelix was well tolerated and no clinically meaningful or novel adverse events were observed during abarelix treatment or in the transition to LHRH agonist maintenance therapy. (Source: BJU International)

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Molecular changes consistent with increased proliferation and invasion are common in rectal cancer

Clinical and Translational Oncology — Tue, 15 Nov 2011 16:54:58 +0100

Conclusion The study suggests that c-FOS and SERPINE-1 may have important but as yet unclear roles in the tumour biology of rectal cancer but probably only represent a small part of the complex molecular biology of rectal cancer. Content Type Journal ArticleCategory Research ArticlesPages 753-759DOI 10.1007/s12094-011-0728-4Authors Rebecca Hughes, Department of Colorectal Surgery, Singleton Hospital, Swansea, SA2 8QA UKJames Parry, School of Medicine, University of Swansea, Swansea, UKJohn Beynon, Department of Colorectal Surgery, Singleton Hospital, Swansea, SA2 8QA UKGareth Jenkins, School of Medicine, University of Swansea, Swansea, UK Journal Clinical and Translational OncologyOnline ISSN 1699-3055Print ISSN 1699-048X Journal Volume Volume 13 Journ...

Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation

Cancer — Tue, 15 Nov 2011 05:00:00 +0100

CONCLUSIONS:Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2011;. © 2011 American Cancer Society. (Source: Cancer)

Can we predict pathologic complete response before surgery for locally advanced rectal cancer treated with preoperative chemoradiation therapy?

International Journal of Colorectal Disease — Mon, 14 Nov 2011 06:35:07 +0100

Conclusions Combining the results of the re-biopsy and post-treatment colonoscopic findings, we can achieve a good prediction rate for pathologic complete response. Post-treatment magnetic resonance images are not useful tools in predicting tumor clearance following chemoradiation. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00384-011-1348-8Authors Li-Jen Kuo, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, TaiwanJeng-Fong Chiou, Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, TaiwanCheng-Jeng Tai, Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, TaiwanChun-Chao Chang, Division of Gastroenterol...

Prognostic value of insulin‐like growth factor II mRNA binding protein 3 in patients treated with radical prostatectomy

BJU International — Fri, 11 Nov 2011 05:00:00 +0100

CONCLUSION• IMP3 expression is abnormal in approximately one‐fifth of prostate cancers. Although IMP3 is differentially expressed in patients with features of biologically aggressive prostate cancer, it does not have an independent prognostic value in patients treated with RP. (Source: BJU International)

Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer

Journal of Gastrointestinal Surgery — Tue, 08 Nov 2011 06:47:48 +0100

Conclusions Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control. Content Type Journal ArticleCategory 2011 SSAT Plenary PresentationPages 1-12DOI 10.1007/s11605-011-1748-7Authors Matthew H. G. Katz, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USAHuamin Wang, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAAparna Balachandran, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAPriya Bhosale, Department of Diagnostic Radiology, The University of Te...

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Outcomes following surgery without radiotherapy for rectal cancer

British Journal of Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Conclusion:Well‐performed, standardized APRs have similar local recurrence to AR. Radiation therapy may not confer much additional benefit. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. (Source: British Journal of Surgery)

Pathologic Nonresponders after Neoadjuvant Chemoradiation for Esophageal Cancer Demonstrate no Survival Benefit Compared with Patients Treated with Primary Esophagectomy

Annals of Surgical Oncology — Tue, 01 Nov 2011 16:52:48 +0100

Conclusions Pathologic nonresponders to NCRT for esophageal cancer receive no benefit in DFS or OS compared with patients treated with PE. For patients with stage II disease, DFS and OS are, in fact, significantly decreased in the pNR. Content Type Journal ArticleCategory Thoracic OncologyPages 1-7DOI 10.1245/s10434-011-2078-4Authors George W. Dittrick, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USAJill M Weber, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USARavi Shridhar, Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USASarah Hoffe, Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USAMarcovalerio Melis, Department of Surgery, New York Presbyterian Veterans Adminis...

Carcinoma of the Ampulla of Vater: Patterns of Failure Following Resection and Benefit of Chemoradiotherapy

Annals of Surgical Oncology — Tue, 01 Nov 2011 16:52:48 +0100

Conclusions Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. Content Type Journal ArticleCategory Gastrointestinal OncologyPages 1-6DOI 10.1245/s10434-011-2117-1Authors Manisha Palta, Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USAPretesh Patel, Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USAGloria Broadwater, Cancer Statistical Center, Duke University Medical Center, Durham, NC, USAChristopher Willett, Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USAJo...

Neoadjuvant and adjuvant chemotherapy for locally advanced bladder carcinoma: Development of novel bladder preservation approach, Osaka Medical College regimen

International Journal of Urology — Tue, 01 Nov 2011 04:00:00 +0100

AbstractCisplatin‐based chemotherapy has been widely used in a neoadjuvant as well as adjuvant setting. Furthermore, trimodal approaches including complete transurethral resection of the bladder tumor followed by combined chemotherapy and radiation have generally been performed as bladder preservation therapy. However, none of the protocols have achieved a 5‐year survival rate of more than 70%. Additionally, the toxicity of chemotherapy and/or a decreased quality of life due to urinary diversion cannot be ignored, as most patients with bladder cancer are elderly. We therefore newly developed the novel trimodal approach of “combined therapy using balloon‐occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation, which delivers an extremely high concen...

Translation and validation of Korean Functional Assessment of Cancer Therapy-Esophageal (FACT-E) scale with squamous cell carcinoma and chemoradiation-only patients

Quality of Life Research — Mon, 31 Oct 2011 16:59:20 +0100

Conclusion The FACT-E has been shown to be a reliable and valid instrument that can now be used to prospectively evaluate the quality of life of Korean patients with esophageal cancer. Content Type Journal ArticleCategory Brief CommunicationPages 1-7DOI 10.1007/s11136-011-0050-1Authors Hee-Jung Yoo, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaSung-Bae Kim, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaDok Hyun Yoon, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaSeung-Il Park, Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaJong-Hoon Kim, Department of Rad...

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Transplantation for Cholangiocarcinoma

Clinics in Liver Disease — Wed, 26 Oct 2011 20:44:51 +0100

Cholangiocarcinoma (CCA) is a primary hepatic neoplasm that arises from malignant transformation of the biliary epithelium. Chronic biliary tree inflammation as occurs in primary sclerosing cholangitis (PSC) is a risk factor for the development of CCA. Surgical resection and liver transplantation following neoadjuvant therapy in patients with early extrahepatic CCA are the only potentially curative modalities. Biliary stenting, chemotherapy, radiation therapy, and photodynamic therapy are palliative treatment options for patients who are not surgical candidates. Liver transplantation following neoadjuvant therapy is an effective therapy for patients with hilar cholangiocarcinoma that is unresectable or arising in the setting of PSC. (Source: Clinics in Liver Disease)

[Histological Classification: Evaluation of Resection Specimens of EMR/ESD - Response Evaluation after Neoadjuvant Therapy.]

Zentralblatt fur Chirurgie — Mon, 24 Oct 2011 04:00:00 +0100

Authors: Munding J, Ziebarth W, Belyaev O, Uhl W, Tannapfel A Abstract The surveillance of patients with Barrett mucosa in the distal oesophagus leads to an increase of patients diagnosed with early cancer of the oesoph-agogastric junction and stomach with only superficial infiltration. Comparable to Asian countries where screening of patients at risk is recommended due to the high incidence of gastric cancer, endoscopic resection of early cancer in the stomach and distal oesophagus is inreasing. In spite of the special endoscopic techniques -there are several requirements for the resected specimen which ensure its exact pathohistological evaluation. This is necessary to detect the exact depth of infiltration and the resection margins. To provide an exact pathohistological diagnosi...

Role of chemotherapy and molecularly targeted agents in the treatment of adenoid cystic carcinoma of the lacrimal gland

British Journal of Ophthalmology — Fri, 21 Oct 2011 04:00:00 +0100

Adenoid cystic carcinoma (ACC) is the most common malignant epithelial cancer of the lacrimal gland. Despite a slow rate of growth, ACCs are ultimately associated with poor clinical outcome. Given the rarity of this disease, most recommendations regarding therapy are guided by expert opinion and retrospective data rather than level 1 evidence. Surgery and postoperative radiation therapy are commonly used as initial local treatment. In patients at high risk of recurrence, concomitant platinum-based chemotherapy may be added to postoperative radiotherapy in an attempt to enhance radio-sensitivity. While encouraging responses have been reported with intra-arterial neoadjuvant chemotherapy, this strategy is associated with substantial toxicity and should be considered investigational. For pati...

Drug-induced Tumor Stem Cell Enrichment [Molecular Bases of Disease]

Journal of Biological Chemistry — Fri, 21 Oct 2011 04:00:00 +0100

Tumor recurrence after chemotherapy or radiation remains a major obstacle to successful cancer treatment. A subset of cancer cells, termed cancer stem cells, can elude conventional treatments and eventually regenerate a tumor that is more aggressive. Despite the large number of studies, molecular events that govern the emergence of aggressive therapy-resistant cells with stem cell properties after chemotherapy are poorly defined. The present study provides evidence for the rare escape of tumor cells from drug-induced cell death, after an intermediate stay in a non-cycling senescent stage followed by unstable multiplication characterized by spontaneous cell death. However, some cells appear to escape and generate stable colonies with an aggressive tumor stem cell-like phenotype. These cells...

[Strategies for preoperative downsizing in patients with local nonresectable pancreatic cancer.]

Der Chirurg — Thu, 20 Oct 2011 04:00:00 +0100

Authors: Combs SE, Habermehl D, Werner J, Büchler MW, Debus J Abstract In about 30-40% of all patients with pancreatic cancer a locally advanced lesion without distant metastases is found at primary diagnosis and the tumor is mostly nonresectable due to the close vicinity to blood vessels. Neoadjuvant treatment strategies, such as neoadjuvant radiochemotherapy offer the possibility to achieve substantial tumor reduction so that secondary resectability can be achieved. Therefore, treatment decisions should be made in an interdisciplinary context. In the future, innovative study protocols as well as novel radiation modalities, such as carbon ions can open new horizons in the treatment of this patient population. Additionally, molecular markers may help to stratify patients for diffe...

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A phase I/II clinical trial of preoperative short‐course carbon‐ion radiotherapy for patients with squamous cell carcinoma of the esophagus

Journal of Surgical Oncology — Wed, 19 Oct 2011 04:00:00 +0100

ConclusionsCIR showed strong local tumor control and is highly effective as a neoadjuvant therapy without severe adverse events. J. Surg. Oncol © 2011 Wiley Periodicals, Inc. (Source: Journal of Surgical Oncology)

Anastomotic Complications After Ivor Lewis Esophagectomy in Patients Treated With Neoadjuvant Chemoradiation Are Related to Radiation Dose to the Gastric Fundus

International Journal of Radiation Oncology * Biology * Physics — Tue, 18 Oct 2011 04:00:00 +0100

Conclusions: In patients undergoing neoadjuvant CRT followed by Ivor Lewis esophagectomy, the incidence of AC is related to the RT dose on the gastric fundus but not to the dose received by the proximal esophagus. When planning preoperative RT, efforts should be made to limit the median dose on the gastric fundus to 29 Gy with a V30 below 40%. (Source: International Journal of Radiation Oncology * Biology * Physics)

The efficacy and safety of neoadjuvant chemotherapy +/− letrozole in postmenopausal women with locally advanced breast cancer: a randomized phase III clinical trial

Breast Cancer Research and Treatment — Sat, 15 Oct 2011 15:46:29 +0100

Abstract This two-arm randomized clinical study aimed to evaluate the efficacy and safety of neoadjuvant concurrent chemotherapy and letrozole in postmenopausal women with locally advanced breast carcinoma. One hundred and one postmenopausal women aged 50–83 years with pathologically proven locally advanced (clinical stage T3, T4 and/or N2, N3) breast cancer were randomly assigned to receive neoadjuvant chemotherapy alone (control arm, n = 51) or neoadjuvant chemotherapy concurrent with letrozole 2.5 mg (study arm, n = 50). Chemotherapy consisted of a median 4 (range 3–5) cycles of intravenous 5-fluorouracil 600 mg/m2, doxorubicin 60 mg/m2, and cyclophosphamide 600 mg/m2, every three weeks. All patients subsequently underwent m...

Oxaliplatin No Help With Locally Advanced Rectal CancerOxaliplatin No Help With Locally Advanced Rectal Cancer

Medscape Today Headlines — Fri, 14 Oct 2011 13:57:43 +0100

European researchers continue to refine neoadjuvant radiation and chemotherapy. Medscape Medical News (Source: Medscape Today Headlines)

Local recurrence of pancreatic cancer after primary surgical intervention: How to deal with this devastating scenario?

Surgical Oncology — Thu, 13 Oct 2011 00:45:02 +0100

We present hereby a comprehensive review of the literature concerning the treatment of recurrent pancreatic cancer based on the case of a patient who 20 months after a pancreaticoduodenectomy developed portal hypertension and symptomatic first degree esophageal, gastric and mesenteric varices, caused by the nearly complete splenic vein obstruction at the portal vein confluence. The varices were revascularized by a percutaneous transhepatic placement of an endovascular stent into the splenic vein, along with a sequent stereotactic body radiation therapy for the local tumor control.Thanks to the accuracy and safety of the present combined treatment, the patient one year later presents control of the disease and its complications.Our paper is the first in the international literature that tri...

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Local Recurrence after Breast-Conserving Surgery: Multivariable Analysis of Risk Factors and the Impact of Young Age

Annals of Surgical Oncology — Wed, 12 Oct 2011 05:46:14 +0100

Conclusions Risk factors for LR after BCS include age <40 years, node positivity, ER negativity, and absence of adjuvant radiation therapy. Patients younger than age 40 years are at increased risk of LR after BCS. Content Type Journal ArticleCategory Breast OncologyPages 1-7DOI 10.1245/s10434-011-2084-6Authors Randy C. Miles, Mayo Medical School, Mayo Clinic, Rochester, MN, USARachel E. Gullerud, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USAChristine M. Lohse, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USAJames W. Jakub, Department of Surgery, Mayo Clinic, Rochester, MN, USAAmy C. Degnim, Department of Surgery, Mayo Clinic, Rochester, MN, USAJudy C. Boughey, Department of Surgery, Mayo Clinic, Rochester, M...

[Radiotherapy of prostate cancer.]

Der Radiologe — Wed, 12 Oct 2011 04:00:00 +0100

This article summarizes the essential publications on definitive and adjuvant radiotherapy and discusses the additional use of androgen deprivation and WPRT. PMID: 21987210 [PubMed - as supplied by publisher] (Source: Der Radiologe)

The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer

Journal of Surgical Oncology — Wed, 12 Oct 2011 00:53:37 +0100

ConclusionsSurvival benefit of postoperative RTx in stage IV rectal cancer after complete removal of tumors was not apparent. RTx could be recommended for selected patients at high risk of local recurrence or for palliation of symptoms. J. Surg. Oncol © 2011 Wiley Periodicals, Inc. (Source: Journal of Surgical Oncology)

Triple negative breast cancer: Proposals for a pragmatic definition and implications for patient management and trial design.

Breast — Sat, 08 Oct 2011 04:00:00 +0100

Authors: Eiermann W, Bergh J, Cardoso F, Conte P, Crown J, Curtin NJ, Gligorov J, Gusterson B, Joensuu H, Linderholm BK, Martin M, Penault-Llorca F, Pestalozzi BC, Razis E, Sotiriou C, Tjulandin S, Viale G Abstract In trials in triple negative breast cancer (TNBC), oestrogen and progesterone receptor negativity should be defined as < 1% positive cells. Negativity is a ratio of <2 between Her2 gene copy number and centromere of chromosome 17 or a copy number of 4 or less. In routine practice, immunohistochemistry is acceptable given stringent quality assurance. Triple negativity emerging after neoadjuvant treatment differs from primary TN and such patients should not enter TNBC trials. Patients relapsing with TN metastases should be eligible even if their primary was positiv...

Spectral Presaturation Inversion Recovery MR Imaging Sequence after Gadolinium Injection to Differentiate Fibrotic Scar Tissue and Neoplastic Strands in the Mesorectal Fat in Patients Undergoing Restaging of Rectal Carcinoma after Neoadjuvant Chemo- and Radiation Therapy

Academic Radiology — Thu, 06 Oct 2011 19:40:27 +0100

Conclusions: Reticular-shaped enhancing strands on SPIR MR imaging after gadolinium injection are associated with tumor infiltration of the mesorectal fat. (Source: Academic Radiology)

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Long-term outcomes of three-dimensional conformal radiation therapy combined with neoadjuvant hormonal therapy for Japanese patients with T1c-T2N0M0 prostate cancer

International Journal of Clinical Oncology — Tue, 04 Oct 2011 05:56:59 +0100

Conclusions The PSA control rates in our series of Japanese patients with stage T1c-T2N0M0 prostate cancer treated with the standard dose of 3D-CRT combined with NAHT seemed at least comparable to those reported from Western countries; as well, the patients had excellent outcomes. The present outcomes can be used as basic data for evaluating the impact of dose escalation with intensity-modulated radiation therapy for Japanese patients with prostate cancer in the future. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s10147-011-0326-zAuthors Takashi Mizowaki, Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 JapanKenji Takayama, Depar...

Role of Surgery Following Induction Therapy for Stage III Non–Small Cell Lung Cancer

Surgical Oncology Clinics of North America — Sat, 01 Oct 2011 04:00:00 +0100

Over the last 30 years neoadjuvant treatment of stage IIIA non–small cell lung cancer (NSCLC) followed by surgical resection for stage IIIB disease has significantly improved the overall results of treatment for patients with stage III NSCLC as well as for those with locally invasive tumors. Different chemotherapy regimens have been used, although in most studies some combination of drugs that include cisplatin is the standard. Radiation when given as part of the induction protocol appears to offer a higher rate of resection and complete resection, and higher doses of radiation are associated with better nodal downstaging. Resection in patients with persistent N2 disease and pneumonectomy following induction therapy remain controversial. Resection in patients with persistent N2 disease a...

An Incidentaloma: Primitive Neuroectodermal Tumor of the Thymus

Infectious Diseases in Obstetrics and Gynecology — Thu, 22 Sep 2011 16:26:01 +0100

After presenting for a routine screening exam, and 57-year-old man was diagnosed with an incidentaloma—a primitive neuroectodermal tumor (PNET) of the thymus. A member of the Ewing sarcoma family of tumors, a PNET is typically regarded as a malignancy of childhood and adolescence, usually occurring in the central nervous system. In the case at hand, our patient had an extremely unusual presentation, given his age and tumor location. Initial presentation is the only predictor for long-term survival. Current treatment recommendations advocate complete surgical resection whenever possible, radiation therapy, and adjuvant versus neoadjuvant chemotherapy. (Source: Infectious Diseases in Obstetrics and Gynecology)

Histological grading of tumour regression and radiation colitis in locally advanced rectal cancer following neoadjuvant therapy: a critical appraisal

Colorectal Disease — Thu, 22 Sep 2011 10:19:43 +0100

Conclusion Radiation colitis grade does not correlate with postoperative complications. More abdominal complications occurred in patients receiving long‐course radiotherapy. (Source: Colorectal Disease)

Adverse Features on Rectal MRI Identify a High-risk Group that May Benefit from More Intensive Preoperative Staging and Treatment

Annals of Surgical Oncology — Tue, 13 Sep 2011 05:49:38 +0100

Conclusions Adverse features found on rectal MRI identify patients at increased risk of synchronous metastatic disease. This group may benefit from additional preoperative investigation for synchronous metastases such as FDG-PET/CT or liver MRI and from alternative neoadjuvant chemotherapy regimens including induction chemotherapy. Content Type Journal ArticleCategory Colorectal CancerPages 1-7DOI 10.1245/s10434-011-2036-1Authors Chris J. Hunter, Department of Colorectal Surgery, Croydon University Hospital, Croyden, UKAurelie Garant, Faculty of Medicine, Laval University, Quebec City, QC, CanadaTé Vuong, Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, CanadaGiovanni Artho, Department of Medical Imaging, Montreal General Hospital, Montreal,...

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Phospho-ERK and AKT status, but not KRAS mutation status, are associated with outcomes in rectal cancer treated with chemoradiotherapy

Radiation Oncology — Mon, 12 Sep 2011 04:00:00 +0100

Conclusions: KRAS mutation was not associated with lesser response to chemoradiotherapy or worse OS. High p-ERK expression was associated with better OS and response. Higher p-AKT expression was correlated with better response but not OS. (Source: Radiation Oncology)

MRI may predict rectal cancer outcomes

MedWire News - Oncology — Sat, 03 Sep 2011 13:06:11 +0100

Magnetic resonance imaging used to evaluate responses to pre-surgery neoadjuvant chemotherapy or radiation may predict survival among patients with advanced rectal cancer, study findings indicate. (Source: MedWire News - Oncology)

Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer

International Journal of Radiation Oncology * Biology * Physics — Wed, 31 Aug 2011 04:00:00 +0100

Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy.Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test.Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (9...

Neoadjuvant capecitabine, radiotherapy, and bevacizumab (CRAB) in locally advanced rectal cancer: results of an open-label phase II study

Radiation Oncology — Tue, 30 Aug 2011 23:00:00 +0100

Conclusions: This study demonstrates the feasibility of preoperative chemoradiotherapy with bevacizumab and capecitabine. The observed adverse events of neoadjuvant treatment are comparable with those previously reported, but the pCR rate was lower. (Source: Radiation Oncology)

MRI Predicts Survival In Locally Advanced Rectal Cancer

Health News from Medical News Today — Tue, 30 Aug 2011 09:00:00 +0100

A new study has shown that magnetic resonance imaging (MRI) used to evaluate responses to pre-surgery (neo-adjuvant) chemotherapy or radiation may predict survival among patients with advanced rectal cancer. The findings suggest that MRI-assessed tumor responses to neoadjuvant therapy can help physicians to better plan their patients' subsequent treatments... (Source: Health News from Medical News Today)

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MRI predicts survival in locally advanced rectal cancer

ScienceDaily Headlines — Mon, 29 Aug 2011 20:46:46 +0100

Effects of radiation therapy on tissue and serum concentrations of tumour associated trypsin inhibitor and their prognostic significance in rectal cancer patients

Radiation Oncology — Tue, 23 Aug 2011 23:00:00 +0100

Conclusions: The results presented here further validate the utility of t-TATI and s-TATI as prognostic biomarkers in patients with rectal cancer, independent of neoadjuvant RT. (Source: Radiation Oncology)

Evaluation of the MD Anderson Prognostic Index for Local-Regional Recurrence After Breast Conserving Therapy in Patients Receiving Neoadjuvant Chemotherapy

Annals of Surgical Oncology — Tue, 23 Aug 2011 05:56:06 +0100

Conclusion The previously developed prognostic index was successful in stratifying patients with respect to LRR in an independent cohort undergoing BCT after neoadjuvant chemotherapy. The prognostic index can be used to identify patients at high risk for LRR who may be considered for more extensive surgery or enrollment into clinical trials evaluating novel strategies for local-regional control. Content Type Journal ArticleCategory Breast OncologyPages 1-7DOI 10.1245/s10434-011-2006-7Authors Catherine L. Akay, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAFunda Meric-Bernstam, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAKelly K. Hunt, Department of Surgical...

Skin-Sparing Mastectomy and Immediate Autologous Breast Reconstruction in Locally Advanced Breast Cancer Patients: A UBC Perspective

Annals of Surgical Oncology — Tue, 16 Aug 2011 06:16:39 +0100

Conclusions The UBC protocol avoids irradiation of the autologous breast reconstruction. Outcomes compare with findings from similar studies with respect to local recurrence, distant relapse, overall survival, and surgical complication rates. Neoadjuvant chemotherapy and preoperative radiotherapy in LABC patients desiring autologous breast reconstruction can be considered a safe option. Content Type Journal ArticleCategory Breast OncologyPages 1-9DOI 10.1245/s10434-011-1989-4Authors Adelyn L. Ho, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, CanadaScott Tyldesley, Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, CanadaSheina A. Macadam,...

Targeted therapies: An important piece of the localized prostate cancer puzzle?

Nature Clinical Practice Oncology — Tue, 16 Aug 2011 04:00:00 +0100

Nature Reviews Clinical Oncology 8, 573 (2011). doi:10.1038/nrclinonc.2011.128 Author: James W. Denham A recent trial randomly allocated 1,979 men with localized prostate cancer to radiation therapy with or without neoadjuvant androgen deprivation. Despite the combination reducing prostate cancer-specific mortality by approximately 60% and producing a modest overall survival benefit in men with intermediate-risk cancers, the authors did not recommend changing the standard of care—why? (Source: Nature Clinical Practice Oncology)

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Locally Advanced Rectal Cancer: Added Value of Diffusion-weighted MR Imaging for Predicting Tumor Clearance of the Mesorectal Fascia after Neoadjuvant Chemotherapy and Radiation Therapy [Gastrointestinal Imaging]

Radiology — Mon, 15 Aug 2011 23:00:00 +0100

Conclusion: Adding DW imaging to T2-weighted imaging can improve the prediction of tumor clearance in the MRF after neoadjuvant CRT compared with T2-weighted imaging alone in patients with locally advanced rectal cancer. © RSNA, 2011 (Source: Radiology)

The value of 3D Power Doppler to predict clinical and histological response to neoadjuvant chemotherapy in locally advanced cervical carcinoma

Ultrasound in Obstetrics and Gynecology — Sun, 14 Aug 2011 23:00:00 +0100

Conclusions:FI is a potential marker for predicting both clinical and histological responses to chemotherapy in patients with locally advanced cervical carcinoma. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

The value of 3D Power Doppler to predict clinical and histological response to neoadjuvant chemotherapy in locally advanced cervical carcinoma.

The Ultrasound Review of Obstetrics and Gynecology — Sun, 14 Aug 2011 23:00:00 +0100

CONCLUSIONS: FI is a potential marker for predicting both clinical and histological responses to chemotherapy in patients with locally advanced cervical carcinoma. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. PMID: 21845741 [PubMed - as supplied by publisher] (Source: The Ultrasound Review of Obstetrics and Gynecology)

Concurrent Image-guided Intensity Modulated Radiotherapy and Chemotherapy Following Neoadjuvant Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

Radiation Oncology — Fri, 12 Aug 2011 23:00:00 +0100

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The Changing Field of Locoregional Treatment for Breast Cancer

Cancer Network — Tue, 09 Aug 2011 12:00:00 +0100

Reviews neoadjuvant chemotherapy, margins in surgery, evaluation of the axilla, and radiation therapy in the locoregional treatment of breast cancer. (Source: Cancer Network)

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Neoadjuvant chemoradiation compared to neoadjuvant radiation alone and surgery alone for Stage II and III soft tissue sarcoma of the extremities

Radiation Oncology — Mon, 08 Aug 2011 23:00:00 +0100

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[Role of locoregional radiation therapy in breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. The Institut Curie-Hôpital René-Huguenin experience.]

Cancer Radiotherapie — Sun, 07 Aug 2011 23:00:00 +0100

CONCLUSIONS: This retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence or death when postmastectomy radiation therapy was omitted in breast cancer patients with pN0 status after neoadjuvant chemotherapy and mastectomy. Whether the omission of postmastectomy radiation therapy is acceptable for these patients should be addressed prospectively. PMID: 21831686 [PubMed - as supplied by publisher] (Source: Cancer Radiotherapie)

Breast MR with special focus on DW-MRI and DCE-MRI.

Cancer Imaging — Sun, 31 Jul 2011 01:45:02 +0100

Authors: Petralia G, Bonello L, Priolo F, Summers P, Bellomi M The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its high sensitivi...

Overview of preoperative radiochemotherapy in breast cancer: past or future?

Clinical and Translational Oncology — Sat, 30 Jul 2011 15:55:23 +0100

Abstract Radiochemotherapy is a standard approach in human solid tumours, with localised stage and radical treatment intention. In the early-intermediate stages of breast cancer model, neoadjuvant radiochemotherapy is an alternative to induction chemotherapy alone and might further impact the surgical technical treatment characteristics (a downsizing effect). In the era of targeted therapy and personalised treatment for breast cancer patients with initial localised disease, radiochemotherapy needs to be explored as a component of optimised local treatment to potentially improve relevant local results, such as breast conservation, breast cosmesis and individualised breast cancer radiochemotherapy response prediction. An overview of available literature data regarding neoadj...

Preoperative Radiotherapy Combined with Capecitabine Chemotherapy in Chinese Patients with Locally Advanced Rectal Cancer

Journal of Gastrointestinal Surgery — Thu, 28 Jul 2011 05:47:08 +0100

Conclusion Preoperative chemoradiotherapy with capecitabine and RT appears to be a safe, well-tolerated, and effective neoadjuvant treatment modality for LARC. Content Type Journal ArticlePages 1-8DOI 10.1007/s11605-011-1637-0Authors Jianhua Jin, Department of Medical Oncology, Wujin People’s Hospital, Jiangsu University, No. 2, North Yongning Rd, Changzhou, 213002 People’s Republic of ChinaHua Meng, Department of Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaGuanghua Zhou, Department of Oncology, 163rd Hospital of People’s Liberation Army (PLA), Changsa, People’s Republic of ChinaXuezhong Xu, Department of Gastrointestinal Surgery, Wujin People’s Hospital, Jiangsu University, Changzhou, People’s Re...

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Molecular Class as a Predictor of Locoregional and Distant Recurrence in the Neoadjuvant Setting for Breast Cancer.

Oncology — Mon, 25 Jul 2011 23:00:00 +0100

Conclusions: IHC subclassification and pCR predict distant failure, DFS, and OS in the neoadjuvant setting. While not predictive of locoregional recurrence, the total number of events were small. More work is needed to define if molecular class can predict patients at risk for locoregional recurrence. PMID: 21791944 [PubMed - as supplied by publisher] (Source: Oncology)

Intensity-modulated radiotherapy (IMRT)/Tomotherapy following neoadjuvant chemotherapy in stage IIB–IVA/B undifferentiated nasopharyngeal carcinomas (UCNT): A mono-institutional experience

Oral Oncology — Sun, 24 Jul 2011 23:00:00 +0100

Summary: To evaluate the outcome of Undifferentiated Nasopharyngeal Carcinomas (UCNT) treated with intensity-modulated radiation therapy with Simultaneous Integrated Boost (SIB), following induction chemotherapy. Between January 2006 and June 2009, 52 patients with stage II B-IVA/B UCNT were treated either with linac-IMRT or Tomotherapy. All patients were scheduled to receive three cycles of cisplatin based neoadjuvant chemotherapy. With a median follow-up of 38.5months (range 12.3–64.1), 3year overall survival (OS), disease-free survival (DFS), and DFS by T2a–2b and T3–T4-stage were 95.0%, 84.6%, 89.0%, and 78.0%, respectively. At multivariate analysis, none of the examined prognostic factors reported statistical significance. N-classification was not a significant predictive factor...

Staging of Breast Cancer with Ultrasound

Seminars in Ultrasound CT and MRI — Thu, 21 Jul 2011 19:26:56 +0100

The prognosis of women with breast cancer depends on tumor size and regional lymph node status. Clinical assessment combined with imaging is important in the staging of primary breast cancer, particularly in a multidisciplinary setting where radiologists, pathologists, medical, surgical, and radiation oncologists work together to optimize patient care. Delineation of loco-regional (multifocal vs multicentric) disease is critical in surgical planning to enable a curative procedure with clear margins and good cosmetic outcome. Regional (ipsilateral axillary, infraclavicular, internal mammary, and supraclavicular) nodal information helps determine patient eligibility for neoadjuvant protocols and also aids in radiation planning. The role of high-resolution ultrasound in staging breast cancer ...

Influence of Specialty and Clinical Experience on Treatment Sequencing in the Multimodal Management of Soft Tissue Extremity Sarcoma

Annals of Surgical Oncology — Mon, 18 Jul 2011 15:54:06 +0100

Conclusions Treatment sequencing in STS is influenced by specialty and clinical experience, with no clear consensus. These patterns may reflect the recent trend toward regionalization of STS care. Content Type Journal ArticlePages 1-7DOI 10.1245/s10434-011-1923-9Authors Nabil Wasif, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USARobert M. Tamurian, Department of Orthopedic Surgery, University of California at Davis Health System, Davis, CA, USAScott Christensen, Department of Hematology and Oncology, University of California at Davis Health System, Davis, CA, USALy Do, Department of Radiation Oncology, University of California at Davis Health System, Davis, CA, USASteve R. Martinez, Department of Surgery, University of California at Davis Health System, ...

Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC)

Radiotherapy and Oncology — Thu, 14 Jul 2011 23:00:00 +0100

Conclusions: Overall, outcome after CHARTWEL or CF was not different. The lower total dose in the CHARTWEL arm was compensated by the shorter overall treatment time, confirming a time factor for NSCLC. The higher efficacy of CHARTWEL versus CF in advanced stages and after chemotherapy provides a basis for further trials on treatment intensification for locally advanced NSCLC. (Source: Radiotherapy and Oncology)

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A Phase II Trial of Neoadjuvant Chemoradiation and Local Excision for T2N0 Rectal Cancer: Preliminary Results of the ACOSOG Z6041 Trial

Annals of Surgical Oncology — Thu, 14 Jul 2011 06:02:45 +0100

Conclusions CRT before LE for T2N0 tumors results in a high pathologic complete response rate and negative resection margins. However, complications during CRT and after LE are high. The true efficacy of this approach will ultimately be assessed by the long-term oncologic outcomes. Content Type Journal ArticlePages 1-8DOI 10.1245/s10434-011-1933-7Authors Julio Garcia-Aguilar, Department of Surgery, City of Hope, Duarte, USAQian Shi, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USACharles R. Thomas, Knight Cancer Institute, Oregon Health and Science University, Portland, USAEmily Chan, Vanderbilt University Medical Center, Nashville, USAPeter Cataldo, Department of Surgery, University of Vermont, Burlington, USAJorge Marcet, Tampa Genera...

Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC).

Mon, 11 Jul 2011 23:00:00 +0100

CONCLUSIONS: Overall, outcome after CHARTWEL or CF was not different. The lower total dose in the CHARTWEL arm was compensated by the shorter overall treatment time, confirming a time factor for NSCLC. The higher efficacy of CHARTWEL versus CF in advanced stages and after chemotherapy provides a basis for further trials on treatment intensification for locally advanced NSCLC. PMID: 21757247 [PubMed - as supplied by publisher] (Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology)

EAU Guidelines on Prostate Cancer. P5art I: Screening, Diagnosis, and Treatment of Clinically Localised Disease.

Actas Urologicas Espanolas — Mon, 11 Jul 2011 23:00:00 +0100

CONCLUSIONS: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. PMID: 21757259 [PubMed - as supplied by publisher] (Source: Actas Urologicas Espanolas)

Chemotherapy: Standardizing the care of invasive bladder cancer

Nature Clinical Practice Oncology — Mon, 11 Jul 2011 23:00:00 +0100

Nature Reviews Clinical Oncology 8, 454 (2011). doi:10.1038/nrclinonc.2011.109 Author: Bernard H. Bochner For many patients with invasive bladder cancer, regional or systemic metastases are present at the time of presentation. Owing to the risk of micrometastatic disease, preoperative neoadjuvant cisplatin-based chemotherapy before radical cystectomy or radiation has been assessed and shown to provide a survival advantage. (Source: Nature Clinical Practice Oncology)

Effect of neoadjuvant chemoradiation and postoperative radiotherapy on expression of heat shock protein 70 (HSP70) in head and neck vessels

Radiation Oncology — Sun, 10 Jul 2011 23:00:00 +0100

Conclusion: Our results showed that anticancer drugs can lead to a thickening of the intima layer of transplant and recipient veins and also increase the HSP70 expression in the media layer of the recipient vessels. In contrast, conventional radiation decreased the HSP70 expression in the intima layer of arteries and the media layer of recipient arteries and veins. Comparing these results with wall thickness, it was concluded, that high levels of HSP70 may prevent the intima layer of arteries and the media layer of vein from thickening. (Source: Radiation Oncology)

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The Timing and Extent of Androgen Deprivation Therapy for Prostate Cancer: Weighing the Clinical Evidence

Endocrinology and Metabolism Clinics of North America — Thu, 07 Jul 2011 23:00:00 +0100

Androgen deprivation therapy (ADT) is an effective means of palliating symptoms of prostate cancer but is associated with significant toxicities that increase with treatment duration. Primary ADT in men with localized disease provides no survival advantage. Neoadjuvant ADT, when combined with external beam radiation, improves survival for men with locally advanced disease. Immediate adjuvant androgen deprivation does not seem to benefit most men undergoing radical prostatectomy. No evidence supports combined androgen blockade or monotherapy with nonsteroidal antiandrogens for locally advanced prostate cancer. ADT with orchiectomy or gonadotropin-releasing hormone agonists or antagonists is standard care for men with metastatic prostate cancer. (Source: Endocrinology and Metabolism Clinics ...

Impact of Radiation Therapy Sequence on Survival Among Patients With Resected Pancreatic Head Ductal Carcinoma

Annals of Surgical Oncology — Thu, 07 Jul 2011 05:46:12 +0100

Conclusions Survival of patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma does not seem to be affected by sequence of perioperative radiation therapy. This finding would imply that prospective studies comparing nRT to aRT is warranted to examine potential clinical benefits of nRT and can be carried out without compromising patient outcome. Content Type Journal ArticlePages 1-5DOI 10.1245/s10434-011-1898-6Authors Jan Franko, Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USADev R. Puri, Radiation Oncology, Mercy Medical Center, Des Moines, IA, USACharles D. Goldman, Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USA Journal Annals of Surgical OncologyOnline ISSN 1534-4681Print ISSN 1068-9265 (...

Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy

Radiotherapy and Oncology — Mon, 04 Jul 2011 04:00:00 +0100

Abstract: Purpose: To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT).Patients and methods: Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34months.Results: In comparison to NE patients, FP patients were younger (p=0.002) with a higher low-risk proportion (p=0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p=0.01...

Role of radiation therapy in patients with resectable pancreatic cancer.

Oncology (Williston Park, N.Y.) — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Palta M, Willett C, Czito B Abstract The 5-year overall survival of patients with pancreatic cancer is approximately 5%, with potentially resectable disease representing the curable minority. Although surgical resection remains the cornerstone of treatment, local and distant failure rates are high after complete resection, and debate continues as to the appropriate adjuvant therapy. Many oncologists advocate for adjuvant chemotherapy alone, given that high rates of systemic metastases are the primary cause of patient mortality. Others, however, view locoregional failure as a significant contributor to morbidity and mortality, thereby justifying the use of adjuvant chemoradiation. As in other gastrointestinal malignancies, neoadjuvant chemoradiotherapy offers potential adva...

Multidisciplinary Discussion and Management of Rectal Cancer: A Population-based Study

World Journal of Surgery — Thu, 30 Jun 2011 17:50:05 +0100

Conclusions Although no difference in CRM+ rate was found for those patients who were discussed and those who were not, our results demonstrate room for improvement, especially in the selection of patients for SCRT or no RT. We advocate standardized documentation of treatment decisions and pathology reports. Content Type Journal ArticlePages 1-9DOI 10.1007/s00268-011-1181-9Authors H. A. M. Swellengrebel, Department of Gastroenterology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The NetherlandsE. G. Peters, Department of Gastroenterology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The NetherlandsA. Cats, Department of Gastroenterology, The Netherlan...

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Poorer outcome in polynesian patients with prostate cancer treated with definitive conformational radiation therapy.

Wed, 29 Jun 2011 23:00:00 +0100

CONCLUSION: FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer. PMID: 21723636 [PubMed - as supplied by publisher] (Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology)

Experience with combination of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

European Archives of Oto-Rhino-Laryngology — Sat, 25 Jun 2011 15:52:55 +0100

Abstract The purpose of this study was to evaluate the efficacy and toxicity of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiation therapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC). A total of 54 patients (stage IIB: 6, stage III: 24, stage IVA–B: 24) with locoregionally advanced NPC were treated with cisplatin 25 mg/m2 intravenously on days 1–3, and gemcitabine 1,000 mg/m2 of 30-min intravenous infusion on days 1 and 8, every 3 weeks for two cycles as neoadjuvant chemotherapy. Two cycles of the same regimen were administered as adjuvant chemotherapy 28 days after the end of radiotherapy. The prescription doses were 66–70.4 Gy to the gross tumor volume (GTV), 66 Gy to positive neck nodes,...

Role of Radiation in Intermediate-Risk Rectal Cancer

Annals of Surgical Oncology — Fri, 24 Jun 2011 05:43:40 +0100

Abstract The treatment of rectal cancer has greatly evolved during the last several decades as a result of the understanding of the pathways of cancer spread, natural history of the disease, stages prognosis and prognostic markers. The tendency is clearly to move toward a more personalized approach to these patients based on preoperative staging and response to therapy. Although in the past we have been adding more treatment modalities to surgery to the point that every stage II/III cancer was treated with neoadjuvant chemo and radiotherapy followed by radical surgery by total mesorectal excision with or without sphincter preservation and more chemotherapy to follow, more recently this algorithm has been under discussion and scrutiny. Two of the major topics of controversy...

Neoadjuvant Chemoradiotherapy for Resectable Oesophageal and Gastro-oesophageal Junction Cancer—Do We Need Another Randomised Trial?

Clinical Oncology — Mon, 20 Jun 2011 04:00:00 +0100

Conclusion: Data from the above studies are potentially conflicting and inconclusive for defining the optimal neoadjuvant treatment schedule. In our opinion, the above question can only be answered within the context of a randomised control trial. We have included a proposal for a trial design for direct comparison of these modalities. (Source: Clinical Oncology)

Mesothelioma at era of helical tomotherapy: Results of two institutions in combining chemotherapy, surgery and radiotherapy

Lung Cancer — Fri, 10 Jun 2011 04:00:00 +0100

Conclusion: With limited follow up, HT has comparable toxicity to those observed with traditional IMRT. Higher radiation dose and good coverage results in excellent local control. (Source: Lung Cancer)

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Point: Short-Course Radiation Therapy Is Preferable in the Neoadjuvant Treatment of Rectal Cancer

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:40 +0100

There are 2 types of neoadjuvant radiation regimens accepted as standard for resectable rectal cancer: short-course (5 × 5 Gy) radiation therapy alone with immediate surgery and long-course combined chemoradiation therapy with delayed surgery. A Polish randomized study (n = 312) and an Australian randomized study (n = 326) compared these 2 schedules. Both trials showed a lower rate of early adverse effects using a short-course radiation regimen and no differences in long-term oncologic outcomes and late toxicity rates between groups. The small number of fractions makes short-course radiation less expensive and more convenient than chemoradiation therapy. These facts indicate that short-course radiation is preferable to chemoradiation for resectable cancers. Additionally, short-course preo...

Counterpoint: Long-Course Chemoradiation Is Preferable in the Neoadjuvant Treatment of Rectal Cancer

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:40 +0100

There are 2 approaches to preoperative therapy. Short-course (25 Gy in 5 fractions) radiation and long-course (50.4 Gy in 28 fractions) radiation combined with chemotherapy (CMT). Although short-course radiation therapy is used in some European countries, it is not favored in all European countries or North America. Unlike long-course CMT, it cannot be safely combined with adequate doses of systemic concurrent chemotherapy, and, as currently designed, it does not increase sphincter preservation. Long-course CMT remains the preferred regimen for cT3 and/or node-positive disease. With parallel advances in staging, surgery, systemic therapy, and molecular markers, more selective approaches are being investigated. (Source: Seminars in Radiation Oncology)

Nonoperative Approaches to Rectal Cancer: A Critical Evaluation

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:40 +0100

A neoadjuvant multimodality approach with chemoradiation therapy (CRT) is the preferred treatment strategy for most distal rectal cancers. Significant downstaging and complete pathologic response may develop after this strategy, and there is still controversy regarding the management of these patients. In this setting, a nonoperative approach has been suggested in select patients with complete clinical response after thorough clinical, endoscopic, and radiologic assessment. However, the assessment of these patients is not straightforward and remains complex. Available data regarding this approach are limited to a single institution's experience from retrospective analyses. Standardization of the assessment of tumor response and the development of radiological/molecular tools may clarify th...

How Low is Low? Evolving Approaches to Sphincter-Sparing Resection Techniques

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:39 +0100

Although advances in rectal cancer staging may ultimately be accurate enough to reliably exclude disease outside the rectal wall (thereby allowing local approaches to be more widely and safely applied) and advances in the use of neoadjuvant chemo- and radiation therapy may ultimately produce more “complete responders” that can be accurately identified and spared surgery altogether, as it stands, radical resection forms the basis of curative treatment for rectal cancer. However, the concepts that guide the surgeon in choosing the optimal approach in radical resection are changing. In the past, the decision as to how to proceed surgically with radical resection was based primarily on the level of the tumor above the anal verge or anorectal ring. The issue was primarily “How low is the ...

Neoadjuvant Chemotherapy Alone for Early-Stage Rectal Cancer: An Evolving Paradigm?

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:39 +0100

Current management of early-stage rectal cancer comprises combinations of surgery, radiotherapy, and chemotherapy, with the presence or absence of several validated high-risk features determining which treatment modalities will be used and the order of administration. In high-risk individuals, most centers have adopted neoadjuvant combined chemotherapy and radiotherapy followed by surgery as the initial approach. However, long-term toxicity, limited survival gains, and high rates of distant failure have called this approach into question, with early data suggesting that neoadjuvant chemotherapy alone may be feasible in selected patient groups. This review discusses the current data and feasibility of managing early stage rectal cancer with neoadjuvant chemotherapy before surgical resection...

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Beyond 5-Fluorouracil: The Emerging Role of Newer Chemotherapeutics and Targeted Agents with Radiation Therapy

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:39 +0100

The management of rectal cancer has undergone significant evolution with advances in surgery, radiation therapy, and chemotherapy. These advances have translated into improved rates of local control, survival, and quality of life. More recently, the integration of newer chemotherapeutic and targeted agents in patients with advanced colorectal cancer have led to further improvements in disease-free and overall survival. These agents are now being studied with radiation therapy in the neoadjuvant therapy of rectal cancer. (Source: Seminars in Radiation Oncology)

Rectal Cancer: Primary Staging and Assessment After Chemoradiotherapy

Seminars in Radiation Oncology — Tue, 07 Jun 2011 14:44:38 +0100

Rectal cancer staging is based on 2 principles. The first is an anatomic definition of the tumor allowing for surgical planning. The second is prognostic stage grouping. A given prognostic stage carries different risks of both local and distant recurrence, a selective and tailored approach to preoperative therapy is appropriate. Increasingly, selective approaches enable an overall reduction in morbidity from overtreatment, while allowing aggressive treatment of high-risk patients. Therefore, the aim of preoperative staging is to accurately and reproducibly differentiate between good and poor prognosis tumors. In the preoperative setting, superficial and flat rectal cancers are probably best initially staged using endoscopic ultrasound, and where available magnetic resonance imaging is used...

Radiation therapy and androgen deprivation in the management of high risk prostate cancer

International Braz J Urol — Mon, 06 Jun 2011 16:04:03 +0100

This article critically reviews the data on the use of RT combined with androgen deprivation for the treatment of high-risk prostate cancer with emphasis on the results of phase 3 trials. (Source: International Braz J Urol)

Outcomes following a limited approach to radiotherapy in rectal cancer

British Journal of Surgery — Tue, 31 May 2011 23:00:00 +0100

Conclusion:Limiting preoperative radiotherapy in rectal cancer to patients with a threatened circumferential margin does not compromise patient outcome. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. (Source: British Journal of Surgery)

Outcomes following a limited approach to radiotherapy in rectal cancer.

The British Journal of Surgery — Tue, 31 May 2011 23:00:00 +0100

CONCLUSION: Limiting preoperative radiotherapy in rectal cancer to patients with a threatened circumferential margin does not compromise patient outcome. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 21633949 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

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International Phase III Trial Assessing Neoadjuvant Cisplatin, Methotrexate, and Vinblastine Chemotherapy for Muscle-Invasive Bladder Cancer: Long-Term Results of the BA06 30894 Trial [Urologic Oncology]

Journal of Clinical Oncology — Thu, 26 May 2011 23:00:00 +0100

Conclusion We conclude that CMV chemotherapy improves outcome as first-line adjunctive treatment for invasive bladder cancer. Two large randomized trials (by the Medical Research Council/European Organisation for Research and Treatment of Cancer and Southwest Oncology Group) have confirmed a statistically significant and clinically relevant survival benefit, and neoadjuvant chemotherapy followed by definitive local therapy should be viewed as state of the art, as compared with cystectomy or radiotherapy alone, for deeply invasive bladder cancer. (Source: Journal of Clinical Oncology)

Curative Treatment Of Oesophageal Carcinoma: Current Options And Future Developments

Radiation Oncology — Wed, 25 May 2011 23:00:00 +0100

Since the 1980s major advances in surgery, radiotherapy and chemotherapy, have established multimodal approaches as curative treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created new opportunities for a more adequate patient selection and therapy response assessment. The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma. In recent years an epidemiological shift towards the latter was observed. From a surgical point of view, adenocarcinomas, which are usually located in the distal third of the oesophagus, may be treated with a transhiatal resection, whereas squamous cell carcinomas, which are typically found in the middle and the upper third, require a tra...

One-fourth of RT patients on ADT experience testosterone breakthrough

Modern Medicine — Tue, 17 May 2011 23:00:00 +0100

Among men treated with curative radiation therapy and neoadjuvant, adjuvant, or concurrent ADT, about one-fourth fail to achieve or maintain true castrate levels of testosterone suppression, according to a study from the University of British Columbia, Vancouver. (Source: Modern Medicine)

Density of CD4(+) and CD8(+) T lymphocytes in biopsy samples can be a predictor of pathological response to chemoradiotherapy (CRT) for rectal cancer

Radiation Oncology — Sun, 15 May 2011 23:00:00 +0100

Conclusions: In RC patients, T lymphocyte-mediated immune reactions play an important role in tumor response to CRT, and the quantitative measurement of TIL in biopsy samples before CRT can be used as a predictor of the clinical effectiveness of CRT for advanced RC. (Source: Radiation Oncology)

Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

International Journal of Radiation Oncology * Biology * Physics — Thu, 12 May 2011 04:00:00 +0100

Conclusions: The thymidylate synthase genotype and XRCC1 Arg399Gln polymorphism might help to identify Stage II-III rectal cancer patients with a better outcome after preoperative concomitant chemoradiotherapy. (Source: International Journal of Radiation Oncology * Biology * Physics)

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Clinically Enlarged Lateral Pelvic Lymph Nodes Do Not Influence Prognosis after Neoadjuvant Therapy and TME in Stage III Rectal Cancer

Journal of Gastrointestinal Surgery — Sun, 01 May 2011 15:32:04 +0100

Conclusions The LPLNs that were identified on pretherapy imaging do not affect the overall or disease-free survival after the neoadjuvant therapy and proctectomy in stage III rectal cancer. A lateral pelvic lymph node dissection does not appear to be justified in stage III patients with LPLNs on pretherapy imaging who receive neoadjuvant therapy. Content Type Journal ArticlePages 1-7DOI 10.1007/s11605-011-1533-7Authors Sekhar Dharmarajan, Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, St. Louis, MO, USADandan Shuai, Department of Radiology, Washington University School of Medicine, St. Louis, MO, USAAlyssa D. Fajardo, Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 So...

[Comment] Androgen deprivation before prostate radiotherapy: how long is long enough?

The Lancet Oncology — Sat, 30 Apr 2011 16:38:57 +0100

Initial results of the Trans-Tasman Radiation Oncology Group (TROG) 96.01 trial showed that neoadjuvant androgen-deprivation therapy (NADT) significantly improved the outcome of radiotherapy for high-risk prostate cancer, in terms of biochemical control and freedom from salvage treatment. The updated results, reported in The Lancet Oncology, confirm that the benefits of NADT also extend to cause-specific and overall survival. Since the benefits of NADT are already well known, most interest will focus on the comparison of 3-month and 6-month NADT. (Source: The Lancet Oncology)

Neoadjuvant Concurrent Chemoradiation for Advanced Esthesioneuroblastoma: A Case Series and Review of the Literature [DIAGNOSIS IN ONCOLOGY]

Journal of Clinical Oncology — Thu, 28 Apr 2011 23:00:00 +0100

(Source: Journal of Clinical Oncology)

Determinants of outcomes in pancreatic surgery and use of hospital resources

Journal of Surgical Oncology — Sun, 24 Apr 2011 23:00:00 +0100

ConclusionsMorbidity after pancreatic surgery remains high. Age, obesity, performance status, medical co‐morbidities, and neoadjuvant radiation affect outcomes and may lead to increased use of hospital resources. J. Surg. Oncol. 9999:XX–XX, XXXX © 2011 Wiley‐Liss, Inc. (Source: Journal of Surgical Oncology)

[Predictive factors of tumour response after neoadjuvant chemoradiation for locally advanced rectal cancer and correlation of these factors with survival.]

Cancer Radiotherapie — Thu, 21 Apr 2011 23:00:00 +0100

CONCLUSION: Downstaging and complete response after chemoradiation improved progression-free survival and overall survival of locally advanced rectal adenocarcinoma. In multivariate analysis, a pre-treatment concentration of carcinoembryonnic antigen below 5ng/mL was associated with complete tumour response, hence with tumour downstaging. PMID: 21515083 [PubMed - as supplied by publisher] (Source: Cancer Radiotherapie)

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Surgical Management of Lung Cancer

Seminars in Respiratory and Critical Care Medicine — Thu, 14 Apr 2011 23:00:00 +0100

Semin Respir Crit Care Med 2011; 32: 069-077DOI: 10.1055/s-0031-1272871ABSTRACTLung cancer continues to be the most frequent cancer-related cause of death in the United States and throughout the world. Surgical resection is currently the most effective treatment in early-stage non-small-cell lung cancer, and historically the only treatment approach achieving significant cure rates. In advanced disease, therapeutic approaches involving chemotherapy and/or radiation therapy are utilized to improve prognosis, either as part of a neoadjuvant treatment approach followed by surgical resection or as definitive treatment alone. The role of surgery in locally advanced or metastatic non-small-cell lung cancer remains controversial, with more studies required to further refine the application of mode...

Minimally Invasive Esophagectomy is Safe and Effective Following Neoadjuvant Chemoradiation Therapy

Annals of Surgical Oncology — Sat, 09 Apr 2011 05:51:37 +0100

Conclusion MIE is safe following NACR. Excellent results can be achieved with this operation in patients with advanced tumors. Content Type Journal ArticlePages 1-6DOI 10.1245/s10434-011-1702-7Authors Kfir Ben-David, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USAGeorge Rossidis, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USARobert A. Zlotecki, Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USAStephen R. Grobmyer, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USAJuan C. Cendan, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USAGeorge A. Sarosi, Department of Surgery, Univers...

Update on Treatment Advances in Combined-Modality Therapy for Anal and Rectal Carcinomas

Current Oncology Reports — Tue, 05 Apr 2011 10:02:12 +0100

Abstract Concurrent radiation therapy and chemotherapy is the primary treatment for patients with squamous cell tumors of the anal canal, and is also employed in the neoadjuvant setting for patients with stage II and III adenocarcinoma of the rectum. There is constant clinical study involving modifications of chemoradiotherapy regimens in an effort to maximize tumor responses while reducing normal tissue toxicity. This review will discuss established regimens as well as newer and novel treatment approaches to treatment of anal and rectal cancer. Content Type Journal ArticlePages 1-9DOI 10.1007/s11912-011-0166-zAuthors Jeffrey Meyer, Department of Radiation Oncology, UT-Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX 75390–9183, USAGlen Balch, Departme...

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

BJU International — Wed, 30 Mar 2011 23:00:00 +0100

CONCLUSIONS• ADT initiation has fallen and marked changes occurred in treatment patterns for prostate cancer.• Changes might be driven by increasing awareness of potential harms and costs, and by new evidence supporting ADT for specific indications. (Source: BJU International)

Chemotherapy/chemoradiation in anal cancer: A systematic review

Cancer Treatment Reviews — Tue, 29 Mar 2011 23:00:00 +0100

Conclusions: In anal cancer T3/T4 lesions fare badly (3year DFS 40–68%). Cisplatin appears an effective drug, but novel strategies have not allowed progress from the schedule of chemoradiation using MMC, infusional 5FU and radiotherapy – the paradigm developed by Nigro over 30years ago. Different cytotoxic agents such as capecitabine, oxaliplatin and docetaxel, and biologically targeted agents – either an EGFR monoclonal antibody or an oral tyrosine kinase inhibitor, which exploits this pathway, might offer an alternative. In particular, the role of EGFR inhibition following chemoradiation should be explored. (Source: Cancer Treatment Reviews)

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A Phase II Study of Neoadjuvant and Adjuvant Chemotherapy with 5-Fluorodeoxyuridine, Leucovorin, Oxaliplatin and Docetaxel in the Treatment of Previously Untreated Advanced Esophageal Adenocarcinoma

Japanese Journal of Clinical Oncology — Mon, 28 Mar 2011 23:00:00 +0100

Conclusion 5-Fluorodeoxyuridine, leucovorin, oxaliplatin and docetaxel regimen is active in patients with esophageal adenocarcinoma. Toxicity profiles are manageable. Neoadjuvant chemotherapy allowed achievement of complete pathologic response without radiation. 18F-fluorodeoxyglucose-positron emission tomography standardized uptake values might be prognostic. (Source: Japanese Journal of Clinical Oncology)

Impact of Breast Cancer Molecular Subtypes on Locoregional Recurrence in Patients Treated with Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer

Annals of Surgical Oncology — Sun, 27 Mar 2011 05:46:02 +0100

Conclusions Molecular subtype predicts LRR with basal-like patients more likely to develop LRR. These patients may be candidates for investigation with novel chemotherapy regimens and radiation sensitizing agents, which may offer improvement in local control. Content Type Journal ArticlePages 1-7DOI 10.1245/s10434-011-1665-8Authors Michael O. Meyers, Division of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC USANancy Klauber-DeMore, Division of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC USADavid W. Ollila, Division of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine at Chapel...

Hormone therapy aids prostate cancer survival

NHS News Feed — Fri, 25 Mar 2011 16:31:00 +0100

Conclusion This long-term follow-up of the TROG 96.01 trial found that having six months of androgen deprivation therapy (goserelin plus flutamide) before radiotherapy reduces the 10-year risk of death among men with locally advanced prostate cancer. The study has a robust design, and it assessed important clinical outcomes – such as the risk of death from prostate cancer – rather than just intermediate outcomes, such as reductions in PSA levels that were the main beneficial outcomes in the previous five-year report of this trial. One limitation noted by the authors is that the dose of radiotherapy used in their study (66 Gy), which was initiated over a decade ago, was low by modern standards. They say that this increase in radiation dose may have contributed to the improved progressio...

Adenocarcinoma of the Esophagogastric Junction: Neoadjuvant Radiochemotherapy and Radical Surgery

Strahlentherapie und Onkologie — Fri, 25 Mar 2011 06:01:07 +0100

Conclusion: Neoadjuvant radiochemotherapy in patients with advanced adenocarcinoma of the esophagogastric junction followed by thoracoabdominal surgery is a feasible concept. Significant tumor regression in 44% of the patients and an ypN0 rate in 67% of the patients may favor this approach due to its high efficacy. However, to avoid toxic pulmonary effects constraints for low-dose radiation volume parameters need specific attention. Content Type Journal ArticlePages 1-7DOI 10.1007/s00066-011-2171-4Authors Bernhard J. Leibl, Department of Surgery, Klinikum Coburg, Coburg, GermanyStephanie Vitz, Department of Radiation Oncology, DiaCura Coburg, Coburg, GermanyWolfgang Schäfer, Department of Radiation Oncology, DiaCura Coburg, Coburg, GermanyMartin Alfrink, Departm...

COX2 Expression Predicts Resistance to Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Annals of Surgical Oncology — Fri, 25 Mar 2011 05:50:29 +0100

Conclusions The COX2 expression predicts resistance to chemoradiotherapy in esophageal squamous cell carcinoma, and it also is a feasible biomarker for evaluating the CRT response. Content Type Journal ArticlePages 1-6DOI 10.1245/s10434-011-1645-zAuthors Yasunori Akutsu, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, JapanNaoyuki Hanari, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, JapanGulbostan Yusup, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, JapanAki Komatsu-Akimoto, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, JapanNorimasa Ikeda, Department of Frontier Surgery, Graduate School of Medicine, Chiba Univ...

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Diagnosis-to-Treatment Interval and Control of Locoregionally Advanced Head and Neck Cancer [Original Article]

Archives of Otolaryngology — Mon, 21 Mar 2011 00:00:00 +0100

Conclusion A prolonged DTI did not appear to adversely affect outcomes in this cohort of patients with LAHNC. (Source: Archives of Otolaryngology)

Neoadjuvant Radiochemotherapy and Surgery for Advanced Rectal Cancer

Strahlentherapie und Onkologie — Sat, 19 Mar 2011 06:35:37 +0100

Conclusion: Preoperative radiochemotherapy is an effective and safe treatment for patients with locally advanced rectal cancer. Pathological parameters after preoperative radiochemotherapy, including tumor regression grading, could be correlated with disease-free survival. The impact of tumor regression grading needs to be further validated in prospective clinical trials. Content Type Journal ArticlePages 1-6DOI 10.1007/s00066-011-2113-1Authors Hans Theodor Eich, Department of Radiation Oncology, University of Cologne, Cologne, GermanyAnna Stepien, Department of Radiation Oncology, University of Cologne, Cologne, GermanyChristian Zimmermann, Department of Radiation Oncology, University of Cologne, Cologne, GermanyMartin Hellmich, Institute of Medical Statistics, I...

Hyperfractionated Radiotherapy for Glioblastoma: Shorter Treatment Time Without Affecting Prognosis

Clinical Oncology — Tue, 15 Mar 2011 18:27:15 +0100

Purpose: Retrospective comparison of the results after hyperfractionated radiotherapy for glioblastoma to conventionally fractionated treatment. Patients and methods: In total, 272 patients with glioblastoma were treated. The mean age at the beginning of radiotherapy was 61 years, the mean Karnofsky performance index was 70%, 55% of the patients had undergone tumour resection. Sixty-three per cent of the patients were applied hyperfractionated radiotherapy (HFR) giving single fractions of 1.5 Gy twice daily up to a total dose of 60 Gy within 4 weeks, whereas the remaining 37% received the same total dose conventionally in daily fractions of 2 Gy(CFR) within 6 weeks. No patient had neoadjuvant or concomitant chemotherapy. (Source: Clinical Oncology)

Outcomes of 11 Years of Prostate LDR Brachytherapy at a UK Centre

Clinical Oncology — Tue, 15 Mar 2011 18:27:11 +0100

Aim: The 11 year experience of I-125 LDR prostate brachytherapy in a UK centre is described. Methods: Between March 1999 and September 2010, 1599 patients underwent prostate brachytherapy, either as monotherapy or in combination with external beam radiotherapy (EBRT) and neoadjuvant hormones (NAH). Data were recorded on a bespoke prospective database. Survival analyses were performed on patients with at least 3 years PSA follow-up. Outcomes were analysed by MSKCC risk grouping, treatment modality, PSA nadir and dosimetry. Biochemical relapse free survival (bRFS) was measured by the nadir+2 definition. (Source: Clinical Oncology)

Value of Diffusion-Weighted Magnetic Resonance Imaging for Prediction and Early Assessment of Response to Neoadjuvant Radiochemotherapy in Rectal Cancer: Preliminary Results

International Journal of Radiation Oncology * Biology * Physics — Mon, 14 Mar 2011 04:00:00 +0100

Conclusions: These initial findings indicate that DWI, using pretreatment ADC, ΔADCduring, and ΔADCpost may be useful for prediction and early assessment of pathologic response to preoperative RCT of LARC, with higher accuracy than volumetric measurements. (Source: International Journal of Radiation Oncology * Biology * Physics)

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Combination of External Beam Radiotherapy (EBRT) With Intratumoral Injection of Dendritic Cells as Neo-Adjuvant Treatment of High-Risk Soft Tissue Sarcoma Patients

International Journal of Radiation Oncology * Biology * Physics — Mon, 14 Mar 2011 04:00:00 +0100

Conclusions: Combination of intratumoral DC administration with EBRT was safe and resulted in induction of antitumor immune responses. This suggests that this therapy is promising and needs further testing in clinical trials design to assess clinical efficacy. (Source: International Journal of Radiation Oncology * Biology * Physics)

Determination of the time for maximal response to neoadjuvant hormone therapy for prostate cancer using magnetic resonance with spectroscopy (MRSI) and dynamic contrast enhancement (DCEMR).

Urologic Oncology — Wed, 09 Mar 2011 00:00:00 +0100

CONCLUSIONS:: To individualize neoadjuvant HT courses prior to definitive treatment, the combination of MRSI and DCEMR may represent a valid noninvasive method, and the addition to PSA data could be used to better assess the time-dependent efficacy of HT in our patients. PMID: 21396849 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

Radiotherapy for Stage II and Stage III Breast Cancer Patients With Negative Lymph Nodes After Preoperative Chemotherapy and Mastectomy

International Journal of Radiation Oncology * Biology * Physics — Mon, 07 Mar 2011 05:00:00 +0100

Conclusions: The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively. (Source: International Journal of Radiation Oncology * Biology * Physics)

Elevation in Exhaled Nitric Oxide Predicts for Radiation Pneumonitis

International Journal of Radiation Oncology * Biology * Physics — Mon, 07 Mar 2011 05:00:00 +0100

Conclusions: Elevations in exhaled NO at the end of RT was found to predict for radiation pneumonitis symptoms. (Source: International Journal of Radiation Oncology * Biology * Physics)

Presidential Address: Can prayer help surgery?

American Journal of Surgery — Tue, 01 Mar 2011 00:00:00 +0100

Surgeons use chemotherapy and radiation as adjuvant therapies to surgery, working synergistically to cure cancers. We believe that neoadjuvant therapy can help our surgical outcomes. Despite the good results we have achieved, our patients want better. There has been a plethora of Internet searches by our patients looking for ways to improve their surgical results. Like other alternative therapies to aid surgery, prayer has become increasingly popular among patients in the United States. Can prayer really help our patients, either by affecting their surgical outcomes or at least by creating a perioperative relaxation response to alleviate their anxiety? Should surgeons pray for the health of their patients? Does prayer with patients detract from or enhance the relationship between surgeons ...

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Logarithmic decrease of serum alpha-fetoprotein or human chorionic gonadotropin in response to chemotherapy can distinguish a subgroup with better prognosis among highly malignant intracranial non-germinomatous germ cell tumors

Journal of Neuro-Oncology — Fri, 25 Feb 2011 17:17:08 +0100

Abstract Intracranial non-germinomatous germ cell tumors (NGGCTs) are a heterogeneous group of tumors. Although alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are considered reliable markers for making diagnosis, the relationship between serum concentration of them and prognosis remains unclear. The present study investigated the decrease of serum tumor markers AFP and HCG as prognostic factors for patients with highly malignant NGGCTs. Eight consecutive patients with AFP > 1000 ng/ml or HCG > 2000 mIU/ml at initial treatments after January 2004 were retrospectively reviewed. Serum AFP or HCG concentration and tumor volume were sequentially measured during the therapeutic period. Six patients were treated by neoadjuvant ch...

Thymidylate Synthase Genotype-Directed Neoadjuvant Chemoradiation for Patients With Rectal Adenocarcinoma [Gastrointestinal Cancer]

Journal of Clinical Oncology — Fri, 25 Feb 2011 00:00:00 +0100

Conclusion To our knowledge, this is the first study to prospectively use TYMS genotyping to direct neoadjuvant CRT in patients with rectal cancer. High rates of DS and ypT0 were achieved among both risk groups when personalized treatment was based on TYMS genotype. These results are encouraging, and further evaluation of this genotype-based strategy using a randomized study design for locally advanced rectal cancer is warranted. (Source: Journal of Clinical Oncology)

Diffusion-Weighted MRI for Selection of Complete Responders After Chemoradiation for Locally Advanced Rectal Cancer: A Multicenter Study

Annals of Surgical Oncology — Wed, 23 Feb 2011 23:04:23 +0100

Conclusions Addition of DWI to standard rectal MRI improves the selection of complete responders after chemoradiation. Content Type Journal ArticlePages 1-8DOI 10.1245/s10434-011-1607-5Authors Doenja M. J. Lambregts, Department of Radiology, Maastricht University Medical Center, Maastricht, The NetherlandsVincent Vandecaveye, Department of Radiology, University Hospitals Leuven, Leuven, BelgiumBrunella Barbaro, Department of Radiology, Università Cattolica del Sacro Cuore, Rome, ItalyFrans C. H. Bakers, Department of Radiology, Maastricht University Medical Center, Maastricht, The NetherlandsMaarten Lambrecht, Department of Radiation Oncology, University Hospitals Leuven, Leuven, BelgiumMonique Maas, Department of Radiology, Maastricht University Medical Center, Maastr...

Optimizing conservative breast surgery

Journal of Surgical Oncology — Tue, 22 Feb 2011 15:27:24 +0100

AbstractThe potential advantages of conservative breast surgery include the minor outpatient nature of the procedures, lower incidence of postoperative pain and complications, preservation of the breast and nipple areolar complex, and shorter delay to adjuvant therapy. In order to optimize the number of patients eligible for conservative breast surgery, one must utilize a multidisciplinary team approach. Imaging implications, use of neoadjuvant therapy for downsizing tumors, oncoplastic techniques, adjuvant radiation options, and pathological assessment are discussed. J. Surg. Oncol. 2011; 103:306–312. © 2011 Wiley‐Liss, Inc. (Source: Journal of Surgical Oncology)

Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer

Annals of Oncology — Tue, 22 Feb 2011 00:00:00 +0100

Conclusions: Dual-time FDG–PET/CT in patients with LARC treated with NCRT and radical surgery supplies limited predictive information. However, an optimal metabolic response appears associated with a favourable patient outcome. (Source: Annals of Oncology)

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Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?

World Journal of Gastroenterology : WJG — Mon, 21 Feb 2011 00:00:00 +0100

Authors: Popek S, Tsikitis VL The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains cont...

Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy

Annals of Surgical Oncology — Sat, 19 Feb 2011 07:29:00 +0100

Conclusions Preoperative factors are associated with perioperative outcomes after PD. The prediction tool estimates the probability of early morbidity and mortality for patients undergoing PD. The tool may be used to provide information for patient counseling during the informed consent process and to identify high-risk patients for the purpose of tailoring perioperative care. Content Type Journal ArticlePages 1-10DOI 10.1245/s10434-011-1594-6Authors David Yu Greenblatt, Department of Surgery, University of Wisconsin, Madison, WI USAKaitlyn J. Kelly, Department of Surgery, University of Wisconsin, Madison, WI USAVictoria Rajamanickam, Department of Surgery, University of Wisconsin, Madison, WI USAYin Wan, Department of Surgery, University of Wisconsin, Madison, WI U...

Outcomes of Positron Emission Tomography–Staged Clinical N3 Breast Cancer Treated With Neoadjuvant Chemotherapy, Surgery, and Radiotherapy

International Journal of Radiation Oncology * Biology * Physics — Mon, 07 Feb 2011 05:00:00 +0100

Conclusion: NCT followed by surgery and RT, including the regional lymph nodes, resulted in excellent locoregional control for patients with PET-positive cN3 breast cancer. The primary treatment failure in this group was due to distant metastasis rather than RF. Neither higher-dose RT directed at PET-positive SCL nodes nor coverage of PET-positive IMN nodes was associated with additional gains in locoregional control or DFS. (Source: International Journal of Radiation Oncology * Biology * Physics)

Current strategy for triple-negative breast cancer: appropriate combination of surgery, radiation, and chemotherapy.

Breast Cancer — Thu, 03 Feb 2011 00:00:00 +0100

Authors: Yagata H, Kajiura Y, Yamauchi H Triple-negative breast cancer (TNBC) often grows rapidly and has poor outcomes, with a high recurrence rate and a short interval between recurrence and death. New molecular-targeted therapies are being developed, but cannot be used at present. Other strategies for the management of TNBC are needed. TNBC is characterized by an expanding growth pattern without extensive intraductal spread and is a good candidate for breast-conserving therapy (BCT) with sufficient margins. The local recurrence rate after BCT is not high as those of other subtypes of breast cancer. In contrast, the regional recurrence rate is higher in TNBC than in other subtypes. Sentinel node biopsy and axillary resection should therefore be performed with the upmost caution. Radi...