Long-term survival in a patient with Virchow’s lymph node metastasis of cecal cancer

Abstract

The patient was a 53-year-old male with a chief complaint of bloody stool. To treat the cecal colon cancer, right hemicolectomy was performed. Histological examination showed moderately differentiated adenocaricinoma, SE, N3, H0, P0, M0 Stage IIIb by Japanese Classification of the Colorectal Carcinoma. After the operation, the patient received a chemotherapy with 6 cycles of Capecitabine regimen. After 1 year later, computed tomography detected swelling of Virchow's lymph node and tumor in the thyroid gland. By fine-needle aspiration cytology, thyroid gland tumor was diagnosed as papillary cancer and Virchow's lymph node was detected adenocarcinoma which was metastasis of cecal cancer. Total thyroidectomy and cervical lymph node dissection were performed. After the operation, the patient received chemotherapy with 6 cycles of FOLFOX regimen. And the patient had taken UFT/LV for 30 months. Now he has no recurrence and keeps his quality of life high. He has been alive for 80 months since the first operation. Virchow lymph node dissection can be one of the options of treatment of metastasis.

http://ift.tt/2wl9AGt

Reputation Management and Content Control: An Analysis of Radiation Oncologists’ Digital Identities

Publication date: Available online 19 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Arpan V. Prabhu, Christopher Kim, Eison De Guzman, Eric Zhao, Evan Madill, Jonathan Cohen, David R. Hansberry, Nitin Agarwal, Dwight E. Heron, Sushil Beriwal
IntroductionGoogle is the most popular search engine in the United States, and patients are increasingly relying on online webpages to seek information about individual physicians. This study aims to characterize what patients find when they search for radiation oncologists online.Material & MethodsThe Centers for Medicare and Medicaid Services (CMS) Physician Comparable Downloadable File was used to identify all Medicare-participating radiation oncologists in the United States and Puerto Rico. Each radiation oncologist was characterized by medical school education, year of graduation, city of practice, gender, and affiliation to an academic institution. Using a custom Google-based search engine, up to the top 10 search results for each physician were extracted and categorized as relating to: (1) physician, hospital, or healthcare system, (2) third-party, (3) social media, (4) academic journal articles, or (5) other.ResultsAmongst all U.S. health care providers within CMS, 4,443 self-identified as being radiation oncologists and yielded 40,764 search results. Of these, 1,161 (26.1%) and 3,282 (73.9%) were classified as academic and nonacademic radiation oncologists, respectively. At least one search result was obtained for 4,398 physicians (99.0%). Physician, hospital and healthcare-controlled websites (16,006; 39.3%) and third-party websites (10,494; 25.7%) were the two most observed domain types. Social media platforms accounted for 2,729 (6.7%) hits, and peer-reviewed academic journal websites accounted for 1,397 (3.4%) results. About 6.8% and 6.7% of the top ten links were social media websites for academic and nonacademic radiation oncologists, respectably.ConclusionsMost radiation oncologists lack self-controlled online content when patients search within the first page of Google search results. With the strong presence of third-party websites and lack of social media, opportunities exist for radiation oncologists to increase their online presence to improve patient-provider communication and better the image of the overall field. We discuss strategies to improve online visibility.

Teaser

The authors identified all Medicare-participating radiation oncologists in the United States and Puerto Rico and developed a customized Google-based search engine. Up tothe top 10 search results for each physician were extracted and categorized. Results for academic and nonacademic radiation oncologists were compared. Most radiation, oncologists lacked self-controlled online content in the first page of Google search results. Strategies for radiation oncologists to improve their digital presence are discussed.


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Low-grade albuminuria is associated with poor memory performance in the nondemented Chinese elderly with type 2 diabetes

Abstract

Recent studies have correlated cognitive function with albuminuria. We investigated the association between low-grade albuminuria and cognitive performance in nondemented elderly with type 2 diabetes in Fuzhou, China. Between January, 2013 and December, 2014, a retrospective study was performed in 815 patients with type 2 diabetes (398 female and 417 male patients), ages ≥60 years, with normal urinary albumin to creatinine ratios (UACR <30 mg/g). Patients were stratified into tertiles based on UACR levels (lowest tertile, UACR <5.8 mg/g; highest tertile, UACR ≥18.1 mg/g). Cognitive function was measured using the Mini Mental State Examination. UACR tertiles correlated directly (p < 0.05) with age, duration of diabetes, systolic blood pressure (SBP), and pulse wave velocity (PWV). Patients in the second and highest tertiles performed significantly worse on memory and language than those in the lowest UACR tertile (p < 0.05). The association between UACR and memory loss was stronger in patients younger than 70 years of age and in those with a history of diabetes for less than 10 years. Low-grade albuminuria is associated with poor memory performance, especially in the youngest old (60–69 years) and in those with shorter duration of diabetes (< 10 years). Type 2 diabetics with urinary albumin excretion in the upper normal range were also at risk for declining memory performance.

http://ift.tt/2x1LVrE

Mid-radiotherapy PET/CT for prognostication and detection of early progression in patients with stage III non-small cell lung cancer

Pre- and mid-radiotherapy FDG-PET metrics have been proposed as biomarkers of recurrence and survival in patients treated for stage III non-small cell lung cancer. We evaluated these metrics in patients treated with definitive radiation therapy (RT). We also evaluated outcomes after progression on mid-radiotherapy PET/CT.

http://ift.tt/2wcUimN

B-acute lymphoblastic leukemia/lymphoma (B-ALL) with precedent or concurrent myelodysplastic syndrome (MDS) with deletion 5q

Abstract

Progression to acute leukemia is an inherited feature of myelodysplastic syndrome (MDS). While majority of acute leukemia cases in this setting is acute myeloid leukemia (AML), rare cases of acute B-lymphoblastic leukemia/lymphoma (B-ALL) also exist. Therefore, detection of increased blasts in a patient with MDS should not be equated with a diagnosis of AML; full immunophenotyping of blasts is required. Previous reports indicate that dysplastic myeloid cells and B-lymphoblasts belong to the same clone. However, dysplastic myeloid cells and B-lymphoblasts could be clonally unrelated. Decitabine in addition to hyperCVAD (fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate and cytarabine) could be a good treatment option in this particular clinical setting.

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A novel somatic JAK2 kinase-domain mutation in pediatric acute lymphoblastic leukemia with rapid on-treatment development of LOH

Publication date: October 2017
Source:Cancer Genetics, Volumes 216–217
Author(s): Teresa Sadras, Susan L. Heatley, Chung H. Kok, Barbara J. McClure, David Yeung, Timothy P. Hughes, Rosemary Sutton, David S. Ziegler, Deborah L. White
We report a novel somatic mutation in the kinase domain of JAK2 (R938Q) in a high-risk pediatric case of B-cell acute lymphoblastic leukemia (ALL). The patient developed on-therapy relapse at 12 months, and interestingly, the JAK2 locus acquired loss of heterozygosity during treatment resulting in 100% mutation load. Furthermore, we show that primary ALL mononuclear cells harboring the JAK2 R938Q mutation display reduced sensitivity to the JAK1/2 ATP-competitive inhibitor ruxolitinib in vitro, compared to ALL cells that carry a more common JAK2 pseudokinase domain mutation. Our findings are in line with previous reports that demonstrate that mutations within the kinase domain of JAK2 are associated with resistance to type I JAK inhibitors. Importantly, given the recent inclusion of ruxolitinib in trial protocols for children with JAK pathway alterations, we predict that inter-patient genetic variability may result in suboptimal responses to JAK inhibitor therapy in a subset of cases. The need for alternate targeted and/or combination therapies for patients who display inherent or developed resistance to JAK inhibitor therapy will be warranted, and we propose that kinase-mutants less sensitive to type I JAK inhibitors may present a currently unexplored platform for investigation of improved therapies.



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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients

Abstract

As proton radiotherapy (RT) remains a limited resource, predictive estimates of the potential reduction in adverse treatment-related outcomes compared to photon RT could potentially help improve treatment selection. The aim of this study was to predict the magnitude of the neurocognitive and hearing deficits associated with proton and photon RT for children with brain tumors. The existing RT plans for 50 children treated with photon intensity modulated RT were compared with generated intensity modulated proton RT plans. The proton and photon RT dose distribution was used to estimate the Full Scale Intelligence Quotient (IQ) via a Monte Carlo model and the probability of hearing loss per ear, based on previously published dose-risk relationships. Compared to photon plans, the mean brain dose was found to be reduced in all proton plans, translating into a gain of \(~2.6 \pm 0.3_^\) IQ points for the whole cohort at 5 years post-RT for dose regimens of 54 Gy, or \(2.9 \pm 0.3_^\) IQ points for dose regimens of 59.4 Gy, where the errors shown represent statistical and systematic uncertainties. The probability of hearing loss ≥20 dB per ear was less for proton versus photon RT: overall (9 ± 4) versus (17 ± 6)%, respectively, based on dose regimens of 54 Gy, and (13 ± 5) versus (23 ± 9)% for dose regimens of 59.4 Gy. Proton RT is thus expected to reduce the detrimental effect of RT upon IQ and hearing as compared to photon RT for pediatric brain tumors.

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Coexistence of congenital left ventricular aneurysm and prominent left ventricular trabeculation in a patient with LDB3 mutation: a case report

The coexistence of congenital left ventricular aneurysm and abnormal cardiac trabeculation with gene mutation has not been reported previously. Here, we report a case of coexisting congenital left ventricular ...

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Evaluation of dose calculations accuracy of a commercial treatment planning system for the head and neck region in radiotherapy

Publication date: September–October 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 5
Author(s): Mohammad Taghi Bahreyni Toossi, Bagher Farhood, Shokouhozaman Soleymanifard
AimThe objective was to quantify dose calculation accuracy of TiGRT TPS for head and neck region in radiotherapy.BackgroundIn radiotherapy of head and neck cancers, treatment planning is difficult, due to the complex shape of target volumes and also to spare critical and normal structures. These organs are often very near to the target volumes and have low tolerance to radiation. In this regard, dose calculation accuracy of treatment planning system (TPS) must be high enough.Materials and methodsThermoluminescent dosimeter-100 (TLD-100) chips were used within RANDO phantom for dose measurement. TiGRT TPS was also applied for dose calculation. Finally, difference between measured doses (Dmeas) and calculated doses (Dcalc) was obtained to quantify the dose calculation accuracy of the TPS at head and neck region.ResultsFor in-field regions, in some points, the TiGRT TPS overestimated the dose compared to the measurements and for other points underestimated the dose. For outside field regions, the TiGRT TPS underestimated the dose compared to the measurements. For most points, the difference values between Dcalc and Dmeas for the in-field and outside field regions were less than 5% and 40%, respectively.ConclusionsDue to the sensitive structures to radiation in the head and neck region, the dose calculation accuracy of TPSs should be sufficient. According to the results of this study, it is concluded that the accuracy of dose calculation of TiGRT TPS is enough for in-field and out of field regions.



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Tumor response assessment: comparison between unstructured free text reporting in routine clinical workflow and computer-aided evaluation based on RECIST 1.1 criteria

Abstract

Purpose

Standardized computer-aided tumor response assessment is common in clinical trials. In contrast, unstructured free text reporting (UFTR) is common in daily routine. Therefore, this study aimed to discern and quantify differences between UFTR and computer-aided standardized tumor response evaluation based on RECIST 1.1 criteria (RECIST), serving as gold standard, in clinical workflow.

Methods

One-hundred consecutive patients with cancer eligible for RECIST 1.1 evaluation, who received five follow-up CTs of the trunk, were retrospectively included. All UFTRs were assigned to RECIST response categories [complete response, partial response (PR), stable disease (SD), progressive disease (PD)]. All CTs were re-evaluated using dedicated software (mint lesion™) applying RECIST 1.1. The accordance in tumor response ratings was analyzed using Cohen's kappa.

Results

At the first follow-up, 47 cases were rated differently with an SD underrepresentation and a PR and PD overrepresentation in UFTR. In the subsequent follow-ups, categorical differences were seen in 38, 44, 37, and 44%. Accordance between UFTR and RECIST was fair to moderate (Cohen's kappa: 0.356, 0.477, 0.390, 0.475, 0.376; always p < 0.001). Differences were mainly caused by the rating of even small tumor burden changes as PD or PR in UFTR or by comparison to the most recent prior CT scan in UFTR instead of comparison to nadir or baseline.

Conclusions

Significant differences in tumor response ratings were detected comparing UFTR and computer-aided standardized evaluation based on RECIST 1.1. Thus, standardized reporting should be implemented in daily routine workflow.

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Réirradiation des cancers des voies aérodigestives supérieures

Publication date: Available online 18 August 2017
Source:Cancer/Radiothérapie
Author(s): J. Doyen, D. Lam Cham Kee, L. Krebs, J. Guigay, O. Dassonville, F. Peyrade, G. Poissonnet, E. Saâda-Bouzid, A. Sudaka, A. Bozec, K. Bénézery
La rechute locorégionale en territoire irradié des cancers des voies aérodigestives supérieures est de pronostic défavorable, aussi bien locorégionalement qu'à distance. La réirradiation est souvent proposée soit de façon exclusive, soit associée à une chimiothérapie, et parfois après une chirurgie de rattrapage en fonction des facteurs histopronostiques. Les données de toxicité de la réirradiation sont acceptables étant donné le pronostic défavorable. Des schémas d'irradiation hyperfractionnés avec split course ou normofractionnés sans split course sont possibles, avec une efficacité semble-t-il similaire. Si le volume tumoral est réduit, une réirradiation stéréotaxique peut être proposée. Enfin, si le centre de traitement est équipé de protonthérapie, cette technique pourrait être envisagée pour apporter une meilleure protection des tissus sains. Il n'y a pas de standards actuels concernant le mode de réirradiation et dans ce contexte, des essais sont nécessaires afin de déterminer la meilleure technique d'irradiation. En revanche, on s'accorde pour recommander une dose totale avoisinant les 60Gy (à raison de 2Gy par fraction). D'autres essais analysant l'association avec de nouvelles chimiothérapies pourraient être d'intérêt, notamment avec les anti-PD1/PD-L1.Locoregional relapse in previously irradiated region for head and neck tumours is associated with a bad locoregional and distant prognosis. Reirradiation might be exclusive, or feasible in addition with surgery and/or chemotherapy, according to histopronostic factors. Data show that reirradiation is feasible with some severe toxicity due to the bad prognosis of this situation. Hyperfractionnated regimen with split course or normofractionnated regimen without split course are possible with similar efficacy. If tumour size is small, stereotactic ablative radiotherapy may be considered, and if the treatment centre has proton therapy, it could be proposed because of better organs at risk sparing. There is no standard regarding reirradiation schedules and several trials have to be done in order to determine the best technique. Nevertheless, it is agreed that a total dose of 60Gy (2Gy per fraction) is needed. Other trials testing the association with new systemic agents have to be performed, among them agents targeting the PD1/PD-L1 axis.



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Mise en œuvre de listes de contrôle « never events » dans le système d’information en radiothérapie

Publication date: Available online 18 August 2017
Source:Cancer/Radiothérapie
Author(s): G. Brusadin, M.S. Bour, E. Deutsch, N. Kouchit, S. Corbin, D. Lefkopoulos
Afin de réduire la fréquence des accidents majeurs lors de la réalisation d'une radiothérapie externe, des listes de contrôle « never events » ont été intégrées dans le système « record and verify ». Cet article détaille le déroulement de cette démarche. Des perspectives d'amélioration sont aussi proposées et notamment la réalisation d'un audit entre pairs sur l'utilisation des checklists et la disponibilité du constructeur du système d'information en radiothérapie à collaborer dans cette démarche de sécurisation du circuit patient.In order to reduce the incidence of major accidents during external radiotherapy treatment, "never events" checklists have been incorporated into the "record and verify" system. This article details this process. Prospects for improvement are also proposed, including a peer-to-peer audit on the use of checklists and the availability of the radiotherapy information system manufacturer to collaborate in this process to secure the patients' journey.



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Metformin incombination with curcumin inhibits the growth?metastasis and angiogenesis of hepatocellular carcinoma in vitro and in vivo

Abstract

Hepatocellular carcinoma (HCC) has poor prognosis due to the advanced disease stages by the time it is diagnosed, high recurrence rates and metastasis. In the present study, we investigated the effects of metformin (a safe anti-diabetic drug) and curcumin (a turmeric polyphenol extracted from rhizome of Curcuma longa Linn.) on proliferation, apoptosis, invasion, metastasis and angiogenesis of HCC in vitro and in vivo. It was found that co-treatment of metformin and curcumin could not only induce tumor cells into apoptosis through activating the mitochondria pathways, but also suppress the invasion, metastasis of HCC cells and angiogenesis of HUVECs. These effects were associated with downregulation of the expression of MMP2/9, VEGF and VEGFR-2, up-regulation of PTEN, P53 and suppression of PI3K/Akt/mTOR/NF-κB and EGFR/STAT3 signaling. Co-administration of metformin and curcumin significantly inhibited HCC tumor growth than administration with metformin or curcumin alone in a xenograft mouse model. Thus, metformin and curcumin in combination showed a better anti-tumor effects in hepatoma cells than either metformin or curcumin presence alone and might represent an effective therapeutic strategy for HCC treatment. This article is protected by copyright. All rights reserved

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Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study

Abstract

We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0–82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (≥200 g/day), fruit (≥200 g/day), whole-grains (≥90 g/day), legumes (≥135 g/week), nuts (≥15 g/day), dairy (≥350 g/day), fish (≥100 g/week), tea (≥450 mL/day), ratio whole-grains:total grains (≥50%), ratio unsaturated fats and oils:total fats (≥50%), red and processed meat (<300 g/week), sugar-containing beverages (≤150 mL/day), alcohol (≤10 g/day) and salt (≤6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0–14). Information on disease incidence and all-cause mortality during a median follow-up period of 13.5 years (range 0–27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based.

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Interim analysis of a phase II trial evaluating the safety and efficacy of capecitabine plus oxaliplatin (XELOX) as adjuvant therapy in Japanese patients with operated stage III colon cancer

Abstract

Purpose

Adjuvant oxaliplatin plus oral capecitabine (XELOX) is recommended for patients with curatively resected colon cancer. However, its safety and tolerability in Asian patients is unclear; therefore, we evaluated the safety and efficacy of adjuvant XELOX in Japanese patients with curatively resected stage III colon cancer (MCSCO-1024) and present the interim safety data.

Methods

This prospective, multi-center, open-label, single-arm phase II study recruited patients with curatively resected stage III colon cancer. The protocol was a 120-min intravenous infusion of oxaliplatin (130 mg/m²) on day 1 and oral capecitabine (2000 mg/m²/day) in two divided doses for 14 days of a 3-week cycle, for a total of eight cycles (24 weeks). The primary endpoint was the 3-year disease-free survival, and secondary endpoints were the treatment completion rate, safety profile (rate and severity of adverse events), and correlation of adverse events, such as peripheral sensory neuropathy (PSN), with the administration period of oxaliplatin, etc.

Results

From November 2011 to August 2014 (34 months), 196 patients were enrolled. Safety was analyzed in 190 patients. The median total doses of capecitabine and oxaliplatin were 215,586.9 and 777.2 mg/m², respectively, while the median relative dose intensities were 82.5 and 76.0%, respectively. The overall treatment completion rate was 73.7%. The most frequent treatment-related adverse event was PSN (88.4%), while the most frequent grade ≥3 treatment-related adverse events were neutropenia (12.6%), PSN (6.3%), diarrhea (4.2%), and thrombocytopenia (4.2%). There were no treatment-related deaths.

Conclusions

Adjuvant XELOX is tolerable for Japanese patients with Stage III colon cancer.

http://ift.tt/2v0tySw

Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee

Abstract

Purpose

Oncologic outcomes of patients with pT3aN0/Nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients.

Methods

A retrospective, multicenter study was performed on 795 patients with pT3aN0/Nx PCa with PSM after RP between January 2006 and December 2014. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan–Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR.

Results

During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pT3aN0/Nx PCa with PSM (GS 6 vs. GS 7 (3 + 4), P = 0.047; vs. GS 7 (4 + 3), P = 0.007, and vs. GS 8–10, P < 0.001). When patients were stratified according to GS, 5-year BFS was 78.6% in GS 6, 66.2% in GS 7 (3 + 4), 51.1% in GS 7 (4 + 3) and 35.5% in GS 8–10.

Conclusions

In patients with pT3aN0/Nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis.

http://ift.tt/2wqH9Wz

Epidural patch with autologous platelet rich plasma: a novel approach

Abstract

We aimed to perform an epidural patch using platelet rich plasma (PRP), which has the potential to regenerate and heal tissues via degranulation of platelets, in a 34-year-old parturient suffering from persistent post-dural puncture headache (PDPH) after failed epidural blood patch (EBP). After her admission to our unit, we reconfirmed the clinical and radiologic diagnosis of PDPH. Cranial MRI with contrast showed diffuse pachymeningeal thickening and contrast enhancement with enlarged pituitary consistent with intracranial hypotension. Clinical and radiological improvements were observed 1 week after the epidural patch using autologous PRP. Therefore, we recommend using autologous PRP for epidural patching in patients with incomplete recovery after standard EBP as a novel successful approach.

http://ift.tt/2wqHKYq

Setting up of the Indian HIPEC Registry: A Registry for Indian Patients with Peritoneal Surface Malignancies

Abstract

There are various registries for patients with peritoneal metastases (PM) that aid pooling of data and generate evidence that dictates current clinical practice. This manuscript describes the setting up of the Indian HIPEC registry that was set up with a similar goal by a group of Indian surgeons. This is a registry for patients with PM treated with CRS and HIPEC in India. It also acts as a database for storing treatment-related information. Patients with PM from colorectal ovarian, gastric, appendiceal tumors, and other rare peritoneal tumors/metastases from rare tumors are enrolled in the registry. A coordinator updates the disease status of patients on a yearly basis. A private organization maintains the database. A non-disclosure agreement is signed between the company and each surgeon contributing to the registry to maintain confidentiality. For enrolling patients, securing institutional permission depends on the requirement of each institute; patient consent is mandatory. Data entry can be prospective or retrospective. To propose and conduct a study, the approval of a scientific committee linked to the registry is required. The Indian HIPEC registry is a practical database for Indian surgeons. There is no regulatory body that mandates collection and publication of scientific data in India. The onus is on each surgeon to capture valuable information pertaining to these common and rare diseases that could contribute to the existing scientific knowledge and guide the treatment of these patients in the future. The next challenge will be to enter data into the registry.

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A prospective study of palonosetron for prevention of chemotherapy-induced nausea and vomiting in malignant lymphoma patients following highly emetogenic chemotherapy

Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) is a troublesome issue in chemotherapy for cancer patients. A second-generation 5HT₃ receptor antagonist (5HT₃RA), palonosetron, is effective and safe for the prevention of CINV in breast cancer patients treated with cyclophosphamide and anthracycline, but there is little data for malignant lymphoma. We conducted a prospective phase 2 study at a single institution to clarify the efficacy and safety of palonosetron in lymphoma patients.

Methods

Chemotherapy-naïve lymphoma patients who were treated with highly emetogenic chemotherapy (HEC) received a single intravenous bolus of palonosetron, 0.75 mg/body, before chemotherapy on day 1 during the first course of chemotherapy. The occurrence of CINV was assessed using the Multinational Association for Supportive Care in Cancer (MASCC) antiemesis tool, which was recorded by patients during the first course of chemotherapy.

Results

A total of 59 patients were enrolled, and 49 patients were eligible and evaluated. The complete response (CR) rate was 93.9% (95% confidence interval 83.1–98.7%) at 0–120 h post-chemotherapy. The proportion of patients who developed nausea of any grade and vomiting at 0–120 h post-chemotherapy was 34.7 and 6.1%, respectively. Although treatment-related adverse events were observed in 36 (73.5%) patients, these were mild and they recovered by the next cycle of chemotherapy.

Conclusion

The present study demonstrated that a single dose of palonosetron was highly effective and safe for the prevention of CINV in lymphoma patients.

http://ift.tt/2fTANJ3

Future Clinical Trials

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Igor Astsaturov

Teaser

The design of modern oncology clinical trials seeks to match patients' cancer molecular biomarkers with medications that specifically target those biomarkers, a general paradigm shift in cancer care coined clinical cancer biology. This approach exploits the synthetic lethality between a specific genetic alteration in the cancer cell and a drug: rapid termination of exaggerated kinase activity exemplifies this phenomenon. Synthetic lethality-based investigations are driven by rapidly evolving technologies for cancer molecular profiling. As these technologies evolve, future clinical trials will test drugs' activity based on the molecular mechanisms rather than by the tumor's appearance under a microscope.


http://ift.tt/2if7IZl

Randomized Clinical Trials in Colon and Rectal Cancer

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Atif Iqbal, Thomas J. George

Teaser

Surgery remains the mainstay of treatment for colon and rectal cancers. Colon cancer outcomes have improved with laparoscopic techniques, enhanced recovery pathways, and adjuvant chemotherapy. Adjuvant 5-fluorouracil with or without oxaliplatin in stage III and possibly high-risk stage II colon cancer is associated with improved survival. Multimodality management of rectal cancer continues to evolve; total mesorectal excision is the cornerstone. Oncologic results do not support the use of laparoscopic resection in rectal cancer. Preoperative short- or long-course radiation for stage II or III rectal cancer is the standard of care. Long course chemoradiation is recommended for bulky tumors.


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Randomized Controlled Trials in Hereditary Cancer Syndromes

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Chethan Ramamurthy, Yana Chertock, Michael J. Hall

Teaser

Conducting randomized controlled trials (RCTs) in patients with germline mutations in genes that predispose to adult-onset cancer is hampered by the rarity of these mutations, barriers to their identification, and challenges inherent to randomizing high-risk individuals as part of a clinical trial. Most of the clinically relevant RCTs have been conducted in 3 syndromes in only some of the high-risk genes for which clinical testing is currently available. This article reviews the surgical, screening, and chemoprevention RCTs in each of the syndromes in clinically relevant studies conducted in the past 10 years.


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An Update on Randomized Clinical Trials in Breast Cancer

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Kayla Barnard, V. Suzanne Klimberg

Teaser

Numerous clinical trials reveal new innovations and therapies that continually change the treatment and prevention of breast cancer. Earlier trials have changed the standard of care from radical mastectomy to breast conservation therapy and individualized treatment based on tumor-specific biology. As research continues and long-term follow-up results become available, updated reviews on randomized clinics trials become exceedingly important in discerning the most effective and oncologically safe therapies to provide optimal outcomes.


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Foreword

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Nicholas J. Petrelli




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Randomized Clinical Trials in Localized Anal Cancer

Publication date: Available online 18 August 2017
Source:Surgical Oncology Clinics of North America
Author(s): Clayton A. Smith, Lisa A. Kachnic

Teaser

Management of anal carcinoma began as abdominoperineal resection and has evolved to combined chemotherapy and radiation. Early randomized trials demonstrated superior clinical outcomes of combined modality therapy over radiotherapy alone. Subsequent trials investigated alterations in the standard backbone of radiotherapy concurrent with 5-fluorouracil and mitomycin C with intent to maintain clinical outcomes while reducing treatment-related morbidity. The addition of intensity-modulated radiotherapy to radiation planning and delivery has subsequently reduced acute toxicity and detrimental treatment breaks. Ongoing and future trials are aimed at reducing therapy in favorable patient populations to decrease morbidity while intensifying treatment in patients with negative prognostic factors.


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