http://ift.tt/2ffcWO5
Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 20 Νοεμβρίου 2016
[MET receptor inhibition: Hope against resistance to targeted therapies?]
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[MET receptor inhibition: Hope against resistance to targeted therapies?]
Bull Cancer. 2016 Nov 15;:
Authors: Hochart A, Leblond P, Le Bourhis X, Meignan S, Tulasne D
Abstract
Overcoming the drug resistance remains a crucial issue in cancer treatment. For refractory patients, the use of MET receptor tyrosine kinase inhibitors seems to be hopeful. Indeed, important mechanisms underlying drug resistance argue for association of MET inhibitors with targeted therapies, both on first-line to prevent a primary resistance and on the second line to overcoming acquired resistance. Indeed, met gene amplification is the second most common alteration involved in acquired resistance to anti-epidermal growth factor receptor (EGFR) therapies in non-small cells lung cancer (NSCLC). Hypoxia, for its part, can activate MET transcription and amplifies HGF signaling resulting in MET activation, which could be involved in vascular endothelial growth factor (VEGF) inhibitors escape. In HER2 positive breast cancers, MET amplification may also induce tumor cells a hatch escape, resulting in secondary resistance. Finally, some patients with BRAF mutated melanoma exhibit primary resistance to BRAF inhibition by stromal HGF (ligand of MET) secretion resulting in MET receptor activation. Experimental data highlight the role of MET in primary and secondary resistance and encourage combined treatments including MET inhibitors. In this context, several promising clinical trials are in progress in numerous cancers (NSCLC, melanoma, breast cancer, glioblastoma…) using combination of anti-MET and other specific therapies targeting EGFR, BRAF, VEGF or HER2. This review summarizes the potential benefits that MET inhibition should provide to patients with cancer refractory to targeted therapies.
PMID: 27863726 [PubMed - as supplied by publisher]
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[What specific socialisation, social, educational and professional for teenagers and young adults with cancer?]
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[What specific socialisation, social, educational and professional for teenagers and young adults with cancer?]
Bull Cancer. 2016 Nov 15;:
Authors: Roesler C, Pautre I, Thirry D, Flores S, Chabbert C, Savre N, Pibarot M, Seveau MA, Dugas K, Rollin Z, Dumont S, Gaspar N, au nom du sous-groupe « Insertion » de groupe onco-hématologie adolescents et jeunes adultes français (GO-AJA)
Abstract
Socialisation, education, first jobs and autonomy are key steps to teenagers and young adults (TYA) integration into the society. The occurrence of a cancer in this population increases the difficulties. Although, suffering of cancer do affect TYA life journey at social, scholar and professional levels, from diagnosis to the after-cancer live and sometime forever, few studies exist in France. A national study on TYA with cancer (TYAC) social, scholar and professional pathways is on-going (ESPOIR-AJA). A national survey of the existing TYAC insertion support in 2013 by the "Insertion group" of groupe onco-hématologie adolescents et jeunes adultes (GO-AJA) revealed structured and ancient support at scholar level based on national governmental or associative structures, but insufficient and non-specific scholar help in secondary school and professional help. Specific initiatives have emerged since 2012 with the "Plan cancer 2". All these helps remain unequal across the country. A referential on TYAC social, scholar and professional insertion has been prepared by GO-AJA in collaboration with the association francophone des soins oncologiques de support (AFSOS). The impact of the action 9 of the nation "plan cancer 3" is awaited.
PMID: 27863725 [PubMed - as supplied by publisher]
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[Which approach of therapeutic education (TE) for adolescents and young adults with cancer? Experience from the TE working group of "Go-AJA"].
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[Which approach of therapeutic education (TE) for adolescents and young adults with cancer? Experience from the TE working group of "Go-AJA"].
Bull Cancer. 2016 Nov 15;:
Authors: Corradini N, Dagorne L, Retailleau M, Rédini F, Sudour-Bonnange H, Gofti-Laroche L, Le Rhun A, Gaspar N
Abstract
INTRODUCTION: Therapeutic education (TE) is a practice developed over 40 years at an international level to give people with chronic illness the skills necessary to help them better manage their disease. The lengthening survival time of cancer patients as well as changes in the patient-caregiver relationship have contributed to the development of TE in oncologic diseases. Every year in France, about 1900 adolescents and young adults (15-25 years old) are diagnosed with cancer which is the second leading cause of death in this age group. The observed survival rates for these patients are lower when compared with children's. Some of the hypotheses put forward to explain this difference include a lack of constancy in care and a non-following treatment, as failure to adhere to therapies is common in this age group. "Go-AJA", an interdisciplinary national organization established in 2012, aims to improve the quality of care and treatment results for AYA living with cancer. Therapeutic education for AYA in oncology is an active working group of "Go-AJA" and intends to draw recommendations and to improve adapted communication on different education topics. Elaboration and preparation of TE programs by skilled multidisciplinary teams engaged in interactive educational actions is the first and most crucial step.
MATERIALS AND METHODS: The TE "Go-AJA" working group has federated pediatric and adult oncologists, nurses, psychologists, TE professionals, and resource patients, thanks to the commitment of professionals from the 8 national teams supported by the National Cancer Institute. Physical meetings and conference calls were organized from 2012 to 2015 to construct TE tools and programs for AYA with cancer.
RESULTS: A competence referential was built and adapted to AYA population with cancer, after focused groups organized in 2 main oncology centers with on-therapy sarcoma patients and members of the multidisciplinary TE working group. Tools were validated and adapted to adolescents or young adults with cancer, to help in the 4 stages of TE: the "educational diagnosis" allowing the caregiver to better understand the patient in his life journey with the disease; the "therapeutic alliance" allowing to agree with the patient on his/her priorities; the "implementation" which is an action step: information, awareness, learning and psychosocial support. The final step called "assessment" allows the caregiver to take stock on the changes and difficulties with the patient. TE for AYA with cancer included individual and/or group sessions to improve self-care skills: knowledge about the disease (group sessions "what is cancer?" with use of microscopes to visualize sarcoma cells, and guided tours in a tumor research laboratory), and details about the treatment and its consequences (workshops about "management of febrile neutropenia"). Moreover, TE aimed to enrich the field of coping skills, in particular to improve the coordination and experience of cares between the different complex and varied network of care (group and/or individual sessions focused on physical rehabilitation, and adapted school/professional orientation).
CONCLUSION: Regardless of the care system, care workers dedicated to AYA with cancer should use TE-specific actions to reinforce treatment participation and therapeutic relationships. This active multidisciplinary TE working group dedicated to AYA with cancer elaborated TE programs by skilled multidisciplinary teams engaged in interactive educational actions. After this work of a national TE organization, more studies using methodological tools are still required to evaluate the impact of such implemented programs on the treatment results and the quality of life.
PMID: 27863724 [PubMed - as supplied by publisher]
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[Polymorphism in HLA and KIR genes and the impact on hematopoietic stem cell transplantation outcomes and unrelated donor selection: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].
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[Polymorphism in HLA and KIR genes and the impact on hematopoietic stem cell transplantation outcomes and unrelated donor selection: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].
Bull Cancer. 2016 Nov 14;:
Authors: Dubois V, Brignier A, Elsermans V, Gagne K, Kennel A, Pedron B, Picard C, Ravinet A, Varlet P, Cesbron A, Delbos F, Yakoub-Agha I, Loiseau P
Abstract
In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its sixth annual workshop series in September 2015 in Lille. This event brought together practitioners from across the country with the purpose of offering careful analysis of published studies on clinical practice issues that remain to be disputed. This article addresses the impact of HLA and KIR gene polymorphism on the outcome of the transplantation in order to optimize unrelated donor selection.
PMID: 27855950 [PubMed - as supplied by publisher]
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[General and ethical considerations for the informed consent process: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].
| Related Articles |
[General and ethical considerations for the informed consent process: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].
Bull Cancer. 2016 Nov 14;:
Authors: Thibert JB, Polomeni A, Yakoub-Agha I, Bordessoule D
Abstract
Informed consent is not restricted to clinical research and must be applied to high-risk care such as hematopoietic stem cell transplantation. If standardized informed consent might improve inequalities in medical practices between different transplantation centers, it is strongly recommended that it be adapted with an honest dialogue between physicians and patients and physicians and donors. In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its sixth annual workshop series in September 2015 in Lille. This event brought together practitioners from across the country. The purpose of this paper is to highlight the French law concerning patients' rights and ethical practices for an informed consent process to be applied to care or research.
PMID: 27855949 [PubMed - as supplied by publisher]
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Rare Case of an Ancient Craniofacial Osteosarcoma with Probable Surgical Intervention
Abstract
Osteosarcoma is the most common primary malignant bone tumor both today and in antiquity. Nevertheless, it is a comparatively rare tumor. This paper describes a case of a highly aggressive craniofacial lesion from the 11th–12th centuries AD, most likely representing osteosarcoma. During the paleopathological study, macroscopic, endoscopic, radiological, scanning-electron and light microscopic investigations were performed. The skull of the approximately 40–50 year-old female revealed several pathological findings. The most impressive macroscopic feature was an extensively spiculated periosteal reaction ("sunburst" pattern) in combination with a massive bone destruction most likely derived from a highly aggressive tumor originating in the ethmoidal area of the medial wall of the orbit. The central parts of the lesion showed excessive new and most probably neoplastic bone formation indicating an underlying high-grade osteosarcoma. The light microscopic examination revealed three different levels of bony structures representing different qualities of bone tissues. Besides the mass lesion, signs of a healed multiple incomplete trephination of the left parietal bone was observed. This case represents a unique example in which the concomitance of a tumor and an incomplete trephination could be observed from the skeletal remains of an ancient individual. The case opens new considerations as to whether surgical interventions, such as incomplete trephination, might have been used already in the Middle Ages as a therapeutic approach.
http://ift.tt/2gs8FvF
Rare Case of an Ancient Craniofacial Osteosarcoma with Probable Surgical Intervention
Abstract
Osteosarcoma is the most common primary malignant bone tumor both today and in antiquity. Nevertheless, it is a comparatively rare tumor. This paper describes a case of a highly aggressive craniofacial lesion from the 11th–12th centuries AD, most likely representing osteosarcoma. During the paleopathological study, macroscopic, endoscopic, radiological, scanning-electron and light microscopic investigations were performed. The skull of the approximately 40–50 year-old female revealed several pathological findings. The most impressive macroscopic feature was an extensively spiculated periosteal reaction ("sunburst" pattern) in combination with a massive bone destruction most likely derived from a highly aggressive tumor originating in the ethmoidal area of the medial wall of the orbit. The central parts of the lesion showed excessive new and most probably neoplastic bone formation indicating an underlying high-grade osteosarcoma. The light microscopic examination revealed three different levels of bony structures representing different qualities of bone tissues. Besides the mass lesion, signs of a healed multiple incomplete trephination of the left parietal bone was observed. This case represents a unique example in which the concomitance of a tumor and an incomplete trephination could be observed from the skeletal remains of an ancient individual. The case opens new considerations as to whether surgical interventions, such as incomplete trephination, might have been used already in the Middle Ages as a therapeutic approach.
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Prospective Qualitative and Quantitative Analysis of Real-time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy
Publication date: Available online 19 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Carlos E. Cardenas, Abdallah S.R. Mohamed, Randa Tao, Andrew J.R. Wong, Musaddiq J. Awan, Shirly Kuruvila, Michalis Aristophanous, G. Brandon Gunn, Jack Phan, Beth M. Beadle, Steven J. Frank, Adam S. Garden, William H. Morrison, Clifton David Fuller, David I. Rosenthal
Purpose/Objective(s)Our department has a long established comprehensive quality assurance (QA) planning clinic for patients undergoing radiation therapy (RT) for head-and-neck cancer. Our aim is to assess the impact of real-time peer review QA process on the quantitative and qualitative radiotherapy plan changes in the era of IMRT.Materials/MethodsProspective data for 85 patients undergoing head-and-neck IMRT presented at a biweekly QA clinic after simulation and contouring were collected. A standard data collection form was used to document alterations made during this process. The original treating-attending-approved pre-QA clinical target volumes (CTVs) were saved before QA and compared to post-QA consensus CTVs. Qualitative assessment was done using a pre-defined criteria. Dice similarity coefficients (DSC) and other volume overlap metrics were calculated for each CTV level and used for quantitative comparison. Changes are categorized as major, minor, and trivial per the degree of overlap. Patterns of failure were analyzed and correlated to plan changes.ResultsAll 85 patients were examined by at least one non-treating-attending head-and-neck sub-specialist radiation oncologist; 80 (94%) were examined by ≥3 faculty. New clinical findings on physical examination were found in 12 patients (14%) leading to major plan changes. Quantitative DSC analysis revealed significantly better agreement in CTV1 (0.94±0.10) contours compared to CTV2 (0.82±0.25) and CTV3 (0.86±0.2) contours (p=0.0002 and p=0.03, respectively; matched-pair Wilcoxon). Treating-attending radiation oncologist experience significantly affected DSC values when considering all CTV levels (p=.012; matched-pair Wilcoxon). After median follow-up of 38 months, only 10 patients (12%) had local and/or regional recurrence mostly in central high-dose areas.ConclusionsComprehensive peer review planning clinic is an essential component of IMRT QA that led to major changes in one third of the study population. This process ensured safety related to target definition and led to favorable disease control profile, with no identifiable recurrences attributable to geometric misses or delineation error.
http://ift.tt/2g6K37G
Rare Case of an Ancient Craniofacial Osteosarcoma with Probable Surgical Intervention
Abstract
Osteosarcoma is the most common primary malignant bone tumor both today and in antiquity. Nevertheless, it is a comparatively rare tumor. This paper describes a case of a highly aggressive craniofacial lesion from the 11th–12th centuries AD, most likely representing osteosarcoma. During the paleopathological study, macroscopic, endoscopic, radiological, scanning-electron and light microscopic investigations were performed. The skull of the approximately 40–50 year-old female revealed several pathological findings. The most impressive macroscopic feature was an extensively spiculated periosteal reaction ("sunburst" pattern) in combination with a massive bone destruction most likely derived from a highly aggressive tumor originating in the ethmoidal area of the medial wall of the orbit. The central parts of the lesion showed excessive new and most probably neoplastic bone formation indicating an underlying high-grade osteosarcoma. The light microscopic examination revealed three different levels of bony structures representing different qualities of bone tissues. Besides the mass lesion, signs of a healed multiple incomplete trephination of the left parietal bone was observed. This case represents a unique example in which the concomitance of a tumor and an incomplete trephination could be observed from the skeletal remains of an ancient individual. The case opens new considerations as to whether surgical interventions, such as incomplete trephination, might have been used already in the Middle Ages as a therapeutic approach.
http://ift.tt/2gs8FvF
Prospective Qualitative and Quantitative Analysis of Real-time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy
Publication date: Available online 19 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Carlos E. Cardenas, Abdallah S.R. Mohamed, Randa Tao, Andrew J.R. Wong, Musaddiq J. Awan, Shirly Kuruvila, Michalis Aristophanous, G. Brandon Gunn, Jack Phan, Beth M. Beadle, Steven J. Frank, Adam S. Garden, William H. Morrison, Clifton David Fuller, David I. Rosenthal
Purpose/Objective(s)Our department has a long established comprehensive quality assurance (QA) planning clinic for patients undergoing radiation therapy (RT) for head-and-neck cancer. Our aim is to assess the impact of real-time peer review QA process on the quantitative and qualitative radiotherapy plan changes in the era of IMRT.Materials/MethodsProspective data for 85 patients undergoing head-and-neck IMRT presented at a biweekly QA clinic after simulation and contouring were collected. A standard data collection form was used to document alterations made during this process. The original treating-attending-approved pre-QA clinical target volumes (CTVs) were saved before QA and compared to post-QA consensus CTVs. Qualitative assessment was done using a pre-defined criteria. Dice similarity coefficients (DSC) and other volume overlap metrics were calculated for each CTV level and used for quantitative comparison. Changes are categorized as major, minor, and trivial per the degree of overlap. Patterns of failure were analyzed and correlated to plan changes.ResultsAll 85 patients were examined by at least one non-treating-attending head-and-neck sub-specialist radiation oncologist; 80 (94%) were examined by ≥3 faculty. New clinical findings on physical examination were found in 12 patients (14%) leading to major plan changes. Quantitative DSC analysis revealed significantly better agreement in CTV1 (0.94±0.10) contours compared to CTV2 (0.82±0.25) and CTV3 (0.86±0.2) contours (p=0.0002 and p=0.03, respectively; matched-pair Wilcoxon). Treating-attending radiation oncologist experience significantly affected DSC values when considering all CTV levels (p=.012; matched-pair Wilcoxon). After median follow-up of 38 months, only 10 patients (12%) had local and/or regional recurrence mostly in central high-dose areas.ConclusionsComprehensive peer review planning clinic is an essential component of IMRT QA that led to major changes in one third of the study population. This process ensured safety related to target definition and led to favorable disease control profile, with no identifiable recurrences attributable to geometric misses or delineation error.
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Persistent fifth arch anomalies – broadening the spectrum to include a variation of double aortic arch vascular ring
Abstract
Fifth arch anomalies are rare and complex and frequently misdiagnosed or mistaken for other entities. We report a double arch vascular ring that is thought to consist of right fourth arch and left fifth arch components, a previously undescribed persistent fifth arch variant. The currently recognized spectrum and classification of fifth arch vascular anomalies are expanded along with illustrative images to justify the proposed changes. Reviewing and expanding the classification of fifth arch anomalies to include a double arch ring variant will promote recognition, correct diagnosis and appropriate management of these anomalies.
http://ift.tt/2fHxzGG
Fat-containing soft-tissue masses in children
Abstract
The diagnosis of soft-tissue masses in children can be difficult because of the frequently nonspecific clinical and imaging characteristics of these lesions. However key findings on imaging can aid in diagnosis. The identification of macroscopic fat within a soft-tissue mass narrows the differential diagnosis considerably and suggests a high likelihood of a benign etiology in children. Fat can be difficult to detect with sonography because of the variable appearance of fat using this modality. Fat is easier to recognize using MRI, particularly with the aid of fat-suppression techniques. Although a large portion of fat-containing masses in children are adipocytic tumors, a variety of other tumors and mass-like conditions that contain fat should be considered by the radiologist confronted with a fat-containing mass in a child. In this article we review the sonographic and MRI findings in the most relevant fat-containing soft-tissue masses in the pediatric age group, including adipocytic tumors (lipoma, angiolipoma, lipomatosis, lipoblastoma, lipomatosis of nerve, and liposarcoma); fibroblastic/myofibroblastic tumors (fibrous hamartoma of infancy and lipofibromatosis); vascular anomalies (involuting hemangioma, intramuscular capillary hemangioma, phosphate and tensin homologue (PTEN) hamartoma of soft tissue, fibro-adipose vascular anomaly), and other miscellaneous entities, such as fat necrosis and epigastric hernia.
http://ift.tt/2fHxxi2
Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511)
Abstract
Purpose
We examined acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) events among 9679 women treated for breast cancer on four adjuvant Alliance for Clinical Trials in Oncology trials with >90 months of follow-up in order to better characterize the risk for AML/MDS in older patients receiving anthracyclines.
Methods
We used multivariable Cox regression to examine factors associated with AML/MDS, adjusting for age (≥65 vs. <65 years; separately for ≥70 vs. <70 years), race/ethnicity, insurance, performance status, and anthracycline receipt. We also examined the effect of cyclophosphamide, the interaction of anthracycline and age, and outcomes for those developing AML/MDS.
Results
On Cancer and Leukemia Group B (CALGB) 40101, 49907, 9344, and 9741, 7290 received anthracyclines; 15% were in the age ≥65 and 7% were ≥70. Overall, 47 patients developed AML/MDS (30 AML [0.3%], 17 MDS [0.2%]); 83% of events occurred within 5 years of study registration. Among those age ≥65 and ≥70, 0.8 and 1.0% developed AML/MDS (vs. 0.4% for age <65), respectively. In adjusted analyses, older age and anthracycline receipt were significantly associated with AML/MDS (adjusted hazard ratio [HR] for age ≥65 [vs. <65] = 3.13, 95% confidence interval [CI] 1.18–8.33; HR for anthracycline receipt [vs. no anthracycline] = 5.16, 95% CI 1.47–18.19). There was no interaction between age and anthracycline use. Deaths occurred in 70% of those developing AML/MDS.
Conclusions
We observed an increased risk for AML/MDS for older patients and those receiving anthracyclines, though these events were rare. Our results help inform discussions surrounding anticipated toxicities of adjuvant chemotherapy in older patients.
http://ift.tt/2ftG9Wn
Persistent fifth arch anomalies – broadening the spectrum to include a variation of double aortic arch vascular ring
Abstract
Fifth arch anomalies are rare and complex and frequently misdiagnosed or mistaken for other entities. We report a double arch vascular ring that is thought to consist of right fourth arch and left fifth arch components, a previously undescribed persistent fifth arch variant. The currently recognized spectrum and classification of fifth arch vascular anomalies are expanded along with illustrative images to justify the proposed changes. Reviewing and expanding the classification of fifth arch anomalies to include a double arch ring variant will promote recognition, correct diagnosis and appropriate management of these anomalies.
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Fat-containing soft-tissue masses in children
Abstract
The diagnosis of soft-tissue masses in children can be difficult because of the frequently nonspecific clinical and imaging characteristics of these lesions. However key findings on imaging can aid in diagnosis. The identification of macroscopic fat within a soft-tissue mass narrows the differential diagnosis considerably and suggests a high likelihood of a benign etiology in children. Fat can be difficult to detect with sonography because of the variable appearance of fat using this modality. Fat is easier to recognize using MRI, particularly with the aid of fat-suppression techniques. Although a large portion of fat-containing masses in children are adipocytic tumors, a variety of other tumors and mass-like conditions that contain fat should be considered by the radiologist confronted with a fat-containing mass in a child. In this article we review the sonographic and MRI findings in the most relevant fat-containing soft-tissue masses in the pediatric age group, including adipocytic tumors (lipoma, angiolipoma, lipomatosis, lipoblastoma, lipomatosis of nerve, and liposarcoma); fibroblastic/myofibroblastic tumors (fibrous hamartoma of infancy and lipofibromatosis); vascular anomalies (involuting hemangioma, intramuscular capillary hemangioma, phosphate and tensin homologue (PTEN) hamartoma of soft tissue, fibro-adipose vascular anomaly), and other miscellaneous entities, such as fat necrosis and epigastric hernia.
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Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer: Step by step description of the surgical technique for a two-teams approach
Source:European Journal of Surgical Oncology (EJSO)
Author(s): María Clara Arroyave, F. Borja DeLacy, Antonio M. Lacy
Interest in transanal total mesorectal excision (taTME) is growing worldwide due to the application of minimally invasive techniques to rectal cancer surgery while maintaining adequate oncologic outcomes.This article presents the standardised and refined technique after performing more than 300 operations at Hospital Clinic of Barcelona.
http://ift.tt/2eTifY8
Mentored experience of establishing a national peritoneal malignancy programme – experience of first 50 operative cases
Source:European Journal of Surgical Oncology (EJSO)
Author(s): K.H. Chang, M. Kazanowski, O. Staunton, R.A. Cahil, B.J. Moran, C. Shields, J. Mulsow
BackgroundCytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland.MethodsThis is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015.ResultsDuring the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, complication and operative mortality were 83%, 0% and 0% respectively. There were no major Clavien-Dindo grade III/IV morbidity.ConclusionsWe report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures.
http://ift.tt/2ftEXCC
Vascular reconstruction after retroperitoneal and lower extremity sarcoma resection
Source:European Journal of Surgical Oncology (EJSO)
Author(s): M. Wortmann, I. Alldinger, D. Böckler, A. Ulrich, A. Hyhlik-Dürr
PurposeSoft tissue sarcomas (STS) of the retroperitoneum and the lower limb with invasion of major blood vessels are very rare malignancies. This study analyses the outcome of patients with vascular replacement during resection of STS of the retroperitoneum and the lower extremity with either arterial or concomitant arterial and venous infiltration.MethodsPatients with vascular replacement during resection of sarcoma of the retroperitoneum and the lower extremity between 1990 and 2014 were included in this retrospective single center study. Patients with a sole infiltration of a major vein were excluded. The follow up was obtained from medical records, the general practitioner and a clinical examination whenever possible. The main endpoints were survival, graft patency and the rate of major amputations.Results47 patients were included in this study. 20 patients have received an operation for a retroperitoneal STS, 27 for a STS of the lower extremity. The median follow-up was 24.5 months. The median survival was 113 months with a median tumor-free survival of 25 months. The two-year patency for arterial bypasses in the retroperitoneum and the lower extremity was 88 % and 72 %, respectively. Limb salvage rate was 89 %.ConclusionsInvasion of major blood vessels is no contraindication for a resection of a STS in the retroperitoneum and the lower extremity, but it is accompanied by a high postoperative morbidity. Since surgical resection is the only curative therapy in these patients, it should also be offered to patients with infiltration of major blood vessels.
http://ift.tt/2eTjffb
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