Luna-Perez P, Arriola EL, Cuadra Y, et al [Hosp de Oncologia, Mexico; Universidad Nacional Autonoma de Mexico]
P53 Protein Overexpression and Response to Induction Chemoradiation Therapy in Patients with Locally Advanced Rectal Adenocarcinoma
Ann Surg Oncol 5: 203-208, 1998
This study of 20 patients with locally advanced rectal adenocarcinoma o to 10 cm from the anal verge were treated with preoperative radiation therapy. 45 Gy concomitantly with bolus infusion of 5- fluorouracil , 450 mg/m2, on days 1to 5 and 28 to 33 days of radiation therapy and surgery done 4 weeks later. Patients with normal p53 protein had a significantly better response to preoperative therapy than patients with mutated p53.
Decker-Baumann C, Buhl K,Frohmuller S, et al [ Univ of Heidelberg, Germany; Humboldt-Univ of Berlin]
Reduction of Chemotherapy -Induced Side-Effects by Parenteral Glutamine Supplementation in Patients With Metastatic Colorectal Cancer
Eur J Cancer 35: 202-207, 1999
This prospective randomized study of 24 patients with colorectal cancer who received 5-flurouracil [5Fu+C] calcium Leucovorin were evaluated . All three courses for GI mucosal effects in two group of patients in one group the patients received amino acids glutamine [Gln] supplementation and other did not After the third course of 5-FU+C the Gln group had significantly less mucositis and less ulceration of duodenal mucosa.
Gryfe R, Kim H, Hsieh ETK, et al [Samuel Lunenfeld Research Inst, Toronto; Univ of Toronto; cancer Care Ontario, Toronto]
Tumor Microsatellite Instability and Clinical Outcome in Young Patients With Colorectal Cancer
N Engl J Med 342: 69-77, 2000
The genomic mutations cause colorectal cancer. The common pathway involves chromosomal instability and microsatellite instability. In this study of 607 patients with colorectal cancer, 5o years or younger underwent DNA analysis for microsatellite instability.
Those with high microsatellite instability were associated with significantly better survival and significantly with fewer metastases to regional nodes.
Isaka N, Nozue M, Doy M, et al [Tsukuba Med Ctr Hosp, Ibaraki, Japan; Univ of Tsukuba, Ibaraki, Japan]
Prognostic Significance of Perirectal Lymph Node Micrometastases in Dukes’ B Rectal Carcinoma: An Immunohistochemical Study by CAM5.2
Clin Cancer Res 5 : 2065-2068, 1999
This study of 42 patients with Dukes stage B carcinoma following low anterior resection or abdominoperineal resection with adjacent lymph node dissection. The samples were stained with immunohistochemically with CAM5.2, a monoclonal antibody against cytokeratin. This type of staining helped in detection micrometastasis and thereby prognosis.
Wolmark N, Bryant J, Smith R, et al [NSABP Operations Ctr, Pittsburgh, Pa; Univ of Pittsburgh, Pa; Natl Cancer Inst, Bethesda, Md; et al]
Adjuvant 5-Fluorouracil and Leucovorin With or Without Interferon Alfa-2a in Colon Carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol C-05
J Natl Cancer Inst 90: 1810-1816, 1998
This study of 2176 Patients with stage B or C colon cancer were randomly assigned to 5-FU plus LV with or without IFN. By adding IFN to 5FU + LV adjuvant therapy in Dukes stage B or C cancer does not enhance the effects of that combination. Furthermore, the toxicity inclined due to IFN.
M. van ‘t Riet, J.W.A. Burger, J.M. van Muiswinkel, G. Kazemier, M.R. Schipperus and H.J. Bonjer [ Departments of Surgery, Radiology and Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands]
Diagnosis and Treatment of Portal Vein Thrombosis Following Splenectomy
Br.Jour. of Surg. Volume 87, No.9, September 2000, Pgs. 1229-1233
The study assesses the incidence, risk factors treatment and outcome of portal vein thrombosis after splenectomy in a large series of patients.
563 splenectomies were reviewed retrospectively, 2% [9 cases] were complicated by symptomatic portal vein thrombosis.
All these 9 cases had either fever or abdominal pain. 2 of 16 patients [myeloproliferative disorder] and 4 of 49 [haemolytic anaemias] developed portal vein thrombosis. Early treatment [within 10 days] was successful in all patients while delayed treatment was ineffective.
Portal vein thrombosis should be suspected after splenectomy if there is fever and/or abdominal pain. Patients with myeloproliferative disorders or haemolytic anaemia were at a higher risk. Early detection with Doppler ultrasonography and early treatment could be life saving.
Dwerryhouse SJ, Seifert JK, McCall JL, et al [Univ of New South Wales, Sydney, Australia]
Hepatic Resection With Cryotherapy to Involved or Inadequate Resection Margin [Edge Freeze] for Metastases From Colorectal Cancer
Br J Surg 85: 185-187, 1998
Resection of liver metastases from a colorectal cancer is an established cancer therapy.
This study of 26 patients who underwent liver resection for metastases from colorectal cancer had cryotherapy for a involved or inadequate resection margin and thereby improving the local control.
Wade TP, Longo WE, Virgo KS, et al [ St Louis Univ]
A Comparison of Adrenalectomy With Other Resections for Metastatic Cancers
Am J Surg 175: 183-186, 1998
This study of 47 patients who underwent adrenalectomy for metastatic cancer, for patient with isolated adrenal metastasis from renal, colorectal and lung primary cancer adrenalectomy may be beneficial procedure. Although survival is not as good as in patients with pulmonary or hepatic metastasis resection.
Tsujinaka T, Shiozaki H, Yamamoto M, et al [Osaka Univ, Japan]
Role of Preoperative Chemoradiation in the Management of Upper Third Thoracic Esophageal Squamous Cell Carcinoma
Am J Surg 177: 503-507, 1999
This study of 37 patients with upper thoracic esophageal cancer underwent surgery and only 27 received preoperative chemoradiation therapy [CRT]. Seven of the CRT patients were downstaged and had a complete response and an additional 13 had partial response. Overall survival was similar and patterns of recurrence were the same. The preoperative CRT could downstage 26% of patients without any increase in morbidity and mortality especially for patients with upper third esophageal cancer.
Sheehan KM, Sheahan K, O’Donoghue DP, et al [ Royal College of Surgeons in Ireland, Dublin; St. Vincent’s Hosp, Dublin; Beaumont Hosp, Dublin]
The Relationship Between Cyclooxygenase-2 Expression and Colorectal Cancer
JAMA 282: 1254-1257, 1999
The lower incidence of colorectal cancer in patient on nonsteroidal anti-inflammatory drugs [ NSAIDs] have been reported.
This study on archival specimens of 76 adult patients with colorectal cancer revealed. Stronger COX2 immunostaining was correlated with more advanced Dukes tumor stage, larger tumors, and lymph node involvement. The editor comments that 60 X 2 has adverse implications in multistage carcinogenesis of colorectal cancer could be due to initiation of some specific prostaglandin enhancement.
Mapp TJ, Hardcastle JD, Moss SM, et al [Inst of Cancer Research, Sutton, England; Univ Hosp, Nottingham, England; City Hosp, Nottingham, England]
Survival of Patients With Colorectal Cancer Diagnosed in a Randomized Controlled Trial of Faecal Occult Blood Screening
Br J Surg 86: 1286-1291, 1999
This well conducted study has highlighted that fecal occult blood testing improved survival in patients with screen detected cancer even after adjustment for stage at diagnosis.
Merad F, Hay J-M, Fingerhut A, et al [ Hopital Louis Mourier, Colombes, France; Center Hospitalier Intercommunal, Poissy, France; Cente Hospitalier, Pau France; et al ]
Is Prophylactic Pelvic Drainage Useful After Elective rectal or Anal Anastomosis? A Multicenter Controlled Randomized Trial
Surgery 125: 529-535, 1999
This study of 494 patients undergoing resection followed by rectal or anal anastomosis were assigned to drainage with suction drains or no drainage. Such drainage did not reduce the rate or severity of postoperative complication.
The editor agrees with the conclusion of this study except for very low pelvic anastomosis, within 5 cm of the anal verge when a pelvic drainage would be important due to considerable dissections within the pelvis leading to accumulation of blood.
Joosten JJA, Strobbe LJA, Wauters CAP, et al [Univ Hosp st Radboud, Nijmegen, The Netherlands]
Intraoperative Lymphatic Mapping and the Sentinel Node Concept in Colorectal Carcinoma
BR J Surg 86: 482-486, 1999
This study of 50 patients with colorectal cancer underwent intraoperative lymphatic mapping by injecting patient blue dye around the tumor and blue stained lymph node identified in the resected specimen. The false negative rate was 60%. Thus in colorectal cancer the concept of lymph mapping and sentinel node identification was not useful.
Cunningham D, for the V301 Study Group [ Royal Marsden Hosp, London]
A Phase III Study of Irinotecan [CPT-II] Versus Best Supportive Care in Patients With Metastatic Colorectal Cancer Who Have Failed 5-Fluorouracil Therapy
Semin Oncol 26 [Suppl 5]: 6-12, 1999
This study of 279 patients with metastatic colorectal cancer in whom 5-FU had failed were assigned in 2:1 ratio to receive best supportive care [BSC] plus CPT-II 350 mg/m2 every 3 weeks or BSC. CPT-II recipients had significantly prolonged survival without performance status deterioration, prolonged survival with more than 5% weight loss, and prolonged the duration of pain-free survival. Patients receiving irinotecan also have a better quality of life.
Varma MG, Rogers SJ, Schrock TR, et al [Univ of California, San Francisco]
Local Excision of Rectal Carcinoma
Arch Surg 134: 863-868, 1999
This study of 58 patients with rectal cancer who underwent local excision from 1982 to 1998 were studied. Local recurrence rate was 14%. None of the clinicopathologic factors predicted for local recurrence. The strongest predictor of local recurrence was the absence of neoadjuvant therapy following local excision as patient treated with adjuvant chemotherapy or radiotherapy had no local recurrence. The editor comments that negative margins of excision are also important in long term outcome.
Lagergren J, Bergstrom R, Lindgren A, et al [Karolinska Inst, Stockholm; Uppsala Univ, Sweden; Falu Hosp, Sweden]
Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma
N Engl J Med 340: 825-831, 1999
This study of 189 patients with esophageal adenocarcinoma and 262 patients with gastric cardia adenocarcinoma were evaluated for symptoms of recurrent heart burn and regurgitation, epidemiologic data, medical history and life style and compared and control subjects.
Among patients with long standing and severe symptoms of reflux the odd ratio were 43.5 for esophageal adenocarcinoma and 4.4 for adenocarcinoma of the cardiac. There was no association between the risk of esophageal squamous cell carcinoma and reflux.
Nakamura K, Morisaki T, Sugitani A, et al [Kyushu Univ, Fukuoka, Japan]
An Early Gastric Carcinoma Treatment Strategy Based on Analysis of Lymph Node Metastasis
Cancer 85: 1500-1505, 1999
This study of 612 patients who underwent D1 or D2 gastrectomy for primary gastric carcinoma were examined to determine which surgical treatment were most appropriate based on preoperative and intraoperative characteristics including lymph node status. The size and tumor and its depth of invasion were independent parameters to determine the type of resection and thereby forming an algorithm i.e. local resection for mucosal tumors, 1 cm or large or for small < 1 cm submucosal tumors whereas gastrectomy for large tumors.
Klinkenbijl JH, Jeekel J, Sahmoud T, et al [ Univ Hosp Rotterdam-Dijkzigt, The Netherlands; EORTC, Brussels, Belgium; Academic Med Ctr, Amsterdam; et al]
Adjuvant Radiotherapy and 5-Fluorouracil After Curative Research of Cancer of the Pancreas and Periampullary Region: Phase III Trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group
Ann Surg 230: 776-784, 1999
This study of 218 patients with pancreatic head or periampullary cancer were assigned to observation or treatment with adjuvant radiotherapy and 5-fluorouracil. The median survival was 19 months in the observation group and 24.5 month in the treatment group. Two year survival estimates were 41% and 51% respectively. Routine use of adjuvant chemotherapy is not justified as standard treatment in patients with cancer of pancreatic head or periampullary region. The authors view point is the use of newer agents [ gemcitabine, taxanes, etc ], particularly in the neoadjuvant combination may provide a better option for these patients.
Norton JA, Fraker DL, Alexander HR, et al [Univ of California, San Francisco, Natl Cancer Inst, Bethesda, Md; NIH, Bethesda, Md; et al]
Surgery to Cure the Zollinger -Ellison Syndrome
N Engl J Med 341: 635-644, 1999
The role of surgery in Zollinger-Ellison syndrome is controversial.
This study is of 151 consecutive patients of ZE undergoing laparotomy. 123 had sporadic gastrinomas of which half the patients were disease free immediately and long term cure was possible in most of these patients, conversely, 28 with multiple endocrine neoplasia rarely became disease free, even after extensive duodenal surgical exploration. Thus authors recommendation of attempted curative resection in all patients with sporadic but not familial gastrinoma without extensive liver metastasis seems prudent in light of the patient follow-up data.
Lillemoe KD, Cameron JL, Hardacre JM, et al [ Johns Hopkins Med Baltimore, Md]
Is Prophylactic Gastrojejunostomy Indicated for Unresectable Periampullary Cancer? A Prospective randomized Trial
Ann Surg 230: 322-330, 1999
25-75% of patients undergoing exploratory laparotomy for periampullary cancer have unresectable disease.
This study of 194 patients with periampullary mallignancy underwent surgery but on exploration was found to be unresectable. Of these, 87 patients were not at risk of gastric outlet obstruction. These subgroups were randomized to prophylactic retrocolic gastrojejunostomy or no gastrojejunostomy. Prophylactic retrocolic gastrojejunostomy did not increase the incidence of postoperative complications or extend the hospital stay but significantly reduced the incidence of large gastric outlet obstruction. Thus prophylactic retrocolic gastrojejunostomy at initial surgery is recommended in unresectable periamupullary carcinoma.
Kemeny N, Huang Y, Cohen AM, et al [ Mem Sloan-Kettering Cancer Ctr, New York]
Hepatic Arterial Infusion of Chemotherapy After Resection of Hepatic From Colorectal Cancer
N Engl J Med 341: 2039-2048, 1999
This study of 156 patients with colorectal cancer with liver metastasis and had undergone liver resection were randomized to hepatic arterial infusion with floxuridine and dexamethasone plus IV fluorouracil with or without leucovorin or to 6 weeks of similar systemic therapy only. The benefit in progression free overall survival in the combined [hepatic arterial + systemic] arm was dramatic as compared to only systemic therapy. However, systemic recurrences outside the liver was quite similar in both groups. The editor comments that this improvement may be offset if one consider the use of new drugs such as CPT-11.
Fong Y, Fortner J, Sun RL, et al [ Mem Sloan-Kettering Cancer Ctr, New York]
Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer: Analysis of 1001 Consecutive Cases
Ann Surg 230: 309-321, 1999
This study has data from 1001 consecutive patients who underwent liver resection for metastatic colorectal cancer. The risk factors that are well known for recurrence are the hepatic resection margin status and presence of extrahepatic disease, particularly nodal in the porta hepatis. The other factors which this article has highlighted for poor survival are shorter disease free interval from primary resection [ less than 12 months], number of tumors, preoperative carcinoembryonic level [ more than 200 mg/mL] and size of largest tumor [more than 5 cm]. In the presence of all the 5 poor risk criteria long-term survival is unusual.
Howard Safran, Henning Gaissert, Paul Akerman, Paul J. Hesketh, Mei-Hsiu Chen, Todd Moore, James Koness, Stephen Graziano, and Harold J. Wanebo (The Brown University Oncology Group, Providence, Rhode Island; Department of Medicine, St. Elizabeth’s Medical Center, Boston, Massachusetts, Department of Medicine, SUNY Health Science Center and Veterans Affairs Medical Center, Syracuse, New York)
Paclitaxel, Cisplatin, and Concurrent Radiation for Esophageal Cancer
Cancer Investigation 2001 Vol. 19 (1) Pg. 1-7
Paclitaxel is an active agent for adenocarcinomas and squamous cell carcinomas of the esophagus and has a radiation sensitization effect.
This study of 41 patients with histologically documented cancer (adenocarcinomas or squamous) were eligible locoregionally advanced cancer (extension into the stomach, involvement of mediastinum or celiac axis, portahepatic, and retroperitoneal lymph nodes) were included but those with peritoneal implants, visceral metastases or tracheoesophageal fistula were excluded.
Patients received paclitaxel 60 mg/m2, 3-hour infusion and cisplatinum 25 mg/m2 every week for 4 weeks along with local radiotherapy. 39.60 Gy in 22 fractions over 30 days. Esophagectomy was planned 4 weeks after completion of chemoradiation except for patients with retroperitoneal or portahepatic adenopathy, of the 41 patients, 97% of planned radiation and 94% of planned chemotherapy was administered. Asymptomatic neutropenia was the commonest toxicity followed by other non hematologic toxicity such as esophagitis, nausea and vomiting.
Complete response was achieved in 29%. 3/5 undergoing surgical resection within 4 weeks of chemoradiation died due to postoperative complications. The 1 and 2 year progression free survival were 48% and 40% respectively and 1 and 2 year overall survival 56% and 42%.
In this study esophagitis was less common than in studies which used 5 FU. 4/21 recurrences in this study were local and hence by increasing the dose of local RT. The reduction in local recurrence and an impact on survival versus high surgical morbidity and mortality remains unanswered.