Van Sandick JW, Va Lanschot JJB, Kuiken BW, et al [Academic Med Centre, Amsterdam]
Impact of Endoscopic Biopsy Surveillance of Barrett’s Oesophagus on Pathological Stage and Clinical Outcome of Barrett’s Carcinoma
Gut 43: 216-222, 1998
Barrett’s esophagus is a premalignant condition found in lower esophageal region in approximately 15% of patients with symptoms of gastroesophageal reflux. Advanced esophageal cancer has a high mortality and hence methods of early detection of this premalignant condition is requred.
This study compares patients with Barrett’s cancer who were under surveillance versus those detected with cancer at significant early stages were found among surveyed patients than among those non-surveyed. The two year survival was 85.9% for surveyed patients compared to 43.3% in non surveyed. This paper supports the theory that adenocarcinoma in Barrett’s esophagus develops through stages of progressive increasing dysplasia ultimately leading to oesophageal cancer.
Livraghi T, Benedini V, Lazzaroni S, et al [Ospedale Civile, Vimercate, Milan Italy, Ospedale C Poma, Mantova, Italy; Ospedale San Biagio, Clusone, Bergamo, Italy; et al]
Long Term Results of Single Session Percutaneous Ethanol Injection in Patients with Large Hepatocellular Carcinoma
Cancer 83: 48-57, 1998
Hepatocellular carcinoma [HCC] in a patient with cirrhosis of liver has a dismal prognosis. Percutaneous ethanol injection [PEI] is one of the procedures tried in such patients.
In this study over 5 year period 108 patients with hepatocellular carcinoma were treated in three groups, 24 patients single encapsulated HCC. 5 to 8.5 cm; 63 patients had a single, infiltrating lesion 5 – 10 cm in size and rest had advanced disease. Patients with single encapsulated lesion and single infiltrate lesion had better prognosis. Major complications of ethanol injection included peritoneal hemorrhage, severe liver failure, transient renal insufficiency, peritoneal seeding and infarctions of segment adjacent to the tumor.
In patient with HCC excluded from any other therapy single session PEI may be option and it has proved to be alternative to surgery and transcatheter arterial chemoembolization with adverse prognostic factors such as esophageal varices at risk of bleeding, marked portal or pulmonary hypertension, hyperfibrinolysis, chronic renal insufficiency and obstructive jaundice.
Rougier P, Van Custem E, Bajetta E, et al [Inst Gustave roussy, Villejuif, France; Univ Hosp Gasthuisberg, Leuven, Belgium; Natl Cancer Inst, Milan, Italy; et al]
Randomized Trial of Irinotecan Versus Fluorouracil by Continuous Infusion After Fluorouracil in Patients with Metastatic Colorectal Cancer
Lancer 352: 1407-1412, 1998
Irinotecan, an S-phase-specific derivative of camptothecin has shown activity against metastatic colon cancer in patients with fluorouracil resistant disease.
Patients with metastatic colon cancer and had earlier received fluorouracil were randomized to 5 Fluorouracil continuous infusion or irinotecan and quality of life assessment by European Organization for Research and Treatment of Cancer.
Patients treated with irinotecan had survival benefit. In addition, there was suggestion of a better quality of life in the irinotecan group as evidenced by enhanced pain free survival, time to performance status deterioration and weight loss.
Cerottini J-P, Caplin S, Saraga E, et al [Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland]
The Type of K-ras Mutation Determines Prognosis in Colorectal Cancer
Am J Surg 175: 198-202, 1998
K-ras mutations on outcome after surgery for colorectal cancer was assessed.
Two year survival and overall survival were significantly lower for patients with K-ras mutation than for patients without mutations.
Siewert JR, and the German Gastric Carcinoma Study Group [ Technische Universtitat Munchen, Germany]
Relevant Prognostic Factors in Gastric Cancer : Ten-year Results of the German Gastric Cancer Study
Ann Surg 228: 449-461, 1998
Ten-year survival data from prospective multicenter observational study of patients with resected gastric cancer were analyzed. The prognostic factor in patients with resected gastric cancer are lymph node ratio and lymph node status. Extended lymph node dissection performed, does not increase the mortality and morbidity. however it does greatly improve long-term survival in patients with stage II disease.
Suzuki K, Kimura T, Ogawa H [ Hamamatsu Univ, Japan ]
Laparoscopic Cholecystectomy Hazardous for Gallbladder Cancer ?
Surgery 123: 311-314, 1998
Laparoscopic Cholecystectomy for patient with gallbladder cancer has been studied. In this study of 3566 patients underwent laparoscopic cholecystectomy of which 30 had unexpected gallbladder cancer laparoscopy appears to increase the incidence of cancer recurrences in the abdominal wall in patients with gallbladder cancer it does not worsen their medium-term prognosis.
Taylor RH, Hay JH, Larsson SN [Vancouver Cancer Ctr, BC, Canada; Vancouver Island Cancer Ctr, BC, Canada]
Transanal Local Excision of Selected Low Rectal Cancers
Am J Surg 175: 360-363, 1998
Transanal local excision [TALE] of selected early low rectal cancer has been compared with or without radiotherapy. The current study compared the efficacy of TALE with the efficacy of more radical resection.
Five years recurrence free survival was 81% for irradiated patients and 52% for unirradiated patients.
The editor comments that small nonfixed T1 and T2 distal rectal cancer that has favorable histology [well - differentiated with evidence of lymphatic or vascular invasion] can successfully be treated with local excision with clear margins only. T3 cancers or cancers with unfavorable history TALE and radiation may not be justified if patient is fit for abdominoperineal resection.
Delpero JR, Pol B, Le Treut YP, et al [ Institut J Paoli-I. Calmettes, Marseille, France, Hopital de la Conception, Marseille, France]
Surgical Resection of Locally Recurrent Colorectal Adenocarcinoma
Br J Surg 85: 372-376, 1998
The recurrence rate after curative surgery for colorectal adenocarcinoma is 50% and 30% of the deaths resulted from locoregional recurrence. This study analyzed 120 patients with locoregional recurrence of colorectal cancer.
The survival rate was 44% for patients undergoing curative resection vs. 0% for those undergoing palliative resection. 45% of the patients operated on for intramural recurrence survived vs. 19% of those with extramural recurrence. The use of adjuvant therapy may further improve the long-term results.
Nakfoor BM, Willett CG, Shellito PC, et al [ Harvard Med School, Boston ]
The Impact of 5-Fluorouracil and Intraoperative Electron Beam Radiation Therapy on the outcome of Patients with Locally Advanced Primary Rectal and Rectosigmoid Cancer
Ann Surg 228: 194-200, 1998
This study 145 patients with locally advanced rectal cancer underwent moderate-to-high dose preoperative irradiation followed by surgery. 93 patients received concomittant 5-fluorouracil and 73 patients received intraoperative electron beam radiation therapy [IOERT] to the surgical bed with persisting tumor adherence or residual pelvic disease.
The patients who received 5-FU during irradiation had significantly better 5-year actuarial local control and disease specific survival. Patients undergoing complete resection and IOERT had a 5-year actuarial local control rate of 89% and disease specific survival rate of 63%. The beneficial effect of intraoperative radiation therapy was seen mainly in the subgroup with microscopic disease following surgery as opposed to gross residual disease.
Kumar H, Heer K, Lee PWR, et al [ Univ of hull, Cottingham, England ]
Preoperative Serum Vascular Endothelial Growth Factor Can Predict Stage in Colorectal Cancer
Clin Cancer Res 4: 1279-1285, 1998
Neovascularization is an essential for the growth of solid tumors. Vascular endothelial growth factor [VEGF] is an important mediator of angiogenesis.
In this study of 108 patients with colorectal cancer serum VEGF levels were measured preoperatively.
Patients with colorectal cancer have rising levels of VEGF with increasing tumor load could be an important tumor marker for all but very early colorectal cancer.
Wallis F, Campbell KL, Eremin O, et al [Aberdeen Royal Infirmary, Scotland]
Self-Expanding Metal Stents in the Management of Colorectal Carcinoma : A Preliminary Report
Clin Radiol 53: 251-154, 1998
Approximately 305 of patients with colorectal cancer present with large bowel obstruction. This study of patients describes the use of expandable metal stents for palliation of rectal carcinoma. Apart from palliation in advanced rectal carcinoma stents placement allowed surgery to be delayed until treatment of medical complications.
Wagman R, minsky BD, Cohen AM, et al [ Mem Sloan Kettering Cancer Ctr, New York ]
Sphincter Preservation in Rectal Cancer with Preoperative Radiation Therapy and Coloanal Anastomosis : Long Term Follow-up
Int J Radiat Concol Biol Phys 42: 51-57, 1998
Abdominoperineal resection is the standard surgical treatment for patients with clinically resectable, distal, invasive rectal cancer who are unable to have a low anterior resection.
The study of 36 patients with invasive, resectable, primary adenocarcinoma of rectum confined to the pelvis received local radiotherapy to pelvis 46.8 Gy followed by a boost 3.6 Gy to the primary tumor. 14% of the patients had complete pathologic response and 70% were able to undergo low anterior resection with coloanal anastomoses. The actuarial survive was 64% at 5-years. Thus by this approach of early local RT followed by surgery most patients could have a good or excellent functional outcomes.
Wong CS, Cumnings BJ, Brierley JD, et al [ Univ of Toronto ]
Treatment of Locally Recurrent Rectal Carcinoma : Results and Prognostic Factors
Int J Radiat Oncol Biol Phys 40: 427-435, 1998
This study of 519 patients with locally recurrent rectal cancer following surgery treated primary with radiation were reviewed, none of these patient had earlier received any adjuvant therapy. Median survival from the time of pelvic irradiation was 14 months. Five year survival was 5%. In a multivariate analysis, overall survival was correlated positively with Eastern Cooperative Oncology Group [ECOG] performance status, absence of extra pelvic mestastases, long intervals from initial surgery to radiation therapy. For local recurrence total radiation dose, and absence of obstructive uropathy were important factors. Patients with local recurrence after previous surgery for rectal cancer has a dismal prognosis and pelvic radiotherapy provides only short term palliation.
Schechter NR, Portlock CS, Yahalom J [ Mem Sloan – Kettering Cancer Ctr, New York ]
Treatment of Mucossa-Associated Lymphoid Tissue Lymphoma of the Stomach with Radiation Alone
J Clin Oncol 16: 2916-1921, 1998
Mucossa associated lymphoid tissue [MALT] lymphoma of the stomach [MLS] is a distinct clinicopathologic entity associated with Helicobacter pylori infection. The antibiotic therapy considered as the primary therapy is followed by gastrectomy and chemotherapy, when there is no evidence of H. pylori. this study of 17 patients with stage I and II low grade MLS and no evidence of H. pylori received local RT to the stomach. Event-free survival was 100%. At a median 27 months after completion of radiotherapy. Low dose radiotherapy appeared as an effective alternative to surgery and thereby preserving the stomach.
Sykes AJ, Burt PA, Selvin NJ, et al [ Christie Hosp NHS Trust, Manchester, England ]
Radical Radiotherapy for Carcinoma of the Oesophagus : An effective Alternative to Surgery
Radiother Oncol 48: 15-21, 1998
The overall mortality rate for esophageal cancer is 95% at 5 years. Radiotherapy is an effective alternative to radical surgery. This study of 101 patients with esophageal cancer received definitive radiotherapy. Use of diagnostic CT as a staging investigation could better assess the selection of patient for radiotherapy.
Esophageal stenosis was the only clinically significant complications.
Rau B, Wust P, Hohenberger P, et al [Humboldt Univ, Berlin]
Preoperative Hyperthermia Combined With Radiochemotherapy in Locally Advanced Rectal Cancer: A Phase II Clinical Trial
Ann Surg 227: 380-389, 1998
This study of 37 patients with locally advanced rectal cancer received regional hyperthermia in combination with preoperative radiotherapy and systemic chemotherapy and surgery. The primary tumor was resected in 86.5%. The overall survival rate was 56% at a median of 21 months. This regimen is safe and effective local control modality.
Bonenkamp JJ, for the Dutch Gastric Cancer Group [Leiden Univ, The Netherlands; et al]
Extended Lymph-Node Dissection for Gastric Cancer
N Engl J Med 340: 908-914, 1999
Japanese surgeons believe in performing an extended [D2] lymph node dissection for gastric cancer.
This study of 966 patients with adenocarcinoma of stomach without evidence of distant metastases were randomized to D1 or D2 lymph node resection and the remaining patients palliative surgery.
There was no significant difference in 5 year survival 45% with D1 and 47% with D2 resection. This western trial does not support the use of D2 lymph node dissection in patients undergoing potentially curative surgery for gastric cancer, however it does increase the postoperative morbidity and mortality.
Merchant NB, Conlon KC, Saigo P, et al [ Mem Sloan -Kettering Cancer Ctr, New York]
Positive Peritoneal Cytology Predicts Unresectability of Pancreatic Adenocarcinoma
J Am Coll Surg 188: 421-426, 1999
This study of 228 patients with resectable pancreatic cancer underwent peritoneal cytology samples from the right and left subdiaphragmatic spaces. Approx. 15% had positive peritoneal cytology [PPC] which predicts unresectability of pancreatic cancer. Fine needle aspiration did not increase the incidence of PPC.
The authors comments that the cell initially lodge on the surface of pleura or peritoneum where there is no vascular supply which then slowly sets in & hence prior to vascular supply chemotherapy may not be useful and hence other therapies such as photodynamic therapy, hyperthermic or intracavitary chemotherapy may be the modalities of future.
Macdonald JS, Smalley SR, Benedetti J, et al
Chemoradiotherapy after Surgery Compared with Surgery Alone for Adenocarcinoma of the Stomach or Gastresophageal Junction
N Engl J Med 2001, 345: 725-730
Literature Alert – Current Oncology Reports Vol. 3(6) November 2001 Pg. 459
This study of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction was randomly assigned to chemoradiotherapy or surgery alone. Adjuvant therapy consisted of bolus administrations of 5 – FU/LCV concurrently with radiotherapy, more than 80% had nodal involvement.
Primary toxicities were hematological and gastrointestinal with a median follow-up of 5-year in addition to the advantage for median overall survival 36 months, the median duration of relapse-free survival was 30 months for chemoradiotherapy group as compared to 27 months and 19 months for surgery alone group respectively.