Biliary tract cancer (BTC) is a disease entity comprising diverse epithelial tumors with features of cholangiocyte differentiation, and it includes cholangiocarcinoma (CCA) and gallbladder cancer (GBC). Depending on its anatomical location, cholangiocarcinoma is categorized as intrahepatic (iCCA), perihilar (pCCA), or distal (dCCA). Nearly two-thirds of patients with biliary tract cancer present with advanced disease at diagnosis and in 68-86% of resections the cancer eventually recurs either locoregionally or at a distance. Chemotherapy is the first-line therapy for advanced or recurrent BTC. With the development of next-generation sequencing (NGS)-guided molecular targeted therapy, more options are available for treatment of advanced BTC. Chemotherapy, and especially a triplet regimen based on gemcitabine/cisplatin/nab-paclitaxel, has had the most significant effect, and fluorouracil, leucovorin, irinotecan plus oxaliplatin (FOLFIRINOX) combined with bevacizumab is promising. Molecular targeted therapy should be based on genome sequencing and appears essential to precision medicine. Fibroblast growth factor receptor (FGFR) inhibitors and isocitrate dehydrogenase (IDH) inhibitors are promising emerging targeted therapies mainly for iCCA. Other targeted therapies such as anti-human epidermal growth factor receptor-2 (HER2) therapies, MEK inhibitors, BRAF inhibitors, and poly ADP ribose polymerase (PARP) inhibitors had tentatively displayed efficacy. Further evaluations of combination strategies in particular are needed. An immune checkpoint inhibitor (ICI) alone is less efficacious, but an ICI in addition to chemotherapy or radiotherapy has resulted in a response according to many case series. However, ICIs are still being evaluated in several ongoing studies. Combination therapies have garnered attention because of interactions between signaling pathways of carcinogenesis in BTC.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bile Duct Neoplasms/therapy , Cholangiocarcinoma/therapy , Gallbladder Neoplasms/therapy , Neoplasm Recurrence, Local/therapy , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/genetics , Bile Duct Neoplasms/mortality , Biomarkers, Tumor/antagonists & inhibitors , Biomarkers, Tumor/genetics , Chemoradiotherapy, Adjuvant/instrumentation , Cholangiocarcinoma/diagnosis , Cholangiocarcinoma/genetics , Cholangiocarcinoma/mortality , Cholecystectomy , DNA Mutational Analysis/methods , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/genetics , Gallbladder Neoplasms/mortality , Hepatectomy , High-Throughput Nucleotide Sequencing , Humans , Immune Checkpoint Inhibitors , Molecular Targeted Therapy/methods , Mutation , Neoadjuvant Therapy/methods , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Progression-Free Survival , Protein Kinase Inhibitors
La edad es el mayor factor de riesgo para el cáncer colorrectal, encontrándose un 70% de los casos en mayores de 70 años. Por este motivo nos propusimos realizar una revisión del tratamiento quirúrgico y quimioterápico del cáncer de colon y recto en el anciano. Para ello se realizó una búsqueda en PubMed incluyendo palabras como elderly, surgery, colorectal cancer, chemotherapy, radiotherapy y oncogeriatrics, y se seleccionaron los artículos de revisión y originales sobre tratamiento del cáncer colorrectal en el anciano. Con los resultados obtenidos se desarrolla de forma narrativa la evidencia más actualizada en el tratamiento de esta patología. Aunque el tratamiento del cáncer colorrectal está estandarizado, en el caso del anciano es necesario realizar una valoración geriátrica integral previa antes de decidir el tipo de tratamiento, con el objetivo de ofrecer estas pautas estandarizadas a ancianos robustos y adaptarlas en los pacientes frágiles (AU)
Age is the biggest risk factor for colorectal cancer, with 70% of the cases in patients over 70 years old. For this reason, a review is presented on the surgical treatment and chemotherapy of cancer of colon and rectum in the elderly. A search was performed in PubMed, including words such as elderly, surgery, colorectal cancer, chemotherapy, radiotherapy, and oncogeriatrics, and review articles and originals on treatment of colorectal cancer in the elderly were selected. A narrative form was developed from the latest evidence with the results obtained on the treatment of this pathology. Although the treatment of colorectal cancer is standardised, a prior comprehensive geriatric assessment is required in the case of the elderly, before deciding the type of treatment in order to offer these robust elderly-standardised guidelines for the robust elderly and adapt them for use in fragile patients (AU)
Humans , Male , Female , Aged , Aged, 80 and over , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/surgery , Risk Factors , Neoplasm Metastasis/therapy , Chemoradiotherapy, Adjuvant/instrumentation , Combined Modality Therapy/methods
Introducción: El estándar de tratamiento del cáncer de recto localmente avanzado es la escisión total del mesorrecto. Sin embargo, la preservación del órgano ha sido propuesta para los tumores con buena respuesta al tratamiento neoadyuvante. El objetivo de este estudio es investigar los resultados oncológicos de esta estrategia. Métodos: Se realizó un estudio de cohorte retrospectivo, en el que se analizó a los pacientes con adenocarcinoma de recto tratados con intención curativa entre 2005 y 2014 que, después de recibir quimiorradioterapia neoadyuvante, presentaron una respuesta clínica completa o casi completa y fueron tratados con preservación del recto. Resultados: Durante el periodo de estudio, 204 pacientes con cáncer del recto recibieron neoadyuvancia. Treinta (14,7%) presentaron una respuesta clínica completa o casi completa y se trataron según una estrategia de preservación de órgano (23 watch & wait y 7 resecciones locales). La mediana de seguimiento fue de 46 meses (rango intercuartil: 30-68). En el grupo de watch & wait, 4 casos presentaron recurrencia local antes del año (tasa actuarial 18,5%). Todos pudieron ser rescatados (2 con cirugía radical y 2 con resecciones locales) sin presentar nuevas recurrencias. El índice de supervivencia libre de enfermedad a distancia a 3 años fue de 94,1% (IC 95%: 82,9-100). De los 7 casos que se trataron mediante resección local, ninguno presentó recurrencia local. Considerando toda la muestra, la proporción de conservación de órgano fue del 93%. Conclusiones: La estrategia de preservación de órgano en el cáncer rectal localmente avanzado es factible en casos con buena respuesta a la neoadyuvancia. Implementada en un grupo altamente seleccionado de pacientes, se asocia con resultados oncológicos satisfactorios (AU)
Introduction: The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. Methods: This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum. Results: A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait» and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait», 4 patients had local recurrence before 12 months (actuarial local recurrence rate = 18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%. Conclusion: The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results (AU)
Humans , Male , Female , Rectal Neoplasms/complications , Rectal Neoplasms/drug therapy , Rectal Neoplasms/therapy , Neoadjuvant Therapy/instrumentation , Neoadjuvant Therapy/methods , Neoadjuvant Therapy , Chemoradiotherapy, Adjuvant/instrumentation , Chemoradiotherapy, Adjuvant/methods , Chemoradiotherapy, Adjuvant , Organ Sparing Treatments/instrumentation , Organ Sparing Treatments/methods , Organ Sparing Treatments , Cohort Studies , Retrospective Studies
Over the last 20 years there was a dramatic change in therapeutic options for head and neck tumors mainly due to improvements in surgical and radiotherapeutic techniques and in the increasing use of multimodal therapy. Especially for locally advanced tumors, one can achieve long lasting disease free intervals in a large proportion of patients. The following article will focus on the novel techniques in radiation oncology and combined radiochemotherapy giving an overview without too many technical details.
Otorhinolaryngologic Neoplasms/radiotherapy , Chemoradiotherapy, Adjuvant/instrumentation , Chemoradiotherapy, Adjuvant/methods , Combined Modality Therapy/instrumentation , Combined Modality Therapy/methods , Cone-Beam Computed Tomography/instrumentation , Cone-Beam Computed Tomography/methods , Equipment Design , Humans , Lymphatic Metastasis/pathology , Lymphatic Metastasis/radiotherapy , Neoplasm Staging , Otorhinolaryngologic Neoplasms/drug therapy , Otorhinolaryngologic Neoplasms/pathology , Otorhinolaryngologic Neoplasms/surgery , Prognosis , Radiation Protection/instrumentation , Radiation Protection/methods , Radiotherapy Planning, Computer-Assisted/instrumentation , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Adjuvant/instrumentation , Radiotherapy, Adjuvant/methods , Radiotherapy, Computer-Assisted/instrumentation , Radiotherapy, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/instrumentation , Radiotherapy, Intensity-Modulated/methods
