Does the addition of oxaliplatin to preoperative chemoradiation benefit cT4 or fixed cT3 rectal cancer treatment? A subgroup analysis from a prospective study.

BACKGROUND: Whether there is any benefit derived from adding oxaliplatin to fluoropyrimidine-based preoperative chemoradiation is currently unknown in cases of advanced cT3 or cT4 tumours. Our aim was to evaluate this issue by analysing a randomized trial, which compared two schedules of preoperative treatment (chemoradiation vs. 5 × 5 Gy with 3 cycles of consolidation chemotherapy) for cT4 or fixed cT3 rectal cancer. PATIENTS AND METHODS: Delivery of oxaliplatin was mandatory to the first part of the study. For the second part, its delivery in both treatment-assigned groups was left to the discretion of the local investigator. We analysed a subgroup of 272 patients (136 in the oxaliplatin group and 136 in the fluorouracil-only group) from institutions that had omitted oxaliplatin in the second part of the study. RESULTS: Circumferential resection margin negative (CRM-) status rate was 68% in the oxaliplatin group and 70% in the fluorouracil-only group, p = 0.72. The pathological complete response rate (pCR) was correspondingly 14% vs. 7%, p = 0.10. Following multivariable analysis, when comparing the CRM- status in the oxaliplatin group to the fluorouracil-only group, the odds ratio was 0.79 (95 CI 0.35-1.74), p = 0.54; there being no interaction between concomitant chemoradiation and 5 × 5 Gy with consolidation chemotherapy; pinteraction = 0.073. For pCR, the corresponding results were 0.47 (95 CI 0.19-1.16), p = 0.10, pinteraction = 0.84. CONCLUSION: No benefit was found of adding oxaliplatin in terms of CRM nor pCR rates for either concomitant or sequential settings in preoperative radiochemotherapy for very advanced rectal cancer.

Bariatric surgery in Poland from 1993 to 2003.

Morbid obesity affects about 300, 000 patients in Poland. The number and type of bariatric procedures performed between 1993 and 2003 has been based on data collected from Polish surgeons active in this field. During the years 1993 - 2003, 1285 primary bariatric procedures were performed in total. Amongst these 79.1% were, commonly done as restrictive ones, including vertical banded gastroplasty-76.3%, laparoscopic adjustable gastric banding-17.7% and silastic ring vertical gastroplasty-5.5% and at last non-adjustable gastric band with 0.5%. Less popular are malabsorptive procedures - 20.9%, with Roux-en-Y gastric bypass - 79.1% and biliopancreatic diversion 20.9%. During last year 2003: malabsorptive procedures represented one third of all primary procedures and the laparoscopic approach was utilised in 18 % of operations. 61 revisions were reported. There are only three centres with experience in treating more than 100 patients (one of them treated over 600). Two centres have experience in carrying out bariatric surgery for longer than five years. During 1993 - 1997 216 operations were performed. Between 1998 - 2002: 724 procedures, and during last year 345. Patients were treated during last year in ten surgical departments. The number of morbidly obese patients treated surgically in Poland is increasing, but it is still inadequate to meet the growing demand.