Update on the management of elderly patients with colorectal cancer

Colorectal cancer (CRC) is one of the most common tumours worldwide, and 70% of CRC patients are over 65 years of age. However, the scientific evidence available for these patients is poor, as they are underrepresented in clinical trials. Therefore, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours, (TTD) and the Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD) have reviewed the scientific evidence available in older patients with CRC. This group of experts recommends a multidisciplinary approach and geriatric assessment (GA) before making a therapeutic decision because GA predicts the risk of toxicity and survival and helps to individualize treatment. In addition, elderly patients with localized CRC should undergo standard cancer resection, preferably laparoscopically. The indication for adjuvant chemotherapy (CT) should be considered based on the potential benefit, the risk of recurrence, the life expectancy and patient comorbidities. When the disease is metastatic, the possibility of radical treatment with surgery, radiofrequency (RF) or stereotactic body radiation therapy (SBRT) should be considered. The efficacy of palliative CT is similar to that seen in younger patients, but elderly patients are at increased risk of toxicity. Clinical trials should be conducted with the elderly population and include GAs and specific treatment plans (AU)

Update on the management of elderly patients with colorectal cancer.

Colorectal cancer (CRC) is one of the most common tumours worldwide, and 70% of CRC patients are over 65 years of age. However, the scientific evidence available for these patients is poor, as they are underrepresented in clinical trials. Therefore, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours, (TTD) and the Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD) have reviewed the scientific evidence available in older patients with CRC. This group of experts recommends a multidisciplinary approach and geriatric assessment (GA) before making a therapeutic decision because GA predicts the risk of toxicity and survival and helps to individualize treatment. In addition, elderly patients with localized CRC should undergo standard cancer resection, preferably laparoscopically. The indication for adjuvant chemotherapy (CT) should be considered based on the potential benefit, the risk of recurrence, the life expectancy and patient comorbidities. When the disease is metastatic, the possibility of radical treatment with surgery, radiofrequency (RF) or stereotactic body radiation therapy (SBRT) should be considered. The efficacy of palliative CT is similar to that seen in younger patients, but elderly patients are at increased risk of toxicity. Clinical trials should be conducted with the elderly population and include GAs and specific treatment plans.

Maintenance of angiogenesis inhibition with aflibercept after progression to bevacizumab in metastatic colorectal cancer: real life study in the Valencian community

Introduction The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. Patients and methods This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. Result 122 patients with a median age of 61 years were included. 89% of patients had PS 0–1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74–6.15 months) and 10.15 (95% CI 7.47–12.82 months), respectively. Disease control rate 59.8%. The most common grade 3–4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58–17.32) in patients with hypertension vs 7.78 (95% CI 5.02–10.54) in patients without hypertension (p = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. Conclusions Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response (AU)

ALPPS monosegmento: una nueva variante de las técnicas de regeneración hepática rápida. Revisión crítica de los resultados iniciales de nuestra serie / Monosegment ALPPS: A new variant of the techniques for rapid hepatic regeneration. Critical review of the initial results of our series

La hepatectomía secuencial, descrita en la literatura anglosajona con el acrónimo ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) es una técnica novedosa que ofrece un crecimiento rápido y efectivo del volumen remanente hepático, y que permite la resección quirúrgica de lesiones hepáticas consideradas inicialmente irresecables. Los resultados a corto y largo plazo y la conveniencia de realizar esta técnica son cuestiones que permanecen en discusión a la espera de los resultados finales de los registros multicéntricos. El objetivo del presente trabajo es la revisión crítica de los resultados de la serie de casos realizados en nuestro centro (n = 8). Por otra parte, es posible con esta técnica dejar un único segmento hepático como remanente y realizamos una descripción de esta variante técnica novedosa (ALPPS monosegmento), llevada a cabo en uno de los casos

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel surgical technique that provides fast and effective growth of liver remnant volume, allowing surgical resection of hepatic lesions initially considered unresectable. Short and long-term results and the convenience of carrying out this technique are issues that still remain under debate while waiting for the final outcomes of the multicenter registries with larger number of cases. The aim of this paper is to describe, from a critical point of view, the outcomes of the cases performed at our center (n = 8). On the other hand, it is possible to leave only one hepatic segment as a liver remnant and we illustrate this new surgical procedure (ALPPS monosegment) performed in one patient

Monosegment ALPPS: A new variant of the techniques for rapid hepatic regeneration. Critical review of the initial results of our series.

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel surgical technique that provides fast and effective growth of liver remnant volume, allowing surgical resection of hepatic lesions initially considered unresectable. Short and long-term results and the convenience of carrying out this technique are issues that still remain under debate while waiting for the final outcomes of the multicenter registries with larger number of cases. The aim of this paper is to describe, from a critical point of view, the outcomes of the cases performed at our center (n=8). On the other hand, it is possible to leave only one hepatic segment as a liver remnant and we illustrate this new surgical procedure (ALPPS monosegment) performed in one patient.

Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience.

INTRODUCTION: Recent studies have suggested a rise in the incidence of testicular germ-cell tumors (TGTs) in the last years, mainly due to an increase of early stage cases. We analysed the time trends in biological features of these patients in order to confirm this tendency in our environment. MATERIALS AND METHODS: The clinical records of 136 consecutive patients with TGTs treated at a single institution over a 20-year period (1984-2003) were retrospectively reviewed. Pathological, clinical, therapeutic and outcome data were collected. Patients were allocated into four consecutive 5- year intervals and their characteristics were compared by means of the chi-squared test. The survival analysis was performed with the method of Kaplan and Meier. RESULTS: A progressive increase in the incidence of new cases, and a more frequent diagnosis of stage I versus stage II-IV disease was confirmed within this time period. It was also observed a greater use of postorchiectomy chemotherapy, mainly due to an increase in the adjuvant indications. A significant decrease in the recurrence rate was noted. Ten-year overall survival was 86.5%. There was a trend for improved outcome, but the differences among the two decades were not statistically significant. CONCLUSIONS: A real increase in the incidence of TGTs and in the proportion of early stages was confirmed. This may be due to an epidemiological change or to an earlier diagnosis. This new pattern is associated with a more frequent use of adjuvant chemotherapy and with a reduction in the relapse rate.

Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience

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Introduction. Recent studies have suggested a risein the incidence of testicular germ-cell tumors(TGTs) in the last years, mainly due to an increaseof early stage cases. We analysed the time trendsin biological features of these patients in order toconfirm this tendency in our environment.Materials and methods. The clinical records of136 consecutive patients with TGTs treated at asingle institution over a 20-year period (1984-2003)were retrospectively reviewed. Pathological, clinical,therapeutic and outcome data were collected.Patients were allocated into four consecutive 5-year intervals and their characteristics were comparedby means of the chi-squared test. The survivalanalysis was performed with the method ofKaplan and Meier.Results. A progressive increase in the incidence ofnew cases, and a more frequent diagnosis of stageI versus stage II-IV disease was confirmed withinthis time period. It was also observed a greater useof postorchiectomy chemotherapy, mainly due toan increase in the adjuvant indications. A significantdecrease in the recurrence rate was noted.Ten-year overall survival was 86.5%. There was atrend for improved outcome, but the differencesamong the two decades were not statistically significant.Conclusions. A real increase in the incidence of TGTsand in the proportion of early stages was confirmed.This may be due to an epidemiological change or toan earlier diagnosis. This new pattern is associatedwith a more frequent use of adjuvant chemotherapyand with a reduction in the relapse rate

Carboplatin and tegafur-uracil concomitant with standard radiotherapy in the management of locally advanced head and neck cancer.

INTRODUCTION: We undertook a prospective study to determine the feasibility, toxicity, response and survival rate of simultaneous chemotherapy (CT) and radiotherapy (RT) for locally-advanced head and neck cancer. MATERIAL AND METHODS: Fifty eight patients were treated with carboplatin (i.e. 100 mg/m(2)) weekly, tegafur-uracil (UFT) (oral 400 mg/m(2)) daily and simultaneous treatment with a cobalt-60 source of radiation (total dose 65-70 Gy). RESULTS: Forty six patients (79%) received the total dose of RT while CT was delayed or reduced in 31 patients (53%). Grade 3-4 toxicity observed was mucositis in 27 (47%), leukopenia in 10 (17%), anaemia in 5 (9%), and diarrhoea in 4 (7%) patients. The objective response rate was 74%; 24 complete response (41%) and 19 partial response (33%). Overall, there are 11 patients (19%) disease-free, 7 (12%) alive with disease, 35 have died of progressive disease (60%) and 3 (5%) from other causes. There were 2 toxic deaths (3%). Median time to progression was 10 months and median survival was 18.4 months. CONCLUSIONS: The use of carboplatin and UFT concomitant with radiotherapy has, in our study, a slightly lower activity than other chemo-radiotherapy protocols, especially with respect to complete responses, but with no significant differences in overall survival or disease-free survival rates.

Carboplatin and tegafur-uracil concomitant with standard radiotherapy in the management of locally advanced head and neck cancer

Introducción. Presentamos un estudio para determinan la toxicidad y actividad tanto en respuesta como en supervivencia de un esquema de quimioterapia (QT) concomitante con radioterapia (RT) en pacientes con tumores localmente avanzados de cabeza y cuello. Material y métodos. Cincuenta y ocho pacientes recibieron tratamiento con carboplatino 100 mg/m² por vía intravenosa semanal y tegafur-uracilo (UFT) 400 mg/m² por vía oral diario junto a radioterapia mediante fuentes de Cobalto-60 (dosis total de 65-70 Gy). Resultados. Cuarenta y seis pacientes (79%) recibieron la dosis completa de RT y la QT debió retraerse o reducirse en 31 pacientes (53%). La toxicidad grado 3-4 fue mucositis en 27 pacientes (47%), leucopenia en 10 (17%), anemia en 5 (9%), y diarrea en 4 (7%). La tasa de respuesta objetiva fue de un 74% con 24 respuestas completas (41%) y 19 respuestas parciales (33%). Once pacientes (19%) permanecen libres de enfermedad y 7 (12%) están vivos con enfermedad. Treinta y cinco han muerto por la enfermedad (60%), 3 (5%) por otras causas y hubo 2 muertes por toxicidad (3%). La mediana de tiempo a la progresión fue de 10 meses y la mediana de supervivencia fue de 18.4 meses. Conclusiones. El uso de carboplatino y UFT concomitante con RT presenta una menor actividad que otros esquemas de QT/RT sobre todo en la capacidad de lograr respuestas completas; de cualquier manera ello no parece influir en la supervivencia global o en la supervivencia libre de enfermedad

Introduction. We undertook a prospective study to determine the feasibility, toxicity, response and survival rate of simultaneous chemotherapy (CT) and radiotherapy (RT) for locally-advanced head & neck cancer. Material and methods. Fifty eight patients were treated with carboplatin (i.e. 100 mg/m²) weekly, tegafur-uracil (UFT) (oral 400 mg/m²) daily and simultaneous treatment with a cobalt-60 source of radiation (total dose 65-70 Gy). Results. Forty six patients (79%) received the total dose of RT while CT was delayed or reduced in 31 patients (53%). Grade 3-4 toxicity observed was mucositis in 27 (47%), leukopenia in 10 (17%), anaemia in 5 (9%), and diarrhoea in 4 (7%) patients. The objective response rate was 74%; 24 complete response (41%) and 19 partial response (33%). Overall, there are 11 patients (19%) disease-free, 7 (12%) alive with disease, 35 have died of progressive disease (60%) and 3 (5%) from other causes. There were 2 toxic deaths (3%). Median time to progression was 10 months and median survival was 18.4 months. Conclusions. The use of carboplatin and UFT concomitant with radiotherapy has, in our study, a slightly lower activity than other chemo-radiotherapy protocols, especially with respect to complete responses, but with no significant differences in overall survival or disease-free survival rates