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1.
Isr Med Assoc J ; 23(12): 805-810, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34954921

RESUMO

BACKGROUND: For locally advanced rectal cancer patients a watch-and-wait strategy is an acceptable treatment option in cases of complete tumor response. Clinicians need robust methods of patient selection after neoadjuvant chemoradiation. OBJECTIVES: To predict pathologic complete response (pCR) using computer vision. To analyze radiomic wavelet transform to predict pCR. METHODS: Neoadjuvant chemoradiation for patients with locally advanced rectal adenocarcinoma who passed computed tomography (CT)-based simulation procedures were examined. Gross tumor volume was examind on the set of CT simulation images. The volume has been analyzed using radiomics software package with wavelets feature extraction module. Statistical analysis using descriptive statistics and logistic regression was performed was used. For prediction evaluation a multilayer perceptron algorithm and Random Forest model were used. RESULTS: In the study 140 patients with II-III stage cancer were included. After a long course of chemoradiation and further surgery the pathology examination showed pCR in 38 (27.1%) of the patients. CT-simulation images of tumor volume were extracted with 850 parameters (119,000 total features). Logistic regression showed high value of wavelet contribution to model. A multilayer perceptron model showed high predictive importance of wavelet. We applied random forest analysis for classifying the texture and predominant features of wavelet parameters. Importance was assigned to wavelets. CONCLUSIONS: We evaluated the feasibility of using non-diagnostic CT images as a data source for texture analysis combined with wavelets feature analysis for predicting pCR in locally advanced rectal cancer patients. The model performance showed the importance of including wavelets features in radiomics analysis.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia/métodos , Neoplasias Retais/terapia , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
2.
Medicina (Kaunas) ; 57(12)2021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34946279

RESUMO

Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V45Gy < 195 ccm in three cases for 54.0 Gy and V15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed.


Assuntos
Adenocarcinoma , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Quimiorradioterapia , Junção Esofagogástrica/diagnóstico por imagem , Humanos , Estudos Prospectivos , Planejamento da Radioterapia Assistida por Computador
3.
Gan To Kagaku Ryoho ; 48(12): 1515-1517, 2021 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-34911922

RESUMO

A 72-year-old man had a chief complaint of anal pain and difficulty in defecation. He was diagnosed with adenocarcinoma by biopsy from a tumor of the anal canal. A computed tomography scan revealed neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa anal canal cancer. Preoperative capecitabine- based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. Digital rectal examination and imaging evaluation 8 weeks after preoperative CRT revealed that the tumor had shrunk. Fifteen weeks after preoperative CRT, laparoscopic abdominoperineal resection was performed. The pathological findings showed mucinous adenocarcinoma associated with anal fistula. At present, 12 months after the operation, no local recurrence and distant metastasis has been detected under follow-up evaluations.


Assuntos
Adenocarcinoma , Laparoscopia , Protectomia , Fístula Retal , Neoplasias Retais , Adenocarcinoma/cirurgia , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia , Humanos , Masculino , Fístula Retal/cirurgia , Fístula Retal/terapia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia
4.
Medicina (Kaunas) ; 57(11)2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34833456

RESUMO

BACKGROUND: Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases. CASE PRESENTATION: We report the case of a 60-year-old man who complained of a right-sided headache, blurred vision, progressive proptosis, ptosis, and right eye pain for 3 months. His past medical history included an ampullary adenocarcinoma stage IIIA treated via the Whipple procedure and adjuvant chemoradiotherapy 1 year ago. However, he was lost to follow-up. Computed tomography of the orbit showed a soft tissue lesion in the right orbital fossa measuring 3.3 × 2 × 2 cm. An orbital mass biopsy demonstrated an intestinal-type adenocarcinoma that tested positive for cytokeratins 7 and 20 and CDX2 on immunohistochemical staining. The pathologic diagnosis was metastatic adenocarcinoma from the ampulla of Vater. Despite oncological treatment, the patient's illness progressed. He received palliative treatment and died 1 month later. CONCLUSIONS: We presented a rare case of orbital metastasis from ampullary adenocarcinoma. This should be considered in the differential diagnosis of patients with a history of ampullary adenocarcinoma who present with symptoms referring to the relevant locations.


Assuntos
Adenocarcinoma , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Pancreáticas , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Ampola Hepatopancreática/diagnóstico por imagem , Neoplasias do Ducto Colédoco/diagnóstico por imagem , Neoplasias do Ducto Colédoco/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia
5.
Clin Adv Hematol Oncol ; 19(11): 711-718, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34807016

RESUMO

The treatment of locally advanced rectal cancer has improved over the years owing to advancements in surgical techniques and chemoradiation, developing into a multidisciplinary approach that has contributed to markedly reduced rates of local recurrence. Despite these advances, however, distant metastatic recurrence continues to be the main cause of rectal cancer-related death. Unfortunately, the former standard of care of neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy is still associated with significant morbidity and distant relapse rates. Many trials have studied the optimal sequence, timing, and duration of the individual components of treatment, more recently shifting both chemoradiation and systemic chemotherapy to the preoperative setting in an approach termed total neoadjuvant therapy (TNT). Some of the potential advantages of TNT include improved adherence to treatment, early treatment of micrometastases, and tumor downstaging, with the possibility of observation instead of surgery for those patients with a complete clinical response. This review provides the historical context for the shift to TNT in the treatment paradigm and discusses the critical clinical trials supporting the newer strategy. It also addresses the recent focus on the personalization of care that TNT makes possible by allowing the selective omission of radiation therapy and nonoperative management with a watch-and-wait strategy.


Assuntos
Adenocarcinoma , Neoplasias Retais , Adenocarcinoma/terapia , Quimiorradioterapia , Humanos , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , Resultado do Tratamento
6.
Anticancer Res ; 41(11): 5593-5598, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732430

RESUMO

BACKGROUND/AIM: To explore the prognostic value of lower urinary tract symptoms (LUTS) in patients with newly diagnosed regional lymph node-positive prostate cancer. PATIENTS AND METHODS: The prognostic value of LUTS for progression-free (PFS) and overall (OS) survival, as well as the differential prognostic impact of radiotherapy by LUTS was investigated. RESULTS: Univariate Cox-model analysis showed a statistically significantly increased hazard risk for PFS and OS for men with International Prostate Symptom Score (IPSS)≥19 and Overactive Bladder Symptom Score (OABSS) ≥8 at diagnosis. Patients with lower IPSS had a better PFS at 5 years (70.0% vs. 51.9%, p=0.027) and OS at 5 year (89.3% vs. 73.6%, p=0.016). Similarly, a lower OABSS was associated with greater PFS at 5 years (67.4% vs. 23.4%, p<0.001) and OS at 5 years (85.3% vs. 57.1%, p=0.012). CONCLUSION: IPSS and OABSS were prognostic for PFS and OS in patients with regional lymph node-metastatic prostate cancer.


Assuntos
Adenocarcinoma/complicações , Sintomas do Trato Urinário Inferior/etiologia , Linfonodos/patologia , Neoplasias da Próstata/complicações , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Idoso , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/mortalidade , Sintomas do Trato Urinário Inferior/terapia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
7.
Anticancer Res ; 41(11): 5855-5861, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732462

RESUMO

BACKGROUND: Large numbers of synchronous colorectal liver metastases are associated with poor prognosis. CASE REPORT: A 47-year-old male patient with rectal cancer and unresectable colorectal liver metastases (over 15 cm in diameter and over 30 metastases) was treated with a multidisciplinary treatment including systemic chemotherapy with mFOLFOX6/panitumumab and surgical therapies (colostomy, modified associating liver partition and portal vein ligation for staged hepatectomy together with radiofrequency ablation). For solitary recurrent colorectal liver metastases, percutaneous radiofrequency ablation with chemoembolization and open radiofrequency ablation in combination with the same systemic chemotherapy was performed. Since the diagnosis 3 years ago, he has been leading a good quality of life, free of any tumor or treatment. CONCLUSION: For patients with far-advanced but liver-only colorectal liver metastases, surgical therapy, systemic chemotherapy, and interventional treatment can be important for achieving good prognosis.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante , Veia Porta/cirurgia , Ablação por Radiofrequência , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante , Colostomia , Humanos , Ligadura , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Resultado do Tratamento
8.
Medicine (Baltimore) ; 100(40): e27348, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622834

RESUMO

RATIONALE: Colorectal mixed neuroendocrine-nonneuroendocrine neoplasms constitute a rare group of gastrointestinal tumors composed by both neuroendocrine and nonneuroendocrine components. Nondiagnostic macroscopic features, specific histological features, and poor awareness of the disease are responsible for the underestimated incidence and conflicting data available. Due to lack of randomized clinical trials and validated clinical guidelines, diagnostic and therapeutic approach are based on the standard of care for pure colorectal neuroendocrine carcinomas or adenocarcinomas. PATIENT CONCERNS: A 76-year-old caucasian male, without relevant medical or familial history, presented a positive faecal occult blood test during colorectal cancer screening. DIAGNOSIS: Total colonoscopy identified a rectal lesion with biopsy showing a moderate rectal adenocarcinoma staged as cT2N0M0. INTERVENTIONS: Anterior resection of the rectum with right ileostomy followed by local radiotherapy with radio-sensitising chemotherapy and adjuvant chemotherapy with capecitabine 1000 mg bid plus oxaliplatin 130 mg/m2. Due to chronic nodular pulmonary aspergillosis and chemotherapy induced immunosuppression patient was on 400 mg/daily of oral voriconazole. OUTCOMES: Overall survival of 15 months after progression under first line treatment and under palliative chemotherapy with platinum plus etoposide regimen. LESSONS: The reported case illustrates the challenge associated to the management of mixed neuroendocrine-nonneuroendocrine carcinomas due to lack of validated guidelines and scientific evidence. From diagnosis and staging to treatment, all steps must be tailored to individual clinical and histological features.


Assuntos
Adenocarcinoma/patologia , Tumor Misto Maligno/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Retais/patologia , Adenocarcinoma/terapia , Idoso , Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Capecitabina/administração & dosagem , Evolução Fatal , Humanos , Masculino , Tumor Misto Maligno/terapia , Tumores Neuroendócrinos/terapia , Oxaliplatina/administração & dosagem , Radioterapia , Neoplasias Retais/terapia , Reto/cirurgia
9.
Int J Mol Sci ; 22(19)2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34638639

RESUMO

The standard treatment of locally advanced esophageal cancer comprises multimodal treatment concepts including preoperative chemoradiotherapy (CRT) followed by radical surgical resection. However, despite intensified treatment approaches, 5-year survival rates are still low. Therefore, new strategies are required to overcome treatment resistance, and to improve patients' outcome. In this study, we investigated the impact of Wnt/ß-catenin signaling on CRT resistance in esophageal cancer cells. Experiments were conducted in adenocarcinoma and squamous cell carcinoma cell lines with varying expression levels of Wnt proteins and Wnt/ß-catenin signaling activities. To investigate the effect of Wnt/ß-catenin signaling on CRT responsiveness, we genetically or pharmacologically inhibited Wnt/ß-catenin signaling. Our experiments revealed that inhibition of Wnt/ß-catenin signaling sensitizes cell lines with robust pathway activity to CRT. In conclusion, Wnt/ß-catenin activity may guide precision therapies in esophageal carcinoma patients.


Assuntos
Resistencia a Medicamentos Antineoplásicos/genética , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/terapia , Proteínas Wnt/genética , Via de Sinalização Wnt/genética , beta Catenina/genética , Adenocarcinoma/genética , Adenocarcinoma/terapia , Linhagem Celular Tumoral , Quimiorradioterapia/métodos , Carcinoma de Células Escamosas do Esôfago/genética , Carcinoma de Células Escamosas do Esôfago/terapia , Humanos
10.
J Med Case Rep ; 15(1): 486, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34598716

RESUMO

INTRODUCTION: Metastases to the female genital tract from extragenital primary tumors are unusual. We report a rare case of uterine cervix metastasis from colon adenocarcinoma and discuss diagnostic and therapeutic issues. CASE REPORT: We report a case of a 38-year-old North African Caucasian woman treated for a non-metastatic colon adenocarcinoma. She had a sigmoidectomy and incomplete adjuvant chemotherapy. Six months later, she consulted with vaginal bleeding caused by a cervical tumor, which was confirmed to be metastatic disease, and the patient underwent decompressive and hemostatic radiotherapy. CONCLUSION: Uterine cervix metastasis from primary colon adenocarcinoma is rare. The resection remains the standard protocol for the local treatment of resectable metastatic disease. Otherwise, systemic therapy is the preferable option.


Assuntos
Adenocarcinoma , Carcinoma , Neoplasias do Colo , Neoplasias do Colo do Útero , Adenocarcinoma/terapia , Adulto , Neoplasias do Colo/terapia , Feminino , Humanos , Neoplasias do Colo do Útero/terapia
11.
Trials ; 22(1): 753, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717717

RESUMO

BACKGROUND: Survival benefit of adjuvant radiotherapy for locally advanced gastric cancer following gastrectomy plus D2 lymphadenectomy has always been controversial. Esophagogastric junction (EGJ) adenocarcinoma, which is usually classified as gastric cancer in East Asia, often has a higher locoregional recurrence rate after operation because of its special anatomical characteristics. The aim of this study is to determine whether adjuvant radiotherapy can improve survival of locally advanced EGJ adenocarcinoma after D2 radical resection. METHODS: In this phase III, randomized, open label, controlled trial, we plan to recruit 378 patients with Siewert type II and III adenocarcinoma of EGJ, who had undergone transabdominal radical surgery and D2 lymphadenectomy, and were divided into pathological stage IIB to IIIC. All patients will be randomized 1:1 to receive either adjuvant chemotherapy alone (control group) or adjuvant chemotherapy plus chemoradiotherapy (experimental group). Patients allocated to control group will receive eight cycles of S-1 plus oxaliplatin (SOX), while the experimental group will receive two cycles of SOX followed by 45-Gy RT combined with S-1 and four additional cycles of SOX. The primary endpoint is 3-year disease-free survival rate (DFS). The secondary endpoints are 3-year overall survival rate (OS), 3-year locoregional recurrence-free survival rate (LRFS), 3-year distant metastasis-free survival rate (DMFS), and quality of life (QoL). DISCUSSION: In the past, the adjuvant treatment of EGJ adenocarcinoma needs to draw on the experience of esophageal adenocarcinoma or gastric adenocarcinoma. In this study, EGJ adenocarcinoma is considered as an independent disease, and the conclusion will provide evidence for optimal adjuvant therapy of locally advanced EGJ adenocarcinoma after D2 radical resection. TRIAL REGISTRATION: ClinicalTrials.gov NCT03973008 . Registered on 1 June 2019 (retrospectively registered), URL: https://clinicaltrials.gov/ct2/show/NCT03973008?term=NCT03973008&draw=2&rank=1.


Assuntos
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante , Ensaios Clínicos Fase III como Assunto , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Humanos , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Oxaliplatina/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
12.
Medicine (Baltimore) ; 100(38): e27366, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559161

RESUMO

ABSTRACT: To determine the clinical and pathological outcome of locally advanced rectal cancer patients treated with neoadjuvant chemoradiation (chemoradiotherapy [CRT]) followed by curative surgery and to identify predictive factors of pathological complete response (pCR).Locally advanced rectal cancer patients undergoing CRT followed by curative surgery from January 2012 to December 2017 were included. Patient's demographic data, pretreatment tumor characteristics, type of CRT regimens, type of surgery, postoperative complications, pathological reports and follow up records were analyzed. Univariate and multivariate analyses were applied to identify predictive factors for pCR. Five-year disease free and overall survival were estimated by Kaplan-Meier method and compared between pCR and non-pCR groups.A total of 85 patients were analyzed. Eighteen patients (21.1%) achieved pCR. The sphincter-saving surgery rate was 57.6%. After univariate analyses, tumor length >4 cm (P = .007) and positive lymph nodes (P = .040) were significantly associated with decreased rate of pCR. Complete clinical response was significantly associated with higher rate of pCR (P = .015). Multivariate analyses demonstrated that tumor length >4 cm (P = .010) was significantly associated with decreased rate of pCR. After a median follow-up of 65 months (IQR 34-79), the calculated 5-year overall survival and disease-free survival rates were 81.4% and 69.7%, respectively. Patients who achieved pCR tend to had longer 5-year disease-free survival (P = .355) and overall survival (P = .361) than those who did not.Tumor length >4 cm was associated with decreased rate of pCR in locally advanced rectal cancer who had CRT followed by surgery. Longer waiting time or more intense adjuvant treatment may be considered to improved pCR and oncological outcomes.


Assuntos
Adenocarcinoma/terapia , Terapia Neoadjuvante , Neoplasias Retais/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protectomia/estatística & dados numéricos , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Tailândia/epidemiologia
14.
Eur J Radiol ; 144: 109963, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34562744

RESUMO

PURPOSE: This study aimed to evaluate the potential role of diffusion kurtosis imaging (DKI)-derived parameters for assessing resistance to CRT in patients with Locally advanced rectal cancer (LARC) by using histogram analysis derived from whole-tumor volumes. METHOD: 136 consecutive patients with histologically confirmed rectal adenocarcinoma who underwent MRI examination before and after chemoradiotherapy were enrolled in our retrospective study. The parameters D, K, and conventional apparent diffusion coefficient (ADC) were measured using whole-tumor volume histogram analysis. The AJCC tumor regression grading (TRG) system was the standard reference (resistance: TRG 3; non-resistance: TRG 0-2). Receiver operating characteristic (ROC) curves were used for evaluating the diagnostic performance. RESULTS: Aside from the skew and kurtosis values, we found all the histogram metrics of D and ADC values significantly increased after CRT (all p < 0.001). In contrast, the histogram metrics of K values significantly decreased after CRT. The majority of percentiles metrics of D, K, and ADC values were correlated with tumor resistance before and after CRT (P < 0.05), except for the skew and kurtosis values. Regarding the comparison of the diagnostic performance of all the histogram metrics, the percentage Dmean change (ΔDmean) showed the highest AUC value of 0.939, and the corresponding sensitivity, specificity, PPV, and NPV were 84.1% and 94.6%, 88.1% and 92.6%, respectively. CONCLUSIONS: These preliminary results demonstrated that DKI-derived histogram metrics, especially the pre-treatment metrics and ΔDmean, were useful to assess tumoral resistance to CRT and individual clinical management for patients with LARC.


Assuntos
Adenocarcinoma , Neoplasias Retais , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Benchmarking , Quimiorradioterapia , Imagem de Difusão por Ressonância Magnética , Humanos , Terapia Neoadjuvante , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/terapia , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
BMJ Case Rep ; 14(9)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535493

RESUMO

Colorectal carcinoma metastases to the head and neck are exceedingly rare. Patients may present with vague symptoms that may lead to a delay in diagnosis. We report the case of a 51-year-old man with a known history of stage IIIB colorectal adenocarcinoma who presented with right-sided molar tooth bleeding and right-sided palate swelling that led to difficulty speaking, eating and weight-loss of 15 pounds. Imaging studies revealed a 3.1×4.8×3 cm mass that was centred around the posterior aspect of the maxilla. Pathology revealed moderately differentiated intestinal type adenocarcinoma of colonic subtype, immune histochemistry was positive for CDX2, CK20 and MUC2, thus confirming metastatic disease to the maxilla. The patient is undergoing chemoradiation therapy for palliation of his symptoms. Clinicians should be aware of this potentional site of metastatic disease and suspect the diagnosis in a timely manner to avoid delays in making a diagnosis.


Assuntos
Adenocarcinoma , Neoplasias Colorretais , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Humanos , Masculino , Seio Maxilar , Pessoa de Meia-Idade
16.
Arab J Gastroenterol ; 22(3): 240-245, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34531134

RESUMO

Small bowel adenocarcinomas (SBAs) are rare tumors of the gastrointestinal tract. Patients often present with advanced disease due to nonspecific symptoms and delayed diagnoses. In combination with non-uniform treatment paradigms, patients who present with SBA often have poor prognoses. In this case series, we present four cases of SBA and review the most recent literature with regard to diagnosis and management. One patient presented with iron-deficient anemia (IDA), and three patients presented with clinical obstruction. The patient with IDA was subjected to protracted investigations, whereas the three patients with obstruction were diagnosed quickly after presentation. All four patients underwent surgical resection, and one patient was eligible for post-operative adjuvant chemotherapy. SBA should be highly suspected in patients who present with occult gastrointestinal bleeds, and appropriate investigations must be initiated. Following diagnosis, surgical resection is the mainstay of treatment for this disease. Our review supports the use of both neoadjuvant and adjuvant chemotherapy in localized disease.


Assuntos
Adenocarcinoma , Neoplasias Duodenais , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Quimioterapia Adjuvante , Hemorragia Gastrointestinal , Humanos , Período Pós-Operatório
18.
Ann Surg ; 274(5): 743-750, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34353984

RESUMO

OBJECTIVE: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands. SUMMARY OF BACKGROUND DATA: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement. METHODS: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011-2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage. RESULTS: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P <0.001) and had higher cT-stage (cT3: 49% vs 46%, P <0.001). After adjustment for confounders, Swedish patients were less frequently allocated to curative treatment (adenocarcinoma: OR=0.31, 95%CI 0.26-0.36; SCC: OR=0.28, 95%CI 0.22-0.36). Overall survival was lower in Swedish patients (adenocarcinoma: HR=1.36, 95%CI 1.27-1.46; SCC: HR=1.38, 95%CI 1.24-1.53), also when allocated to curative treatment (adenocarcinoma: HR=1.12, 95%CI 1.01-1.24; SCC: HR=1.34, 95%CI 1.14-1.59). CONCLUSION: Swedish patients with potentially curable esophageal cancer were less frequently allocated to curative treatment, and showed lower survival compared to Dutch patients. The less pronounced inter-country survival difference after curative treatment suggests that the overall survival difference could at least partly be due to relative undertreatment of Swedish patients. Shared curative treatment thresholds across Europe may help improve survival of esophageal cancer patients.


Assuntos
Adenocarcinoma/terapia , Gerenciamento Clínico , Neoplasias Esofágicas/terapia , Estadiamento de Neoplasias/métodos , Sistema de Registros , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Idoso , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Países Baixos/epidemiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suécia/epidemiologia
19.
Oncoimmunology ; 10(1): 1954807, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34377591

RESUMO

Esophageal adenocarcinoma (EAC) is a disease with dismal treatment outcomes. Response to neoadjuvant chemoradiation (CRT) varies greatly. Although the underlying mechanisms of CRT resistance are not identified, accumulating evidence indicates an important role for local antitumor immunity. To explore the immune microenvironment in relation to response to CRT we performed an in-depth analysis using multiplex immunohistochemistry, flow cytometry and mRNA expression analysis (NanoString) to generate a detailed map of the immunological landscape of pretreatment biopsies as well as peripheral blood mononuclear cells (PBMCs) of EAC patients. Response to CRT was assessed by Mandard's tumor regression grade (TRG), disease-free- and overall survival. Tumors with a complete pathological response (TRG 1) to neoadjuvant CRT had significantly higher tumor-infiltrating T cell levels compared to all other response groups (TRG 2-5). These T cells were also in closer proximity to tumor cells in complete responders compared to other response groups. Notably, immune profiles of near-complete responders (TRG 2) showed more resemblance to non-responders (TRG 3-5) than to complete responders. A high CD8:CD163 ratio in the tumor was associated with an improved disease-free survival. Gene expression analyses revealed that T cells in non-responders were Th2-skewed, while complete responders were enriched in cytotoxic immune cells. Finally, complete responders were enriched in circulating memory T cells. preexisting immune activation enhances the chance for a complete pathological response to neoadjuvant CRT. This information can potentially be used for future patient selection, but also fuels the development of immunomodulatory strategies to enhance CRT efficacy.


Assuntos
Adenocarcinoma , Neoplasias Retais , Adenocarcinoma/terapia , Humanos , Leucócitos Mononucleares , Terapia Neoadjuvante , Linfócitos T , Microambiente Tumoral
20.
J Med Case Rep ; 15(1): 401, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34380562

RESUMO

BACKGROUND: Actinomycosis is a rare chronic infection caused by Actinomyces. The abdominopelvic localization of this pathology makes preoperative diagnosis extremely exceptional. The following report is the case of a patient treated for adenocarcinoma of the middle rectum associated with mesorectal actinomycosis. The diagnosis of actinomycosis was made postoperatively. CASE PRESENTATION: A 69-year-old Caucasian male patient was admitted for rectal bleeding. Clinical and paraclinical assessment revealed a middle rectum adenocarcinoma with local extension in the mesorectum. The patient underwent an anterior resection of the rectum by laparotomy after neoadjuvant chemoradiotherapy. Postoperative follow-up was simple. Pathological study of the specimen noted complete sterilization of the rectal adenocarcinoma and the presence of large foci of suppurative necrosis containing actinomycotic grains in the mesorectum. CONCLUSION: Abdominopelvic actinomycosis is a rare pathology and has therefore rarely been dealt with. This issue can lead to unnecessary and mutilating surgery. We report an exceptional coincidence of rectal adenocarcinoma and mesorectal actinomycosis mistaken for mesorectal extension of the cancer.


Assuntos
Actinomicose , Adenocarcinoma , Neoplasias Retais , Actinomicose/diagnóstico , Actinomicose/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Idoso , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Reto/cirurgia
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