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1.
Medicine (Baltimore) ; 99(5): e19028, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000450

RESUMO

INTRODUCTION: Anorectal malignant melanoma (AMM) is a rare and aggressive malignance with poor prognosis, yet no consensus of treatment exists to date. Abdominoperineal resection surgery (APR) is the standard treatment of anorectal malignant melanoma, capable of controlling lymphatic spread and obtaining a large negative margin for local control but it can lead to complications. Wide local excision (WLE) allows for quicker recovery and has minimal impact on bowel function (i.e., bypassing the need for a stoma). PATIENT CONCERNS: A 66-year-old male patient presented with a 2-months history of painless rectal bleeding. DIAGNOSIS: The characteristic finding from colonoscopy and magnetic resonance imaging led to a diagnosis of colorectal cancer. Immunohistochemistry analyses confirmed malignant melanoma. The tumor was classified as: HMB-45(+), S-100(+), CD117(±), PCK(-), ki-67(+, 10%). INTERVENTIONS: The patient underwent abdominoperineal resection with no other adjuvant therapy. OUTCOMES: The patient is doing well at 24 month after the operation, with no signs of recurrence. CONCLUSION: AMM is a rare malignance, and is easy to misdiagnose. The therapy approach remains controversial. Every effort should be made to ensure prompt diagnosis and to define the optimally effective standard therapy approach.


Assuntos
Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Idoso , Colonoscopia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 1-9, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958923

RESUMO

Patients with clinical complete response(cCR) after neoadjuvant treatment receiving the Watch and Wait('W&W') policy can achieve similar survival of those with yeild pathological complete response (ypCR), and have significantly improved quality of life compared to those undergoing radical operation. Based on thoroughly reviewing the literatures and guidelines at home and abroad, and referring associated clinical experiences from a lot of domestic medical centers, the present version of Chinese Consensus on W&W was established by a panel of many experts of gastrointestinal surgery, medical oncology, radiation oncology, pathology, endoscopy, radiology. This consensus mainly elucidates important conceptions of the W&W policy, current key evidences, risks and benefits for patients, conditions to carry out W&W, criteria of cCR diagnosis, timing of evaluation, follow - up plan, salvage treatment for local relapse and distant metastasis, associated problems of local resection, and is expected to facilitate the clinical practice and research of W&W policy in China.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais/terapia , Conduta Expectante , China , Consenso , Humanos , Guias de Prática Clínica como Assunto , Qualidade de Vida , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Indução de Remissão/métodos , Resultado do Tratamento
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 15-19, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958925

RESUMO

Although the surgical treatment of colorectal disease progresses slowly, with the advancement of minimally invasive surgical techniques, perioperative comprehensive treatment strategies and clinical research in recent years, Chinese colorectal surgery has developed rapidly. Transanal total mesorectal excision, lateral pelvic lymph node dissection,"watch and wait"strategy for clinical complete response of neoadjuvant radiotherapy for rectal cancer, and robotic colorectal surgery are still hot topics in colorectal surgery in recent years. The construction of clinical registry database and clinical research for colorectal cancer surgery are discussed, with a view to combing the development of colorectal surgery for colleagues in the surgical field, and to seek the development of colorectal surgery in China.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/tendências , China , Neoplasias Colorretais/terapia , Terapia Combinada/tendências , Humanos , Laparoscopia/tendências , Excisão de Linfonodo , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos/tendências , Conduta Expectante
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 56-64, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958932

RESUMO

Objective: To explore the application of endoscopic tattooing with carbon nanoparticles in the treatment of advanced colorectal cancer (ACRC). Methods: A randomized controlled study was used. Inclusion criteria: (1) age more than 18 years old, and colorectal cancer was found for the first time and confirmed by colonoscopy and biopsy; (2) advanced colorectal cancer (preoperative TNM stage of T3/N1 or above, local unresectable lesion, M1 stage and simultaneously resectable metastatic lesion), and patients agreed to receive neoadjuvant therapy; (3) advanced colorectal cancer (TNM stage of T3/N1 or above) with simultaneous unresectable metastatic lesion, and patients refused operation and consented to chemoradiotherapy. Patients with previous abdominal surgery history, radiotherapy and chemotherapy history, urgent need for surgery or endoscopic stent placement and those with severe allergic constitution were excluded. Based on the above criteria, 120 patients diagnosed with ACRC in No.900 Hospital of the Joint Logistics Team from January 2016 to December 2017 were prospectively enrolled and randomly divided into tattoo group and non-tattoo group by random number table method. Tattoo group were tattooed within 1-7 days before chemoradiotherapy. The labeling location of the lesions: (1) if the colonoscopy could pass smoothly, 4 points were injected into the intestinal wall of the both opposite sides 1 cm cephalad and caudad of the tumor; (2) if the colorectal cavity was severely narrow and the colonoscopy could not pass, only 4 points were injected in 4 quadrants at 1 cm caudad of the tumor. Each injection point was injected with 0.1 ml carbon nanoparticles, and the size of the tumor was measured according to the range of carbon nanoparticles staining. The efficacy was evaluated after 8 weeks of chemoradiotherapy. Patients who were defined to be suitable for operation underwent operation 6 weeks after chemoradiotherapy. The following parameters were compared between two groups: lesion identification time, operation time, blood loss, distance from lesion to distal margin, the rate of first positive margin and the rate of anal sphincter preservation (rectal cancer). Among patients who had been evaluated as having no indication for surgery, those who were effective in chemoradiotherapy continued to receive chemotherapy in the original regimen; if the treatment failed, the chemotherapy regimen was replaced, and the efficacy was finally evaluated after six months [referring to the revised RECIST guidelines (version 1.1)]. Results: Three patients withdrew from this study, and 117 patients were enrolled in this study finally, including 59 cases in tattoo group and 58 cases in the non-tattoo group. There were no significant differences in baseline data between two groups (all P>0.05). All the patients had slight adverse reactions of radiotherapy and chemotherapy before operation, and could tolerate after symptomatic management without interruption of treatment. All the patients in the tattoo group had no discomfort such as fever, abdominal pain, abdominal distention, hematochezia, etc. and the intestinal mucosa could be seen clearly with black staining after being tattooed. A total of 77 patients were evaluated with surgical indications, including 39 cases in the tattoo group (tattoo-operable) and 38 cases in the non-tattoo group (non-tattoo-operatable). There were no significant differences in baseline data between the two groups (all P>0.05). Forty patients without operation indications continued chemoradiotherapy, including 20 cases in tattoo group (tattoo-inoperable) and 20 cases in non-tattoo group (non-tattoo-inoperable), whose differences in baseline data between the two groups were not significant as well (all P>0.05). No obvious edema, necrosis or abscess were found in the tattooed segments and the black spots could be seen quickly and clearly on the serosa of rectum in tattoo-operable patients. As compared to non-tattoo group, tattoo group had significantly shorter lesion identification time [(3.4±1.4) minutes vs. (11.8±3.4) minutes, t=-14.07,P<0.001], shorter operation time [(155.7±44.5) minutes vs. (177.2±30.2) minutes, t=-2.48,P=0.015], less blood loss [(101.3±36.7) ml vs.(120.2±38.2) ml, t=-2.22,P=0.029], shorter distance from lesion to distal margin [(3.7±1.0) cm vs. (4.6±1.7) cm, t=-2.20, P=0.034], while tattoo group had slightly higher rate of anal sphincter preservation [66.7%(16/24) vs. 45.5%(10/22), χ(2)=2.10,P=0.234] and lower rate of first positive resection margin [0 vs. 4.5%(1/22), χ(2)=0.62,P=0.480], but their differences were not significant. There were no significant differences in the degree of tumor differentiation and TNM stage between two groups. Patients without operative indication were evaluated for efficacy of chemoradiotherapy again after half a year. One case of complete response (CR), 8 of partial response (PR), 10 of stable disease (SD) and 1 of progressive disease (PD) were found and the improvement rate was 45.0% (9/20) in tattoo-inoperable patients. No case of CR, 6 of PR, 11 of SD and 3 of PD were found and the improvement rate was 30.0% (6/20) in non-tattoo-inoperable patients. There was no significant difference in the improvement rate between the two groups (P=0.514). Conclusions: Endoscopic tattooing with carbon nanoparticles injection is safe and reliable for colorectal tumor positioning. It can assist rapid detection of lesions during surgery after neoadjuvant treatment, perform accurate resection, significantly shorten the operation time and reduce surgical trauma; can assist colonoscopy accurately to measure the size of the lesions before and after chemoradiotherapy, and increase the means of assessing the efficacy to guide the follow-up treatment plan. This technique is worth clinical promotion and application.


Assuntos
Carbono/administração & dosagem , Neoplasias do Colo/terapia , Nanopartículas/administração & dosagem , Neoplasias Retais/terapia , Tatuagem/métodos , Adolescente , Quimiorradioterapia Adjuvante , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/terapia , Terapia Combinada , Humanos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 92-95, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958939

RESUMO

Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients' urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons' attention of nerve preservation technique and to improve their understanding of ELAPE procedure.


Assuntos
Sistema Nervoso Autônomo/lesões , Traumatismos dos Nervos Periféricos/prevenção & controle , Protectomia/efeitos adversos , Protectomia/métodos , Neoplasias Retais/cirurgia , Sistema Urogenital/inervação , Sistema Nervoso Autônomo/cirurgia , Humanos , Diafragma da Pelve/lesões , Diafragma da Pelve/cirurgia , Períneo , Traumatismos dos Nervos Periféricos/etiologia , Protectomia/normas , Qualidade de Vida , Resultado do Tratamento , Sistema Urogenital/lesões , Sistema Urogenital/cirurgia
6.
Mymensingh Med J ; 29(1): 73-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915339

RESUMO

Anterior resection (AR), especially low anterior resection (LAR), for low rectal cancer and colorectal anastomosis is a technical challenge to surgeons. But by using circular stapling devices now it is possible make more LARs technically feasible. A stapled end-to-end colorectal anastomosis is increasingly adopted following a low anterior resection for low rectal cancer. This descriptive cross-sectional study was carried out in the department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. The ensuing doughnuts created from the stapling device are routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine the role of sending distal doughnut for histological examination following a stapled end-to-end colorectal anastomosis done in low anterior resection for low rectal cancers.


Assuntos
Adenocarcinoma/cirurgia , Técnicas Histológicas , Neoplasias Retais/cirurgia , Reto/patologia , Grampeamento Cirúrgico , Adenocarcinoma/patologia , Anastomose Cirúrgica/métodos , Bangladesh , Estudos Transversais , Humanos , Neoplasias Retais/patologia , Reto/cirurgia , Grampeamento Cirúrgico/efeitos adversos
7.
Khirurgiia (Mosk) ; (1): 94-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994507

RESUMO

Nowadays, the issue of splenic flexure mobilization (SFM) in anterior and low anterior rectal resection for rectal cancer is still debatable. This stage is important because dissection results tension-free anastomosis and excision of specimen of enough length with adequate number of harvested lymph nodes. However, literature review confirmed the absence of agreement regarding reduced incidence of colorectal anastomotic leakage and improved long-term oncologic outcomes after SFM. Opinion about selective approach to this procedure is becoming more common. Therefore, randomized trials are necessary to determine a need for routine SFM or indications for selective approach to SFM in anterior rectal resection for rectal cancer.


Assuntos
Colo Transverso/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Colectomia/métodos , Dissecação/métodos , Humanos , Laparoscopia
8.
Medicine (Baltimore) ; 99(4): e18835, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977879

RESUMO

The treatment strategy for elderly patients with locally advanced rectal cancer (LARC) remains controversial. The aim of this study was to identify the significance of adjuvant chemotherapy (AC) for elderly patients with LARC after neoadjuvant chemoradiotherapy (nCRT) and surgical resection. Between February 2002 and December 2012, a total of 43 patients aged ≥70 years with LARC following nCRT and surgery were retrospectively reviewed. The median follow-up time was 51 months (range 15-161 months). All patients completed the programmed chemoradiotherapy, of which 20 patients (46.5%) received 5-fluorouracil-based AC, and other 23 patients (53.5%) received no adjuvant chemotherapy. The 5-year overall survival and disease-free survival rates for AC group and non-adjuvant chemotherapy (NAC) group were 74.7% vs 63.4% (P = .562) and 73.4% vs 66.3% (P = .445), respectively. More patients in AC group suffered from severe leucopenia than that in NAC group (60% vs 17.4%, P = .004). For elderly patients with LARC following nCRT and surgery, AC may not benefit for survival, but increase treatment related leucopenia.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Neoplasias Retais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimiorradioterapia , Quimioterapia Adjuvante/métodos , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/mortalidade , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(1): e18479, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895780

RESUMO

INTRODUCTION: Periorbital metastasis of colorectal cancer is rare. Therefore, herein, we report a patient with rectal cancer who presented with periorbital metastasis without any systemic metastasis. PATIENT CONCERNS: The patient was a 57-year-old man who had a painless nodule on his left eyelid. DIAGNOSIS: The patient presented with loose and frequent stools and was diagnosed with rectal adenocarcinoma via colonoscopic biopsy at the local clinic. Curative resection (low anterior resection with temporary ileostomy formation) was performed 4 weeks after completing chemoradiotherapy. The final TNM stage was yp stage T2N0M0. Eight months after the diagnosis of rectal cancer, a protruding lesion was noticed on the patient's left eyelid. Histologic evaluation of the nodule revealed metastatic adenocarcinoma of rectal cancer. INTERVENTIONS: The patient received neoadjuvant chemoradiotherapy and curative resection for rectal cancer. After excision of the periorbital nodule, he received 5 cycles of chemotherapy. OUTCOMES: The patient underwent regular follow-up because he was not able to endure chemotherapy; no recurrence has been observed 21 months after the diagnosis of rectal cancer. Histologic examination revealed metastatic adenocarcinoma of rectal cancer on the patient's left eyelid. However, consecutive imaging studies revealed no other metastatic lesions. Finally, the patient was diagnosed with a solitary periorbital metastasis of rectal cancer. CONCLUSION: This case report helps in understanding the course of progression from rectal cancer to periorbital metastasis.


Assuntos
Adenocarcinoma/patologia , Neoplasias Orbitárias/secundário , Neoplasias Retais/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/terapia , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia
10.
Rev Med Suisse ; 16(676-7): 23-26, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961077

RESUMO

The main novelties in 2019 are about colorectal surgery and oncologic surgery. Acute diverticulitis and mechanical bowel obstruction are frequently diagnosed in primary care medicine. In 2019, EAES (European Association for Endoscopic Surgery) and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) published their recommendations for the management of diverticulitis. Recent data, along with our current practice favor ambulatory treatment without antibiotics for mild diverticulitis. For mechanical bowel obstruction, multicentric studies have demonstrated the increasing role of imaging in predicting the need for surgery and reducing operative delays. The role of minimally invasive techniques in this clinical condition is also emphasized. In addition, the latest published results about neoadjuvant treatment of colon and rectal cancer are reviewed.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Retais , Oncologia Cirúrgica , Endoscopia , Humanos , Terapia Neoadjuvante , Neoplasias Retais/cirurgia , Oncologia Cirúrgica/tendências , Estados Unidos
11.
Zhonghua Wai Ke Za Zhi ; 58(1): 52-56, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902171

RESUMO

Recently, with the development and widespread application of total mesorectal excision and neoadjuvant chemoradiotherapy, the long-term overall survival and disease-free survival of patients with middle & low rectal cancer have been greatly improved. Moreover, there are also researches in minimally invasive techniques, such as laparoscopy and robotic surgical system in the radical rectal surgery, as well as the combination of tumor molecular targeting markers and gene sequencing technology. Nowadays, the treatment of rectal cancer has entered a new era of individualized precise medicine. However, there are still some controversies in lateral lymph node dissection. The criteria of diagnosis and treatment, neoadjuvant therapy, indications of lateral lymph node dissection, the area of dissection and neuroprotection are still unsatisfactory. It is necessary to explore the personalized treatment strategies of lateral lymph node dissection in the precise medical era.


Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retais/patologia , Terapia Combinada , Humanos , Metástase Linfática , Pelve/patologia , Pelve/cirurgia , Medicina de Precisão , Neoplasias Retais/cirurgia
12.
J Comput Assist Tomogr ; 44(1): 102-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939890

RESUMO

OBJECTIVE: To evaluate the overall diagnostic value of magnetic resonance imaging (MRI) in restaging of rectal cancer after preoperative chemoradiotherapy based on qualified studies. METHODS: PubMed, Cochrane, and EMBASE database were searched by the index words to identify the qualified studies, and relevant literature sources were also searched. The latest research was done in April 2019. Heterogeneity of the included studies was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were also performed. RESULT: Nineteen studies with 1262 patients were involved in the meta-analysis exploring the diagnostic accuracy of MRI for rectal cancer. The diagnostic accuracy of MRI in T3-T4 rectal cancer was as follows: sensitivity, 81% (95% confidence interval [CI], 67%-90%); specificity, 67% (95% CI, 51%-80%); positive likelihood ratio, 2.48 (95% CI, 1.57-3.91); negative likelihood ratio, 0.28 (95% CI, 0.15-0.52); global DOR, 6.86 (95% CI, 3.07-15.30); the area under the SROC was high (0.81; 95% CI, 0.78-0.84). The diagnostic accuracy of MRI in lymphatic metastasis of rectal cancer was as follows: sensitivity, 77% (95% CI, 65%-86%); specificity, 77% (95% CI, 63%-87%); positive likelihood ratio, 3.40 (95% CI, 2.07-5.59); negative likelihood ratio, 0.30 (95% CI, 0.20-0.45); DOR, 10.81 (95% CI, 4.99-23.39); area under the SROC was high (0.84; 95% CI, 0.80-0.87). CONCLUSIONS: This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI for rectal cancer. The results indicate that MRI is a highly accurate diagnostic tool for rectal cancer T3-T4 staging and N staging but sensitivity and specificity are not high.


Assuntos
Quimiorradioterapia/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Humanos , Metástase Linfática , Terapia Neoadjuvante , Estadiamento de Neoplasias , Razão de Chances , Curva ROC , Neoplasias Retais/patologia , Sensibilidade e Especificidade , Resultado do Tratamento
13.
Cancer Treat Rev ; 83: 101948, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31955069

RESUMO

While adjuvant chemotherapy is an established treatment for pathological stage II and especially stage III colon cancer, its role in the multimodal management of rectal cancer remains controversial. As a result, there is substantial variation in the use of this treatment in clinical practice. Even among centres and physicians who consider adjuvant chemotherapy as a standard treatment, notable heterogeneity exists with regard to patient selection criteria and chemotherapy regimens. The controversy around this topic is confirmed by the lack of full consensus among national and international clinical guidelines. While most of the clinical trials do not support the contention that adjuvant chemotherapy may improve survival outcomes if pre-operative (chemo)radiotherapy is also given, these suffer from many limitations that preclude drawing definitive conclusions. Nevertheless, in the era of evidence-based medicine, physicians should be guided by the available data and refrain from extrapolating results of adjuvant colon cancer trials to inform treatment decisions for rectal cancer. Patients should be informed of the evidence gap, be given the opportunity to carefully discuss pros and cons of all the possible management options and be empowered in the decision making. In this article we review the available evidence on adjuvant chemotherapy for rectal cancer and propose a risk-adapted decisional algorithm that largely relies on informed patient preferences.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Seleção de Pacientes , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/tratamento farmacológico , Quimioterapia Adjuvante , Humanos
14.
Ann R Coll Surg Engl ; 102(1): e1-e3, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31155921

RESUMO

Diffuse cavernous haemangioma is a rare disease of the rectum. It usually presents with a history of rectal bleeding in children and young adults. When conservative methods fail to control bleeding, traditionally resection is recommended. A 50-year-old man presented with per rectal bleeding and was diagnosed with diffuse cavernous haemangioma of the sigmoid and rectum extending up to 40 cm in the left colon through endoscopy, magnetic resonance imaging and computed tomography. The diagnosis was confirmed by biopsy. This patient was successful managed conservatively with tranexamic acid as needed, avoiding the need for resection.


Assuntos
Antifibrinolíticos/administração & dosagem , Tratamento Conservador/métodos , Hemangioma Cavernoso/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Administração Oral , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Hemangioma Cavernoso/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias Retais/diagnóstico , Neoplasias do Colo Sigmoide/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Conduta Expectante
15.
J Cancer Res Clin Oncol ; 146(1): 105-115, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31781865

RESUMO

PURPOSE: We aimed to identify biomarkers of response to preoperative CRT in patients with LARC using comprehensive miRNA analysis. METHODS: This study included 65 rectal cancer specimens and 89 serum samples from patients diagnosed with LARC and treated with preoperative. All specimens were collected before CRT for evaluation of biologic differences between the good and poor CRT response groups (ypStage 0/I versus II/III/IV). For specific miRNA discovery, 800 miRNAs in 20 rectal cancer specimens were analyzed with a NanoString assay. For validation, a total of 65 tissue and 89 serum samples were tested with reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In the discovery set, 16 target miRNAs were detected. In the validation set, higher expression of three miRNAs (miR-199a/b-3p, miR-199a-5p, and miR-199b-5p) was significantly associated with better response to CRT. In the univariate survival analysis, upregulation of these three miRNAs was associated with superior relapse-free survival (RFS) and overall survival (OS). Meanwhile, only a higher level of tissue miR-199a-5p was associated with superior RFS [hazard ratio (HR), 0.0.91; 95% confidence interval (CI) 0.035-0.580; p = 0.002] and OS (HR, 0.272; 95% CI 0.023-0.658; p < 0.001) in the multivariate survival analysis. Also, a higher level of exosomal miR-199b-5p correlated with better response to CRT (p = 0.0397). CONCLUSION: High expression of tissue miR-199a/b-3p, miR-199a-5p, and miR-199b-5p was significantly associated with response to CRT, and a high level of tissue miR-199a-5p was associated with superior survival outcomes. Also, upregulated exosomal miR-199b-5p correlated with CRT response, reflecting its promise as a circulating biomarker of CRT response in patients with LARC.


Assuntos
MicroRNAs/biossíntese , Neoplasias Retais/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/biossíntese , Biomarcadores Tumorais/genética , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/metabolismo , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Taxa de Sobrevida
16.
Cancer Treat Rev ; 82: 101930, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31756591

RESUMO

BACKGROUND: While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines. METHODS: Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ2 statistic test. RESULTS: Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ2 = 2.6, p = 0.106). Agreement was frequently reached for questions regarding diagnosis, staging, and radiology/pathology pro-forma reporting, while disagreement characterised most of the treatment-related topics. CONCLUSIONS: Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence.


Assuntos
Guias de Prática Clínica como Assunto , Lacunas da Prática Profissional , Neoplasias Retais/terapia , Medicina Baseada em Evidências , Humanos
17.
Cancer Sci ; 111(1): 23-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31660687

RESUMO

Chemoradiotherapy (CRT) is the standard neoadjuvant therapy for locally advanced rectal cancer (RC). However, neoadjuvant chemotherapy (NAC) also shows favorable outcomes. Although the immunological environment of RC has been thoroughly discussed, the effect of NAC on it is less clear. Here, we investigated the immunological microenvironment, including T cell infiltration, activation, and topological distribution, of resected RC tissue after neoadjuvant therapies and evaluated the correlation between T cell subsets and patient prognosis. Rectal cancer patients (n = 188) were enrolled and categorized into 3 groups, namely CRT (n = 41), NAC (n = 46), and control (surgery alone; n = 101) groups. Characterization of residual carcinoma cells and T cell subsets in resected tissues was performed using multiplex fluorescence immunohistochemistry. The densities of total and activated (Ki67high ) T cells in tissues after NAC, but not CRT, were higher than in control. In both CRT and NAC groups, patients presenting with higher treatment effects showed aggressive infiltration of T cell subsets into carcinomas. Multivariate analyses of pathological and immunological features and prognosis revealed that carcinoma Ki67high CD4+ T cells after CRT and stromal Ki67high CD8+ T cells after NAC are important prognostic factors, respectively. Our results suggest that evaluation of T cell activation with Ki67 expression and its tumor localization can be used to determine the prognosis of advanced RC after neoadjuvant therapies.


Assuntos
Biomarcadores Tumorais/metabolismo , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Antígeno Ki-67/metabolismo , Neoplasias Retais/imunologia , Neoplasias Retais/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Quimiorradioterapia/métodos , Feminino , Humanos , Linfócitos do Interstício Tumoral/imunologia , Linfócitos do Interstício Tumoral/metabolismo , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Prognóstico , Neoplasias Retais/tratamento farmacológico , Microambiente Tumoral/imunologia
18.
J Cancer Res Clin Oncol ; 146(1): 205-219, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31620896

RESUMO

BACKGROUND: Third line innovative systemic treatments and loco-regional chemotherapy by hypoxic pelvic perfusion (HPP) have both been proposed for the treatment of unresectable not responsive recurrent rectal cancer (URRC). In the present study, we have compared the safety and efficacy of HPP/target therapy, using drug regimens selected by liquid biopsy precision oncotherapy, to third-line systemic therapy based on tissue specimens precision oncotherapy. METHODS: HPP/target therapy regimens were selected based on precision oncotherapy, including assays for chemosensitivity and viability, and qRT-PCR for tumor-related gene expression. In the control group, systemic third-line and further lines of therapy were defined according to clinical and biological parameters. RESULTS: From 2007 to 2019, 62 URRC patients were enrolled, comprised of 43 patients in the HPP/target-therapy group and 19 patients in the systemic therapy control group. No HPP related complications were reported and the most common adverse events were skin and bone marrow toxicity. In the HPP/target-therapy group, the ORR was 41.8% whereas in the systemic therapy control group was 15.8%. DCR of the HPP/target-therapy group was significantly improved over the systemic therapy group (P = 0.001), associated with a PFS of 8 vs 4 months (P = 0.009), and OS of 20 vs 8 months (P = 0.046). CONCLUSIONS: The present data indicate that in URCC patients, the integration of HPP/target-therapy and precision oncotherapy based upon liquid biopsy is as effective and efficacious as third-line treatment in local disease control and, therefore, deserves to be further assessed and compared to conventional systemic treatments in future prospective randomized trials.


Assuntos
Biópsia Líquida/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Medicina de Precisão/métodos , Estudos Retrospectivos
19.
World Neurosurg ; 133: 240-244, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568906

RESUMO

BACKGROUND: Spinal epidural hematoma associated with epidural metastasis is very rare. Epidural hematoma is unusual in itself, and metastatic epidural tumors do not commonly occur. CASE DESCRIPTION: A 76-year-old man with a medical history of untreated stage III rectal cancer and chronic obstructive pulmonary disease underwent emergency spine surgery for acute development of severe quadriplegia due to cervical epidural hematoma after minor indirect trauma. Hemorrhagic lesions, such as yellow ligaments, were accompanied by hematomas that adhered to the dura mater and were confirmed on pathology to be small cell carcinoma. Some nodules were detected in the right pulmonary hilar lesion and pleural lesion on computed tomography, and stage IV small cell carcinoma was diagnosed. CONCLUSIONS: To our knowledge, spinal epidural hematoma accompanied by epidural metastasis has not previously been reported. We hypothesized that tissue invasion of malignant neoplasms may cause hemorrhagic conditions. The presence of a tumor should therefore be considered in the differential diagnosis of cases of epidural hematoma.


Assuntos
Carcinoma de Células Pequenas/complicações , Hematoma Epidural Espinal/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Quadriplegia/cirurgia , Neoplasias Retais/complicações , Idoso , Carcinoma de Células Pequenas/diagnóstico por imagem , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Quadriplegia/diagnóstico por imagem , Quadriplegia/etiologia , Neoplasias Retais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Int J Cancer ; 146(1): 94-102, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31199501

RESUMO

Little information is available on the clinical significance of cancer-related genes such as KRAS, NRAS, BRAF, PIK3CA and TP53 in nonmetastatic rectal cancer. We investigated mutations of these genes in a large prospective series of locally advanced rectal cancer (LARC) patients who were recruited into two phase II trials. Mutational analyses were performed with diagnostically validated methods including polymerase chain reaction, capillary electrophoresis single-strand conformational analysis, Sanger sequencing and next-generation sequencing. Associations between single or multiple gene mutations and clinicopathological characteristics and treatment outcomes were explored. Of these 269, 210 (78%) patients were assessable. Mutations of KRAS, NRAS, BRAF, PIK3CA and TP53 occurred in 43, 9, 4, 9 and 60% of patients, respectively. Concordance between paired biopsy and resection specimens was 82% for KRAS, 95% for NRAS, 99% for BRAF, 96% for PIK3CA and 63% for TP53. TP53 mutations were associated with extramural venous invasion on baseline MRI (78% vs. 65%, p = 0.04), poor pathological tumour regression (23% vs. 36%, p = 0.05) and a trend toward a worse 5-year progression-free survival (PFS; 60% vs. 74%, HR 1.59, p = 0.06). Patients with tumours harbouring mutation of TP53 and either KRAS or NRAS (32%) had a worse 5-year PFS than those with TP53/KRAS/NRAS wild-type tumours (54% vs. 72%, HR 1.75, p = 0.02). In univariate analysis, BRAF mutation predicted poor 5-year overall survival only among patients treated without cetuximab (20% vs. 73%, HR 3.29, p = 0.03). This is one of the largest biomarker studies in a prospective, largely homogeneous, LARC population. Our findings are hypothesis generating and require validation in independent series.


Assuntos
Classe I de Fosfatidilinositol 3-Quinases/genética , GTP Fosfo-Hidrolases/genética , Mutação/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Retais/genética , Proteína Supressora de Tumor p53/genética , Biomarcadores Tumorais/genética , Análise Mutacional de DNA/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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