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1.
Cancer Radiother ; 24(6-7): 493-500, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32814670

RESUMO

For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia Adjuvante , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/terapia , Humanos
2.
Updates Surg ; 72(3): 793-800, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32632764

RESUMO

According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.


Assuntos
Quimiorradioterapia Adjuvante , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Metástase Linfática/terapia , Terapia Neoadjuvante , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
3.
Acta otorrinolaringol. esp ; 71(3): 131-139, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192627

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El análisis de partición recursiva (APR) es una técnica que permite la clasificación pronóstica en pacientes oncológicos. El objetivo del presente estudio es analizar mediante un APR una cohorte de pacientes con carcinomas escamosos de cabeza y cuello (CECC). MÉTODOS: Se analizaron de forma retrospectiva 5.226 CECC con un APR considerando la supervivencia específica y el control local de la enfermedad como variables dependientes. Se utilizó una cohorte de pacientes para la creación del modelo de clasificación, y otra cohorte para llevar a cabo la validación interna del modelo. RESULTADOS: Al considerar como variable dependiente la supervivencia específica se obtuvo un árbol de clasificación con 14 nodos terminales que se agruparon en 5 categorías, incluyendo como variables de partición la extensión local y regional del tumor, y la localización del tumor. Al considerar el control local de la enfermedad como variable dependiente se obtuvo un árbol de clasificación con 10 nodos terminales que se agruparon en 4 categorías, incluyendo como variables de partición la extensión local del tumor y su localización, el tipo de tratamiento realizado, la edad del paciente, y si se trataba de un primer tumor o una neoplasia sucesiva. El estudio de validación confirmó la capacidad pronóstica de los modelos desarrollados con el APR. Una de las ventajas del APR es que permite la identificación de grupos de pacientes con un comportamiento singular. CONCLUSIÓN: El APR se muestra como una técnica eficaz para la clasificación pronóstica de los pacientes con un CECC


INTRODUCTION AND OBJECTIVES: Recursive partitioning analysis (RPA) is a technique that allows prognostic classification in oncological patients. The aim of the present study is to analyse by means of an RPA a cohort of patients with squamous carcinomas of the head and neck (SCHN). METHODS: 5,226 SCHN were retrospectively analysed with an RPA, considering the specific survival and local control of the disease as dependent variables. A cohort of patients was used for the creation of the classification model, and another cohort was used to carry out its internal validation. RESULTS: Considering specific survival as a dependent variable we obtained a classification tree with 14 terminal nodes that were grouped into 5 categories, including as partition variables the local and regional extent of the tumour, and the location of the tumour. When considering the local control of the disease as a dependent variable we obtained a classification tree with 10 terminal nodes that were grouped into 4 categories, including as partition variables the local extension and location of the tumour, the type of treatment performed, the age of the patient, and if it was a first tumour or a subsequent neoplasm. The validation study confirmed the prognostic capacity of the models developed with the RPA. One of the advantages of the RPA is that it allows the identification of groups of patients with specific behaviour. CONCLUSION: RPA is shown to be an effective technique for the prognostic classification of patients with a SCHN


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Sobrevida , Carcinoma de Células Escamosas/epidemiologia , Neoplasias de Cabeça e Pescoço/classificação , Estudos de Coortes , Modelos de Riscos Proporcionais , Prognóstico , Estudos Retrospectivos , Quimiorradioterapia Adjuvante
4.
Biochim Biophys Acta Rev Cancer ; 1874(1): 188386, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32540465

RESUMO

BACKGROUND: Chemotherapy (CT), radiotherapy (RT), and chemoradiotherapy (CRT) are able to alter the composition of the tumor immune microenvironment (TIME). Understanding the effect of these modalities on the TIME could aid in the development of improved treatment strategies. Our aim was to systematically review studies investigating the influence of CT, RT or CRT on different TIME markers. METHODS: The EMBASE (Ovid) and PubMed databases were searched until January 2019 for prospective or retrospective studies investigating the dynamics of the local TIME in cancer patients (pts) treated with CT, RT or CRT, with or without targeted agents. Studies could either compare baseline and follow-up specimens - before and after treatment - or a treated versus an untreated cohort. Studies were included if they used immunohistochemistry and/or flow cytometry to assess the TIME. RESULTS: In total we included 110 studies (n = 8850 pts), of which n = 89 (n = 6295 pts) compared pre-treatment to post-treatment specimens and n = 25 (n = 2555 pts) a treated versus an untreated cohort (4 studies conducted both comparisons). For several tumor types (among others; breast, cervical, esophageal, ovarian, rectal, lung mesothelioma and pancreatic cancer) remodeling of the TIME was observed, leading to a potentially more immunologically active microenvironment, including one or more of the following: an increase in CD3 or CD8 lymphocytes, a decrease in FOXP3 Tregs and increased PD-L1 expression. Both CT and CRT were able to immunologically alter the TIME. CONCLUSION: The TIME of several tumor types is significantly altered after conventional therapy creating opportunities for concurrent or sequential immunotherapy.


Assuntos
Biomarcadores Tumorais/análise , Quimiorradioterapia Adjuvante/métodos , Imunoterapia/métodos , Terapia Neoadjuvante/métodos , Neoplasias/terapia , Microambiente Tumoral/imunologia , Antineoplásicos Imunológicos/farmacologia , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/imunologia , Biópsia , Ensaios Clínicos como Assunto , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Terapia de Alvo Molecular/métodos , Neoplasias/diagnóstico , Neoplasias/imunologia , Neoplasias/patologia , Resultado do Tratamento , Microambiente Tumoral/efeitos dos fármacos , Microambiente Tumoral/efeitos da radiação
5.
Oncol Res Treat ; 43(7-8): 372-379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32485721

RESUMO

INTRODUCTION: Esophageal cancer (EC) is a common malignant tumor entity with increasing occurrence. The incidence of esophageal adenocarcinoma (AC), particularly, is constantly rising in the Western world. The mainstays of therapy with curative intent for EC in advanced stages are neoadjuvant radiochemotherapy (neoRCT) with surgery and definitive radiochemotherapy (defRCT). METHODS: We examined our internal files to identify patients suffering from EC. Palliative cases were excluded. Statistical testing was performed by χ2 test, Student's t test, Kaplan-Meier analyses, and the Mann-Whitney U test. RESULTS: One hundred and twenty-two cases were included. Histology revealed squamous cell carcinoma in 92 cases and AC in 23 cases. Ninety-five patients underwent defRCT, 27 underwent neoRCT, and 114 (in both therapy regimes) received simultaneous chemotherapy. There was no difference in the overall survival (OS) (p = 0.654; HR 1.145; 95% CI 0.629-2.086) or and progression-free survival (PFS) (p = 0.912) of patients who underwent neoRCT or defRCT. Median OS was 13.5 (2-197) months for defRCT patients and 19.5 (2-134) months for neoRCT patients (p = 0.751). Karnofsky index (KI) with a cut-off of 70% was strongest, but not a significant parameter for OS (p = 0.608) or PFS (p = 0.137). CONCLUSION: defRCT is a valid and an equal alternative to neoRCT for patients suffering from EC. Selection of patients for therapy is of crucial relevance. Further studies and improvements in follow-up are needed when neoRCT has been completed before surgery, in order to spare the patient undergoing operative treatment if there is complete remission. The identification of valid markers urgently needed to limit treatment side effects.


Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/terapia , Terapia Neoadjuvante/mortalidade , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Oncology ; 98(10): 706-713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516775

RESUMO

BACKGROUND: Adenocarcinoma of the esophagogastric junction (AEG) is a rare but rising tumor entity in the Western world. Treatment is complex, as multimodality is key to optimal results. However, trials solely including AEG are rare, and the question if neoadjuvant radiochemotherapy (NRCT) or neoadjuvant/perioperative chemotherapy (NACT) is superior remains unanswered. PATIENTS AND METHODS: Patients with AEG I-III treated between October 2010 and August 2019 at the Ordensklinikum Linz or the Kepler University Hospital were identified either from a monitored tumor registry or by chart review. Time-to-event data were analyzed by Kaplan-Meier product limit estimation. The Kruskal-Wallis test and Fisher's exact test were used for comparing continuous and categorical data, respectively. RESULTS: A total of 85 patients (median age 63 years; median Charlson Comorbidity Index 3; 98.8% ECOG PS 0-1) were analyzed. Of these, 52 patients received NRCT (81% CROSS protocol) and 33 NACT (65% EOX and 35% FLOT protocol). There was a significantly higher pathological complete response rate in the NRCT group (30 vs. 12%; p = 0.010); distant relapse rates were higher in the NRCT group and local relapse rates were higher in the NACT group (both not significant). These differences, however, did not translate into a different disease-free survival (20 months; 95% CI: 13-34) or overall survival (44 months; 95% CI: 33-NA). Patients >65 years old had the same advantage from treatment as patients <65 years of age. CONCLUSIONS: Although treatment of AEG is complex, the progress documented over the last centuries can be reproduced in our real-life setting. Data regarding the superiority of either type of neoadjuvant/perioperative treatment are sparse. We assume no difference between EOX-based NACT and NRCT.


Assuntos
Neoplasias Esofágicas/terapia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/terapia , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Assistência Perioperatória , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
7.
J Cancer Res Ther ; 16(2): 280-285, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474514

RESUMO

Context: The safety and efficacy of irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) are well established. However, whether adjuvant chemoradiotherapy after IRE increases, the survival rate remains unknown. Therefore, this study evaluated the effect of chemoradiotherapy combined with IRE in patients with LAPC. Subjects and Methods: We retrospectively analyzed 42 patients with LAPC between July 2015 and December 2016 at PLA General Hospital treated with IRE or IRE combined with radiation and/or chemotherapy. These patients were divided into the IRE group and the combined-therapy group. All patients underwent computed tomography (CT), magnetic resonance imaging, and positron-emission tomography-CT and no signs of metastases were found. The prognosis of these patients was observed. Results: The times after operation and after diagnosis in the combined-therapy group (304.20 ± 118.54) and (334.40 ± 114.07) days, respectively, were better those than in the IRE group (214.36 ± 95.68) and (244.68 ± 110.61) days, respectively. Moreover, patients in the combined-therapy group had a significantly better survival rate than the IRE group (80 vs. 45.45%, P < 0.05). Conclusions: IRE combined with radiotherapy or chemotherapy was superior to IRE alone for the treatment of LAPC, as it prolonged the survival time and improved the survival rate, making it worthy of wide dissemination and clinical application.


Assuntos
Quimiorradioterapia Adjuvante/mortalidade , Eletroporação/métodos , Neoplasias Pancreáticas/terapia , Quimiorradioterapia Adjuvante/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X/métodos
8.
Anticancer Res ; 40(5): 2833-2840, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366431

RESUMO

BACKGROUND/AIM: The prognostic value of the number of harvested negative lymph nodes (NLNs) in patients with node-negative esophageal carcinoma treated by esophagectomy with or without neoadjuvant chemoradiation is unclear. PATIENTS AND METHODS: A total of 136 patients who underwent oncological esophagectomy with two-field lymphadenectomy from 1995 to 2014 were analyzed regarding the prognostic impact of NLNs. 86 patients received primary surgery (group 1) and 50 patients had preoperative chemoradiation followed by surgery (group 2). RESULTS: The 5-year overall survival (OS) was 61.1%. Median lymph node harvest was significantly higher in group 1 (39 vs. 34 in group 2, p=0.007). In group 1, patients with a higher number of negative lymph nodes (>40) had a better OS [57.6% vs. 78.9%, HR=0.5 (0.3-0.9), p=0.026], whereas there was no significant difference in group 2 using the same cutoff (47.6% vs. 66.7%, p=0.476). CONCLUSION: The number of NLNs is an independent prognostic factor for patients with esophageal carcinoma treated by primary esophagectomy, but not in patients after neoadjuvant chemoradiation.


Assuntos
Quimiorradioterapia Adjuvante/métodos , Esofagectomia/métodos , Linfonodos/patologia , Esofagectomia/mortalidade , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
9.
J Surg Oncol ; 122(2): 328-335, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436267

RESUMO

INTRODUCTION: Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored. MATERIALS AND METHODS: Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed. We selected all patients (n = 88) after sleeve lobectomy or sleeve bilobectomy for lung cancer with fully completed neoadjuvant chemoradiotherapy. Bronchial healing was assessed by bronchoscopy on the 7th postoperative day using our earlier published classification from grades 1 to 5. RESULTS: The median interval to surgery was 50 days (interquartile range 46-53, mean 50.03 ± 3.72). Mean anastomotic grade was 2.05 ± 1.03 and in 29.5% of the patients a critical anastomosis (grade ≥3) was documented. Anastomotic healing showed optimal results (bronchoscopic grade mean value: 1.5 ± 0.70) between the 6th and 8th postchemoradiotherapy week (P = .001). All patients operated before (bronchoscopic grade mean value: 2.3 ± 1.02) or after the above period (bronchoscopic grade mean value: 2.5 ± 1.15) had an increased ratio of anastomotic healing complications. CONCLUSION: It is safer to perform sleeve-resections for non-small cell lung cancer after neoadjuvant trimodal treatment between the 6th and 8th week of completion of chemoradiotherapy.


Assuntos
Anastomose Cirúrgica/métodos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Anastomose Cirúrgica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Quimiorradioterapia Adjuvante , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Pneumonectomia/efeitos adversos , Estudos Retrospectivos
10.
J Cancer Res Clin Oncol ; 146(10): 2631-2638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32435893

RESUMO

PURPOSE: Treatment strategies for low rectal cancer have been evolving toward achieving less treatment morbidity with the same oncological success-we aimed to assess the results of the new watch and wait (W&W) strategy in our cohort. METHODS: A tertiary care cohort study was conducted. New patients with rectal adenocarcinoma up to 6 cm from the anal margin, cM0, locally staged higher than cT1N0, evaluated between November 2014 and October 2018, were included. All 93 patients received neoadjuvant radiotherapy ± chemotherapy. Re-evaluation was planned 8-12 weeks after the end of treatment. Patients showing clinical complete response (cCR) were given the choice of either to proceed to surgery or to enter W&W. RESULTS: Of the 93 patients, 82.8% were re-evaluated and 20.8% had cCR. Patients in clinical stages II/III were significantly less likely to achieve cCR than those in stage I (p = 0.017). After a mean follow-up of 17.44 months, there were 4 regrowths in the 16 patients under W&W, all submitted to R0 surgery, ypN0; there were no deaths or local recurrences; one patient with regrowth had distant recurrence. Sixty patients underwent direct surgery after a mean follow-up of 16.23 months; 3 patients had local and distant recurrences; 7 others had only distant recurrences; there were 8 deaths. There were no statistically significant differences between patients under W&W and patients who underwent direct surgery regarding local or distant recurrences, or death (p > 0.9; p = 0.44; p = 0.19, respectively). CONCLUSION: The W&W strategy for low rectal cancer achieved the same oncological outcomes as the traditional strategy while sparing some patients from surgery.


Assuntos
Adenocarcinoma/terapia , Neoplasias Retais/terapia , Conduta Expectante/métodos , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Radioterapia Adjuvante , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Resultado do Tratamento
11.
J Surg Oncol ; 122(3): 506-514, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32410271

RESUMO

BACKGROUND AND OBJECTIVES: Primary pulmonary sarcoma (PPS) accounts for less than 1.1% of all pulmonary tumors. Few outcome data are reported. We evaluated outcome and prognostic factors in our series. METHODS: We retrospectively reviewed all patients who underwent resection for PPS in our center from 2002 to 2018. Survival was calculated from the date of surgery until last follow-up. Impact on survival of gender, type of lung resection, completeness of resection, grade, size, and TNM staging for lung cancer and soft tissue sarcoma (STS) was assessed. RESULTS: Thirteen patients were included. Eight (61.5%) patients received neoadjuvant treatment. Median tumor size at diagnosis was 11.5 cm (1-30 cm). Type of lung resection was wedge (n = 2, 15%), lobectomy (n = 4, 31%), intrapericardial (n = 3, 23%), and extrapleural pneumonectomies (n = 4, 31%). In-hospital mortality was 8%. Overall 5-year survival was 60%. Median disease-free survival was 17 months. Tumor size was a predictor for survival (P = .02) and recurrence (P = .05). Gender (P = .04) and type of lung resection (P = .04) were predictors of survival. T stage for STS of trunk and extremity, and TNM stage for lung cancer were predictors for recurrence (P = .03 and P = .04, respectively). CONCLUSION: Surgical resection within a multimodality therapy concept in highly selected patients can offer good long-term outcome.


Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Pneumonectomia/métodos , Estudos Retrospectivos , Sarcoma/terapia , Taxa de Sobrevida , Adulto Jovem
12.
Oncology ; 98(8): 542-548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32434189

RESUMO

BACKGROUND: Preoperative induction chemotherapy followed by chemoradiation yields better R0 resection rates, pathologic complete response (pCR) rates and improved survival for localized gastric adenocarcinoma (GAC). We report the effect of three-drug induction chemotherapy on a large cohort of localized GAC patients. METHODS: We identified 97 patients with localized GAC who received three-drug induction chemotherapy followed by preoperative chemoradiation therapy. We assessed various endpoints (overall survival [OS], recurrence-free survival [RFS], R0 resection and pCR rate). RESULTS: The median follow-up time was 3.5 years (range; 0.4-16.7). The induction chemotherapy regimen was a fluoropyrimidine and a platinum compound (cisplatin or oxaliplatin) with a taxane (docetaxel or paclitaxel) for 95% of patients. Seventy-three (75.3%) out of 97 patients underwent planned surgery. R0 resection and pCR rae were 93.2 and 20.6%, respectively. Pathologic partial response (<50% residual carcinoma) rate was 50.7%. The median OS was 6.4 years (95% Cl 3.3-12.4) for the entire cohort and 11.1 years (95% Cl 7.1-not estimable) for patients that underwent surgery. The estimated 2- and 5-year OS rates were 72.4% (95% CI 62.1-80.3) and 54.3% (95% CI 43.2-64.1) for the entire cohort and 83.2% (95% CI 72.3--90.1) and 66% (95% CI 52.3-75.8) for patients that underwent surgery. Pathologic lesser stage (stage I/II vs. stage III/IV) (p = 0.001) and R0 resection (p = 0.02) were independently associated with longer RFS in the multivariate analysis. CONCLUSION: Our data shows that three-drug combination is feasible without providing substantial advantage compared with two-drug combination in this setting of preoperative induction chemotherapy followed by chemoradiation and surgery.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Quimioterapia Adjuvante/métodos , Quimioterapia de Indução/métodos , Terapia Neoadjuvante/métodos , Cuidados Pré-Operatórios/métodos , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
13.
Surg Today ; 50(10): 1262-1271, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32372154

RESUMO

PURPOSE: Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the "ribcage" procedure for tumors involving the chest wall after induction chemoradiotherapy. METHODS: This was a single center retrospective study conducted from 2012 to 2018. The "ribcage" procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure. RESULTS: Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients. CONCLUSION: Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimiorradioterapia Adjuvante , Neoplasias Pulmonares/cirurgia , Terapia Neoadjuvante , Pleura/cirurgia , Costelas/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Parede Torácica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
14.
J Surg Oncol ; 122(3): 457-468, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32470166

RESUMO

BACKGROUND: For pancreatic adenocarcinoma (PDAC), no studies have established any association between earlier treatment initiation and long-term outcomes. In addition, an optimal type of initial treatment for the localized disease remains ill-defined. METHODS: Patients in the National Cancer Database (2004-2015) with clinical stage I (CS-I) and II (CS-II) PDAC who underwent curative-intent resection were included. Optimal time from diagnosis-to-treatment including neoadjuvant chemotherapy, neoadjuvant chemoradiation, or upfront surgery was assessed. An optimal type of treatment was evaluated. The primary outcome was overall survival (OS). RESULTS: Among 29 167 patients, starting any treatment within 0 to 6 weeks was associated with improved median OS compared with 7 to 12 weeks (21.0 vs 20.1 months; P = .004). This persisted when accounting for sex, race, and Charlson-Deyo score (hazard ratio [HR], 0.94; P = 0.02) and on subset analysis for CS-I (23.5 vs 21.8 months; P = .04) and CS-II (19.4 vs 18.3 months; P = .03). Neoadjuvant chemotherapy was associated with improved OS compared with neoadjuvant chemoradiation (25.6 vs 22.7 months; P < .0001) or US (25.6 vs 20.1 months; P < .0001) even when accounting for sex, race, and Charlson-Deyo score (neoadjuvant chemoradiation: HR, 0.86; P < .001; US: HR, 0.79; P < .001). This improvement persisted in subset analysis with NC compared with neoadjuvant chemoradiation (CS-I: 28.6 vs 25.0 months; CS-II: 25.0 vs 22.9 months; both P < .0001) and to US (CS-I: 28.6 vs 22.9 months; CS-II: 24.7 vs 18.4 months; both P < .0001). On multivariable analysis for each CS-I/CS-II, NC remained associated with 20% improved survival compared with neoadjuvant chemoradiation or upfront surgery. CONCLUSIONS: For PDAC, initiation of therapy within 6 weeks from diagnosis is associated with improved survival, with neoadjuvant chemotherapy associated with the best survival compared with neoadjuvant chemoradiation or upfront surgery.


Assuntos
Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/terapia , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/terapia , Idoso , Carcinoma Ductal Pancreático/patologia , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Humanos , Masculino , Terapia Neoadjuvante/estatística & dados numéricos , Estadiamento de Neoplasias , Neoplasias Pancreáticas/patologia , Sistema de Registros , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores de Tempo , Estados Unidos/epidemiologia
15.
Surg Today ; 50(10): 1223-1231, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32409870

RESUMO

PURPOSES: Preoperative chemoradiation is a potential treatment option for localized gastric adenocarcinoma (GAC). Currently, the response to chemoradiation cannot be predicted. We analyzed the pretreatment maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) on positron emission tomography/computed tomography as potential predictors of the response to chemoradiation. METHODS: We analyzed the SUVmax and TLG data from 59 GAC patients who received preoperative chemoradiation. We used logistic regression models to predict a pathologic complete response (pCR) and Kaplan-Meier curves to determine overall survival among patients with high and low SUVmax or TLG. RESULTS: Twenty-nine patients (49%) had Siewert type III adenocarcinoma and 30 (51%) had tumors located in the lower stomach. Forty-one patients had poorly differentiated GAC, and 26 had signet ring cells. The median SUVmax was 7.3 (0-28.2) and the median TLG was 56.6 (0-1881.5). Patients with signet ring cells had a low pCR rate, as well as a low SUVmax and TLG. In the multivariable logistic regression model, high SUVmax was a predictor of pCR (odds ratio = 11.1, 95% confidence interval = 2.12-50.0, p = 0.004). Overall survival was not associated with the SUVmax (log-rank p = 0.69) or TLG (log-rank p = 0.85) CONCLUSION: A high SUVmax was associated with sensitivity to chemoradiation and pCR in GAC, and signet ring cells seemed to confer resistance.


Assuntos
Adenocarcinoma/metabolismo , Adenocarcinoma/terapia , Carcinoma de Células em Anel de Sinete/metabolismo , Carcinoma de Células em Anel de Sinete/terapia , Quimiorradioterapia Adjuvante , Glicólise , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/patologia , Estudos de Coortes , Análise de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia
16.
Updates Surg ; 72(2): 453-461, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32232742

RESUMO

BACKGROUND: We currently do not know the optimal time interval between the end of chemoradiotherapy and surgery. Longer intervals have been associated with a higher pathological response rate, worse pathological outcomes and more morbidity. The aim of this study was to evaluate the effect and safety of the current trend of increasing time interval between the end of chemoradiotherapy and surgery (< 10 weeks vs. ≥ 10 weeks) on postoperative morbidity and pathological outcomes. This study analyzed 232 consecutive patients with locally advanced rectal cancer treated with long-course neoadjuvant chemoradiotherapy from January 2012 to August 2018. 125 patients underwent surgery before 10 weeks from the end of chemoradiotherapy (Group 1) and 107 patients underwent surgery after 10 or more weeks after the end of chemoradiotherapy (Group 2). Results have shown that wait for ≥ 10 weeks did not compromise surgical safety. Pathological complete response and tumor stage was statistically significant among groups. The effect of wait for ≥ 10 weeks before surgery shown higher tumor regression than the first group (Group 1, 12.8% vs Group 2, 31.8%; p < 0.001). On multivariate analysis, wait for ≥ 10 weeks was associated with pathological compete response. Patients from the second group were four time more likely to achieve pathologic complete response than patients from the first group (OR, 4.27 95%CI 1.60-11.40; p = 0.004). Patients who undergo surgery after ≥ 10 weeks of the end of chemoradiotherapy are four time more likely to achieve complete tumor remission without compromise surgical safety or postoperative morbidity.


Assuntos
Quimiorradioterapia Adjuvante , Terapia Neoadjuvante , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Retais/patologia , Indução de Remissão , Segurança , Fatores de Tempo , Resultado do Tratamento
17.
Updates Surg ; 72(2): 469-475, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32306273

RESUMO

Ideal time interval between end of neoadjuvant radio-chemotherapy (NRCT) and surgery for rectal cancer is debated. Effect that different time intervals have on postoperative complications with particular regard to anastomotic dehiscence (AD) was evaluated on 167 patients who underwent surgery after long-course NRCT. Three different time intervals were considered: (0-42; 43-56; > 57 days). A time interval > 57 days was significantly protective for AD (p = 0.04, Odds ratio = 0.35; 95% CI 0.1254-0.9585) without influence on early oncological outcomes. Optimal time interval after end of NRCT and surgery may help achieving the best pathological response with lowest postoperative morbidity.Trial registration number: Clinical Trial. Gov NCT04013347. https://clinicaltrials.gov/ct2/results?cond=&term=NCT04013347&cntry=&state=&city=&dist= ).


Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Quimiorradioterapia Adjuvante , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Terapia Neoadjuvante , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Retais/cirurgia , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/prevenção & controle , Tempo para o Tratamento , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/terapia , Estudos Retrospectivos , Deiscência da Ferida Operatória/etiologia , Fatores de Tempo
18.
Ann R Coll Surg Engl ; 102(6): e130-e132, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326737

RESUMO

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.


Assuntos
Esofagectomia/efeitos adversos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Toracoscopia/efeitos adversos , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia Adjuvante , Colo Transverso/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Neoplasias Esofágicas/terapia , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/etiologia , Herniorrafia/instrumentação , Humanos , Intestino Delgado/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Terapia Neoadjuvante , Readmissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
J Cancer Res Clin Oncol ; 146(8): 2161-2171, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32328776

RESUMO

BACKGROUND: Numerous studies have reported the preventive and protective effects of aspirin in patients with rectal cancer. However, it is not clear whether aspirin can be used as an assistance drug in preoperative neoadjuvant chemoradiotherapy. Therefore, this study will explore the efficacy of aspirin as an adjuvant agent in rectal cancer neoadjuvant chemoradiotherapy. METHODS: A literature search was performed using the electronic platforms to obtain relevant research studies published up to Jan 2020. The search was limited to papers published in English or Chinese language. Confidence intervals of research endpoints in each study were extracted and merged. The meta-analysis was performed using Stata12.0 software. Furthermore, we performed trial sequential analysis (TSA) to evaluate the robustness of our findings and to obtain a more conservative estimation. RESULTS: A total of 5 studies including 977 patients were identified to be eligible for this meta-analysis. Compared with control group, aspirin group significantly increased pathologic complete response rate from 16.5 to 22.3% (RR 1.41, 95% CI 1.01-1.96, P = 0.041), partial remission rate from 21.8 to 45.7% (RR 1.87, 95% CI 1.37-2.54, P < 0.001), and tumor down-staging rate from 44.4 to 63.8% (RR 1.43, 95% CI 1.17-1.75, P = 0.001). Moreover, aspirin group can reduce local recurrence rate (RR 0.37, 95% CI 0.17-0.84, P = 0.017), improve 3-year survival rate (RR 1.24, 95% CI 1.12-1.36, P < 0.001), and 5-year survival rate (RR 1.29, 95% CI 1.14-1.46, P < 0.001). TSA shows that the meta-analysis results of pathologic complete response rate and local recurrence rate may be a false positive. Furthermore, the meta-analysis results of other study endpoints were further confirmed by TSA. CONCLUSION: Aspirin, as an adjuvant agent, can enhance the effect of neoadjuvant chemoradiotherapy and improve the prognosis of patients with rectal cancer. Neoadjuvant therapy combined with aspirin may be considered a better option for preoperative rectal cancer patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Aspirina/administração & dosagem , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Aspirina/farmacologia , Quimiorradioterapia Adjuvante , Sinergismo Farmacológico , Humanos , Terapia Neoadjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Ann Thorac Surg ; 110(2): 398-405, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289300

RESUMO

BACKGROUND: The incidence of lower esophageal and gastroesophageal junction adenocarcinoma has sharply increased over the past several decades and is a serious public health problem. Preoperative therapy with either chemotherapy or chemoradiation is recommended, but the optimal regimen is unknown. We used the National Cancer Database and propensity score matching to investigate whether preoperative chemoradiation therapy offers an advantage over chemotherapy alone for patients with these tumors. METHODS: From the National Cancer Database esophageal and gastric dataset, we selected patients with either lower esophageal or gastric cardia adenocarcinomas who had undergone definitive resection after chemotherapy or chemoradiation. We used propensity score matching to balance groups based on the preoperative treatment they received. We then used conditional multivariable logistic regression and Cox proportional hazard models to examine the association between preoperative therapy regimen and pathological response, overall survival (OS), and postoperative outcomes. RESULTS: Our study included 13,783 patients; 12,129 (89.0%) had received preoperative chemoradiation. Propensity score matching created 1650 pairs. Patients receiving chemoradiation were 2.7 (95% confidence interval, 1.29-3.23) times more likely to achieve complete response in the primary tumor than were those receiving chemotherapy alone; however, chemoradiation was not associated with improved OS (hazard ratio, 1.01; 95% confidence interval, 0.91-1.12). Short-term outcomes (length of stay, mortality, and readmissions) were similar between the 2 groups. CONCLUSIONS: Preoperative chemoradiation was associated with a higher complete response rate in the primary tumor but not with improved OS in lower esophageal and gastroesophageal junction adenocarcinoma.


Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Junção Esofagogástrica , Cuidados Pré-Operatórios , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Adenocarcinoma/cirurgia , Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
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