Neoadjuvant Chemotherapy Radiotherapy Research Articles

G-CSF-Producing Left Lung Squamous Cell Carcinoma Positive for ROS1 Rearrangements Completely Resected after Neoadjuvant Radiation Chemotherapy: A Case Report

G-CSF-Producing Left Lung Squamous Cell Carcinoma Positive for ROS1 Rearrangements Completely Resected after Neoadjuvant Radiation Chemotherapy: A Case Report

Outcomes After Multimodality Therapy in Modern Breast Cancer Patients Presenting With Clinical N3c Supraclavicular Node Involvement

<h3>Purpose/Objective(s)</h3> Breast cancer patients with clinical N3c (cN3c) disease at diagnosis have poor outcomes relative to other breast cancer patients. Radiotherapy (RT) has an important role in the management of these patients as the supraclavicular (SCV) nodes are not routinely surgically dissected. However, outcomes and prognostic factors in the era of modern neoadjuvant chemotherapy (NAC) are not well-described. <h3>Materials/Methods</h3> We reviewed breast cancer patients with non-metastatic cN3c disease treated at our institution from 2014-2019 with curative intent NAC, surgery, and adjuvant RT. All patients received nodal RT including the SCV, infraclavicular, and internal mammary nodes. Institutional guidelines recommend a 10 Gy boost to clinically resolved N3 nodal basins and 16 Gy to unresolved N3 nodes. Variables including initial and boost dose, pathologic response, and type of nodal dissection were collected. Local (LC) and regional control (RC), freedom from distant metastases (FFDM), and overall survival (OS) were analyzed with the Kaplan Meier method. A saturated multivariable Cox proportional hazards model of OS with backward elimination identified clinical variables associated with OS at <b>P</b> < 0.10. <h3>Results</h3> A total of 176 consecutive patients were analyzed. The median follow-up time was 2.83 years. The median age was 54 years, 76 (43%) were ER+/HER2-, 20 (11%) ER+/HER2+, 26 (15%) ER-/HER2+, and 54 (31%) ER-/HER2-. 102 (57%) had T3/4 disease, 41 (23%) underwent lumpectomy, 142 (81%) had pathologic confirmation of N3c, and 10 (6%) had a neck dissection. The median initial radiation dose was 50 Gy (range, 44-56.25), SCV boost 10 Gy (range, 6-16), and 156 (89%) received cumulative SCV dose ≥60 Gy. The 3-year OS, FFDM, RC, and LC were 79%, 64%, 93%, and 96%, respectively. For cumulative SCV dose of ≥60 Gy vs. < 60 Gy, the 3-year OS was 81% vs. 61% (<i>P</i> = 0.03). Among patients with a nodal pCR after NAC, the 3-year OS for SCV dose ≥60 Gy vs. < 60 Gy was 93% vs. 53% (<i>P</i> = 0.03). In multivariable analysis, cumulative SCV dose ≥60 Gy, extranodal extension, ER status, HER2 status, number of dissected lymph nodes, and ECOG status were associated with OS (Table 1). <h3>Conclusion</h3> In a large, modern cohort of non-metastatic cN3c breast cancer patients treated with multimodality therapy, cumulative SCV dose ≥60 Gy was found to be associated with improved OS. Although optimal radiation dosing cannot be established from this data, a SCV radiation boost should be considered in cN3c patients treated with curative intent respecting normal tissue constraints.

How to approach pancreatic cancer after neoadjuvant treatment: assessment of resectability using multidetector CT and tumor markers.

To investigate clinical and CT factors associated with local resectability in patients with nonmetastatic pancreatic cancers after neoadjuvant chemotherapy ± radiation therapy (CRT). This retrospective study included consecutive patients with nonmetastatic pancreatic cancers who underwent neoadjuvant CRT between June 2009 and June 2019. Tumor size, tumor-vascular contact with artery/vein, and local resectability categories (resectable, borderline resectable, or locally advanced) were assessed at baseline and post-CRT CT. Baseline and post-CRT carbohydrate antigen (CA) 19-9 levels were also assessed. Clinical or imaging features related to R0 resection were determined using logistic regression analysis. A total of 179 patients (mean age, 62.4 ± 9.3 years; 92 men) were included. After neoadjuvant CRT, 105 (58.7%) patients received R0 resection, while 74 (41.3%) did not. R0 resection rates were significantly different according to post-CRT CT resectability categories (p < 0.001): 82.8% (48/58), 70.1% (47/67), and 18.5% (10/54) for resectable, borderline resectable, and locally advanced disease, respectively. For post-CRT borderline resectable disease, ≥ 50% decrease in CA 19-9 was significantly associated with R0 resection (odds ratio (OR), 3.160; p = 0.02). For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm (OR, 9.668; p = 0.026) and decreased tumor-arterial contact (OR, 24.213; p = 0.022) were significantly associated with R0 resection. Post-CRT CT resectability categorization may be useful for the assessment of R0 resectability in patients with pancreatic cancer following neoadjuvant CRT. Additionally, ≥ 50% decrease in CA 19-9 was associated with R0 resection in post-CRT borderline resectable disease, while small post-CRT tumor size and decreased tumor-arterial contact were with locally advanced disease. • R0 resection rates following neoadjuvant chemotherapy ± radiation therapy (CRT) were 82.8%, 70.1%, and 18.5% in resectable, borderline resectable, and locally advanced disease, respectively, at post-CRT CT (p < 0.001). • For post-CRT borderline resectable disease, ≥ 50% decrease in carbohydrate antigen (CA) 19-9 was significantly associated with R0 resection. • For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm and decreased tumor-arterial contact were significantly associated with R0 resection.

Patterns of Recurrence and Predictors of Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy, Surgery, and Radiation

Neoadjuvant chemotherapy (NAC) is standard of care for locally advanced breast cancer. There is wide variation in radiation therapy (RT) practice and limited data describing locoregional relapse (LRR) after NAC. We hypothesized a low LRR risk with modern NAC, surgery, and RT and aimed to elucidate patterns of LRR and predictors of disease-free survival (DFS) and overall survival (OS) in these patients. Data from 416 patients with stage II/III breast cancer treated between 2008 and 2015 with NAC, surgery, and adjuvant RT were reviewed retrospectively. DFS and OS rates were calculated using the Kaplan-Meier method. The LRR rate was estimated using the cumulative incidence function, treating death as a competing risk. Multivariable survival analysis was performed using Cox regression. Median follow-up was 4.7 years. Most patients had cT2/3 (74%) cN1 (61%) disease and underwent mastectomy (75%) and axillary dissection (84%). Pathologic complete response (pCR) was achieved in 22% of patients. There were 27 LRRs (including 4 isolated LRRs) and 89 distant failures. Two patients developed LRR 2 months after surgery, before adjuvant RT. LRR could be mapped in 23 patients: most (20) recurred within the RT field; 1 in- and out-of-field; and 2 out-of-field. Five-year LRR, DFS, and OS were 6.4%, 77%, and 90%, respectively. On multivariable analysis, triple-negative subtype (hazard ratio [HR] 2.82; 95% confidence interval [CI], 1.78-4.47; P < .001), stage III disease (HR 1.72; 95% CI, 1.11-2.69; P = .016), and non-pCR (HR 4.76; 95% CI 2.13-10.0; P < .001) were associated with poor DFS and OS (HR 4.13 [95% CI, 2.21-7.72; P < .001]; HR 1.94 [95% CI, 1.001-3.75; P = .049]; and HR 2.38 [95% CI, 0.98-5.88; P = .055], respectively). Patients with breast cancer treated with modern NAC, surgery, and RT have a low 5-year LRR risk, with the majority occurring in-field. Triple-negative subtype, stage III disease, and non-pCR were associated with inferior DFS and OS.

Use of radiation therapy in neoadjuvany treatment for pancreatic adenocarcinoma decreases risk of postoperative pancreatic fistula: A nsqip analysis

Presenter: Christopher Mangieri MD | Wake Forest University Background: Neoadjuvant therapy for pancreatic cancer decreases the risk of post-operative pancreatic fistula (POPF). However, there is a paucity of published data specifying which neoadjuvant regimen is most protective against POPF development. We evaluated the differences between neoadjuvant chemotherapy (CT), radiation therapy (RT), and chemotherapy/radiation therapy (CRT) in regard to effect on POPF rates. We hypothesize combined therapy decreases POPF. Methods: The main and targeted pancreatectomy National Surgical Quality Improvement (NSQIP) registries for 2014-2016 were retrospectively reviewed. Cases that did not contain information on the use of neoadjuvant therapy or POPF development were excluded. Additionally, cases that did not identify a malignant etiology were excluded. Linear regression analysis of NSQIP factors that have previously been shown to be associated with or suspected to be associated with POPF was performed. Factors included neoadjuvant therapy, sex, age, BMI, diabetes, smoking, steroid therapy, preoperative weight loss, preoperative albumin level, perioperative blood transfusions, wound classification, ASA classification, duct size (6mm), gland texture (soft, intermediate, hard), and anastomotic technique. Factors identified to be statistically significant with the development of POPF were then compared between cases that received neoadjuvant CT, RT, and CRT. Results: 10,117 cases were analyzed. Development of POPF was significantly associated with lack of neoadjuvant therapy, male sex, higher BMI, non-diabetic status, post-operative blood transfusion, decreased duct size, and soft gland texture. Neoadjuvant therapy, BMI, duct size, and gland texture had the strongest associations with development of POPF (all p values < 0.0001). Overall 1,765 cases (17.45%) underwent neoadjuvant therapy. 1,031 cases underwent CT, 62 cases underwent RT, and 672 cases underwent CRT. The POPF rates were 20.1%, 11.15%, 4.84%, and 8.18% for cases that received no neoadjuvant therapy, CT, RT, and CRT respectively (p value < 0.0001). Comparison of POPF rates between groups receiving only neoadjuvant therapy demonstrated persistent significant differences with the inclusion of radiation therapy (p value 0.039). Decreasing POPF rates correlated significantly with firmer gland texture with the hard gland rates being 54.84%, 54.17%, 42.48%, and 29.01% in the RT, CRT, CT, and no therapy groups respectively (p value < 0.001). Comparison of the neoadjuvant treatment groups revealed no statistically significant differences between duct size, diabetic status, post-operative transfusions, and BMI. Conclusion: To our knowledge this is the largest analysis of specific neoadjuvant regimens in regard to the development of POPF following pancreaticoduodenectomy. The addition of radiation therapy to neoadjuvant regimens provides the strongest protective effect. This is potentially due to increased fibrosis in the pancreatic parenchyma from the radiation therapy resulting in a firmer gland. These findings provide additional support to alleviate concerns the use of neoadjuvant therapy with radiation will increase adverse outcomes after pancreaticoduodenectomy.

Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer.

Neoadjuvant chemotherapy (NAC) ± radiation (NRT) is the "gold standard" approach for locally advanced esophageal cancer (EC). However, the benefits of RT on overall survival (OS) in patients with resectable EC undergoing neoadjuvant therapy followed by esophagectomy remain controversial. The National Cancer Data Base was queried for patients with nonmetastatic EC between 2004 and 2014. Kaplan-Meier, log-rank, and Cox multivariable regression analysis were performed to analyze OS. Logistic regression analyzed factors associated with 90-day mortality, lymph node involvement, and complete pathological response (pCR). A total of 12,238 EC patients who underwent neoadjuvant therapy [neoadjuvant chemoradiation (NACR), 92.1% and NAC, 7.9%] followed by esophagectomy were included. OS was similar in patients undergoing NAC ± RT (35.9 vs. 37.6 mo, respectively, p = 0.393). pCR rate was 18.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). NRT was an independent predictor for increased pCR (HR 2.593, p < 0.001). Patients with pCR had increased survival compared with those without pCR (62.3 vs. 34.4 mo, p < 0.001); however, no difference was found between NACR and NAC (61.7 mo vs. median not reached, p = 0.745) in pCR patients. In non-pCR patients, NAC had improved OS compared with NACR (37.3 vs. 30.8 mo, p = 0.002). NRT was associated with worse 90-day mortality (8.2% vs. 7.7%, HR1.872, p = 0.036) In Cox regression, NRT was an independent predictor of worse OS (HR 1.561, p < 0.001). Neoadjuvant RT is associated with improved pCR rates; however, it had deleterious effects in short- and long-term survival. Also, patients who did not achieve pCR had worse OS after neoadjuvant RT.

Predictors of Survival and Patterns of Recurrence in Breast Cancer Treated with Neoadjuvant Chemotherapy, Surgery, and Radiation

Neoadjuvant chemotherapy (NAC) is standard of care for locally-advanced breast cancer and is increasingly used for early-stage high-risk disease. Previous studies have shown wide variation in radiation (RT) practice and limited data on locoregional relapse (LRR) following NAC. We hypothesized a low LRR risk after treatment with modern NAC, surgery, and RT, and aimed to elucidate patterns of LRR and predictors of disease-free survival (DFS) and overall survival (OS) in these patients. Data from 416 stage II/III breast cancer patients treated with NAC, surgery, and adjuvant RT at our institution between 2008 and 2015 were retrospectively reviewed. Hormone receptor (HR) and HER2 status defined molecular subtypes: HR+HER2- (45%), HR-HER2+ (11%), HR+HER2+ (22%), and HR-HER2- (22%). DFS and OS rates were calculated using the Kaplan-Meier method. LRR rate was estimated using the cumulative incidence function, treating death as a competing risk. Multivariable survival analysis was performed using Cox regression. Median follow-up was 4.7 years (range 0.5 – 10.7). Median age was 48 years (range 24 - 79). Most patients had cT2/3 (75%) cN1 (62%) disease and underwent mastectomy (76%) and axillary dissection (84%). pCR was achieved in 23% of patients: 8% of HR+HER2-, 53% of HR-HER2+, 19% of HR+HER2+, and 41% of HR-HER2- subtype. All patients received adjuvant RT, most (99%) with 50 Gy in 25 fractions. Nodal RT was given to 96% of the patients: 83% axilla and supraclavicular fossa (SCF); 8.5% SCF alone; 8% axilla, SCF, and internal mammary nodes (IMN); and 0.5% SCF and IMN. There were 19 local, 17 regional, and 88 distant failures (DM). Of the 27 patients with LRR (12 HR+HER2-, 0 HR-HER2+, 6 HR+HER2+, 9 HR-HER2-), all but 4 developed DM, 13 of which were synchronous. Two developed LRR 2 months after surgery, prior to adjuvant RT. LRR could be mapped in 22 patients: most (19) recurred in the RT field (in-field); 1 in- and out-of-field; and 2 out-of-fields (1 isolated IMN recurrence and 1 IMN with DM). The 5-year LRR, DFS, and OS were 6.4%, 77%, and 90% for the entire cohort, respectively. On multivariable analysis, HR-HER2- subtype, stage III disease, and non-pCR were associated with poor DFS and OS (Table 1). Breast cancer patients treated with NAC, surgery, and RT have low 5-year LRR risk. Most LRR occur in-field. HR-HER2- subtype, stage III disease, and non-pCR are associated with poor DFS and OS.Abstract 2054; Table 1Multivariable Cox regression analysisCovariateDFSOSHR (95% CI)pHR (95% CI)pMolecular SubtypeHR+HER2-ReferenceReferenceHR-HER2+0.52 (0.2, 1.34)0.181.21 (0.39, 3.79)0.75HR+HER2+0.58 (0.32, 1.04)0.070.73 (0.28, 1.89)0.52HR-HER2-2.19 (1.33, 3.61)0.0023.91 (1.92, 7.95)<0.001StageIIReferenceReferenceIII1.78 (1.14, 2.79)0.011.74 (0.91, 3.35)0.095pCR0.24 (0.11, 0.53)0.0010.38 (0.15, 0.96)0.04 Open table in a new tab

Neoadjuvant chemotherapy plus radiation versus chemotherapy plus regional hyperthermia in high-grade soft tissue sarcomas: a retrospective comparison

Purpose: Localized adult high-grade soft tissue sarcomas (STS) usually require multimodality treatment including surgery, radiotherapy, chemotherapy and hyperthermia. If maximal preoperative tumor-shrinkage is envisaged, neoadjuvant chemotherapy + radiation (CRT) is often applied, however at the expense of relatively high toxicities and increased postoperative complication rates. This study aims to compare preoperative CRT with neoadjuvant chemotherapy + regional hyperthermia (HCT) regarding histopathological response, toxicity and outcome.Methods: In this retrospective analysis, 61 consecutive high-grade STS patients treated between 2009 and 2016 were included. All patients were treated within a prospective treatment protocol. 28 patients received neoadjuvant CRT 33 patients HCT. CRT consisted of four cycles doxorubicin/ifosfamide and two cycles ifosfamide concomitant to 50.4 Gray external beam radiotherapy. HCT consisted of 4–6 cycles doxorubicin/ifosfamide with deep regional hyperthermia administered bi-weekly during each cycle. Association of treatment modality with overall survival (OS), local control (LC) and freedom from distant metastases (FFDM) was evaluated by Kaplan–Meier and log-rank analyses.Results: The overall patient characteristics were well balanced. Histopathological tumor response did not differ significantly between both groups (p = .67), neither did higher-grade toxicities during neoadjuvant treatment. Wound dehiscence (p = .018) and surgical hospital re-admissions (p < .001) were both significantly more frequent in the CRT group. Two-year OS, LC and FFDM rates of all patients were 93, 85 and 71% with no significant differences between CRT and HCT.Conclusion: Compared to CRT, HCT seems equally efficient and appears to bear less surgical complications. Interpretation should be cautious due to the low number of patients and the retrospective nature of this study.

MRI of Extramural Venous Invasion in Locally Advanced Rectal Cancer: Relationship to Tumor Recurrence and Overall Survival.

Purpose To study the relationship between MRI-defined extramural venous invasion (EMVI) prior to treatment and prognosis in patients with locally advanced rectal cancer treated with neoadjuvant chemotherapy-radiation therapy followed by surgery. Materials and Methods This retrospective study included 517 patients with locally advanced rectal cancer evaluated from August 2008 to December 2014. Baseline and posttherapy MRI and follow-up data were retrieved for all patients. After training by using 328 cases with pathologic evaluation of EMVI after therapy, radiologists evaluated baseline MRI for EMVI status in addition to tumor size and characteristics, nodal status, and invasion of the mesorectal fascia. Reader reproducibility was determined by using κ coefficient. Kaplan-Meier curves and adjusted Cox models were used to determine the relationship of baseline MRI parameters to overall survival, metastasis-free survival, and local relapse-free survival. Results Among 517 patients, 335 (64.8%) were men; the mean age was 55.6 years ± 11.5 (standard deviation). At baseline, radiologists identified 259 of 517 (50%) patients with EMVI by using MRI. In adjusted analysis, EMVI and mesorectal fascial invasion at baseline MRI were predictors of metastasis-free survival (hazard ratio, 0.3 and 0.6; P ˂ .01 and P ˂ .02, respectively) and overall survival (hazard ratio, 0.5 and 0.5; P = .01 and P = .02, respectively). EMVI was the only factor associated with local relapse-free survival (hazard ratio, 0.3; P ˂ .01). The κ coefficient for determination of EMVI was 0.80. Conclusion Extramural venous invasion (EMVI) can be reliably evaluated with MRI. The presence of EMVI was associated with greater risk of local and distant tumor recurrence and overall death in patients with locally advanced rectal cancer treated with neoadjuvant chemotherapy-radiation therapy. © RSNA, 2018 Online supplemental material is available for this article.

MR Imaging of Rectal Cancer: Radiomics Analysis to Assess Treatment Response after Neoadjuvant Therapy.

Purpose To investigate the value of T2-weighted-based radiomics compared with qualitative assessment at T2-weighted imaging and diffusion-weighted (DW) imaging for diagnosis of clinical complete response in patients with rectal cancer after neoadjuvant chemotherapy-radiation therapy (CRT). Materials and Methods This retrospective study included 114 patients with rectal cancer who underwent magnetic resonance (MR) imaging after CRT between March 2012 and February 2016. Median age among women (47 of 114, 41%) was 55.9 years (interquartile range, 45.4-66.7 years) and median age among men (67 of 114, 59%) was 55 years (interquartile range, 48-67 years). Surgical histopathologic analysis was the reference standard for pathologic complete response (pCR). For qualitative assessment, two radiologists reached a consensus. For radiomics, one radiologist segmented the volume of interest on high-spatial-resolution T2-weighted images. A random forest classifier was trained to separate the patients by their outcomes after balancing the number of patients in each response category by using the synthetic minority oversampling technique. Statistical analysis was performed by using the Wilcoxon rank-sum test, McNemar test, and Benjamini-Hochberg method. Results Twenty-one of 114 patients (18%) achieved pCR. The radiomic classifier demonstrated an area under the curve of 0.93 (95% confidence interval [CI]: 0.87, 0.96), sensitivity of 100% (95% CI: 0.84, 1), specificity of 91% (95% CI: 0.84, 0.96), positive predictive value of 72% (95% CI: 0.53, 0.87), and negative predictive value of 100% (95% CI: 0.96, 1). The diagnostic performance of radiomics was significantly higher than was qualitative assessment at T2-weighted imaging or DW imaging alone (P < .02). The specificity and positive predictive values were significantly higher in radiomics than were at combined T2-weighted and DW imaging (P < .0001). Conclusion T2-weighted-based radiomics showed better classification performance compared with qualitative assessment at T2-weighted and DW imaging for diagnosing pCR in patients with locally advanced rectal cancer after CRT. © RSNA, 2018 Online supplemental material is available for this article.

Predictive Value of APAF-1 and COX-2 Expression in Pathologic Complete Response of Locally Advanced Rectal Adenocarcinoma After Neoadjuvant Radiation Chemotherapy

Predictive Value of APAF-1 and COX-2 Expression in Pathologic Complete Response of Locally Advanced Rectal Adenocarcinoma After Neoadjuvant Radiation Chemotherapy

Perineural Invasion and Radial Margin Predict Survival in Neoadjuvant Radiation Chemotherapy for Advanced Rectal Cancer

Perineural Invasion and Radial Margin Predict Survival in Neoadjuvant Radiation Chemotherapy for Advanced Rectal Cancer

Prediction of neoadjuvant radiation chemotherapy response and survival using pretreatment [(18)F]FDG PET/CT scans in locally advanced rectal cancer.

The aim of this study was to investigate metabolic and textural parameters from pretreatment [(18)F]FDG PET/CT scans for the prediction of neoadjuvant radiation chemotherapy response and 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). We performed a retrospective review of 74 patients diagnosed with LARC who were initially examined with [(18)F]FDG PET/CT, and who underwent neoadjuvant radiation chemotherapy followed by complete resection. The standardized uptake value (mean, peak, and maximum), metabolic volume (MV), and total lesion glycolysis of rectal cancer lesions were calculated using the isocontour method with various thresholds. Using three-dimensional textural analysis, about 50 textural features were calculated for PET images. Response to neoadjuvant radiation chemotherapy, as assessed by histological tumour regression grading (TRG) after surgery and 3-year DFS, was evaluated using univariate/multivariate binary logistic regression and univariate/multivariate Cox regression analyses. MVs calculated using the thresholds mean standardized uptake value of the liver + two standard deviations (SDs), and mean standard uptake of the liver + three SDs were significantly associated with TRG. Textural parameters from histogram-based and co-occurrence analysis were significantly associated with TRG. However, multivariate analysis revealed that none of these parameters had any significance. On the other hand, MV calculated using various thresholds was significantly associated with 3-year DFS, and MV calculated using a higher threshold tended to be more strongly associated with 3-year DFS. In addition, textural parameters including kurtosis of the absolute gradient (GrKurtosis) were significantly associated with 3-year DFS. Multivariate analysis revealed that GrKurtosis could be a prognostic factor for 3-year DFS. Metabolic and textural parameters from initial [(18)F]FDG PET/CT scans could be indexes to assess tumour heterogeneity for the prediction of neoadjuvant radiation chemotherapy response and recurrence in LARC.

P-0180 - Retrospective Analysis in Adjuvant Treatment of Locally Advanced Rectal Cancer

Background: Adjuvant treatment with xelox, folfox or capecitabine is considered the standard treatment for locally advanced rectal cancer (RC) treated with neoadjuvant chemotherapy-radiotherapy, however, not all patients can receive a combination therapy. The objective of our study was to evaluate the overall survival, disease free survival and toxicity in our patients with locally advanced CR to treated with neoadjuvant chemotherapy-radiotherapy and adjuvant treatment.

EUS Accuracy in the Preoperative Staging and Restaging of Advanced Rectal Cancer

Background: Endoscopic ultrasonography (EUS) is highly accurate for locoregional staging of rectal cancer (RC). Purpose: The aim of the study was to evaluate accuracy of EUS in the staging and restaging [after neoadjuvant chemotherapy + radiotherapy (NAT)] of patients (pts) with RC at our Institution. Material and Methods: From 5/1994 to 10/2006, 212 pts with RC underwent EUS for locoregional staging at our Institution. There were 118 men, and 94 women, with a mean age of 60 years (40-80). EUS was performed using Olympus CF UM 20 and Olympus GF UM160.

Traitement chirurgical du cancer du pancréas : les exérèses à visée curative

Curative resection of pancreatic adenocarcinoma can only be performed in 10% of patients. This review article reports resectability rates and criteria, results of pancreatic resection and prognostic factors. Lymph node and/or vascular involvement and retroperitoneal tissue invasion constitute very poor prognostic factors; however, lymph node involvement limited to the first draining nodes and limited invasion of the mesenteric-portal vein do not constitute contraindications to surgical resection. Cephalic pancreaticoduodenectomy is still the reference procedure and its postoperative mortality has greatly decreased. The risk of pancreatic fistula mainly depends on the friability of the pancreatic stump. Median survival rate after tumour resection is usually limited between 12 and 18 months. Five-year actuarial survival rate is no more than 5%, but after curative resection (RO), it may be as high as 20 to 25% in recent surgical series. Concomitant or neoadjuvant chemotherapy-radiotherapy, currently under evaluation, may increase resection and survival rates.