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Julio Garciaaguilar - One of the best experts on this subject based on the ideXlab platform.
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salvage Radical Surgery after failed local excision for early rectal cancer
Diseases of The Colon & Rectum, 2002Co-Authors: Charles M Friel, David A Rothenberger, Robert D Madoff, John W Cromwell, Claudio Marra, Julio GarciaaguilarAbstract:OBJECTIVES: Local recurrence after transanal excision of rectal cancer is often amenable to salvage Radical proctectomy, but the long-term results remain unknown. This study was designed to determine the outcome of salvage Radical Surgery after failed local excision in patients with early rectal cancer. METHODS: We retrospectively reviewed the charts of 29 patients who underwent salvage Radical Surgery for local recurrence after a full-thickness transanal excision for Stage I rectal cancer. End points included local and distant recurrences and disease-free survival after salvage Radical Surgery. Comparisons between groups were performed by chi-squared test. RESULTS: Recurrence involved the rectal wall in 26 patients (90 percent) and was purely extrarectal in only 3 (10 percent). Mean time between local excision and Radical operation was 26 months. The resection was considered curative in 23 patients (79 percent). The stage of the recurrent tumor was more advanced than the primary tumor in 27 patients (93 percent). At a mean follow-up of 39 (range, 2–147) months after Radical Surgery, 17 patients (59 percent) remained free of disease. The disease-free survival rate was 68 percent for patients with tumors with favorable histology vs. 29 percent for patients with tumors with unfavorable histology. CONCLUSION: Salvage Surgery for recurrence after local excision of rectal cancers may not provide results equivalent to those of initial Radical treatment. In the present study the poor results of salvage Surgery emphasize the importance of appropriate selection of the initial treatment of Stage I rectal cancer.
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is local excision adequate therapy for early rectal cancer
Diseases of The Colon & Rectum, 2000Co-Authors: Anders F. Mellgren, Prayuth Sirivongs, David A Rothenberger, Robert D Madoff, Julio GarciaaguilarAbstract:PURPOSE: Radical Surgery of rectal cancer is associated with significant morbidity, and some patients with low-lying lesions must accept a permanent colostomy. Several studies have suggested satisfactory tumor control after local excision of early rectal cancer. The purpose of this study was to compare recurrence and survival rates after treating early rectal cancers with local excision and Radical Surgery. METHODS: One hundred eight patients with T1 and T2 rectal adenocarcinomas treated by transanal excision were compared with 153 patients with T1N0 and T2N0 rectal adenocarcinomas treated with Radical Surgery. Neither group received adjuvant chemoradiation. Mean follow-up time was 4.4 years after local excision and 4.8 years after Radical Surgery. RESULTS: The estimated five-year local recurrence rate was 28 percent (18 percent for T1 tumors and 47 percent for T2 tumors) after local excision and 4 percent (none for T1 tumors and 6 percent for T2 tumors) after Radical Surgery. Overall recurrence was also higher after local excision (21 percent for T1 tumors and 47 percent for T2 tumors) than after Radical Surgery (9 percent for T1 tumors and 16 percent for T2 tumors). Twenty-four of 27 patients with recurrence after local excision underwent salvage Surgery. The estimated five-year overall survival rate was 69 percent after local excision (72 percent for T1 tumors and 65 percent after T2 tumors) and 82 percent after Radical Surgery (80 percent for T1 tumors and 81 percent for T2 tumors). Differences in survival rate between local excision and Radical Surgery were statistically significant in patients with T2 tumors. CONCLUSIONS: Local excision of early rectal cancer carries a high risk of local recurrence. Salvage Surgery is possible in most patients with local recurrence, but may be effective only in patients with T1 tumors. When compared with Radical Surgery, local excision may compromise overall survival in patients with T2 rectal cancers.
Qiyu Zhang - One of the best experts on this subject based on the ideXlab platform.
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preoperative fasting hyperglycemia is an independent prognostic factor for postoperative survival after gallbladder carcinoma Radical Surgery
Cancer management and research, 2019Co-Authors: Peng Zheng, Xiaoqian Wang, Zhong Hong, Feixia Shen, Qiyu ZhangAbstract:Background Preoperative high blood glucose levels are closely associated with poor performance and high mortality in cancer patients. This study was designed to investigate the relationship between preoperative fasting hyperglycemia and the prognosis of patients with gallbladder cancer (GBC) after undergoing GBC Radical Surgery. Patients and methods A retrospective analysis of 83 eligible patients who underwent GBC Radical Surgery between 2007 and 2016 was performed. Factors affecting overall survival (OS) and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses. Results Of the 83 patients, 35 (42.2%) had preoperative fasting hyperglycemia. The median OS of the enrolled patients was 12 months. The median OS in patients with fasting hyperglycemia before Surgery was 18 months, which was shorter than for patients with normal fasting blood glucose levels before Surgery (47 months, P<0.001). Preoperative fasting hyperglycemia was associated with shorter survival times in univariate analyses (HR, 3.215; 95% CI, 1.846-5.601; P<0.001). Multivariate analysis showed that patients with preoperative fasting hyperglycemia had a lower OS (HR, 2.832; 95% CI, 1.480-5.418; P=0.002) and RFS (HR, 2.051; 95% CI, 1.127-3.733; P=0.019) than patients with normal preoperative fasting blood glucose levels. Conclusion Preoperative fasting hyperglycemia is an independent indicator of poor prognosis in GBC patients after GBC Radical Surgery.
Giovanni Scambia - One of the best experts on this subject based on the ideXlab platform.
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chemoradiation with concomitant boosts followed by Radical Surgery in locally advanced cervical cancer long term results of the roma 2 prospective phase 2 study
International Journal of Radiation Oncology Biology Physics, 2014Co-Authors: Gabriella Ferrandina, Anna Fagotti, Francesco Fanfani, Antonietta Gambacorta, Valerio Gallotta, D Smaniotto, Luca Tagliaferri, E Foti, R Autorino, Giovanni ScambiaAbstract:Purpose This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with CBs (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m 2 , days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m 2 /daily, orally) during the first 2 and the last 2 weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if >45 pCR were registered (α error = 0.05; β error = 0.1). Results pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36 months (range: 7-85 months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or 2. Conclusions Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by Radical Surgery results in a high rate of pathologically assessed complete response to CRT and a very encouraging local control rate, with acceptable toxicity.
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Radical Surgery rs plus intraperitoneal hyperthermic perfusion iphp with oxaliplatin followed by intravenous docetaxel in the treatment of peritoneal carcinosis from platinum sensitive recurrent ovarian cancer oc a pilot study
Journal of Clinical Oncology, 2007Co-Authors: Anna Fagotti, G Ferrandina, Ida Paris, A Mari, Francesco Legge, Francesco Fanfani, G Facchini, Giovanni ScambiaAbstract:16077 Background: Much attention has been focused on the efficacy of Radical Surgery (RS) plus intraperitoneal hyperthermic perfusion (IPHP) in peritoneal carcinosis from recurrent OC. Methods: A pilot study aimed at analyzing the feasibility, morbidity, and toxicity of RS/IPHP and adjuvant chemotherapy has been carried out. Patients with recurrent, platinum-sensitive OC (PFI->6 months), have been enrolled. RS has been performed with peritonectomy procedures. The perfusion of the abdominal cavity has been achieved using 2 liters/m2 of 5% dextrose solution with oxaliplatin 460 mg/m2, preheated (41.5°C), and infused through the closed abdomen technique. After RS/IPHP, patients have received systemic chemotherapy with docetaxel (75 mg/mq), day 1, every 21 days, for 6 cycles. Results: As of December 2006, 14 patients underwent RS/IPHP: median age was 48.5 yrs (range 34–62). Ten (71.4%) patients had an ECOG PS=0. Median PFI was 24 months (range 7–72). TMedian value of PCI was 6 (range 2–10). Completeness of cy...
G Brown - One of the best experts on this subject based on the ideXlab platform.
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the results of local excision with or without postoperative adjuvant chemoradiotherapy for early rectal cancer among patients choosing to avoid Radical Surgery
Colorectal Disease, 2017Co-Authors: Svetlana Balyasnikova, David Cunningham, D Tait, James Read, Andrew Wotherspoon, Ian Swift, Paris P Tekkis, G BrownAbstract:Aim The study aimed to establish the oncological outcome of patients who opted for close surveillance with or without adjuvant chemoradiotherapy (CRT) rather than Radical Surgery after local excision (LE) of early rectal cancer (ERC) Method The Royal Marsden Hospital Rectal Cancer database was used to identify rectal cancer patients treated by primary LE from 2006-2015. All patients were entered in an intensive surveillance programme. Results Twenty eight of 34 analysed patients had a high or very high risk of residual disease predicted by adverse histopathological features for which the recommendation had been Radical Surgery. Eighteen (52%) of the 34 had received radiotherapy following LE. Three-year disease free survival for the 34 patients was 85% (95% CI 78.8-91.2%) and overall survival was 100%. Twenty two of 24 patients with a low tumour which would have required total rectal excision have so far avoided Radical Surgery and remain disease free at a median follow up 3.2 years. Conclusion The findings suggest that with modern MRI and clinical surveillance Radical Surgery can be avoided in patients following initial LE of a histopathologically defined high risk ERC. These findings are comparable with those obtained after major Radical resection and warrant further prospective investigation as a treatment arm in larger prospective trials. This article is protected by copyright. All rights reserved.
Iris D Nagtegaal - One of the best experts on this subject based on the ideXlab platform.
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a multi centred randomised trial of Radical Surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer
BMC Cancer, 2016Co-Authors: W A Borstlap, P J Tanis, T W A Koedam, Corrie A M Marijnen, C Cunningham, Evelien Dekker, M E Van Leerdam, G J Meijer, N C T Van Grieken, Iris D NagtegaalAbstract:Rectal cancer Surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5–20 %) suggesting that local excision alone is not sufficient, while completion Radical Surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage Surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients. The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a Radically removed intermediate risk early rectal cancer by polypectomy or transanal Surgery that is conventionally treated with subsequent Radical Surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME Surgery. NCT02371304 , registration date: February 2015
