Clinical colorectal cancer最新文献

{"title":"The Next Best Thing: Three Key Conversations to Convey Prognosis Over the Course of an Incurable Cancer","authors":"Lindsay Gage,&nbsp;Melissa Teply","doi":"10.1016/j.clcc.2023.07.002","DOIUrl":"10.1016/j.clcc.2023.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Waiting until a person is very near end of life to discuss limited life expectancy risks lower goal-concordant care and increased utilization of medical interventions with lower likelihood of benefit at the end of life. Medical training on communication skills in serious illness often focuses on early and late conversations regarding prognosis, with no guidance on navigating the conversations occurring in the middle of the illness course.</p></div><div><h3>Goal of the review</h3><p>We propose a new framework for identifying and discussing prognosis at various points along the cancer course, as a continuum from beginning to end, that is prompted by changes in clinical status and number of available remaining cancer directed interventions.</p></div><div><h3>Discussion</h3><p>SPIKES is a framework utilized for early conversations in a cancer course. REMAP is a framework utilization for late conversations in a cancer course. There is a gap in guidance on how to navigate conversations that occur between the early and late phases of a cancer course. We describe 3 general phases of care during a cancer course (“early,” “middle,” and “late”), with each phase warranting specific communication skills in order to improve patient understanding of prognosis, goal concordant care, and best practices for healthcare utilization in the acute and end of life care settings.</p></div><div><h3>Conclusion</h3><p>Framing prognosis by available medical interventions through a framework of “early,” “middle,” and “late” adds clarity to the phase of illness, expectations around delivery of information to the patient, and framing of recommendations at each given phase.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 354-360"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10246338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Cetuximab Concentrations Correlate With Survival in Patients With Advanced KRAS Wild Type Colorectal Cancer","authors":"Di Maria Jiang ,&nbsp;Shruti Parshad ,&nbsp;Luna Zhan ,&nbsp;Hao-Wen Sim ,&nbsp;Lillian L. Siu ,&nbsp;Geoffrey Liu ,&nbsp;Jeremy D. Shapiro ,&nbsp;Timothy J. Price ,&nbsp;Derek J. Jonker ,&nbsp;Christos S. Karapetis ,&nbsp;Andrew H. Strickland ,&nbsp;Wenjiang Zhang ,&nbsp;Mark Jeffery ,&nbsp;Dongsheng Tu ,&nbsp;Siobhan Ng ,&nbsp;Sabe Sabesan ,&nbsp;Jenny Shannon ,&nbsp;Amanda Townsend ,&nbsp;Chris J. O'Callaghan ,&nbsp;Eric X. Chen","doi":"10.1016/j.clcc.2023.08.006","DOIUrl":"10.1016/j.clcc.2023.08.006","url":null,"abstract":"<div><h3>Background</h3><p>Cetuximab is a standard of care therapy for patients with RAS wild-type (WT) advanced colorectal cancer. Limited data suggest a wide variation in cetuximab plasma concentrations after standard dosing regimens. We correlated cetuximab plasma concentrations with survival and toxicity.</p></div><div><h3>Methods</h3><p>The CO. 20 study randomized patients with RAS WT advanced colorectal cancer in a 1:1 ratio to cetuximab 400 mg/m² intravenously followed by weekly maintenance of 250 mg/m², plus brivanib 800 mg orally daily or placebo. Blood samples obtained at week 5 precetuximab treatment were analyzed by ELISA. Patients were grouped into tertiles based on plasma cetuximab concentrations. Cetuximab concentration tertiles were correlated with survival outcomes and toxicity. Patient demographic and biochemical parameters were evaluated as co-variables.</p></div><div><h3>Results</h3><p>Week 5 plasma cetuximab concentrations were available for 591 patients (78.8%). The median overall survival (OS) was 11.4 months and 7.8 months for patients in the highest (T3) and lowest tertiles (T1) respectively. On multivariable analysis, plasma cetuximab concentration was associated with OS (HR 0.66, 95% confidence interval [CI]: 0.53-0.83, <em>P</em> &lt; .001, T3 vs. T1), and a trend towards progression-free survival (HR 0.82, 95% CI: 0.66-1.02, <em>P</em> = .07, T3 vs. T1). There was no association between cetuximab concentration and skin toxicity or diarrhea.</p></div><div><h3>Conclusion</h3><p>The standard cetuximab dosing regimen may not be optimal for all patients. Further pharmacokinetic studies are needed to optimize cetuximab dosing given the potential improvement in OS.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 457-463"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1533002823000841/pdfft?md5=e0a41a9a60e704490112f06409d6077d&pid=1-s2.0-S1533002823000841-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Body Radiotherapy for Management of Pulmonary Oligometastases in Stage IV Colorectal Cancer: A Perspective","authors":"Michael X. Fu ,&nbsp;Catarina Carvalho ,&nbsp;Bella Milan-Chhatrisha ,&nbsp;Nishita Gadi","doi":"10.1016/j.clcc.2023.09.001","DOIUrl":"10.1016/j.clcc.2023.09.001","url":null,"abstract":"<div><p><span>In pulmonary oligometastases from colorectal cancer (POM-CRC), metastasectomy<span><span> is the primarily recommended treatment. </span>Stereotactic body radiotherapy (SBRT) has been suggested as a viable alternative therapy. SBRT efficacy for POM-CRC is poorly delineated compared to selected non-CRC primaries. This perspective article aims to critically summarize the existing evidence regarding efficacy of SBRT in terms of overall survival (OS) and local control (LC), and factors modulating this, in the treatment of POM-CRC. Overall, reasonable LC and OS rates were observed. The wide range of expansions in planning target volume margins introduced variation in pretreatment protocols. Dose-fractionation schedules varied according to patient and tumor characteristics, though leverage of BED</span></span>₁₀<span><span> in select studies enabled standardization. An association between SBRT dose and improved OS and LC was observed across multiple studies. Prognostic factors that were associated with improved LC included: fewer oligometastases, absence of extra-pulmonary metastases, primary </span>tumor histology<span>, and smaller gross tumor volume. Differences in SBRT modality and techniques over time further confounded results. Many studies included patients receiving additional systemic therapies; preprotocol and adjuvant chemotherapies were identified as prognostic factors for LC. SBRT compared with metastasectomy showed no differences in short-term OS and LC outcomes. In conclusion, SBRT is an efficacious treatment for POM-CRC, in terms of OS and LC. Heterogeneity in study design, particularly pertaining to dose protocols, patient selection, and additional therapies should be controlled for future randomized studies to further validate SBRT efficacy.</span></span></p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 402-410"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Feasibility Assessment in the Design of ctDNA Guided Trials – Results From the OPTIPAL II Study","authors":"Louise Bach Callesen ,&nbsp;Anders Kindberg Boysen ,&nbsp;Christina Søs Auður Andersen ,&nbsp;Niels Pallisgaard ,&nbsp;Karen-Lise Garm Spindler","doi":"10.1016/j.clcc.2023.07.005","DOIUrl":"10.1016/j.clcc.2023.07.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Both quantitative and molecular changes in ctDNA can hold important information when treating metastatic colorectal cancer (mCRC), but its clinical utility is yet to be established. Before conducting a large-scale randomized trial, it is essential to test feasibility. This study investigates whether ctDNA is feasible for detecting patients who will benefit from treatment with epidermal growth factor receptor inhibitors and the prognostic value of circulating tumor DNA (ctDNA) response.</p></div><div><h3>Materials and methods</h3><p>Patients with mCRC, who were considered for systemic palliative treatment and were eligible for ctDNA analysis. Mutational testing on cell-free DNA (cfDNA) was done by ddPCR. ctDNA response from baseline to the third treatment cycle was evaluated in patients with detectable ctDNA at baseline. ctDNA maximum response was defined as undetectable ctDNA at the third treatment cycle, ctDNA partial response as any decrease in the ctDNA level, and ctDNA progression as any increase in the ctDNA level.</p></div><div><h3>Results</h3><p>Forty-nine patients were included. The time to test results for mutational testing on cfDNA was significantly shorter than on tumor tissue (<em>p</em> &lt; .001). Progression-free survival were 11.2 months (reference group), 7.5 months (HR = 10.7, <em>p</em>= .02), and 4.6 months (HR = 11.4, <em>p</em>= .02) in patients with ctDNA maximum response, partial response, and progression, respectively. Overall survival was 31.2 months (reference group), 15.2 months (HR = 4.1, <em>p</em>= .03), and 9.0 months (HR = 2.6, <em>p</em>= .03) in patients with ctDNA maximum response, partial response, and progression, respectively.</p></div><div><h3>Conclusion</h3><p>Pretreatment mutational testing on cfDNA in daily clinic is feasible and can be applied in randomized clinical trials evaluating the clinical utility of ctDNA. Early dynamics in ctDNA during systemic treatment hold prognostic value.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 421-430.e1"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1533002823000646/pdfft?md5=a4efabfb35ea44f63ae0be8cc3a8eae0&pid=1-s2.0-S1533002823000646-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10389343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-VEGF Therapy Possibly Extends Survival in Patients With Colorectal Brain Metastasis by Protecting Patients From Neurologic Disability","authors":"Chih-Wen Chen ,&nbsp;Tao-Shen Ou ,&nbsp;Wei-Shone Chen ,&nbsp;Jeng-Kai Jiang ,&nbsp;Shung-Haur Yang ,&nbsp;Huann-Sheng Wang ,&nbsp;Shih-Ching Chang ,&nbsp;Yuan-Tzu Lan ,&nbsp;Chun-Chi Lin ,&nbsp;Hung-Hsin Lin ,&nbsp;Sheng-Chieh Huang ,&nbsp;Hou-Hsuan Cheng ,&nbsp;Yi-Wen Yang ,&nbsp;Yu-Zu Lin ,&nbsp;Yee Chao ,&nbsp;Ling-Wei Wang ,&nbsp;Hao-Wei Teng","doi":"10.1016/j.clcc.2023.03.003","DOIUrl":"10.1016/j.clcc.2023.03.003","url":null,"abstract":"<div><h3>Background</h3><p>Colorectal brain metastases (CBMs) are rare with poor prognosis. There is still no standard systemic treatment for multiple or unresectable CBM. our study aimed to explore the impact of anti-VEGF therapy on overall survival, brain-specific disease control, and neurologic symptom burden in patients with CBM<em>.</em></p></div><div><h3>Methods</h3><p>A total of 65 patients with CBM under treatment were retrospectively enrolled and divided into anti-VEGF based systemic therapy or non–anti-VEGF based therapy. A total of 25 patients who received at least 3 cycles of anti-VEGF agent and 40 patients without anti-VEGF therapy were analyzed by endpoints of overall survival (OS), progression-free survival (PFS), intracranial PFS (iPFS) and neurogenic event-free survival (nEFS)<strong><em>.</em></strong> Gene expression in paired primary metastatic colorectal cancer (mCRC), liver, lung and brain metastasis from NCBI data was analyzed using top Gene Ontology (GO) and cBioPortal.</p></div><div><h3>Results</h3><p>Patients who treated with anti-VEGF therapy had significantly longer OS (19.5 vs. 5.5 months, <em>P</em> = .009), iPFS (14.6 vs. 4.1 months, <em>P</em> &lt; .001) and nEFS (17.6 vs. 4.4 months, <em>P</em> &lt; .001). Patients who received anti-VEGF therapy beyond any disease progression presented with superior OS (19.7 vs. 9.4 months, <em>P</em> = .039). Top GO and cBioPortal analysis revealed a stronger molecular function of angiogenesis in intracranial metastasis.</p></div><div><h3>Conclusions</h3><p>Anti-VEGF based systemic therapy showed favorable efficacy that was reflected in longer overall survival, iPFS and NEFS in patients with CBM.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 267-279"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ShorTrip Trial: A Prospective, Multicentric Phase II Single-Arm Trial of Short-Course Radiotherapy Followed by Intensified Consolidation Chemotherapy With the Triplet FOLFOXIRI as Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer","authors":"Beatrice Borelli ,&nbsp;Veronica Conca ,&nbsp;Martina Carullo ,&nbsp;Aldo Sainato ,&nbsp;Roberto Mattioni ,&nbsp;Bruno Manfredi ,&nbsp;Riccardo Balestri ,&nbsp;Piero Buccianti ,&nbsp;Luca Morelli ,&nbsp;Piercarlo Rossi ,&nbsp;Paola Vagli ,&nbsp;Alessandra Anna Prete ,&nbsp;Frassineti Luca ,&nbsp;Federica Morano ,&nbsp;Samantha Di Donato ,&nbsp;Lisa Salvatore ,&nbsp;Carmelo Bengala ,&nbsp;Daniele Rossini ,&nbsp;Luca Boni ,&nbsp;Carlotta Antoniotti ,&nbsp;Roberto Moretto","doi":"10.1016/j.clcc.2023.06.002","DOIUrl":"10.1016/j.clcc.2023.06.002","url":null,"abstract":"<div><h3>Background</h3><p>In patients with locally advanced rectal cancer (LARC) treated with preoperative (chemo) radiotherapy and surgery, adjuvant chemotherapy is poorly feasible and its benefit is questionable. In the last years, several total neoadjuvant treatment (TNT) strategies, moving the adjuvant chemotherapy to the neoadjuvant setting, have been investigated with the aim of improving compliance to systemic chemotherapy, treating micrometastases earlier and then reducing distant recurrence.</p></div><div><h3>Patients and Methods</h3><p>ShorTrip (NTC05253846) is a prospective, multicentre, single-arm phase II trial where 63 patients with LARC will be treated with short-course radiotherapy followed by intensified consolidation chemotherapy with FOLFOXIRI regimen and surgery. Primary endpoint is pCR. Among the first 11 patients who started consolidation chemotherapy, a preliminary safety analysis showed a high rate of grade 3 to 4 neutropenia (N = 7, 64%) during the first cycle of FOLFOXIRI. Therefore, the protocol has been emended with the recommendation to omit irinotecan during the first cycle of consolidation chemotherapy. After amendment, in a subsequent safety analysis focused on the first 9 patients treated with FOLFOX as first cycle and then with FOLFOXIRI, grade 3 to 4 neutropenia was reported in only one case during the second cycle.</p></div><div><h3>Aim of the study</h3><p>The aim of this study is to assess the safety and activity of a TNT strategy including SCRT, intensified consolidation treatment with FOLFOXIRI and delayed surgery. After protocol amendment, the treatment seems feasible without safety concern. Results are expected at the end of 2024.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 339-343.e3"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Efficacy of Targeted Monoclonal Antibodies in Left-Sided Colon and Rectal Metastatic Cancers","authors":"Hiroyuki Kodama,&nbsp;Toshiki Masuishi,&nbsp;Munehiro Wakabayashi,&nbsp;Akinobu Nakata,&nbsp;Ryosuke Kumanishi,&nbsp;Taiko Nakazawa,&nbsp;Takatsugu Ogata,&nbsp;Yuki Matsubara,&nbsp;Kazunori Honda,&nbsp;Yukiya Narita,&nbsp;Hiroya Taniguchi,&nbsp;Shigenori Kadowaki,&nbsp;Masashi Ando,&nbsp;Kei Muro","doi":"10.1016/j.clcc.2023.05.002","DOIUrl":"10.1016/j.clcc.2023.05.002","url":null,"abstract":"<div><h3>Background</h3><p>The recommended first-line chemotherapy for <em>RAS/BRAF</em> wild-type metastatic colorectal cancer (mCRC) is bevacizumab (BEV)-containing therapy for right-sided colon cancer (R) and antiepidermal growth factor receptor antibody (anti-EGFR)-containing therapy for left-sided colon cancer (L) or rectal cancer (RE). However, anatomical or biological heterogeneity reportedly exists between L and RE. Therefore, we aimed to compare the efficacies of anti-EGFR and BEV therapies for L and RE, respectively.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 265 patients with <em>KRAS (RAS</em>)/<em>BRAF</em> wild-type mCRC treated with fluoropyrimidine-based doublet chemotherapy plus anti-EGFR or BEV as the first-line treatment at a single institution. They were divided into 3 groups: R, L, and RE. Overall survival (OS), progression-free survival (PFS), objective response rate, and conversion surgery rate were analyzed.</p></div><div><h3>Results</h3><p>Forty-five patients had R (anti-EGFR/BEV: 6/39), 137 patients had L (45/92), and 83 patients had RE (25/58). In patients with R, both median (m) PFS and OS were superior with BEV therapy (mPFS, anti-EGFR vs. BEV: 8.7 vs. 13.0 months, hazard ratio [HR]: 3.90, <em>P</em> = .01; mOS, 17.1 vs. 33.9 months, HR: 1.54, <em>P</em> = .38). In patients with L, better mPFS and comparable mOS with anti-EGFR therapy were observed (mPFS, 20.0 vs. 13.4 months, HR: 0.68, <em>P</em> = .08; mOS, 44.8 vs. 36.0 months, HR: 0.87, <em>P</em> = .53), whereas, in patients with RE, comparable mPFS and worse mOS with anti-EGFR therapy were observed (mPFS, 17.2 vs. 17.8 months, HR: 1.08, <em>P</em> = .81; mOS, 29.1 vs. 42.2 months, HR: 1.53, <em>P</em> = .17).</p></div><div><h3>Conclusions</h3><p>Efficacies of anti-EGFR and BEV therapies may differ between patients with L and RE.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 298-306"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensification of Local Therapy With High Dose Rate, Intraoperative Radiation Therapy (HDR-IORT) and Extended Resection for Locally Advanced and Recurrent Colorectal Cancer","authors":"Ryan Anthony F. Agas ,&nbsp;Jennifer Tan ,&nbsp;Jing Xie ,&nbsp;Sylvia Van Dyk ,&nbsp;Joseph C．H． Kong ,&nbsp;Alexander Heriot ,&nbsp;Samuel Y. Ngan","doi":"10.1016/j.clcc.2023.03.002","DOIUrl":"10.1016/j.clcc.2023.03.002","url":null,"abstract":"<div><h3>Background</h3><p>We report our long-term experience with high dose rate intraoperative radiotherapy (HDR-IORT) in a single, quaternary institution.</p></div><div><h3>Patients/Methods</h3><p>From 2004 to 2020, 60 HDR-IORT procedures for locally advanced colorectal cancer (LACC) and 81 for locally recurrent colorectal cancer (LRCC) were done in our institution. Preoperative radiotherapy was done prior to majority of the resections (89%, 125/141). Sixty-nine percent (58/84) of the resections involving pelvic exenterations had &gt;3 en bloc organs resected. HDR-IORT was delivered using a Freiburg applicator. A single 10 Gy fraction was delivered. Margin status was R0 and R1 in 54% (76/141) and 46% (65/141) of the resections, respectively.</p></div><div><h3>Results</h3><p>With a median follow-up time of 4 years, 3-, 5-, and 7- year, overall survival (OS) rates were 84%, 58%, and 58% for LACC and 68%, 41%, and 37% for LRCC, respectively. Local progression-free survival (LPFS) rates were 97%, 93%, and 93% for LACC and 80%, 80%, 80% for LRCC, respectively. For the LRCC group, an R1 resection was associated with worse OS, LPFS, and progression-free survival (PFS), preoperative EBRT was associated with improved LPFS and PFS, and ≥2 years disease-free interval was associated with improved PFS. The most common severe adverse events were postoperative abscess (n = 25) and bowel obstruction (n = 11). There were 68 grade 3 to 4 and no grade 5 adverse events.</p></div><div><h3>Conclusions</h3><p>Favorable OS and LPFS can be achieved for LACC and LRCC with intensive local therapy. In patients with risk factors for poorer outcomes, optimization of EBRT and IORT, surgical resection, and systemic therapy are required.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 257-266"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10113621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Radical Radiotherapy-Radiochemotherapy Results in Anal Canal Cancers: (TROD Gastrointestinal Group Study 02-005)","authors":"Sule Karabulut GUL ,&nbsp;Huseyin Tepetam ,&nbsp;Ferah Yildiz ,&nbsp;Ilhami Er ,&nbsp;Didem Colpan Oksuz ,&nbsp;Murtaza Parvizi ,&nbsp;Ayse Sevgi Ozden ,&nbsp;Zumre Arican Alicikus ,&nbsp;Sezin Yuce Sari ,&nbsp;Omar Alomari ,&nbsp;Ilknur Bilkay Gorken","doi":"10.1016/j.clcc.2023.05.004","DOIUrl":"10.1016/j.clcc.2023.05.004","url":null,"abstract":"<div><h3>Background and Aim</h3><p>This study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature.</p></div><div><h3>Material and Method</h3><p>The study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20.</p></div><div><h3>Results</h3><p>Median follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (<em>P</em> &lt; .000) and 112 with complete response (<em>P</em> &lt; .000). Anemia (<em>P</em> &lt; .002), local progression, and systemic progression (<em>P</em> &lt; .000) resulted in lower OS (<em>P</em> &lt; .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects.</p></div><div><h3>Conclusion</h3><p>Radiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 318-326"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Radiotherapy Decision-Tree for Rectal Cancer Patients: A Real-World Analysis Based on the Swedish Colorectal Cancer Registry","authors":"Bin Luo ,&nbsp;Chuanwen Fan ,&nbsp;Xuqin Xie ,&nbsp;Per Loftås ,&nbsp;Xiao-Feng Sun","doi":"10.1016/j.clcc.2023.04.001","DOIUrl":"10.1016/j.clcc.2023.04.001","url":null,"abstract":"<div><h3>Background</h3><p>There are 3 widely used preoperative radiotherapy (RT) procedures in rectal cancer treatment including long-course RT (LRT), short-course RT with delayed surgery (SRTW), and short-course RT with immediate surgery (SRT). However, further evidence is required to determine which treatment option results in more optimal patient survival.</p></div><div><h3>Methods</h3><p>This Swedish Colorectal Cancer Registry-based retrospective study of real-world data included 7766 stage I–III rectal cancer patients, of which 2982, 1089, 763, and 2932 patients received no RT (NRT), LRT, SRTW, and SRT, respectively. The Kaplan-Meier survival curve and Cox proportional hazard multivariate model were used to identify potential risk factors and to examine the independent association of RT with patient survival after adjusting for baseline confounding factors.</p></div><div><h3>Results</h3><p>RT effects on survival differed by age and clinical T stage (cT) subgroups. Subsequent survival analysis by age and cT subgroups confirmed that patients ≥70 years old with cT4 benefited from any RT (<em>P</em> &lt; .001, NRT as reference) and equally from any RT (<em>P</em> &gt; .05 pairwise between RTs). In contrast, for cT3 patients ≥70 years, SRT and LRT were associated with better survival than SRTW (<em>P</em> &lt; .001). In patients &lt;70 years, LRT and SRTW had superior survival benefits in cT4 patients but inferior to SRT (<em>P</em> &lt; .001); SRT was the only effective treatment in the cT3N+ subgroup (<em>P</em> = .032); patients with cT3N0 and &lt;70 years did not benefit from any RT.</p></div><div><h3>Conclusion</h3><p>This study suggests that preoperative RT strategies may have varying effects on the survival of rectal cancer patients, depending on their age and clinical stage.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 3","pages":"Pages 280-290"},"PeriodicalIF":3.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}