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Cancer pain is highly prevalent, and existing treatments are often insufficient to provide adequate relief. We assessed the long-term safety and efficacy of subcutaneous tetrodotoxin treatment in reducing the intensity of chronic cancer-related pain. In this multicentre open-label longitudinal trial, 30 &mu, g tetrodotoxin was administered subcutaneously twice daily for 4 days in a heterogeneous cohort of patients with persistent pain despite opioids and other analgesics. &ldquo, Responder&rdquo, was defined as a mean reduction of 30% or more in pain intensity from baseline, and &ldquo, clinical responder&rdquo, as some pain reduction, but less than 30%, plus agreement on the part of both the patient and the physician that a meaningful analgesic response to treatment had occurred. Of 45 patients who entered the longitudinal trial, 41 had sufficient data for analysis. Of all 45 patients, 21 (47%) met the criteria for &ldquo, responder&rdquo, [16 patients (36%)] or &ldquo, [5 patients (11%)]. Onset of pain relief was typically cumulative over days, and after administration ended, the analgesic effect subsided over the course of a few weeks. No evidence of loss of analgesic effect was observed during subsequent treatments (2526 patient&ndash, days in total and a maximum of 400 days in 1 patient). One patient withdrew from the study because of adverse events. Toxicity was usually mild (82%) or moderate (13%), and remained so through subsequent treatment cycles, with no evidence of cumulative toxicity or tolerance. Long-term treatment with tetrodotoxin is associated with acceptable toxicity and, in a substantial minority of patients, resulted in a sustained analgesic effect. Further study of tetrodotoxin for moderate-to-severe cancer pain is warranted.

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Halifax, Nova Scotia, October 20&ndash, 22, 2011. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of rectal cancer, including pathology reporting, neoadjuvant systemic and radiation therapy, surgical techniques, and palliative care of rectal cancer patients. Other topics discussed include multidisciplinary cancer conferences, treatment of gastrointestinal stromal tumours and pancreatic neuroendocrine tumours, the use of folfirinox in pancreatic cancer, and treatment of stage ii colon cancer.

Original citation Curr Oncol 2015;22:e305–15. (doi: http://dx.doi.org/10.3747/co.22.2603) Author Description of the Error and Correction It came to our attention that, over the course of putting together this article, we inadvertently forgot to include one of our colleagues, Dr. Celia Marginean, who had contributed to the guidelines. That omission was a complete oversight on our part. The correct author list, affiliations, and conflict of interest disclosures appear here.

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, October 22&ndash, 24, 2009. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management colorectal cancer, such as the management of hepatic and pulmonary metastases, the role of monoclonal antibodies to the epidermal growth factor receptor, and the benefits and safety of chemotherapy in elderly patients. The management of gastrointestinal neuroendocrine tumours and gastric cancer are also discussed.

Hepatocellular carcinoma (hcc) is an uncommon tumour, but its incidence is increasing in Canada and elsewhere. Currently, there are no Canadian recommendations for diagnosis and treatment of hcc, and possible options may have regional limitations. A consensus symposium was held in the Ottawa region to consider current diagnostic and management options for hcc. These recommendations were developed: Diagnosis&mdash, with adequate imaging, a biopsy is not required pre-surgery, but is required before the start of systemic therapy, lesions smaller than 1 cm should be followed and not biopsied, repeat biopsies should be core tissue biopsies, magnetic resonance imaging is preferred, but triphasic computed tomography imaging can be useful Resection&mdash, recommended for localized hcc Radiofrequency ablation&mdash, recommended for unresectable or non-transplantable hcc, should not be performed in the presence of ascites Trans-arterial chemoembolization (tace)&mdash, doxorubicin with lipiodol is the agent of choice, trans-catheter embolization is an alternative for patients if tace is not tolerated or is contraindicated Medical management&mdash, first-line sorafenib should be considered the standard of care Transplantation&mdash, suitable patients meeting Milan criteria should be assessed for a graft regardless of other treatments offered