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The technique of hepatic arterial infusion (HAI) for the treatment of liver metastases from colorectal cancer has been developed over more than 30 years. Although the indications and protocols for this technique have evolved with time, HAI is not routinely performed in clinical practice. Studies have been heterogeneous, with different regimens of intra-arterial drugs, associated or not with systemic chemotherapy, and with unconvincing outcomes. Technical difficulties for catheter placement have limited the implementation of this method in routine practice. The aim of this review is to present recent studies, highlighting technical improvements and promising combinations of oxaliplatin-based HAI with systemic treatments. HAI is being investigated in both the metastatic setting - in the first line and beyond - and in the adjuvant setting, and we will discuss its potential place in current and future patient management.

Background Ovarian metastases from gastrointestinal tumours frequently lead to locoregional complications and undermine quality of life. The chemosensitivity of ovarian metastases from gastric cancer is unknown. Aim To evaluate the efficacy of modern chemotherapy regimens in first-line treatment for patients with ovarian metastases from gastric cancer. Methods All consecutive patients with ovarian metastases from gastric cancer who received at least one cycle of chemotherapy were included in this retrospective study. Results Thirty-five patients were included (median age, 50.5 years; synchronous ovarian metastases, 60%). Seventeen patients (48.6%) underwent oophorectomy. Patients were treated with first-line chemotherapy based on platinum (n = 14), irinotecan (n = 8), taxane plus platinum (n = 4) or epirubicin plus platinum (n = 9). The median PFS and OS were 6.8 and 18.8 months, respectively. The objective response rate (ORR) for extra-ovarian (13.6%) and ovarian (20.9%) metastatic sites was not significantly different (p = 0.55). There was no significant difference in terms of ORR on ovarian metastatic site according to the first-line chemotherapy (p = 0.21). In multivariate analysis, oophorectomy was an independent prognostic factor for OS (p Conclusions This study suggests that ovarian metastases from gastric cancer are not more resistant than extra-ovarian metastases, and that oophorectomy is an independent prognostic factor significantly linked to OS. Prospective studies are needed to confirm these results.

Background Few data are available on management of very elderly colon cancer patients, especially concerning the parameters of therapeutic decisions and the role of geriatricians. Methods We retrospectively reviewed the charts of patients over 80 years of age who underwent surgery for a localised colon cancer in a French academic hospital. Results A total of 176 patients underwent surgery (postoperative morbidity and mortality rates: 25% and 6.7%). Adjuvant chemotherapy was discussed at a multidisciplinary team meeting for 91% of stage III patients, but only 13.5% of them were treated. Twenty-five patients relapsed: 19 were discussed at the multidisciplinary meeting and 16 were treated (5 had a metastasectomy). Despite their increase with time, geriatric assessments were infrequent, 17% (33% after 2006), and had no impact on postoperative morbi-mortality. Median overall survival and recurrence-free survival were 65.3 months and 65.1 months, respectively. Age, emergency surgery, and Charlson comorbidity index were independent prognostic factors. Conclusion Selected elderly colon cancer patients have significant access to surgery. However, postoperative morbi-mortality rates remain high and adjuvant chemotherapy rarely prescribed. Perioperative geriatric assessment, especially before surgery, should be routinely proposed to these patients to evaluate its impact on postoperative morbi-mortality and prescription of adjuvant treatment.

Objective To compare chemotherapy first (group 1) versus self-expanding metal stent first (group 2) for the management of malignant dysphagia in unresectable oesophageal or gastro-oesophageal junction cancer. Methods Patients from two university hospitals with severe malignant dysphagia (dysphagia score ≥ 2) uneligible for surgery or radiochemotherapy were evaluated retrospectively. Results Forty-two patients were included in group 1, and 29 in group 2. After 4 weeks, dysphagia scores improved by at least 1 point in 67% of patients in group 1 versus 93% in group 2 ( p = 0.01); 48% of patients in group 1 were able to eat solid food versus 68% in group 2 ( p = 0.054). In group 1, a self-expanding metal stent was secondarily placed in 18 patients (42.9%), whereas in group 2 dysphagia required a second self-expanding metal stent placement in 33.3% of patients. Conclusion Chemotherapy as the first treatment may be a valid option, avoiding self-expanding metal stent insertion in half of the patients.

1. Digestive oncology – a changing fieldDigestive cancer accounts for a quarter of all cancers and con-siderable knowledge of the particular features of these disordersis required for correct treatment. Digestive oncology (DO) is amajor field of activity for hepato-gastroenterologists (HGE), whoare involved at all stages, from screening to diagnosis, follow-up,tumour evaluationandpalliativetreatment.HGEhavealsorecentlybeen recruited to multidisciplinary teams, due to their consider-able competence in the management of digestive cancers. OverallDO accounts for more than 50% of all admissions to most gas-troenterology (GI) departments. In Belgium, France and Germany,HGE withspecific,recognizedcompetenceareallowedtoadminis-ter chemotherapy and targeted therapies. In these countries, suchcompetence isconsideredtobeattainedaftertwoyearsoftrainingwith an additional course and certification controlled by special-ists in oncology. HGE work in close collaboration with the otherspecialists responsible for managing digestive cancer, as part ofmultidisciplinary teams. Together, Belgium, France and Germanyaccount for 40% of the European population (about 200 millionEuropean citizens). The system works well in these countries andit is not clear why other European countries have not also electedto allow HGE to perform these functions after specific training.Chemotherapy and targeted therapies are no more complex toadminister than other drugs regularly prescribed by HGE, suchas immunosuppressants, antiviral treatments and anti-TNF treat-ments.The reasonsforthissituationmaybehistorical,demographicoreven political.1.1. Historical aspectsWhen 5FU (fluorouracil Roche lb), the first antineoplastic drug,was discovered 50 years ago, HGE expressed great scepticism con-cerning its utility. However, the situation changed in the 1990s