151 results on '"Unresectable disease"'
Search Results
2. Unresectable Ovarian Cancer Requires a Structured Plan of Action: A Prospective Cohort Study.
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Nieuwenhuyzen-de Boer, Gatske M., Kengsakul, Malika, Boere, Ingrid A., van Doorn, Helena C., and van Beekhuizen, Heleen J.
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STATISTICS , *OVARIAN tumors , *PROFESSIONS , *POSTOPERATIVE care , *TUMOR classification , *SURVIVAL analysis (Biometry) , *DESCRIPTIVE statistics , *RESEARCH funding , *TERMINATION of treatment , *DATA analysis , *LONGITUDINAL method - Abstract
Simple Summary: Patients with unresectable ovarian cancer during cytoreductive surgery for advanced-stage ovarian cancer are typically underreported. Hence, knowledge of further postoperative treatment and survival in case of unresectable disease during surgery is limited. The aim of this study is to address the knowledge gap about postoperative treatment and survival of patients whose surgery was abandoned due to unresectability after abdominal exploration. This is a post hoc analysis of the PlaComOv study, a randomized controlled trial. In this prospective study, 27 patients with the unresectable disease are described. Treatment was divers, ranging from the cessation of treatment to, predominantly, one or several lines of chemotherapy with or without maintenance treatment with bevacizumab and/or PARP inhibitors. The median overall survival after surgery was 16 (IQR 5–21) months (95%CI 14–18). At 24 months of follow-up, four patients (15%) were alive with the disease. Background: Patients with unresectable disease during cytoreductive surgery (CRS) for advanced-stage ovarian cancer are underreported. Knowledge of treatment and survival after surgery is limited. The aim of this study is to address the knowledge gap about postoperative treatment and survival of patients whose surgery was abandoned due to unresectability after abdominal exploration. Methods: Women with FIGO stage IIIB-IV epithelial ovarian cancer whose disease was considered to be unresectable during surgery were included in this prospective study, a post hoc analysis of the PlaComOv study. The unresectable disease was defined as the inability to achieve at least suboptimal CRS without attempted CRS after careful inspection of the entire abdomen. Preoperative clinical data, perioperative findings, postoperative treatment and survival data were analyzed. Results: From 2018 to 2020, 27 patients were included in this analysis. Treatment ranged from the cessation of treatment to one or several lines of chemotherapy with or without maintenance therapy. The median overall survival was 16 (IQR 5–21) months (95%CI 14–18). At 24 months of follow-up, four patients (15%) were alive. Conclusions: This study indicated a two-year survival of 15%. Optimal treatment strategies in terms of survival benefits are still ill-defined. Further study of this specific group of patients is warranted. We advocate an (inter)national registry of patients with unresectable cancer and comprehensive follow-up. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Denosumab Treatment for Giant Cell Tumor of the Spine Including the Sacrum.
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Bukata, Susan V., Blay, Jean-Yves, Rutkowski, Piotr, Skubitz, Keith, Henshaw, Robert, Seeger, Leanne, Tian Dai, Jandial, Danielle, Chawla, Sant, and Dai, Tian
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GIANT cell tumors , *SACRUM , *DENOSUMAB , *SPINE , *DRUG efficacy - Abstract
Study Design: This was a subanalysis of an international, multicenter, open-label study.Objective: The aim of this study was to assess the efficacy and safety of denosumab in a subset of patients with giant cell tumors of bone (GCTB) of the spine including the sacrum from an international, open-label, single-arm, phase 2 study (ClinicalTrials.gov: NCT00680992).Summary Of Background Data: Standard GCTB treatment is surgical removal, either by curettage or resection, combined with intraoperative adjuvant therapy; however, some sites may not be amenable to resection (e.g., skull, spine).Methods: Adults or skeletally mature adolescents with pathologically confirmed GCTB of the spine including the sacrum, and radiologically measurable evidence of active disease, were included. Patients received denosumab (120 mg subcutaneously) once every 4 weeks during the treatment phase, with loading doses on days 8 and 15 of the first cycle. Patients had surgically unsalvageable GCTB (Cohort 1), had planned surgery expected to result in severe morbidity (Cohort 2), or were enrolled from a previous GCTB study (Cohort 3).Results: Overall, 132 patients were included in the safety analysis (103 in Cohort 1, 24 in Cohort 2, and five in Cohort 3); 131 patients were included in the efficacy analysis. Kaplan-Meier estimated probabilities of disease progression or recurrence were 3% (95% confidence interval [CI], 0.0-6.2) at year 1 and 7.4% (95% CI, 2.1-12.7) at years 3 and 5 in Cohort 1, and not estimable in Cohorts 2 and 3. Of 23 patients (Cohort 2) with surgery planned at baseline, 10 (43%) had on-study surgery; of these, one patient had reported disease progression or recurrence after the on-study surgery. Clinical benefit was reported in 83% of patients overall (all cohorts).Conclusion: Results from the analysis suggest that denosumab is potentially effective treatment for patients with GCTB of the spine including the sacrum. The adverse event profile was consistent with the full study population.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]- Published
- 2021
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4. Laparoscopic Staging of Periampullary Neoplasms
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Conlon, Kevin C., Johnston, Sean M., CLAVIEN, PIERRE-ALAIN, editor, Sarr, Michael G., editor, Fong, Yuman, editor, and Miyazaki, Masaru, editor
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- 2016
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5. To determine the prognostic value of the albumin-bilirubin grade (ALBI) in patients underwent transarterial chemoembolization for unresectable hepatocellular carcinoma.
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Khalid, Muhammad Ali, Achakzai, Inamullah Khan, Hanif, Farina M., Ahmed, Shoaib, Majid, Zain, and Luck, Nasir Hassan
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ASCITES , *LIVER disease diagnosis , *BILIRUBIN , *BIOMARKERS , *COMPUTED tomography , *HEPATITIS viruses , *CIRRHOSIS of the liver , *HEPATOCELLULAR carcinoma , *STATISTICS , *ALBUMINS , *PROPORTIONAL hazards models , *CHEMOEMBOLIZATION , *PROGNOSIS , *THERAPEUTICS - Abstract
Aim: We aimed at determining the prognostic value of the albumin-bilirubin grade (ALBI) in patients undergoing transarterial Chemoembolization for unresectable Hepatocellular carcinoma. Background: Various noninvasive liver reserve markers are used to predict the severity of liver injury. The role and probability of these markers in predicting the prognosis of patients with hepatocellular carcinoma (HCC) is still unknown. Methods: Patients who underwent TACE from 2013 to 2017 were included. Patient's age, gender, cause of cirrhosis, ALBI Grade along with the site, size and number of tumors were recorded. Radiological response to TACE was assessed by CT scan at 1 and 3 months after the procedure, respectively. Survival assessment was performed and all patients were assessed for survival until the last follow-up. Results: A total of 71 patients were included. Majority of them were male (80.3 %). The mean tumor size of 6 ± 3.9 cm. Majority of patients (54.9 %) had a single lesion and it was mostly localized to the right lobe (60.5 %). The most common cause of chronic liver disease was HCV (65.3%). Median Child class score (CTP) and MELD score were 7 and 10, respectively. Ascites was treated prior to TACE in 12 patients (16.9 %). Mean ALBI score in the study population was -1.59 ± 0.69, with the majority (49. 2 %) falling in grade 2. The mean duration of survival at the last follow up was of 12.1 ± 12.14 months (1- 49). Univariate analysis showed serum albumin (p = 0.003), serum bilirubin (p = 0.018), CTP score (p = 0.019), ALBI grade (p = 0.001) and presence of varices (p = 0.04) to be the main predictors of 6 months survival after TACE. On Cox analysis, only ALBI score (p = 0.038) showed statistical significant association. Conclusion: ALBI grade may serve as a surrogate marker in predicting the prognosis of HCC patients undergoing Transarterial Chemoembolization. [ABSTRACT FROM AUTHOR]
- Published
- 2019
6. Clinical Predictors of Unresectable Disease at Laparotomy in Patients With Pancreatic Ductal Adenocarcinoma Planning to Undergo Surgical Resection
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Shozo Mori, Takayuki Shimizu, Mitsuru Ishizuka, Shun Sato, Yukihiro Iso, Takayuki Shiraki, Yuhki Sakuraoka, Takatsugu Matsumoto, Keiichi Kubota, and Taku Aoki
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Male ,Surgical resection ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,Pancreatic ductal adenocarcinoma ,CA-19-9 Antigen ,endocrine system diseases ,medicine.medical_treatment ,Unresectable disease ,Adenocarcinoma ,Laparotomy ,Preoperative Care ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General Medicine ,Prognosis ,digestive system diseases ,Pancreatic Neoplasms ,ROC Curve ,Oncology ,Positron emission tomography ,Female ,CA19-9 ,Radiology ,business ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
BACKGROUND/AIM Computed tomography and positron emission tomography cannot detect all minute distant metastases and fully evaluate extensive vascular invasion in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate predictors of laparotomy only and palliative surgery in PDAC patients planning surgical resection. PATIENTS AND METHODS We reviewed 239 PDAC patients planning surgical resection. Patients were divided into two groups based on resection status. Multivariate analyses were performed to identify predictors of unresectable disease at laparotomy. RESULTS Twenty-five patients had unresectable disease at laparotomy. Multivariate analysis revealed that anatomical borderline resectable status (yes/no) (HR=5.458, p=0.012), pretreatment CA19-9 (>260/≤260 ng/ml) (HR=4.907, p=0.041), and tumor size (>25/≤25 mm) (HR=21.42, p=0.004) were associated with unresectable disease at laparotomy. CONCLUSION Borderline resectable status, pretreatment CA19-9, and tumor size were closely associated with unresectable disease at laparotomy in PDAC patients planning surgical resection.
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- 2021
7. Minimal Access Management of Pancreatic Cancer
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Hamilton, Nicholas A., Matthews, Brent D., Greene, Frederick L., editor, and Heniford, B. Todd, editor
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- 2010
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8. Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study.
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Chang, Hui, Yu, Xin, Xiao, Wei-wei, Wang, Qiao-xuan, Zhou, Wen-hao, Zeng, Zhi-fan, Ding, Pei-rong, Li, Li-ren, and Gao, Yuan-hong
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ADJUVANT treatment of cancer , *COLON cancer treatment , *CHEMORADIOTHERAPY , *COLON cancer diagnosis , *SURVIVAL analysis (Biometry) , *LONGITUDINAL method - Abstract
Background: The prognosis of locally unresectable colon cancer (CC) is poor. This prospective observational study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery in these patients. Patients and methods: We consecutively enrolled patients who were diagnosed with locally unresectable CC from November 2010 to March 2017, and received NACRT followed by surgery. The data of all the patients were collected prospectively. The R0 resection, downstage and pathologic complete response (pCR) rates were calculated to evaluate the short-term treatment effects. The overall survival (OS) was used to evaluate the long-term outcome. The incidence of NACRT-related acute toxicities and postsurgical complications were used to assess the safety. Results: A total of 60 patients were eligible for analysis, including 57 (95.0%) patients who attained resectability after NACRT. Among patients managed with surgery, 49 cases (86.0%) achieved R0 resection, and 15 cases (26.3%) achieved pCR. Down T stage was seen in 47 cases (82.5%), and down N stage was seen in 53 cases (93.0%). After a median follow-up time of 26 months, the OS appeared as 76.7%. The most common grade 3/4 NACRT-related toxicity was myelosuppression (incidence, 20.0%). The incidence of grade 3/4 surgery-related complication was 7.0%. Conclusion: NACRT might be a safe and effective choice for patients with locally unresectable CC to improve treatment effects, long-term survival and life quality, though further validation is needed. [ABSTRACT FROM AUTHOR]
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- 2018
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9. Laparoscopic Staging
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Katz, Matthew H., Moossa, Abdool R., Bouvet, Michael, Pollock, Raphael E., editor, Lowy, Andrew M., editor, Leach, Steven D., editor, and Philip, Philip A., editor
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- 2008
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10. Preoperative Staging of Pancreatic Adenocarcinoma
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Pontey, Eric, Greene, Frederick L., Mostafa, Gamal, Patel, Anand, and Scott-Conner, Carol E. H., editor
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- 2008
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11. Emerging biological therapies for the treatment of malignant pleural mesothelioma
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Stephen Clarke, Michael Boyer, Alexander P Davis, Steven Kao, and Nick Pavlakis
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Oncology ,medicine.medical_specialty ,Pleural Neoplasms ,medicine.medical_treatment ,Immune checkpoint inhibitors ,Unresectable disease ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Biomarkers, Tumor ,Humans ,Medicine ,Pharmacology (medical) ,Mesothelin ,Precision Medicine ,Pharmacology ,Biological therapies ,biology ,business.industry ,Pleural mesothelioma ,Mesothelioma, Malignant ,Treatment options ,Immunotherapy ,respiratory system ,respiratory tract diseases ,Biological Therapy ,030220 oncology & carcinogenesis ,biology.protein ,Dendritic Cell Therapy ,business - Abstract
Introduction: Malignant pleural mesothelioma (MPM) has limited treatment options with minimal new therapy approvals for unresectable disease in the past 15 years. However, considerable work has occ...
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- 2021
12. Periampullary Malignancies
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Godellas, Constantine V., Saclarides, Theodore J., editor, Millikan, Keith W., editor, and Godellas, Constantine V., editor
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- 2003
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13. Rationale for Neoadjuvant Chemotherapy for Advanced Gastric Cancer
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Yamao, Takekazu, Nakajima, Toshifusa, editor, and Yamaguchi, Toshiharu, editor
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- 1999
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14. CA19-9 capability as predictor of pancreatic cancer resectability in a Spanish cohort
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Agueda Iglesias-Gómez, María Francisco, Emma Martínez Moneo, Luis Bujanda, Marta García-Cougil, Mario Rodríguez-López, Lourdes Ruiz-Rebollo, E Iyo, Emilio Garabitos, Maider Martos, Mario Montes, Marta Herreros-Villanueva, Ibon Martínez-Arranz, Joaquín Cubiella, and Enrique de Madaria
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Male ,0301 basic medicine ,medicine.medical_specialty ,CA-19-9 Antigen ,endocrine system diseases ,Unresectable disease ,Adenocarcinoma ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Borderline resectable ,Internal medicine ,Pancreatic cancer ,Biomarkers, Tumor ,Genetics ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Molecular Biology ,Aged ,Aged, 80 and over ,business.industry ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,digestive system diseases ,Pancreatic Neoplasms ,030104 developmental biology ,ROC Curve ,Spain ,030220 oncology & carcinogenesis ,Cohort ,Female ,CA19-9 ,business - Abstract
CA19-9 serum has been suggested as a marker of unresectability but different cut-off levels have been published. A cut-off of 500 U/ml is currently considered in an international consensus as biological criteria of borderline resectable pancreatic adenocarcinoma. To evaluate whether serum CA19-9 threshold of 500 U/ml could be adequate predictor of resectability in pancreatic adenocarcinoma. Multicenter, observational, prospective study performed in Spain including 203 patients diagnosed with pancreatic adenocarcinoma. 43 (21.2%) cases were resectable and 160 (78.8%) unresectable. Among the 176 preoperative CA19-9 available values, 98 (58.3%) were ≤ 500 U/ml and 73 (42.7%) > 500 U/ml. Resectability rate in those patients with CA19-9 ≤ 500 U/ml was 60% while it was found to be 18% when CA19-9 > 500 U/ml. Statistical model to predict resectability based on CA19-9 provide an AUC of 0.6618 (95% CI 0.53–0.83) when only CA19-9 values > 500 U/ml are studied. Serum levels of CA19-9 higher than 500 U/ml are indicative of unresectable disease, however reduced sensitivity and specificity lead to a limited clinical applicability for resectability.
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- 2020
15. Hypofractionated radiotherapy for elderly breast cancer patients: from early stages disease to local palliation for unresectable disease
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Vimoj Nair and Jean-Michel Caudrelier
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Oncology ,Hypofractionated Radiotherapy ,Cancer Research ,medicine.medical_specialty ,partial breast radiation ,hypofractionation ,business.industry ,Unresectable disease ,Review Article ,Disease ,medicine.disease ,re-irradiation ,Regimen ,Breast cancer ,Locally advanced disease ,Internal medicine ,palliative radiation therapy ,medicine ,Radiotherapy dose ,Radiology, Nuclear Medicine and imaging ,Breast disease ,Elderly breast cancer ,skin and connective tissue diseases ,business - Abstract
There is a lack of clear guidelines on optimal radiotherapy dose regimen for elderly breast cancer patients. This review summarizes the current evidence on role of hypofractionated radiotherapy in elderly breast cancer. Also, suggestions have been provided on the best fractionation approaches based on current evidence. Hypofractionated radiotherapy is feasible and well tolerated in elderly breast cancer patients with both early and locally advanced disease. Ultra-hypofractionated regimen seem appropriate for palliation of unresectable primary breast disease and could become a safe approach for adjuvant treatments. Hypofractionated radiotherapy should be considered for treatment of elderly breast cancer for curative intent, as well as for palliation.
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- 2020
16. Radioembolization of Intrahepatic Cholangiocarcinoma: Patient Selection, Outcomes, and Competing Therapies
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Christopher Molvar and Joseph Ray Ness
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Oncology ,medicine.medical_specialty ,Side effect ,medicine.diagnostic_test ,business.industry ,Locally advanced ,Unresectable disease ,Interventional radiology ,Transarterial Radioembolization ,Hepatic malignancy ,Review article ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Intrahepatic Cholangiocarcinoma - Abstract
Intrahepatic cholangiocarcinoma is the second most common primary hepatic malignancy and poses a therapeutic challenge owing to its late-stage presentation and treatment-resistant outcomes. Most patients are diagnosed with locally advanced, unresectable disease and are treated with a combination of systemic and local regional therapies. Transarterial radioembolization offers a survival benefit and a favorable side effect profile, with a growing body of evidence to support its use. Herein, we review patient selection and detail outcomes of radioembolization for intrahepatic cholangiocarcinoma, together with mention of competing treatments.
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- 2021
17. A Case Report of Papillary Digital Adenocarcinoma With BRAFV600E Mutation and Quantified Mutational Burden
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George W. Niedt, Magdalena Jurkiewicz, Richard D. Carvajal, Shaheer Khan, Larisa J. Geskin, and Megan H. Trager
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Mutation ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Right forearm ,Kinase ,business.industry ,education ,Unresectable disease ,Dermatology ,General Medicine ,medicine.disease_cause ,medicine.disease ,Pathology and Forensic Medicine ,Metastasis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Eccrine Tumor ,Biopsy ,medicine ,Adenocarcinoma ,business - Abstract
Papillary digital adenocarcinoma (PDA) is a rare eccrine tumor that is most often found on the digits. Few case reports have described PDAs located on atypical sites. It is now accepted that PDAs cannot be distinguished from benign adenomas based on histological features, and it is recommended to excise all of these lesions. Even with excision, recurrence and metastasis rates are high. Only limited genomic analyses have been performed to date, and no driver mutations have been identified. We report a case of a 63-year-old woman with a PDA on the right forearm. Biopsy showed moderate cytologic atypia and mitotic figures. Next-generation DNA sequencing of the tumor showed a BRAFV600E mutation and high tumor mutational burden (5.51 mutations/Mb). This mutation is known for its response to small molecular inhibitors of BRAF and Mitogen-activated protein kinase kinase. Such therapy may be a consideration should our patient develop recurrent unresectable disease.
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- 2020
18. Management of locally recurrent rectal cancer
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Bradley R. Davis and Kathryn A. Schlosser
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medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Unresectable disease ,Disease ,medicine.disease ,Primary tumor ,Therapy naive ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,business ,R0 resection ,Recurrent Rectal Cancer - Abstract
The diagnosis and management of recurrent rectal cancer is surgically and oncologically challenging. Recurrence usually presents within 1–3 years of treatment for primary tumor, and diagnostic workup should assess pelvic resectability and workup for metastatic disease. Treatment includes neoadjuvant chemotherapy and/or radiotherapy, as well as surgical resection when an R0 resection is feasible. Neoadjuvant chemotherapy and radiotherapy is recommended in chemo/radiotherapy naive patients. Preoperative or intraoperative reirradiation is feasible, but the long term impact on likelihood of R0 resection and survivability is controversial. Chemoradiation may also be used to palliate unresectable disease.
- Published
- 2019
19. Liver transplantation for perihilar cholangiocarcinoma: patient selection and outcomes
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Sharon M. Weber, Alexandra W. Acher, and Timothy M. Pawlik
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medicine.medical_specialty ,medicine.medical_treatment ,Unresectable disease ,Liver transplantation ,digestive system ,Bile duct cancer ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Perihilar Cholangiocarcinoma ,Selection (genetic algorithm) ,Hepatology ,business.industry ,Patient Selection ,Gastroenterology ,medicine.disease ,Neoadjuvant Therapy ,Liver Transplantation ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business ,Klatskin Tumor - Abstract
Introduction: Peri-hilar cholangiocarcinoma is an aggressive bile duct cancer. Long-term survival is possible with margin-negative surgery. Historically, unresectable disease was approached with no...
- Published
- 2021
20. Carotid Artery Sacrifice and Reconstruction in the Setting of Advanced Head and Neck Cancer.
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Mourad, Moustafa, Saman, Masoud, Stroman, David, Lee, Thomas, and Ducic, Yadranko
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Objective: To determine oncological and neuromorbidity outcomes in patients with advanced head and neck cancer (stage IVB) requiring sacrifice and reconstruction of the carotid artery.Study Design: Case series with chart review.Setting: Tertiary care referral center.Subjects and Methods: Overall, 51 patients underwent carotid artery sacrifice during surgical treatment of the neck, in both the primary and salvage setting. All patients underwent autogenous in-line carotid artery bypass grafting with either saphenous vein or the deep femoral vein in conjunction with vascular surgery. In all, the study included 39 males and 12 female subjects, with age ranging from 39 to 82 (mean, 62.7).Results: Two patients (3.9%) had a cerebral vascular accident in the immediate postoperative period. The remaining 49 patients (96%) had no neurologic sequela. Serial ultrasonic evaluation revealed 4 patients with intra-luminal thrombus within the site of reconstruction. Perioperative mortality occurred in a single patient. Disease-related mortality occurred in 9.8% (5) of patients, with an overall 2-year survival of 82%.Conclusions: We presently report the largest series of surgical treatment for advanced head and neck cancer with carotid artery involvement. We document an overall 2-year survival of 82% in the setting of low perioperative neuromorbidity and mortality rates. We therefore consider carotid artery sacrifice and autogenous vein graft reconstruction in the absence of distant metastatic disease as a viable treatment option for what was once thought to be a palliative procedure. [ABSTRACT FROM AUTHOR]- Published
- 2015
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21. The Role of Endoscopic Ultrasound in Cholangiocarcinoma
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Michael J. Levy, Neil B. Marya, and Tarek Sawas
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Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,fungi ,Unresectable disease ,medicine.disease ,digestive system diseases ,Tumor seeding ,Primary sclerosing cholangitis ,Fine-needle aspiration ,medicine ,Tissue diagnosis ,Biliary stent ,Radiology ,business - Abstract
The role of endoscopic ultrasound (EUS) in cholangiocarcinoma (CCA) has grown in recent years due to the suboptimal endoscopic methods in obtaining tissue diagnosis. The current chapter focuses on the role of EUS in the diagnosis and staging of CCA. While EUS-guided fine needle aspiration (FNA) of the primary CCA tumor is strongly discouraged due to risk of tumor seeding, EUS-FNA plays an essential role in evaluating CCA-associated lymphadenopathy and has a significant impact on prognosis and guiding management. Regardless of cross-sectional imaging (unless unresectable disease is identified), EUS can be useful in providing enhanced staging data, primarily via improved nodal assessment. Although primary sclerosing cholangitis and the presence of biliary stents can hinder EUS performance, their impact is greatly minimized by adopting careful examination techniques.
- Published
- 2021
22. Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease
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E. Falcó, Ana Fernandez-Montes, Francis Esposito, Hermini Manzano, Pilar Escudero, Sara Serrano, Ana Ruiz-Casado, and Jorge Aparicio
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Oncology ,medicine.medical_specialty ,targeted agents ,Bevacizumab ,Colorectal cancer ,medicine.medical_treatment ,lcsh:Medicine ,Unresectable disease ,colorectal cancer ,Review ,Malignancy ,chemotherapy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,First line therapy ,Growth factor receptor ,Randomized controlled trial ,law ,Internal medicine ,medicine ,030212 general & internal medicine ,Chemotherapy ,business.industry ,lcsh:R ,General Medicine ,medicine.disease ,030220 oncology & carcinogenesis ,business ,metastatic disease ,medicine.drug - Abstract
Colorectal cancer (CRC) is a commonly diagnosed malignancy. The prognosis of patients with unresectable, metastatic colorectal cancer (mCRC) is dismal and medical treatment is mainly palliative in nature. Although chemotherapy remains the backbone of treatment, the landscape is changing with the understanding of its heterogeneity and molecular biology. First-line therapy relies on a combination of chemotherapy and targeted therapies, according to clinical patient characteristics and tumor molecular profile. Here we review current evidence from randomized clinical trials for using chemotherapy doublets or triplets, and for the addition of bevacizumab or anti-epidermal growth factor receptor (EGFR) agents. Novel therapies developed for small, selected populations are also discussed.
- Published
- 2020
23. Denosumab Treatment for Giant Cell Tumor of the Spine Including the Sacrum
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Jean-Yves Blay, Robert M. Henshaw, Leanne L. Seeger, Sant P. Chawla, Piotr Rutkowski, Keith M. Skubitz, Susan V. Bukata, Danielle Jandial, and Tian Dai
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musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,Sacrum ,Adolescent ,medicine.medical_treatment ,Phases of clinical research ,Bone Neoplasms ,open-label ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,unresectable disease ,Randomized Trial ,medicine ,Adjuvant therapy ,Humans ,Orthopedics and Sports Medicine ,Adverse effect ,Aged ,GCTB ,Aged, 80 and over ,Giant Cell Tumor of Bone ,030222 orthopedics ,receptor activator of nuclear factor-kappa B (RANK) ,Spinal Neoplasms ,Bone Density Conservation Agents ,business.industry ,clinical trial ,Middle Aged ,musculoskeletal system ,bone malignancies ,Combined Modality Therapy ,Curettage ,Confidence interval ,Spine ,Surgery ,Denosumab ,Treatment Outcome ,Cohort ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
This subanalysis of an international, multicenter, open-label study assessed efficacy and safety of denosumab in patients with giant cell tumors of bone of the spine including the sacrum. Results suggest denosumab is potentially effective in these patients and the safety profile was consistent with the full study population., Study Design. This was a subanalysis of an international, multicenter, open-label study. Objective. The aim of this study was to assess the efficacy and safety of denosumab in a subset of patients with giant cell tumors of bone (GCTB) of the spine including the sacrum from an international, open-label, single-arm, phase 2 study (ClinicalTrials.gov: NCT00680992). Summary of Background Data. Standard GCTB treatment is surgical removal, either by curettage or resection, combined with intraoperative adjuvant therapy; however, some sites may not be amenable to resection (e.g., skull, spine). Methods. Adults or skeletally mature adolescents with pathologically confirmed GCTB of the spine including the sacrum, and radiologically measurable evidence of active disease, were included. Patients received denosumab (120 mg subcutaneously) once every 4 weeks during the treatment phase, with loading doses on days 8 and 15 of the first cycle. Patients had surgically unsalvageable GCTB (Cohort 1), had planned surgery expected to result in severe morbidity (Cohort 2), or were enrolled from a previous GCTB study (Cohort 3). Results. Overall, 132 patients were included in the safety analysis (103 in Cohort 1, 24 in Cohort 2, and five in Cohort 3); 131 patients were included in the efficacy analysis. Kaplan-Meier estimated probabilities of disease progression or recurrence were 3% (95% confidence interval [CI], 0.0–6.2) at year 1 and 7.4% (95% CI, 2.1–12.7) at years 3 and 5 in Cohort 1, and not estimable in Cohorts 2 and 3. Of 23 patients (Cohort 2) with surgery planned at baseline, 10 (43%) had on-study surgery; of these, one patient had reported disease progression or recurrence after the on-study surgery. Clinical benefit was reported in 83% of patients overall (all cohorts). Conclusion. Results from the analysis suggest that denosumab is potentially effective treatment for patients with GCTB of the spine including the sacrum. The adverse event profile was consistent with the full study population. Level of Evidence: 2
- Published
- 2020
24. A role of PSMA PET/CT in multimodality imaging approach in adenoid cystic carcinoma
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Karda Cavanagh, Nattakorn Dhiantravan, Lachlan McDowell, and Aravind S. Ravi Kumar
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medicine.medical_specialty ,Treatment response ,Adenoid cystic carcinoma ,business.industry ,Unresectable disease ,medicine.disease ,Carcinoma, Adenoid Cystic ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Psma pet ,Positron Emission Tomography Computed Tomography ,Radiation oncology ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Psma pet ct ,Head and neck ,business ,Rare disease - Abstract
Adenoid cystic carcinoma is a rare disease and characterised by slow but unrelenting local progression and risk of haematogenous metastases. We present a case of locally unresectable disease where PSMA PET/CT provided complementary staging and early treatment response assessment.
- Published
- 2020
25. Chemoembolization for Hepatocellular Carcinoma
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Vlasios Sotirchos and Michael C. Soulen
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body regions ,Oncology ,medicine.medical_specialty ,business.industry ,Hepatocellular carcinoma ,Internal medicine ,medicine ,Bridge to transplantation ,Unresectable disease ,medicine.disease ,business ,Cancer death ,Selection (genetic algorithm) - Abstract
Hepatocellular carcinoma is a leading cause of cancer death worldwide. Chemoembolization is the mainstay of therapy for unresectable disease, and also serves as a bridge to transplantation. This chapter reviews patient selection, periprocedural care, and technical requirements for safe and effective performance.
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- 2020
26. Implementation and early outcomes for a surgeon-directed hepatic arterial infusion pump program for colorectal liver metastases
- Author
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Gail W. Davidson, Mary Dillhoff, Eliza W. Beal, Sherif Abdel-Misih, Mark Bloomston, Steven Sun, Aaron Chafitz, Joshua Reardon, Timothy M. Pawlik, Jason Galo, Jeffery Chakedis, and Carl Schmidt
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Unresectable disease ,General Medicine ,Perioperative ,medicine.disease ,Resection ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Hepatic arterial infusion ,Oncology ,030220 oncology & carcinogenesis ,Laparotomy ,Sarcopenia ,medicine ,Overall survival ,030212 general & internal medicine ,business ,Adjuvant - Abstract
Introduction Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial in selected patients yet wide acceptance in the oncology community is lacking. Methods A surgeon-led team implemented a HAIP program in 2012. Pumps were placed by laparotomy for CRLM and fluorodeoxyuridine was infused via HAIP every 28 days without systemic chemotherapy supervised by the operating surgeon. Results Sixty patients were treated with HAIP, either in the adjuvant setting after liver resection or ablation of CRLM in 26 (43%) patients or with the unresectable disease in 34 (57%). Perioperative complications occurred in 19 (32%) and pump-specific complications in 14 (23%) that included intrahepatic biliary stricture in one (2%). Time to liver progression was a median 9.2 months (95% CI, 3.1-15.3 months) in unresectable patients and liver recurrence was a median 24.7 months (2.5-46.9 months) in the adjuvant group. Estimated 3-year overall survival from the time of HAIP placement was 64% in the adjuvant group and 37% in the unresectable group. Sarcopenia was prevalent (48%) and was associated with a worse survival (HR 2.4, 95% CI, 1.1-5.0). Conclusion A surgeon-led HAIP program may achieve outcomes on par with those of experienced centers and foster strong relationships between surgical and medical oncologists.
- Published
- 2018
27. Systemic therapies for unresectable locoregional melanoma: a significant area of need
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Emilia Nan Tie, David E. Gyorki, and Julia Lai-Kwon
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Oncology ,medicine.medical_specialty ,Metastatic melanoma ,medicine.medical_treatment ,Immune checkpoint inhibitors ,Population ,Unresectable disease ,in-transit ,Dermatology ,Disease ,Review ,unresectable ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,melanoma ,030212 general & internal medicine ,Stage (cooking) ,education ,education.field_of_study ,business.industry ,Melanoma ,Immunotherapy ,medicine.disease ,targeted therapies ,030220 oncology & carcinogenesis ,immunotherapy ,business - Abstract
Immune checkpoint inhibitors and BRAF-MEK inhibitors have revolutionized the management and prognosis of patients with metastatic melanoma. However, there is minimal evidence to guide their incorporation into current treatment paradigms for unresectable stage III disease. The era of effective systemic therapies has prompted a discussion about what constitutes unresectable disease. Patients with unresectable stage III disease can experience significant morbidity from their disease and locoregional therapies, and may progress with distant metastases. Despite increasing use of systemic therapies in unresectable stage III disease, further evidence is needed to establish their degree of benefit in this population.
- Published
- 2019
28. Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis
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Ryan C. Fields, Matthew J. Weiss, George A. Poultsides, Todd W. Bauer, Aslam Ejaz, Luca Aldrighetti, Shishir K. Maithel, Timothy M. Pawlik, Hugo Marques, Bradley N. Reames, Ejaz, A, Reames, Bn, Maithel, S, Poultsides, Ga, Bauer, Tw, Fields, Rc, Weiss, Mj, Marques, Hp, Aldrighetti, L, and Pawlik, Tm
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Unresectable disease ,Carcinoma, Neuroendocrine/surgery ,030230 surgery ,Metastasis ,Liver Neoplasms/surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Carcinoma ,Humans ,Aged ,Retrospective Studies ,Carcinoma, Neuroendocrine/secondary ,Hepatology ,Cytoreduction Surgical Procedures/mortality ,Liver Neoplasms/mortality ,business.industry ,Liver Neoplasms ,Gastroenterology ,Carcinoma, Neuroendocrine/mortality ,Debulking Procedure ,Retrospective cohort study ,Cytoreduction Surgical Procedures ,Middle Aged ,HCC CIR ,medicine.disease ,Debulking ,United States ,Carcinoma, Neuroendocrine ,Surgery ,Europe ,Treatment Outcome ,Survival benefit ,Multicenter study ,Liver Neoplasms/secondary ,Cytoreduction Surgical Procedures/adverse effects ,030220 oncology & carcinogenesis ,Female ,Neoplasm Grading ,business - Abstract
BACKGROUND: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM. METHODS: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80% debulking (R2). RESULTS: 179 (29.2%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8% vs. R2: 35.0%; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8% vs. R2: 75.6%; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2% vs. R2: 60.7%; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50% NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6%, respectively. CONCLUSION: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit. info:eu-repo/semantics/publishedVersion
- Published
- 2018
29. The emerging role of stereotactic radiotherapy in gastrointestinal malignancies: a review of the literature and analysis from the Irish perspective
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Daniel N. Cagney and Siobhra O’Sullivan
- Subjects
medicine.medical_specialty ,Radiofrequency ablation ,medicine.medical_treatment ,Unresectable disease ,Radiosurgery ,law.invention ,Stereotactic radiotherapy ,03 medical and health sciences ,Health services ,0302 clinical medicine ,law ,Health care ,medicine ,Humans ,Intensive care medicine ,Gastrointestinal Neoplasms ,Chemotherapy ,business.industry ,Gold standard ,General Medicine ,Radiation therapy ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Ireland - Abstract
Primary and secondary malignancies of the liver and pancreas result in significant morbidity and mortality, with increasing incidence and increasing demands on health services worldwide. Surgery is the only curative single modality of treatment and remains the gold standard. Unfortunately, up to 80% of the patients present with unresectable disease, and so, alternative efficacious local and systemic treatments are needed. Technologic advances in radiotherapy over recent decades have meant that precision high-dose treatment with stereotactic body radiotherapy (SBRT) has emerged as a viable cost-effective outpatient-based treatment in the management of these difficult to treat abdominal malignancies. This article reviews the current indications for SBRT in these settings, comparing it with other treatments including surgery, chemotherapy, radiofrequency ablation, and trans-arterial chemoembolisation. We also review the current use of abdominal SBRT and future projections in the Irish healthcare setting.
- Published
- 2018
30. The preoperative modified Glasgow prognostic score for the prediction of survival after pancreatic cancer resection following non-surgical treatment of an initially unresectable disease
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Takayoshi Nakajima, Naoki Yamanaka, Takashi Sonoda, Shinichi Ikuta, and Tsukasa Aihara
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0301 basic medicine ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,pancreatic cancer ,lcsh:Medicine ,Unresectable disease ,Resection ,Prognostic score ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,medicine ,Radiology, Nuclear Medicine and imaging ,Pathological ,modified Glasgow prognostic score ,Original Paper ,Chemotherapy ,Univariate analysis ,business.industry ,lcsh:R ,medicine.disease ,Surgery ,030104 developmental biology ,Oncology ,conversion surgery ,030220 oncology & carcinogenesis ,business - Abstract
Aim of the study Recent advances in chemotherapy have increasingly enabled conversion surgery (CS) in patients with initially unresectable pancreatic cancer (PC), but patient selection remains controversial. We examined the characteristics of patients who would benefit from this procedure. Material and methods The clinical and pathological data of 38 patients with unresectable PC, who underwent CS after a favourable response to chemo(radio)therapy at our institute, were investigated. Univariate and multivariate analyses were performed to identify predictors for overall survival (OS). Several inflammation-based scores, such as the modified Glasgow prognostic score (mGPS), were also evaluated. Results The patients included 13 with locally advanced disease and 25 with metastatic disease. After non-surgical treatment with a median duration of six months, 27 patients (71%) underwent R0/1 resection, and the remainder underwent R2 resection. The two-year and five-year OS from the initial treatment for all patients were 64% and 29%, respectively, and the median survival was 29.1 months. Univariate analysis showed that age < 62 years, preoperative CA19-9 decrease rate ≥ 89%, preoperative mGPS-0, and R0/1 resection were related to a favourable OS. R0/1 resection and mGPS-0 were independent prognostic factors according to multivariate analysis. Conclusions Preoperative mGPS is a potential predictor of survival and can aid selection of patients for whom CS could yield promising prognosis for initially unresectable PC.
- Published
- 2018
31. Laparoscopic Heated Intraperitoneal Chemotherapy in the Treatment of Carcinomatosis of Gastric Adenocarcinoma Origin
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Brian D. Badgwell and Michael G. White
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medicine.medical_specialty ,HIPEC ,business.industry ,Communication ,Intraperitoneal chemotherapy ,Unresectable disease ,carcinomatosis ,General Medicine ,medicine.disease ,Metastasis ,Surgery ,Clinical trial ,Gastric adenocarcinoma ,regional therapies ,Neoadjuvant treatment ,Ascites ,Medicine ,In patient ,gastric adenocarcinoma ,medicine.symptom ,business - Abstract
The use of heated intraperitoneal chemotherapy (HIPEC) in conjunction with cytoreductive surgery has been gaining increasing traction in treating gastric adenocarcinoma with metastasis to the peritoneum in recent years. The addition of laparoscopic HIPEC (LS-HIPEC) to these treatment algorithms has increased the flexibility and adaptability of HIPEC integrating into treatment sequencing, allowing for iterative protocols of LS-HIPEC prior to cytoreduction as neoadjuvant treatment, as well as in the palliation of patients with unresectable disease and uncontrolled ascites. As the use of HIPEC in gastric adenocarcinoma continues to be refined, LS-HIPEC algorithms should continue to be considered and utilized both in curative treatment algorithms as well as in patients in the palliative setting. Given that LS-HIPEC remains a relatively nascent treatment modality, we advocate for its use in the setting of a clinical trial when feasible.
- Published
- 2021
32. Survival after primary surgery compared with neoadjuvant chemotherapy in early-stage ovarian cancer
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Amjad Jalil, Deanna Huffman, Thomas Krivak, and Rodney E. Wegner
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Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Obstetrics and Gynecology ,Unresectable disease ,Debulking ,Logistic regression ,medicine.disease ,Surgery ,Oncology ,Overall survival ,medicine ,Stage (cooking) ,business ,Ovarian cancer ,Median survival - Abstract
Objectives: Our study evaluates survival of women with early-stage ovarian cancer treated with neoadjuvant chemotherapy (NAC) vs primary debulking surgery (PDS). Methods: We used the 2004-2015 NCDB to identify women with early ovarian cancer treated with multiagent chemotherapy and appropriate surgery. Logistic regression was used to identify predictors of NAC. Overall survival estimates were compared using Kaplan-Meier analysis and Cox proportional hazards regression models were used to examine variables. Results: In total, 14,627 women were included. The majority (96%) underwent PDS while (4%) underwent NAC. Median survival times were 40 months (95% CI [37.190-47.280], P Download : Download high-res image (124KB) Download : Download full-size image Conclusions: Women treated with neoadjuvant chemotherapy (NAC) had worse overall and 5-year survival. This finding agrees with the accepted convention of reserving NAC for women with advanced, unresectable disease.
- Published
- 2021
33. Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma.
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Cattaneo, Giovanni M., Passoni, Paolo, Longobardi, Barbara, Slim, Najla, Reni, Michele, Cereda, Stefano, di Muzio, Nadia, and Calandrino, Riccardo
- Subjects
- *
CANCER radiotherapy , *CANCER chemotherapy , *RADIATION dosimetry , *PANCREATIC cancer treatment , *PHYSIOLOGICAL effects of radiation , *HISTOLOGY , *LYMPH nodes , *ADENOCARCINOMA - Abstract
Abstract: Background and purpose: Hypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materials: Sixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48–58Gy. RT was delivered with Helical Tomotherapy. Dose–volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. Results: The crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33%. The 12-month actuarial rate of “anatomical” (gastro-duodenal mucosa damage) toxicity was 13% (95% CI: 4–22%). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V 20[%] were strong independent predictors of acute GI grade ⩾2 toxicity. The high-dose region of duodenum DVH (V 45[%]; V 40[%]) was strongly correlated with grade ⩾2 “anatomical” toxicity; the best V 40[%] and V 45[%] cut-off values were 16% and 2.6% respectively. Conclusion: Regarding dosimetric indices, stomach V 20[%] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH. [Copyright &y& Elsevier]
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- 2013
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34. Real-world neo-adjuvant with or without adjuvant treatment patterns among pancreatic ductal adenocarcinoma patients in the U.S
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Prakash Navaratnam, Monica Chase, Michael J. Pishvaian, S. Joo, and Howard Steven Friedman
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Cancer Research ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,Oncology ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Unresectable disease ,Neo adjuvant ,business ,Adjuvant ,Gastroenterology - Abstract
e16217 Background: The vast majority of pancreatic ductal adenocarcinoma (PDAC) patients have unresectable disease at diagnosis, with only about 20% presenting with either resectable or borderline resectable tumors and who may receive adjuvant with or without neo-adjuvant treatment with surgery. This study seeks to characterize these treatment patterns in the real-world setting. Methods: This was a retrospective observational study to evaluate adjuvant treatment of PDAC patients, with or without neo-adjuvant treatment in the U.S. Patients with at least two medical claims with a primary diagnosis for PDAC between 2016 to 2019 were identified in the Truven MarketScan administrative claims database. A surgical resection within 3 months of any primary PDAC coded medical encounter was the index event, with patients required to be continuously enrolled for at least 3 months before and 6 months after the surgery. Patient demographics and treatment patterns (chemotherapy, radiotherapy, and chemoradiation) were evaluated over the pre-index (3 months) and post-index (3 and 6 months) observation windows. Neo-adjuvant and adjuvant treatment patterns were reported for the overall population and also stratified by age and sex. Results: 737 patients met the selection criteria with a majority (n=520, 71%) being
- Published
- 2021
35. Sorafenib therapy in advanced hepatocellular carcinoma: the SHARP trial.
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- 2009
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36. Limited utility of conventional criteria for predicting unresectable disease in patients with advanced stage epithelial ovarian cancer
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Salani, Ritu, Axtell, Allison, Gerardi, Melissa, Holschneider, Christine, and Bristow, Robert E.
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DISEASES in women , *CANCER patients , *WOMEN'S health , *LYMPHOID tissue - Abstract
Abstract: Objective: To evaluate the predictive value of conventional criteria for identifying surgically unresectable disease among patients with ovarian cancer undergoing initial operative intervention at tertiary referral centers employing a so-called aggressive approach to surgical cytoreduction. Methods: All patients with advanced epithelial ovarian cancer undergoing primary surgery between August 1997 and August 2006 were identified. Surgical/pathological documentation of disease extent pre/post-cytoreduction was extracted from the medical record retrospectively. All patients meeting conventional criteria for unresectable disease criteria (ascites>1000 mL, omental extension to spleen >1 cm, parenchymal liver disease >1cm, porta hepatis involvement >1 cm, diaphragmatic disease >1 cm, carcinomatosis >1 cm, and suprarenal adenopathy >1 cm) were selected for further study. Results: A total of 180 consecutive patients had disease meeting conventional criteria for unresectability at =1 site(s). Optimal cytoreduction (residual disease =1 cm) was achieved in 166 patients (92.2%). Optimal resection rates according to the most common individual unresectable disease criteria were as follows: ascites >1000 mL=91.3% (116/127), carcinomatosis >1 cm=91.0% (81/89), and splenic involvement >1 cm=84.9% (45/53). For patients with ascites >1000 mL alone, optimal cytoreduction was achieved in 95.8% (46/48) of cases. Optimal resection rates according to the total number of unresectable disease sites were as follows: 1 site=95.0% (19/20), 2 sites=93.8% (61/65), 3 sites=81.5% (22/27), 4 sites=93.3% (14/15), and 5 sites=80.0% (4/5). Conclusions: These data suggest that commonly accepted criteria of surgically unresectable disease for women with advanced ovarian cancer lack the necessary precision to guide clinical management. Pre-operative assessment of resectability should be made by an experienced surgical team prior to deferring the initial attempt at surgical cytoreduction. [Copyright &y& Elsevier]
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- 2008
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37. Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data
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Colette M. Shaw, Susan Shamimi-Noori, and Carin F. Gonsalves
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Psychological intervention ,Tumor burden ,Thermal ablation ,Unresectable disease ,Metastatic liver disease ,Interventional radiology ,Disease ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Diffuse disease ,Radiology, Nuclear Medicine and imaging ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Metastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.
- Published
- 2017
38. Colonic stenting: When and how
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Maher A. Abbas and Zoltan Lackberg
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,Mortality rate ,Gastroenterology ,Colostomy ,Stent ,Unresectable disease ,equipment and supplies ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Emergency surgery ,Quality of life ,030220 oncology & carcinogenesis ,Medicine ,030211 gastroenterology & hepatology ,In patient ,cardiovascular diseases ,Bridge to surgery ,business - Abstract
Since the first report in 1990 by Dohomoto et al., endoluminal stenting of the colorectum has become a viable alternative to surgery. For patients with unresectable disease, stent implantation can be considered, avoiding the need for colostomy and has been associated with a better quality of life. The long-term outcomes of palliative stenting has shown favorable results. Emergency surgery in patients with colonic obstruction is associated with significant morbidity and mortality rates. Stenting as bridge to surgery is now an alternative to emergency surgery despite the uncertainity of its long-term oncologic safety. Colonic stenting has been used in benign colonic obstructions but the data on long-term outcomes remains limited. The appropriate decision for stent or surgery in the setting of acute colonic obstruction requires a structured approach.
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- 2017
39. Surveillance for neoplasia in the pancreas
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Marco J. Bruno, Djuna L. Cahen, Kasper A. Overbeek, Marcia I. Canto, and Gastroenterology & Hepatology
- Subjects
medicine.medical_specialty ,Population ,Early detection ,Unresectable disease ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Neoplastic Syndromes, Hereditary ,Risk Factors ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,Genetic Predisposition to Disease ,Intensive care medicine ,education ,Early Detection of Cancer ,education.field_of_study ,Modalities ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Pancreatic Neoplasms ,Clinical Practice ,medicine.anatomical_structure ,Population Surveillance ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Pancreas ,business - Abstract
Despite its low incidence in the general population, pancreatic cancer is one of the leading causes of cancer-related mortality. Survival greatly depends on operability, but most patients present with unresectable disease. Therefore, there is great interest in the early detection of pancreatic cancer and its precursor lesions by surveillance. Worldwide, several programs have been initiated for individuals at high risk for pancreatic cancer. Their first results suggest that surveillance in high-risk individuals is feasible, but their effectiveness in decreasing mortality remains to be proven. This review will discuss which individuals are eligible for surveillance, which lesions are aimed to be detected, and which surveillance modalities are being used in current clinical practice. Furthermore, it addresses the management of abnormalities found during surveillance and topics for future research.
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- 2016
40. Can pancreatic cancer be detected by adrenomedullin in patients with new-onset diabetes? The PaCANOD cohort study protocol
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Paolo Aurello, Laura Antolino, Francesco D'Angelo, Giovanni Ramacciato, Federico Todde, Mara La Rocca, Elena Catarinozzi, and Lucilla Bollanti
- Subjects
Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Unresectable disease ,Adrenomedullin ,03 medical and health sciences ,0302 clinical medicine ,New onset diabetes ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,In patient ,Screening tool ,Age of Onset ,Aged ,business.industry ,adrenomedullin ,new-onset diabetes ,pancreatic cancer ,screening tool ,study protocol ,General Medicine ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Early Diagnosis ,Diabetes Mellitus, Type 2 ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,Cohort study - Abstract
Introduction: Pancreatic cancer is a leading cause of cancer-related death. Its diagnosis is often delayed and patients are frequently found to have unresectable disease. Patients diagnosed with new-onset diabetes have an 8-fold risk of harboring pancreatic cancer. Adrenomedullin has been claimed to mediate diabetes in pancreatic cancer. New screening tools are needed to develop an early diagnosis protocol. Methods: Patients aged 45-75 years within 2 years of first fulfilling the ADA criteria for diabetes will be prospectively enrolled in this study. Sepsis, renal failure, microangiopathy, pregnancy, acute heart failure and previous malignancies will be considered as exclusion criteria. Results: 440 patients diagnosed with new-onset diabetes will be enrolled and divided into 2 groups: one with high adrenomedullin levels and one with low adrenomedullin levels. Patients will undergo 3 years’ follow-up to detect pancreatic cancer development. Conclusions: Identifying a marker for pancreatic cancer among high-risk patients such as new-onset diabetics might lead to the identification of a subpopulation needing to be screened in order to enable early diagnosis and treatment of a highly lethal tumor. Trial registration: This trial was registered at ClinicalTrials.gov on May 25, 2015 under registration number NCT02456051.
- Published
- 2018
41. Initial systemic chemotherapeutic and targeted therapy strategies for the treatment of colorectal cancer patients with liver metastases
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Omar Abdel-Rahman and Anas M. Saad
- Subjects
Oncology ,Surgical resection ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Unresectable disease ,Antineoplastic Agents ,Metastasis ,Targeted therapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Pharmacology ,Chemotherapy ,Systemic chemotherapy ,business.industry ,Liver Neoplasms ,General Medicine ,medicine.disease ,Prognosis ,Neoadjuvant Therapy ,Bevacizumab ,030220 oncology & carcinogenesis ,Expert opinion ,Microsatellite Instability ,business ,Colorectal Neoplasms ,030217 neurology & neurosurgery - Abstract
Introduction: The liver is the most common metastatic site in colorectal cancer with more than half the patients developing a liver metastasis either at the time of their diagnosis (synchronous) or later (metachronous). Surgical resection remains the principal curative approach that offers significant survival improvements. However, upfront surgery is only possible in about 10-20% of patients at the time of diagnosis, making the consideration of other treatment modalities essential. Areas covered: In this review, the authors provide an overview of the standard approaches for the initial management of patients with colorectal cancer with liver metastases. They then provide an up-to-date discussion of first-line systemic chemotherapy/targeted therapy options in the contexts of initially resectable and unresectable disease and review toxicities and complications following these options. Expert opinion: Advances in chemotherapeutic agents and biological targeted therapies have improved the prognosis of colorectal cancer with liver metastases. However, there is still no 'single best approach', making further trials necessary to provide more evidence.
- Published
- 2019
42. To determine the prognostic value of the albumin-bilirubin grade (ALBI) in patients underwent transarterial chemoembolization for unresectable hepatocellular carcinoma
- Author
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Muhammad Ali, Khalid, Inamullah Khan, Achakzai, Farina M, Hanif, Shoaib, Ahmed, Zain, Majid, and Nasir Hassan, Luck
- Subjects
ALBI grade ,Hepatocellular carcinoma ,CTP score ,MELD score ,Original Article ,Unresectable disease ,Transarterial chemoemobolization - Abstract
Aim: We aimed at determining the prognostic value of the albumin–bilirubin grade (ALBI) in patients undergoing transarterial Chemoembolization for unresectable Hepatocellular carcinoma. Background: Various noninvasive liver reserve markers are used to predict the severity of liver injury. The role and probability of these markers in predicting the prognosis of patients with hepatocellular carcinoma (HCC) is still unknown. Methods: Patients who underwent TACE from 2013 to 2017 were included. Patient’s age, gender, cause of cirrhosis, ALBI Grade along with the site, size and number of tumors were recorded. Radiological response to TACE was assessed by CT scan at 1 and 3 months after the procedure, respectively. Survival assessment was performed and all patients were assessed for survival until the last follow-up. Results: A total of 71 patients were included. Majority of them were male (80.3 %). The mean tumor size of 6 ± 3.9 cm. Majority of patients (54.9 %) had a single lesion and it was mostly localized to the right lobe (60.5 %). The most common cause of chronic liver disease was HCV (65.3%). Median Child class score (CTP) and MELD score were 7 and 10, respectively. Ascites was treated prior to TACE in 12 patients (16.9 %). Mean ALBI score in the study population was -1.59 ± 0.69, with the majority (49. 2 %) falling in grade 2. The mean duration of survival at the last follow up was of 12.1 ± 12.14 months (1- 49). Univariate analysis showed serum albumin (p = 0.003), serum bilirubin (p = 0.018), CTP score (p = 0.019), ALBI grade (p = 0.001) and presence of varices (p = 0.04) to be the main predictors of 6 months survival after TACE. On Cox analysis, only ALBI score (p = 0.038) showed statistical significant association. Conclusion: ALBI grade may serve as a surrogate marker in predicting the prognosis of HCC patients undergoing Transarterial Chemoembolization.
- Published
- 2019
43. Current Immunotherapy Practices in Melanoma
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Vernon K. Sondak, Amod A. Sarnaik, Luke D. Rothermel, and Nikhil I. Khushalani
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Oncology ,medicine.medical_specialty ,Metastatic melanoma ,medicine.medical_treatment ,Unresectable disease ,Disease ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Practice Patterns, Physicians' ,Melanoma ,business.industry ,Mucosal melanoma ,Immunotherapy ,medicine.disease ,030220 oncology & carcinogenesis ,Cutaneous melanoma ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
Immunotherapy has revolutionized the treatment of melanoma, with implications for the surgical management of this disease. Surgeons must be aware of the impact of various immunotherapies on patients with resectable and unresectable disease, and how surgical decision-making should progress as a result. We expect that current and developing immunotherapies will increase surgeon involvement for resection of metastatic melanoma, whether for tumor harvests to generate autologous lymphocytes or for consolidating control of disease beyond what immunotherapies alone can achieve. Despite remarkable advancements in the field, significant work is needed to optimize the immuno-modulation that targets cancers while minimizing toxicity for patients.
- Published
- 2019
44. Abordaje del colangiocarcinoma
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Daniela D’Avanzo Zúñiga, Karla Verónica Mora Membreño, and Nicole D Alaimo Brenes
- Subjects
Gynecology ,Surgical resection ,Poor prognosis ,medicine.medical_specialty ,business.industry ,medicine ,Unresectable disease ,Therapeutic resistance ,medicine.disease ,business ,Primary sclerosing cholangitis - Abstract
espanolEl colangiocarcinoma es una neoplasia maligna, relativamente rara que surge del epitelio de los conductos biliares. Se puede clasificar segun su distribucion anatomica como intrahepatico o extrahepatico. Las variaciones geograficas en la incidencia del colangiocarcinoma estan relacionadas con variaciones en los factores de riesgo, entre los principales estan la hepatitis viral, cirrosis, colangitis esclerosante primaria y colelitiasis.A pesar de las diferencias en la ubicacion del colangiocarcinoma, este se asocia con un mal pronostico y es la reseccion quirurgica quien ofrece la mejor posibilidad de curacion. La resistencia terapeutica se ve influenciada por el rico microambiente tumoral y la heterogeneidad genetica caracteristica del colangiocarcinoma. Aquellos pacientes con enfermedad irresecable siguen siendo considerados como incurables. EnglishCholangiocarcinoma is a relatively rare malignant neoplasm that arises from the bile duct epithelium. It can be classified according to its anatomical distribution as intrahepatic or extrahepatic. Geographical variations in the incidence of cholangiocarcinoma are related to variations in risk factors, the main ones being viral hepatitis, cirrhosis, primary sclerosing cholangitis and cholelithiasis.Despite the differences in the location of cholangiocarcinoma, it is associated with a poor prognosis and it is surgical resection that offers the best chance of cure. Therapeutic resistance is influenced by the rich tumor microenvironment and genetic heterogeneity characteristic of cholangiocarcinoma. Those patients with unresectable disease are still considered incurable.
- Published
- 2020
45. Access to care and outcomes for noncurative esophagogastric cancer: A population-based geographic study
- Author
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Alyson L. Mahar, Natalie G. Coburn, Victoria Zuk, Ying Liu, Gail Darling, Vaibhav Gupta, Laura E. Davis, Elliott K. Yee, and Julie Hallet
- Subjects
High rate ,Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,Esophagogastric cancer ,General surgery ,medicine ,Unresectable disease ,Population based ,business - Abstract
284 Background: Esophagogastric cancer (EGC) carries a heavy mortality burden owing largely to high rates of unresectable disease at diagnosis. Among patients not undergoing curative-intent therapy, access to care may vary. We examined the geographic distribution of care delivery and survival across a jurisdiction, and its relationship with distance to cancer centres (CCs), for non-curative EGC. Methods: We conducted a population-based analysis of adults with non-curative EGC from 2005-2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival (OS). We used geographic information system analysis to map locations of CCs and outcomes across census divisions. Regions of discordance between care use and OS were identified with bivariate choropleth maps. Multivariable modified Poisson models assessed the relationship between distance to the nearest CC and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results: Of 10,228 patients surviving a median of 5.1 months (IQR: 2.0-12.0), 68.6% had medical oncology consultation and 32.2% received chemotherapy. Regions of comparable OS and care delivery were clustered throughout the province. CCs were distributed unevenly, with higher levels in Southern Ontario. Higher-level CCs clustered in regions with higher rates of consultation, chemotherapy use, and OS. Each increment in distance from location of residence to the nearest CC (11-50, 51-100, and ≥101 km) was associated with lower likelihood of seeing medical oncology and receiving chemotherapy, and inferior OS, compared to ≤10 km. Conclusions: A third of patients with non-curative EGC did not see medical oncology, and the majority did not receive chemotherapy. Care delivery and OS exhibited high geographic variability. Location of residence influenced access to care and OS, with inferior outcomes for those living further from a CC. These findings are important for designing interventions and policies to reduce disparities in access to care and outcomes for non-curative EGC.
- Published
- 2020
46. Tumor downsizing following neoadjuvant therapy for borderline-resectable pancreatic adenocarcinoma
- Author
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Sebastian G. de la Fuente, Patrick Hunter Meyer, Ahmed Zakari, Alberto Monreal, Swati G. Patel, and Joseph Reza
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Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Unresectable disease ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Borderline resectable ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Adenocarcinoma ,In patient ,business ,Neoadjuvant therapy ,030215 immunology - Abstract
690 Background: Downstaging of pancreatic adenocarcinoma in patients presenting with nonmetastatic, unresectable disease has proven to be associated with improved clinical outcomes. Efforts at rescuing these patients to become surgical candidates are commonly attempted with a combination of systemic and radiation strategies. In this study, we aimed to determine tumor downsizing in patients that underwent neoadjuvant systemic therapy followed by a curative-intended surgical resection. Methods: A retrospective review of consecutive patients that underwent surgical resection for pancreatic adenocarcinoma following a course of neoadjuvant therapy was performed. Basic demographics, endoscopic ultrasound (EUS) findings, chemotherapy regimens and duration, rates of radiotherapy, type of surgical procedure and pathologic results were recorded. Tumor response to neoadjuvant therapy was established by correlating EUS- to pathologic tumor dimensions. Analysis of the data was done using Mann-Whitney U test, Pearson correlation and Chi-square when indicated. Results: A total of 97 patients were analyzed; 40 underwent neoadjuvant chemotherapy (13 patients also received concurrent radiation therapy). In those 57 patients that were resected upfront, EUS tended to underestimate tumor sizes significantly compared to pathologic dimensions, with an average difference between dimensions of 0.66 cm (p = 0.0004). Within the group treated with neoadjuvant chemotherapy, 90% of patients had downsizing at an average of 8% of tumor size. There were no differences in rates of tumor downsizing between FOLFIRINOX or Gemcitabine/Nac-paclitaxel treated patients. In addition, there were no correlations in margin status (R0) based on chemotherapy used, with both regimens achieving a similar rate of R0 resections (mean 61%). The type of chemotherapy regimen used did not affect the ratio of positive lymph nodes harvested. Conclusions: In patients that present with borderline resectable pancreatic adenocarcinoma, a course of neoadjuvant therapy results in tumor downsizing in a significant number allowing for margin negative resections. These results were seen regardless of the chemotherapeutic regimens utilized.
- Published
- 2020
47. Case Series: Abscopal Benefit of Surgery in 3 Immunotherapy-Treated Patients With Unresectable Cancer
- Author
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Christopher A. Larson, Tony R. Reid, Bryan Oronsky, and Corey A. Carter
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0301 basic medicine ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Case Report ,Unresectable disease ,surgery ,03 medical and health sciences ,unresectable disease ,0302 clinical medicine ,medicine ,lcsh:Pathology ,cancer ,Safety, Risk, Reliability and Quality ,lcsh:R5-920 ,business.industry ,Cancer ,Immunotherapy ,medicine.disease ,Debulking ,Surgery ,030104 developmental biology ,030220 oncology & carcinogenesis ,immunotherapy ,Metastasectomy ,business ,lcsh:Medicine (General) ,Safety Research ,lcsh:RB1-214 - Abstract
For all of the optimism that immunotherapy has engendered, the flip side is that 7/10 patients with susceptible tumor types do not respond, while in nonsusceptible tumor types the response rates are significantly lower. In contradiction of the current orthodoxy against surgery in the setting of unresectable disease, we present 3 examples of immunotherapy-treated patients with widespread recurrence who experienced dramatic clinical improvement following debulking/metastasectomy. Taken together with examples from the literature that correlate longer survival with surgical intervention during treatment with immunotherapy, these 3 cases suggest that a new paradigm involving a wider role for surgery in the management of these patients should be explored. Possible mechanisms by which surgery may synergize with immunotherapy and improve outcomes are also discussed.
- Published
- 2018
48. Repeating of local therapy of distant metastases increases overall survival in patients with synchronous metastasized rectal cancer-a monocentric analysis
- Author
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Melanie Langheinrich, Michael Beck, Axel Denz, Daniela Schmidt, Axel Schmid, Robert Grützmann, Markus Hecht, Sabine Semrau, Marlen Haderlein, Sebastian Lettmaier, and Rainer Fietkau
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Organoplatinum Compounds ,Colorectal cancer ,medicine.medical_treatment ,Leucovorin ,Unresectable disease ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Overall survival ,medicine ,Humans ,In patient ,Aged ,FOLFOXIRI ,Chemotherapy ,business.industry ,Rectal Neoplasms ,Gastroenterology ,Metastatic rectal cancer ,Hepatology ,Middle Aged ,medicine.disease ,Survival Analysis ,Progression-Free Survival ,Treatment Outcome ,030220 oncology & carcinogenesis ,Camptothecin ,Female ,Fluorouracil ,business ,Follow-Up Studies - Abstract
The aim was to evaluate the outcome of treatment-naive patients with synchronous metastatic rectal cancer after chemotherapy with FOLFOXIRI followed by local therapeutic procedures of all tumor lesions as complete as possible. We reviewed data of 30 patients with synchronous distant metastatic rectal cancer who underwent chemotherapy with FOLFOXIRI and subsequent local therapy in our institution. Median follow-up was 28 months (range: 8; 74). Cumulative overall survival (OS) and progression-free survival (PFS) was 93.3, 76.9, 55.6% and 46.2, 29.7, 29.7% after 1, 2, 4 years. Non-response to chemotherapy with FOLFOXIRI was associated with a highly significant decreased OS (p
- Published
- 2018
49. Staging of pancreatic cancer: resectable, borderline resectable, and unresectable disease
- Author
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Eric P. Tamm, Erik V. Soloff, Marc Zins, Jeffrey Meier, and Atif Zaheer
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medicine.medical_specialty ,Poor prognosis ,Urology ,Unresectable disease ,Adenocarcinoma ,Malignancy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Borderline resectable ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiation treatment planning ,Neoplasm Staging ,Radiological and Ultrasound Technology ,business.industry ,Patient Selection ,Gastroenterology ,Hepatology ,medicine.disease ,Prognosis ,Pancreatic Neoplasms ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Radiology ,business ,Carcinoma, Pancreatic Ductal - Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a relatively common malignancy that carries an overall poor prognosis, with five-year survival below 10%. Despite ongoing research, surgical resection remains the only potentially curative treatment. Therefore, accurate identification of those patients who would benefit from surgical resection is of paramount importance. High-quality imaging and image interpretation is central to this process. Radiology helps in the determination of whether patients are resectable, borderline resectable, or unresectable and guides treatment planning.
- Published
- 2017
50. Carotid Artery Sacrifice and Reconstruction in the Setting of Advanced Head and Neck Cancer
- Author
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Thomas S. Lee, Masoud Saman, Yadranko Ducic, David W. Stroman, and Moustafa Mourad
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Adult ,Male ,medicine.medical_specialty ,Carotid arteries ,Unresectable disease ,medicine ,Humans ,Saphenous Vein ,In patient ,Stage (cooking) ,Autografts ,Aged ,Aged, 80 and over ,business.industry ,Head and neck cancer ,Femoral Vein ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Stroke ,Carotid Arteries ,Treatment Outcome ,Otorhinolaryngology ,Head and Neck Neoplasms ,Carcinoma, Squamous Cell ,Female ,Radiology ,business - Abstract
To determine oncological and neuromorbidity outcomes in patients with advanced head and neck cancer (stage IVB) requiring sacrifice and reconstruction of the carotid artery.Case series with chart review.Tertiary care referral center.Overall, 51 patients underwent carotid artery sacrifice during surgical treatment of the neck, in both the primary and salvage setting. All patients underwent autogenous in-line carotid artery bypass grafting with either saphenous vein or the deep femoral vein in conjunction with vascular surgery. In all, the study included 39 males and 12 female subjects, with age ranging from 39 to 82 (mean, 62.7).Two patients (3.9%) had a cerebral vascular accident in the immediate postoperative period. The remaining 49 patients (96%) had no neurologic sequela. Serial ultrasonic evaluation revealed 4 patients with intra-luminal thrombus within the site of reconstruction. Perioperative mortality occurred in a single patient. Disease-related mortality occurred in 9.8% (5) of patients, with an overall 2-year survival of 82%.We presently report the largest series of surgical treatment for advanced head and neck cancer with carotid artery involvement. We document an overall 2-year survival of 82% in the setting of low perioperative neuromorbidity and mortality rates. We therefore consider carotid artery sacrifice and autogenous vein graft reconstruction in the absence of distant metastatic disease as a viable treatment option for what was once thought to be a palliative procedure.
- Published
- 2015
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