Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial

BACKGROUND

The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer.

PATIENTS AND METHODS

Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type.

RESULTS

Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107).

CONCLUSION

Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.

The effects of grazing management on perennial ryegrass (Lolium perenne L.) herbage mass and persistence in south-eastern Australia

The effect of various grazing management treatments on newly sown and degraded perennial ryegrass pastures was studied at 6 different locations in the temperate high rainfall zone of southern Australia, as part of the Temperate Pasture Sustainability Key Program. The sites were located at Hamilton (2 sites, 1 grazed by cattle, 1 grazed by sheep) and Cavendish, western Victoria, Victor Harbor (Delamere), South Australia, and Ross and Parattah in Tasmania. Grazing management treatments significantly influenced the ryegrass mass and persistence of the pasture, but effects were not always consistent across sites. Autumn closure increased the perennial ryegrass content at Cavendish and Ross, as did the winter and summer closures at Ross. Spring closure increased the perennialryegrass content at Hamilton, Cavendish and Ross, but decreased it at Parattah, as did the summer closures at Parattah and Delamere. Fodder conservation decreased the ryegrass only at Parattah. At the Hamilton sheep site, and at Ross, mob stocking increased the ryegrass content, as did increased superphosphate treatments at Hamilton. Rotational grazing at Cavendish and Delamere increased the ryegrass content, as did the late spring or a late summer closure with a short autumn deferment at Cavendish and Ross, but both these treatments decreased ryegrass at Parattah. The treatments that had a negative effect at Parattah may have had a positive effect on cocksfoot at that site, creating competition for, and decreasing the ryegrass content. At most sites, treatments that included some spelling during spring to foster seed shedding, and spelling again in the following autumn to encourage germination seem to have been of benefit to the perennial ryegrass.

Quantitation of B cells in peripheral blood by polyacrylamide beads coated with anti-human chain antibody

A method for quantitating peripheral blood B cells is described which utilizes anti-heavy chain specific antibody attached to polyacrylamide beads. The method has the advantages of ease of performance, of utilizing reagents which are commercially available and routine phase microscopy. In addition, the reagents are stable for prolonged periods of time and only small amounts are required. Utilizing this assay, the following percentages of B cells have been found in normals: IgG 6.3 +/- 0.6; IgM 4.3 +/- 0.5; IgA 4.0 +/- 0.5. The polyacrylamide beads may be phatocytized allowed recognition of certain phagocytic mononuclear cells.