The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 24th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2022

This article summarises expert discussion on the management of patients with hepatocellular carcinoma (HCC), which took place during the 24th World Gastrointestinal Cancer Congress (WGICC) in Barcelona, July 2022. A multidisciplinary approach is mandatory to ensure an optimal diagnosis and staging of HCC, planning of curative and therapeutic options, including surgical, embolisation, ablative strategies, or systemic therapy. Furthermore, in many patients with HCC, underlying liver cirrhosis represents a challenge and influences the therapeutic options.

Challenges in oncology career: are we closing the gender gap? Results of the new ESMO Women for Oncology Committee survey

BACKGROUND

Following a European Society for Medical Oncology Women for Oncology (ESMO W4O) survey in 2016 showing severe under-representation of female oncologists in leadership roles, ESMO launched a series of initiatives to address obstacles to gender equity. A follow-up survey in October 2021 investigated progress achieved.

MATERIALS AND METHODS

The W4O questionnaire 2021 expanded on the 2016 survey, with additional questions on the impact of ethnicity, sexual orientation and religion on career development. Results were analysed according to respondent gender and age.

RESULTS

The survey sample was larger than in 2016 (n = 1473 versus 482), especially among men. Significantly fewer respondents had managerial or leadership roles than in 2016 (31.8% versus 51.7%). Lack of leadership development for women and unconscious bias were considered more important in 2021 than in 2016. In 2021, more people reported harassment in the workplace than in 2016 (50.3% versus 41.0%). In 2021, ethnicity, sexual orientation and religion were considered to have little or no impact on professional career opportunities, salary setting or related potential pay gap. However, gender had a significant or major impact on career development (25.5% of respondents), especially in respondents ≤40 years of age and women. As in 2016, highest ranked initiatives to foster workplace equity were promotion of work-life balance, development and leadership training and flexible working. Significantly more 2021 respondents (mainly women) supported the need for culture and gender equity education at work than in 2016.

CONCLUSIONS

Gender remains a major barrier to career progression in oncology and, although some obstacles may have been reduced since 2016, we are a long way from closing the gender gap. Increased reporting of discrimination and inappropriate behaviour in the workplace is a major, priority concern. The W4O 2021 survey findings provide new evidence and highlight the areas for future ESMO interventions to support equity and diversity in oncology career development.

Industry Funding of Oncology Randomised Controlled Trials: Implications for Design, Results and Interpretation

AIMS

Most randomised controlled trials (RCTs) in oncology are now funded by the pharmaceutical industry. We explore the extent to which RCT design, results and interpretation differ between industry-funded and non-industry-funded RCTs.

MATERIALS AND METHODS

In this cross-sectional analysis, a structured literature search was used to identify all oncology RCTs published globally during 2014-2017. Industry funding was identified based on explicit statements in the publication. Descriptive statistics were used to compare elements of trial methodology and output between industry- and non-industry-funded RCTs.

RESULTS

The study sample included 694 RCTs; 71% were funded by industry. Industry-funded trials were more likely to test systemic therapy (97% versus 62%; P < 0.001), palliative-intent therapy (71% versus 41%; P < 0.001) and study breast cancer (20% versus 12%; P < 0.001). Industry-funded trials were larger (median sample size 474 versus 375; P < 0.001) and more likely to meet their primary end point (49% versus 41%; P < 0.001). Among positive trials, there were no differences in the magnitude of benefit between industry- and non-industry-funded RCTs. Trials funded by industry were published in journals that had a significantly higher median impact factor (21, interquartile range 7, 28) than non-industry-funded trials (impact factor 12, interquartile range 5, 24; P = 0.005); this persisted when adjusted for whether a trial was positive or negative.

CONCLUSIONS

The vast majority of oncology RCTs are now funded by industry. Industry-funded trials are larger, more likely to be positive, predominantly test systemic therapies in the palliative setting and are published in higher impact journals than trials without industry support.

Drain or No Drain Following Pancreaticoduodenectomy: The Unsolved Dilemma

BACKGROUND AND AIMS

There is no consensus regarding the routine placement of intra-abdominal drains after pancreaticoduodenectomy. We aim to determine the effects of intraperitoneal drain placement during pancreaticoduodenectomy on 30-day postoperative morbidity and mortality.

METHODS

Patients who underwent pancreaticoduodenectomy for pancreatic tumors were identified from the 2014-2015 American College of Surgeons-National Surgical Quality Improvement Program Database. Univariate and multivariate analyses adjusting for known prognostic variables were performed. A subgroup analysis was performed based on the risk for development of postoperative pancreatic leak determined by the pancreatic duct caliber, parenchymal texture, and body mass index.

RESULTS

A total of 6858 patients with pancreatic tumors who underwent pancreaticoduodenectomy were identified in the 2014-2015 American College of Surgeons-National Surgical Quality Improvement Program Database dataset. In all, 87.4% of patients had intraperitoneal drains placed. A 30-day mortality rate was higher in the no-drain group (2.9% vs. 1.7%, P = 0.003). Patients in the drain group had a higher incidence of overall morbidity (49.5% vs. 41.2%, P = 0.0008), delayed gastric emptying (18.1% vs. 13.7%, P = 0.004), pancreatic fistulae (19.4% vs. 9.9%, P ⩽ 0.0001), and prolonged length of hospital stay over 10 days (43.7% vs. 34.9%, P < 0.0001). Subgroup analysis based on risk categories revealed a higher 30-day mortality rate in the no-drain group among patients with high-risk features (3.1% vs. 1.6%, P = 0.02). Delayed gastric emptying and pancreatic fistula development remained significantly higher in the drain group only in the high-risk category. Prolonged length of hospital stay and composite morbidity remained higher in the drain group regardless of the risk category.

CONCLUSION

To our knowledge, this is the largest study to date that aims at clarifying the pros and cons of the intraperitoneal drain placement during pancreaticoduodenectomy for pancreatic tumors. We showed a higher 30-day mortality rate if drain insertion was omitted during pancreaticoduodenectomy in patients with softer pancreatic textures, smaller pancreatic duct caliber, and body mass index over 25. Postoperative 30-day morbidity rate was higher if a drain was inserted regardless of the risk category. Further randomized controlled trials with prospective evaluation of stratification factors for fistula risk are needed to establish a clear recommendation.

A Novel Method for the Synthesis of Core-shell Magnetic Nanoparticle

<p>Core-shell type magnetic nanoparticles are finding attractive applications in biomedicine, from diagnostic to cancer therapy. Both for targeted drug delivery and hyperthermia, as well as a contrast agent used for external biomedical imaging systems, small (&lt; 20 nm) superparamagnetic nanoparticles are desired. Some iron oxide nanoparticle formulations are already approved for human administration as contrast agent for magnetic resonance imaging. However, search continues for nanoparticles with higher saturation magnetisation. Metallic, bi-metallic and intermetallic magnetic nanoparticles are finding attention. Biocompatibility and optimal clearance are important criteria for the medical applications and therefore core-shell type particles are favored, where a biocompatible shell (e.g. polymer, Silica) can prevent inadvertent host reaction with the magnetic core. A recently developed novel synthesis method (electrochemical selective phase dissolution - ESPD), which can produce core-shell magnetic nanoparticles, is reviewed in this paper. ESPD, as the name suggests, uses electro-chemical separation of a phase from metallic alloys to synthesize nanoparticles. It is a versatile method and can be adopted to produce a wide range of nanostructures in addition to the core-shell magnetic nanoparticles.</p>

Neutron and synchrotron probes in the development of Co–Re-based alloys for next generation gas turbines with an emphasis on the influence of boron additives

Nickel-based superalloys are the materials of choice in the hot section of current gas turbines, but they are reaching temperature limits constrained by their melting temperature range. Co–Re alloy development was prompted by a search for new materials for future gas turbines, where the temperature of application will be considerably higher. Addition of the very high melting point refractory metal Re to Co can increase the melting range of Co alloys to much higher temperatures than the commercial Co alloys in use today. The alloy development strategy is first discussed very briefly. In this program, model ternary and quaternary compositions were studied in order to develop a basic understanding of the alloy system.In situneutron and synchrotron measurements (small and wide angle) at high temperatures were extensively used for this purpose and some selected results from thein situmeasurements are presented. In particular, the effect of boron doping in Co–Re–Cr alloys and the stability of the TaC precipitates at high temperatures were investigated. A fine dispersion of TaC precipitates strengthens some Co–Re alloys, and their stability at the application temperature is critical for the long-term creep properties.

Visceral disease in castration-resistant prostate cancer

Metastatic involvement of the viscera in men with advanced castration-resistant prostate cancer (CRPC) has been poorly characterised to date. In 359 CRPC patients treated between June 2003 and December 2011, the frequency of radiologically detected visceral metastases before death was 32%. Of the 92 patients with computed tomography performed within 3 mo of death, 49% had visceral metastases. Visceral metastases most commonly involved the liver (20%) and lung (13%). Median survival from diagnosis of visceral disease was 7.1 mo (95% confidence interval, 5.9-8.3). Survival was affected by the degree of bone involvement at detection of visceral disease, varying from 6.1 mo in men with more than six bone metastases to 18.2 mo in men with no bone metastases (p=0.001). Heterogeneity was noted in clinical phenotypes and prostate-specific antigen trends at development of visceral metastases. Visceral metastases are now more commonly detected in men with CRPC, likely due to the introduction of novel survival-prolonging treatments.

Antitumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer

BACKGROUND

Abiraterone is a standard treatment for men with castration-resistant prostate cancer (CRPC). We evaluated the antitumour activity of abiraterone following the synthetic oestrogen diethylstilboestrol (DES).

METHODS

Castration-resistant prostate cancer patients treated with abiraterone were identified. Demographics, response variables and survival data were recorded.

RESULTS

Two-hundred and seventy-four patients received abiraterone, 114 (41.6%) after DES. Pre-chemotherapy abiraterone resulted in ≥50% PSA declines in 35/41 (85.4%) DES-naïve and 20/27 (74.1%) DES-treated patients. Post-docetaxel abiraterone resulted in ≥50% PSA declines in 40/113 (35.4%) DES-naïve and 23/81 (28.4%) DES-treated patients. Time to PSA progression was similar regardless of prior DES.

CONCLUSION

Abiraterone has important antitumour activity in men with CRPC even after DES exposure.

Sarcopenia and change in body composition following maximal androgen suppression with abiraterone in men with castration-resistant prostate cancer

BACKGROUND

Standard medical castration reduces muscle mass. We sought to characterize body composition changes in men undergoing maximal androgen suppression with and without exogenous gluocorticoids.

METHODS

Cross-sectional areas of total fat, visceral fat and muscle were measured on serial CT scans in a post-hoc analysis of patients treated in Phase I/II trials with abiraterone followed by abiraterone and dexamethasone 0.5 mg daily. Linear mixed regression models were used to account for variations in time-on-treatment and baseline body mass index (BMI).

RESULTS

Fifty-five patients received a median of 7.5 months abiraterone followed by 5.4 months abiraterone and dexamethasone. Muscle loss was observed on single-agent abiraterone (maximal in patients with baseline BMI >30, -4.3%), but no further loss was observed after addition of dexamethasone. Loss of visceral fat was also observed on single-agent abiraterone, (baseline BMI >30 patients -19.6%). In contrast, addition of dexamethasone led to an increase in central visceral and total fat and BMI in all the patients.

INTERPRETATION

Maximal androgen suppression was associated with loss of muscle and visceral fat. Addition of low dose dexamethasone resulted in significant increases in visceral and total fat. These changes could have important quality-of-life implications for men treated with abiraterone.

Chemotherapy for squamous cell carcinoma of the penis: An 8-year, single-institution experience

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Background: Penile cancer is a rare malignancy affecting approximately 400 men per year in the United Kingdom. There are relatively limited data regarding the role of chemotherapy, although it may be considered in the adjuvant setting for high-risk disease and for palliation of metastatic disease.

Methods: Patients treated with chemotherapy between June 2002 and March 2010 were identified from our prospectively maintained institutional database. Regimens were recorded and toxicity documented according to the Common Toxicity Criteria version 4.0. Response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 until 2009 and then version 1.1.

Results: Twenty patients received chemotherapy either for adjuvant treatment (n=6) or for metastatic disease (n=14). Median age was 59 (range 33-80). Different regimens were used over the time period. In the adjuvant setting 4-6 cycles of chemotherapy were planned and all patients received cisplatin in combination with 5-FU or capecitabine. Five (83%) completed planned treatment with no grade 3 or 4 toxicities. One patient stopped after 2 cycles due to deteriorating renal function. Patients remained disease free at up to 22 months follow-up. In the metastatic setting, 10 patients received cisplatin and capecitabine, 1 cisplatin and 5-FU and 1 carboplatin and capecitabine. Of these 12 patients, 2 (17%) had partial response as their best response, 4 (33%) had stable disease (SD) and 6 (50%) had progressive disease (PD). Three patients (25%) experienced pulmonary embolism, 1 of whom died. Two (17%) developed grade 3 neutropenia. One patient received carboplatin, methotrexate and bleomycin with PD after 3 cycles and developed grade 3 neutropenia, stomatitis, and diarrhea. One patient received 3 cycles of paclitaxel, ifosfamide, and cisplatin with SD and no grade 3 or 4 toxicities.

Conclusions: Combination chemotherapy can be delivered with acceptable toxicity in the adjuvant setting. In the metastatic setting response rates were disappointing and treatments were associated with greater toxicity. New treatments are urgently required to improve outcomes in this difficult malignancy.

[Table: see text]

Cyclic magnetic-field -induced deformation and magneto-mechanical fatigue of Ni-Mn-Ga ferromagnetic martensites

Four Ni-Mn-Ga single crystals exhibiting modulated 10M and 14M martensites were exposed to rotating magnetic fields of 1 and 2 T. Large periodic magnetic-field-induced strains were obtained for crystals that had been subjected to a mechanical stress while the martensite formed on cooling and to deformation in a magnetic field prior to the experiments with rotating field. A reduction of the magnetic-field-induced strain and fracture occurred when the field-induced strain was close to the transformation strain whereas a constant magneto-mechanical response was detected over more than 10 million field cycles when the field-induced strain was small. The cyclic magneto-mechanical response is related to the interaction of groups of twinning dislocations and twin boundaries. If the dislocations move in large groups, they nucleate cracks at twin boundaries. If the dislocations move in small groups, no cracks are formed resulting in a long lifetime.

The measurement of internal strain in core-shell Ni3Si(Al)-SiOx nanoparticles

Internal defects and strain in nanoparticles can influence their properties and therefore measuring these values is relevant. Powder diffraction techniques (neutron and synchrotron) are successfully used to characterize internal strain in the core-shell Ni(3)Si(Al)-SiO(x) nanoparticles having mean diameters of approximately 80 nm. The nanoparticles, which are strain-free after extraction from the bulk alloys, develop internal strain on heating. Both micro- and macro-strains can be measured from the analysis of Bragg peak shift and broadening. It is identified that differences in thermal expansion coefficient of the metallic core and the amorphous shell of the nanoparticles, as well as partial disordering of the L1(2) ordered core phase, are the main causes of strain evolution. Synchrotron measurements also detected partial crystallization of the amorphous silica shell.

Results of a phase I study to evaluate the feasibility, safety, and biological effects of intravenous administration of wild-type reovirus with docetaxel to patients with advanced malignancies

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Background: Reovirus has minimal pathogenicity in humans but selectively replicates in cells with activated Ras. Wild- type reovirus serotype 3 Dearing strain (Reolysin) has selective antitumor activity in vitro, in murine models, and after systemic delivery in humans in phase 1 trials. Synergistic tumour kill has been observed combining reovirus with taxanes in a range of cancer cell lines and in vivo. Methods: Patients were treated in an open-label, dose-escalating, phase I trial and received 3- weekly 75mg/m2 docetaxel i.v. and reovirus i.v. (day 1–5 of first week inclusive). Reovirus was administered at a starting dose of 3x109 tissue culture infectious dose (TCID50) and then increased to 1 x 1010 and 3 x 1010 TCID50. Primary endpoints were to determine the maximum tolerated dose (MTD), dose limiting toxicity (DLT) and to recommend a dose and schedule for future investigation. Secondary endpoints were to evaluate pharmacokinetics, neutralizing antibody development, cell- mediated immune response and anti-tumour activity. Results: 17 patients were treated (15 males, median age 60 years). No MTD has been reached. DLT's observed were G4 neutropenia (and a recurrent perianal abcess) and G3 rise in AST. Other toxicities observed were fatigue, hypotension and neutropenic sepsis. At present, 5 patients remain on treatment. We have observed 2 partial responses (breast and gastric carcinoma) and 10 patients had stable disease as best response. Conclusions: Reovirus is well tolerated when administered in combination with intravenous docetaxel, with predictable toxicity observed. The recommended dose has been defined at 3x1010 TCID50 and phase II studies are planned. Objective radiological evidence of anticancer activity for this combination has been observed.

[Table: see text]

Coating of meso-porous metallic membranes with oriented channel-like fine pores by pulsed laser deposition

There is increasing demand to functionalize meso- and nanoporous materials by coating and make the porous substrate biocompatible or environmentally friendly. However, coating on a meso-porous substrate poses great challenges, especially if the pore aspect ratio is high. We adopted the pulsed laser deposition (PLD) method to coat Ni(3)Al-based meso-porous membranes, which were fabricated from a single-crystal Ni-based superalloy by a unique selective phase dissolution technique. These membranes were about 250 µm thick and had channel-like pores (∼200 nm wide) with very high aspect ratio. Two different coating materials, i.e. diamond-like carbon (DLC) and titanium, were used to coat these membranes. High energy C or Ti ions, produced in the plasma plume by the PLD process, penetrated the channel-like pores and deposited coatings on the pore walls deep inside the membrane. The thickness and the quality of coatings on the pore walls were examined using the dual-beam system. The coating thickness, of the order of 50 nm, was adherent to the pore walls and was quite uniform at different depths. The carbon and the Ti deposition behaved quite similarly. The preliminary experiments showed that the PLD is an adequate method for coating fine open cavities of complex geometry. Simulations based on stopping and the range of ions in matter (SRIM) calculations helped in understanding the deposition processes on pore walls at great depths.

Tumor lysis syndrome and acute renal failure ? an increasing spectrum of presentations

Tumor lysis syndrome has historically been associated with hyperuricemia and uric acid crystal deposition. We present three cases of tumor lysis syndrome resulting in renal failure in the context of normouricema, highlighting the spectrum of clinical presentations and mechanisms of renal damage. Two cases occurred following the treatment of hematological malignancies and were associated with hyperphosphatemia; the third resulted from ischemic necrosis following transarterial chemoembolization of a hepatic tumor. We also discuss the role of renal biopsy in the investigation of tumor lysis syndrome.

Ni(3)Si(Al)/a-SiO(x) core-shell nanoparticles: characterization, shell formation, and stability

We have used an electrochemical selective phase dissolution method to extract nanoprecipitates of the Ni(3)Si-type intermetallic phase from two-phase Ni-Si and Ni-Si-Al alloys by dissolving the matrix phase. The extracted nanoparticles are characterized by transmission electron microscopy, energy-dispersive x-ray spectrometry, x-ray powder diffraction, and electron powder diffraction. It is found that the Ni(3)Si-type nanoparticles have a core-shell structure. The core maintains the size, the shape, and the crystal structure of the precipitates that existed in the bulk alloys, while the shell is an amorphous phase, containing only Si and O (SiO(x)). The shell forms around the precipitates during the extraction process. After annealing the nanoparticles in nitrogen at 700 °C, the tridymite phase recrystallizes within the shell, which remains partially amorphous. In contrast, on annealing in air at 1000 °C, no changes in the composition or the structure of the nanoparticles occur. It is suggested that the shell forms after dealloying of the matrix phase, where Si atoms, the main constituents of the shell, migrate to the surface of the precipitates.

Spatial patterns of anthropometric variation in India with reference to geographic, climatic, ethnic and linguistic backgrounds

BACKGROUND

Anthropometric variation can be fruitfully utilized to investigate microevolutionary processes. Anthropometric variations in the Indian subcontinent based on stature and three indices (Cephalic Index, Nasal Index, and Total Facial Index) are highly variable and discriminative among populations across geographical regions.

AIMS

Anthropometric variation in stature, Cephalic Index (CI), Nasal Index (NI) and Total Facial Index (TFI) were investigated with respect to ethnic, linguistic, geographical and climatic affiliation, across the Indian subcontinent.

SUBJECTS AND METHODS

Published data on anthropometric variations of 531 populations from the Indian subcontinent were analysed using discriminant analysis and spatial autocorrelation analysis.

RESULTS

Discriminant analysis of the four anthropometric variables shows that stature and NI are good discriminators for populations of different languages. Stature, NI and CI discriminate well among populations of diverse ethnic origin and climatic conditions in different regions. TFI is not a good discriminator for populations of diverse ethnic, linguistic and climatic attributes. Spatial autocorrelation analysis showed significant departure from randomness, suggesting geographic structuring. The Moran's I estimate is positive and statistically significant for the four variables at low distances but exhibits significant negative association at higher values.

CONCLUSION

The results suggest geographical clines for the four anthropometric variables and indicate the influence of population structure on the studied variables.

Nano-structured materials produced from simple metallic alloys by phase separation

A method which is able to produce different types of nano-structured materials, namely nano-particles, nano-structured surfaces and nano-porous membranes, from two-phase metallic alloys is reviewed. The new process first establishes nano-structures in the bulk alloy and then separates them by selective phase dissolution. Variation in processing makes it possible to produce different types of nano-structure even from the same alloy. The process can be applied to many different alloy systems. An overview is presented emphasizing the versatility of the process with examples of different nano-structure types that can be produced. Further, the new method is discussed in relation to similar processes (specifically, electrochemical processes) which have been used for nano-structure synthesis.

A comparative study on the effect of felodipine and propranolol on serum lipid profile of rabbits

Effect of felodipine on serum lipids of rabbits was studied and was compared with that of propranolol. Lipid parameters were estimated at basal (0 wk), end of 4th and 16th week of diet/drug administration by using standard kits for analysis. There was a significant increase in mean serum cholesterol, TG, VLDLc, LDLC and decrease in HDLc, (P<0.05) in the group of rabbits receiving Atherogenic diet (AD)/Propranolol. This effect was maximally observed in rabbits receiving both AD and propranolol. This change was satisfactorily prevented when felodipine was administered from very beginning (P<0.001). In addition, there was a significant increase in HDLc (28.89%) of rabbits receiving felodipine from beginning. Thus both AD and propranolol have dyslipidemic effect and early administration of felodipine favorably changes all lipid parameters.

Effect of family planning, economy and education on infant mortality

"There is an assumption that family planning leads to less infant mortality, and [that a] lower rate of infant mortality will lead toward the evolution of small family. The present paper, based on the data collected from 472 eligible couples from a suburban area of West Bengal, does not reveal any such strong relation between family planning and infant mortality. The data have also been examined in the perspective of familial economic status and formal educational standard of the mothers concerned."

Spatial patterns of out-migration in Maharashtra: 1961-71

In view of the importance of migration in Maharashtra state. India an attempt is made to identify the areas of out-migration, and to assess the probable causes for it. The analysis is confined to the decade 1961-1971 and based on secondary data, with the taluka as the unit of analysis. The total number of births and deaths in each taluka for the period of study was complied and enabled the natural increase of population to be computed. A comparison of this with the actual increase as indicated by the census made it possible to identify the areas of out-migration. The study revealed that the out-migration talukas were located in 3 areas and that the relative significance of out-migration varied. The analysis indicated that the causes of out-migration were probably unfavorable relief efforts, susceptibility to drought, closure of household industries, and the 'pull' effect of metropolitan centers like Bombay.