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Cambray M, González-Viguera J, Losa F, Martínez-Villacampa M, Frago R, Mata F, Castellví J, Guinó E. Determining the optimal interval between neoadjuvant radiochemotherapy and surgery in rectal cancer: a retrospective cohort study. Int J Colorectal Dis 2023; 38:154. [PMID: 37261511 DOI: 10.1007/s00384-023-04457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION In locally advanced rectal cancer, the optimal interval between completion of neoadjuvant radiochemotherapy (RT-ChT) and surgical resection remains unclear due to contradictory data on the benefits of extending this interval. Therefore, the aim of this retrospective study was to determine the impact of this interval on outcomes in patients treated for rectal cancer at our center. METHODS We retrospectively reviewed 382 consecutive patients treated for stage II/III rectal cancer between October 1, 2012, and December 31, 2017. We evaluated four different cut-off points (56, 63, 70, and 77 days) to determine which had the greatest impact on treatment outcomes. RESULTS The median time between completion of RT-ChT and surgery was 67.2 days (range, 28-294). Intervals > 8 weeks (56 days) were associated with worse therapeutic outcomes. Specifically, an interval ≥ 77 days was associated with a significant decrease in overall survival (OS; 84% vs. 70%; p = 0.004), which is why we selected this interval for the comparative analysis. Several outcome variables were significantly better in the short interval (< 77 days) group, including margin involvement (5.2% vs. 13.9%; p = 0.01), sphincter preservation (78% vs. 59.3%; p = 0.003), and distant dissemination (22.6% vs. 32.5%; p = 0.04). No significant between-group differences were found in complete/nearly complete response rates (19.2% vs. 24.4%; p = 0.3). Time to surgery was statistically significant on both the univariate and multivariate analyses. CONCLUSIONS Our findings suggest that surgery should not be delayed more than 8 weeks (56 days) after neoadjuvant treatment. An interval > 8 weeks should only be considered in patients who demonstrate a good response to neoadjuvant RT-ChT.
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Affiliation(s)
- Maria Cambray
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier González-Viguera
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ferran Losa
- Medical Oncology Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ricard Frago
- General and Digestive Surgery Department, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Fernando Mata
- General and Digestive Surgery Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Jordi Castellví
- General and Digestive Surgery Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Elisabet Guinó
- Data Analytics Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Martínez-Villacampa M, Tavera SB, Vivas CS, Izquierdo C, Bruna J, Velasco R. Rechallenge with oxaliplatin and peripheral neuropathy in colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marín J, Soler G, Martínez-Villacampa M, Vázquez S, Vivas CS, Margalef NM, Teule A, Salazar R. G8 screening tool for treatment decision-making in elderly colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gonçalves-Ribeiro S, Sanz-Pamplona R, Vidal A, Sanjuan X, Guillen Díaz-Maroto N, Soriano A, Guardiola J, Albert N, Martínez-Villacampa M, López I, Santos C, Serra-Musach J, Salazar R, Capellà G, Villanueva A, Molleví DG. Prediction of pathological response to neoadjuvant treatment in rectal cancer with a two-protein immunohistochemical score derived from stromal gene-profiling. Ann Oncol 2018; 28:2160-2168. [PMID: 28911071 DOI: 10.1093/annonc/mdx293] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Preoperative chemoradiotherapy followed by surgical mesorectal resection is the standard of care for locally advanced rectal carcinomas. Yet, predicting that patients will respond to treatment remains an unmet clinical challenge. Experimental design Using laser-capture microdissection we isolated RNA from stroma and tumour glands from prospective pre-treatment samples (n = 15). Transcriptomic profiles were obtained hybridising PrimeView Affymetrix arrays. We modelled a carcinoma-associated fibroblast-specific genes filtering data using GSE39396. Results The analysis of differentially expressed genes of stroma/tumour glands from responder and non-responder patients shows that most changes were associated with the stromal compartment; codifying mainly for extracellular matrix and ribosomal components. We built a carcinoma-associated fibroblast (CAF) specific classifier with genes showing changes in expression according to the tumour regression grade (FN1, COL3A1, COL1A1, MMP2 and IGFBP5). We assessed these five genes at the protein level by means of immunohistochemical staining in a patient's cohort (n = 38). For predictive purposes we used a leave-one-out cross-validated model with a positive predictive value (PPV) of 83.3%. Random Forest identified FN1 and COL3A1 as the best predictors. Rebuilding the leave-one-out cross-validated regression model improved the classification performance with a PPV of 93.3%. An independent cohort was used for classifier validation (n = 36), achieving a PPV of 88.2%. In a multivariate analysis, the two-protein classifier proved to be the only independent predictor of response. Conclusion We developed a two-protein immunohistochemical classifier that performs well at predicting the non-response to neoadjuvant treatment in rectal cancer.
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Affiliation(s)
| | - R Sanz-Pamplona
- Program of Prevention and Cancer Control, Biomarkers Unit, Catalan Institute of Oncology
| | | | | | | | - A Soriano
- Department of Gastroenterology Endoscopy Unit, Hospital Universitari de Bellvitge
| | - J Guardiola
- Department of Gastroenterology Endoscopy Unit, Hospital Universitari de Bellvitge
| | - N Albert
- Program Against Cancer Therapeutic Resistance
| | | | - I López
- Department of Medical Oncology
| | | | | | | | - G Capellà
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | - D G Molleví
- Program Against Cancer Therapeutic Resistance
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Gravalos C, Capdevila J, Layos L, Pericay C, Martínez-Villacampa M, López López C, Losa F, Safont M, Gómez-España A, Alonso V, Escudero P, Gallego J, García-Paredes B, Palacios A, Biondo S, Salazar R, Aranda Aguilar E. Phase II randomized trial of capecitabine + radiation therapy with/without bevacizumab as preoperative treatment for patients with resectable locally advanced rectal adenocarcinoma: Final results of 3 and 5-year disease free survival, distant relapse free survival and overall survival. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Molina-Mata K, Navarro-Martin A, Martínez-Villacampa M, Bergamino Sirven M, Soler G, Cambray M, Ramos R, Santos C, Arnaiz Maria DM, Pérez Martín Francisco J, Salazar R. Stereotactic body radiotherapy: A promising approach for colorectal lung oligometastases. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Enrique SG, Elez E, Caratu G, Matito J, Garcia A, Grasselli J, Martínez-Villacampa M, Santos C, Mulet N, Vidal J, Argiles G, Macarulla T, Capdevila J, Sauri T, Matos I, Aranda E, Jones F, Dientsmann R, Montagut C, Tabernero J, Salazar R, Vivancos A. Impact in prognosis of circulating tumor DNA mutant allele fraction (MAF) in RAS mutant metastatic colorectal cancer (mCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx262.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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González-Castillo A, Biondo S, García-Granero Á, Cambray M, Martínez-Villacampa M, Kreisler E. Resultados de la cirugía de la recidiva pélvica de cáncer de recto. Experiencia en un centro de referencia. Cir Esp 2016; 94:518-524. [DOI: 10.1016/j.ciresp.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 01/14/2023]
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Sastre J, Argilés G, Benavides M, Feliú J, García-Alfonso P, García-Carbonero R, Grávalos C, Guillén-Ponce C, Martínez-Villacampa M, Pericay C. Clinical management of regorafenib in the treatment of patients with advanced colorectal cancer. Clin Transl Oncol 2014; 16:942-53. [PMID: 25223744 PMCID: PMC4194027 DOI: 10.1007/s12094-014-1212-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 12/19/2022]
Abstract
Colorectal cancer is one of the most common tumors worldwide and at least 50 % of patients with this disease develop metastases. In this setting, additional treatment options are needed for patients presenting disease progression after exhausting all standard therapies. Regorafenib is an orally administered multikinase inhibitor which has been shown to provide survival benefits to patients with metastatic colorectal cancer (mCRC). Although most adverse events (AEs) associated with regorafenib may resolve within the first 8 weeks of treatment, some of them may require dose reduction or treatment interruption. Overall, while remaining aware of the safety profile of regorafenib and how to manage the most common toxicities related to its use, this drug should be considered a new standard of care for patients with pretreated mCRC. This review addresses practical aspects of its use, such as dosing, patient monitoring, and management of the most common regorafenib-related AEs.
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Affiliation(s)
- J Sastre
- Medical Oncology Department, Clinic San Carlos University Hospital (Center Affiliated with the Red Tematica de Investigacion Cooperativa en Cancer, Instituto Carlos III, Spanish Ministry of Science and Innovation), Calle Profesor Martín Lagos, s/n, 28040, Madrid, Spain,
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Majem M, Galán M, Pérez FJ, Muñoz M, Chicote S, Soler G, Navarro M, Martínez-Villacampa M, García del Muro X, Dotor E, Laquente B, Germà JR. The oncology acute toxicity unit (OATU): an outpatient facility for improving the management of chemotherapy toxicity. Clin Transl Oncol 2008; 9:784-8. [PMID: 18158982 DOI: 10.1007/s12094-007-0140-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an outpatient facility to improve the management of chemotherapy toxicity in cancer patients. PATIENTS AND METHODS We set up an oncology acute toxicity unit (OATU) to improve toxicity management. A telephone helpline was the initial contact which filters out inappropriate non-toxicity-related events. Patients were provided an information booklet describing the possible side effects of the chemotherapy and the helpline telephone number. A specialist nurse received the calls and consulted the doctor if necessary. Depending on requirements, the patient's problem was resolved by telephone, or a consultation visit at the OATU was arranged. RESULTS Between February 1999 and August 2001, 1126 patients made 2007 contacts with the OATU. The most common tumours were breast (26%), colorectal (20%) and lung (20%). The telephone helpline was used in 87% of contacts and 37% were considered inappropriate. Of the 1263 appropriate contacts, the most frequent chemotherapy schedules that had been administered were 5FU-leucovorin (11.2%) and CMF (10.4%). The most frequent side effects were fever (35.5%), diarrhoea (18.5%), mucositis (16.2%) and emesis (13%). The problem was resolved by telephone in 48% of cases and 52% required attendance in the OATU, of which 40% required hospital admission, i.e., 21.1% of the initial appropriate helpline contacts. The most frequent reason was Grade 3-4 neutropenic fever (56.5%). CONCLUSIONS The OATU enables prompt and efficient access of patients to medical oncology facilities in the event of toxicity due to chemotherapy. Unnecessary emergency room use is avoided while oncology outpatient and hospitalisation facilities are optimised.
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Affiliation(s)
- M Majem
- Department of Medical Oncology, Institut Català d'Oncologia L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
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Arrazubi V, Majem M, Navarro M, Pareja L, Biondo S, Ribes J, Cambray M, Martínez-Villacampa M, Soler G, Germà J. Mortality trends in colorectal cancer (CRC) and influencing factors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13527 Background: A decline in overall cancer death rate was observed in the early 1990s after more than six decades of increase in cancer mortality. Effective prevention, screening and early detection as well as improved treatment strategies may be influencing factors. The aim of this study is to compare the overall survival of patients (pts) with CRC in two different years using our prospective regularly updated register database. Methods: Patients diagnosed of CRC during 1996 and 2000 were included in the study. To analyse the relation between variables the exact Fisher test was used. Survival curves were constructed according to the Kaplan-Meier method and compared by log rank analysis. Analyses were performed using the SPSS package. Results: 289 pts in 1996 and 380 in 2000 were included. Demographic data and tumour characteristics were similar in both groups. 42% of pts in 1996 and 56% in 2000 had received chemotherapy (ChT) (p<0.05). In adjuvant setting, 41.8% of patients with stage II-III colon cancer received ChT in 1996 and 57.5% in 2000 (p=0.019). ChT schedules for advanced CRC included Oxaliplatin and Irinotecan in 23% of ChT in 1996 and in 68% in 2000 (p<0.005). The number of palliative ChT lines was significantly higher in 2000 (p<0.05). Radiotherapy was administered as part of rectal cancer therapy to 48% of pts 1996 and to 60% in 2000 (p=0.05). From those, preoperative radiotherapy was administered to 21% of pts in 1996 and to 66% in 2000 (p<0.05). 4.1% of all pts were lost of follow up. With a median follow up of 104.5 months (m) for 1996 and 56.3 m for 2000, the 5-year overall survival (OS) was 45% and 61.6% respectively (p<0.001). The 5-year disease free survival (DFS) of pts with radical surgery was 73% and 81% respectively (p=0.09). The median survival of pts with radical surgery that relapse during follow up was 13.4 m in 1996 and 17.6 m in 2000 (p<0.04). There were statistical significant differences in OS between 1996 and 2000 in tumour site, stage II-III cancer and males, not in females. DFS for stages II-III was better in 2000, but no significant differences were observed. Conclusions: A positive CRC mortality trend was observed. The influencing factors were related with the use of ChT as an adjuvant treatment and the addition of new drugs in colon cancer therapies as well as preoperative radiotherapy for rectal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- V. Arrazubi
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M. Majem
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M. Navarro
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - L. Pareja
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - S. Biondo
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J. Ribes
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M. Cambray
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M. Martínez-Villacampa
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - G. Soler
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J. Germà
- Institut Català d′Oncologia, L′Hospitatet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Figueras J, Lladó-Garriga L, Lama C, Pujol-Ràfols J, Navarro M, Martínez-Villacampa M, Domínguez J, Sancho C, Rafecas A, Fabregat J, Torras J, Ramos E, Xiol X, Baliellas C, Casanovas T, Jaurrieta E. [Resection as elective treatment of hilar cholangiocarcinoma (Klatskin tumor)]. Gastroenterol Hepatol 1998; 21:218-23. [PMID: 9644874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective analysis of our experience in the treatment of hiliary cholangiocarcinoma or Klatskin tumor was performed with the aim of evaluating the morbi-mortality and prognosis of its treatment to thereby determine the usefulness of the different therapeutic options. From 1989 to 1997, 51 patients diagnosed with hiliary cholangiocarcinoma were treated in our hospital. Surgery was indicated in 16 with curative aims (group I) while palliative treatment with percutaneous biliary drainage was indicated in 35 (group II). Biliary resection was carried out in 8 patients being associated with hepatic resection in 4 (group IA) and in 8 patients undergoing liver transplantation (group IB). Clinico-epidemiologic data and hospital stay were similar in all the groups. The frequency of complications was similar in groups I and II although the frequency of cholangitis (49%) in group II was noticeable. The percentage of readmissions was also greater in group II (12 vs 46%, respectively; p = 0.03) with prosthesis obstruction being the most frequent cause. Accumulated survival at 1, 2, and 3 years in group I was 84, 64 and 48% with a median survival of 33 months, while in group II the median survival was of 6 months with no patient surviving more than 2 years (p = 0.0001). When groups IA and IB were compared, greater frequency of complications in groups IA (100 vs 37%; p = 0.002), similar frequency of readmissions (87 vs 75%; p = NS), median survival greater in group IB (12.5 months vs 48 months) and significantly higher actuarial survival in group IB (48% in 2 years vs 83% to 2 years; p = 0.02) was observed. In conclusion, surgery is the treatment of choice in hiliary cholangiocarcinoma whenever possible, given the greater survival without a significant increase in morbimortality. Likewise, we consider that liver transplantation is a useful option in the treatment of patients with cholangiocarcinoma type IV of Bismuth.
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Affiliation(s)
- J Figueras
- Servicio de Cirugía, Hospital Príncipes de España, C.S.U. Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat
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