Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: An aid to clinical decision-making

2008 ◽  
Vol 17 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Fenella K.S. Welsh ◽  
Paris P. Tekkis ◽  
Tom O’Rourke ◽  
Timothy G. John ◽  
Myrddin Rees
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Hepatic Resection ◽  
Metastatic Colorectal Cancer ◽  
Clinical Decision Making ◽  
Resection Margin ◽  
Clinical Decision ◽  
R1 Resection

Highly specific detection of KRAS single nucleotide polymorphism by asymmetric PCR/SERS assay

The Analyst ◽  
2021 ◽  
Author(s):  
Nana Lyu ◽  
Vinoth Kumar Rajendran ◽  
Jun Li ◽  
Alexander Engel ◽  
Mark P. Molloy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nucleotide Polymorphism ◽  
Asymmetric Pcr ◽  
Specific Detection ◽  
Kras Mutations ◽  
Single Nucleotide ◽  
The Common

The molecular diagnosis of KRAS mutations has become crucial for clinical decision-making in colorectal cancer (CRC) treatments. Currently, the common methods for detecting mutations are based on quantitative PCR, DNA...

scholarly journals Precision Approaches in the Management of Colorectal Cancer: Current Evidence and Latest Advancements towards Individualizing the Treatment

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3481
Author(s):  
Rebecca A. Shuford ◽  
Ashley L. Cairns ◽  
Omeed Moaven
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Metastatic Colorectal Cancer ◽  
Mismatch Repair ◽  
Clinical Decision Making ◽  
Growth Factor Receptor ◽  
Clinical Decision ◽  
Current Evidence ◽  
Therapeutic Modalities ◽  
Clinically Significant

The genetic and molecular underpinnings of metastatic colorectal cancer have been studied for decades, and the applicability of these findings in clinical decision making continues to evolve. Advancements in translating molecular studies have provided a basis for tailoring chemotherapeutic regimens in metastatic colorectal cancer (mCRC) treatment, which have informed multiple practice guidelines. Various genetic and molecular pathways have been identified as clinically significant in the pathogenesis of metastatic colorectal cancer. These include rat sarcoma (RAS), epithelial growth factor receptor (EGFR), vascular endothelial growth factor VEGF, microsatellite instability, mismatch repair, and v-raf murine sarcoma viral oncogene homolog b1 (BRAF) with established clinical implications. RAS mutations and deficiencies in the mismatch repair pathway guide decisions regarding the administration of anti-EGFR-based therapies and immunotherapy, respectively. Furthermore, there are several emerging pathways and therapeutic modalities that have not entered mainstream use in mCRC treatment and are ripe for further investigation. The well-established data in the arena of targeted therapies provide evidence-based support for the use or avoidance of various therapeutic regimens in mCRC treatment, while the emerging pathways and platforms offer a glimpse into the future of transforming a precision approach into a personalized treatment.

Metastatic Colorectal Cancer: Current State and Future Directions

2015 ◽  
Vol 33 (16) ◽  
pp. 1809-1824 ◽  
Author(s):  
Marwan G. Fakih
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Targeted Therapies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cytotoxic Agents ◽  
Braf Mutations ◽  
Curative Intent ◽  
Future Directions ◽  
Unresectable Metastatic Colorectal Cancer

Substantial improvements have been made in the management of metastatic colorectal cancer over the last two decades. The overall survival of patients diagnosed with unresectable metastatic colorectal cancer has increased from approximately 1 year during the era of fluoropyrimidine monotherapy to more than 30 months with the integration of multiple cytotoxic agents and targeted therapies. More effective therapeutic combinations have increased the rate of curative-intent surgical resections, resulting in median survival in this subgroup that exceed 5 years. Here we review the landscape of systemic therapies for unresectable metastatic colorectal cancer during the current era of targeted therapies, review the effects of RAS and BRAF mutations on clinical decision making, and reflect on future directions for the treatment of metastatic colorectal cancer.

scholarly journals Empowering Clinical Decision Making in Oligometastatic Colorectal Cancer: The Potential Role of Drug Screening of Patient-Derived Organoids

2021 ◽  
pp. 1192-1199
Author(s):  
Gianluca Mauri ◽  
Erika Durinikova ◽  
Alessio Amatu ◽  
Federica Tosi ◽  
Andrea Cassingena ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Drug Screening ◽  
Potential Role ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Risk assessment and clinical decision making for colorectal cancer screening

2013 ◽  
Vol 18 (5) ◽  
pp. 1327-1338 ◽  
Author(s):  
Paul C. Schroy ◽  
Sarah E. Caron ◽  
Bonnie J. Sherman ◽  
Timothy C. Heeren ◽  
Tracy A. Battaglia
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
Decision Making ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals An Electronic Clinical Decision-Making Tool for Patients with Suspected Colorectal Cancer—Preliminary Evaluation in Patients Presenting with Rectal Bleeding

2019 ◽  
Vol 3 (5) ◽  
pp. 204-209
Author(s):  
Nauzer Forbes ◽  
Mohan Cooray ◽  
Michael Hackett ◽  
Nishwa Shah ◽  
Yuhong Yuan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Rectal Bleeding ◽  
Test Performance ◽  
Clinical Decision Making ◽  
A Priori ◽  
Clinical Decision ◽  
Preliminary Evaluation ◽  
Clinical Criteria ◽  
Urgent Referral

Abstract Background and Objectives The CarePath-CRC electronic clinical decision-making application was designed to assist physicians with evaluation of patients with suspected colorectal cancer (CRC). The physician completes an interactive checklist of evidence-based clinical parameters, and a recommended referral urgency is generated based on the post-test probability of CRC. This study aimed toward validation of the tool in symptomatic patients presenting with rectal bleeding. Methods The medical records of a sample of patients with histologically confirmed CRC from 2010 to 2014 were reviewed. The CarePath-CRC tool was applied retrospectively to all patients who initially presented with rectal bleeding, to determine its sensitivity for detecting CRC in this population. A generated recommendation of ‘immediate referral’ (referral ≤24 hours, expected endoscopy ≤2 weeks) or ‘urgent referral’ (expected consultation and endoscopy ≤4 and ≤8 weeks) was considered a positive test result. An a priori sensitivity of 90% was deemed adequate, based on test characteristics of the tool’s individual clinical criteria. Results The tool was applied to 281 patients. A total of 69 (24.6%) and 211 (75.1%) patients met criteria for immediate and urgent referral, respectively. The remaining patient (0.4%) met criteria for ‘possible priority referral’, while none met criteria for ‘no specific action recommended’. This resulted in a calculated sensitivity of 99.6% (95% confidence interval 98.0 to 99.9%). Conclusions The CarePath-CRC tool is sensitive in the prediction of CRC in patients presenting with rectal bleeding. A prospective cohort study is being designed to allow for acquisition of comprehensive test performance characteristics and full validation of the instrument.

scholarly journals A Standardized Framework for Fluorescence-Guided Margin Assessment for Head and Neck Cancer Using a Tumor Acidosis Sensitive Optical Imaging Agent

2021 ◽  
Author(s):  
Pieter Jan Steinkamp ◽  
Floris Jan Voskuil ◽  
Bert van der Vegt ◽  
Jan Johannes Doff ◽  
Kees-Pieter Schepman ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck ◽  
Real Time ◽  
Clinical Decision Making ◽  
Resection Margin ◽  
Clinical Decision ◽  
Fluorescent Imaging ◽  
Imaging Agent ◽  
Margin Assessment ◽  
Surgical Specimen

Abstract Purpose Intra-operative management of the surgical margin in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) remains challenging as surgeons still have to rely on visual and tactile information. Fluorescence-guided surgery using tumor-specific imaging agents can assist in clinical decision-making. However, a standardized imaging methodology is lacking. In this study, we determined whether a standardized, specimen-driven, fluorescence imaging framework using ONM-100 could assist in clinical decision-making during surgery. Procedures Thirteen patients with histologically proven HNSCC were included in this clinical study and received ONM-100 24 ± 8 h before surgery. Fluorescence images of the excised surgical specimen and of the surgical cavity were analyzed. A fluorescent lesion with a tumor-to-background ratio (TBR) > 1.5 was considered fluorescence-positive and correlated to standard of care (SOC) histopathology. Results All six tumor-positive surgical margins were detected immediately after excision using fluorescence-guided intra-operative imaging. Postoperative analysis showed a median TBR (±IQR) of the fluorescent lesions on the resection margin of 3.36 ± 1.62. Three fluorescence-positive lesions in the surgical cavity were biopsied and showed occult carcinoma and severe dysplasia, and a false-positive fluorescence lesion. Conclusion Our specimen-driven fluorescence framework using a novel, pH-activatable, fluorescent imaging agent could assist in reliable and real-time adequate clinical decision-making showing that a fluorescent lesion on the surgical specimen with a TBR of 1.5 is correlated to a tumor-positive resection margin. The binary mechanism of ONM-100 allows for a sharp tumor delineation in all patients, giving the surgeon a clinical tool for real-time margin assessment, with a high sensitivity.

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