Tertiary Care Multidisciplinary Teams Associated with Improved Survival in Rectal Cancer Patients: A Comparative Study

2018 ◽  
Vol 84 (10) ◽  
pp. 1645-1649
Author(s):  
Beverly Tambe ◽  
Clara V. Wang ◽  
Erik Noren ◽  
M. Philip Duldulao ◽  
Afsaneh Barzi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Stage Ii ◽  
Multidisciplinary Teams

For stage II/III rectal cancer patients, comprehensive multidisciplinary care (MDC) affects outcomes. Randomized trials have shown the effectiveness of adjuvant and neoadjuvant therapy in treatment of these patients. However, the effectiveness of collaboration within MDC is undetermined. It is possible that regional variation in survival outcomes may be tied to treatment facility. We retrospectively reviewed a prospectively collected database of patients with stage II/III rectal cancer who received MDC at any location and underwent oncologic colorectal resection at a tertiary care center (TCC) between 2005 and 2011. Of the 571 rectal cancer patients, 391 had a stage II/III rectal cancer and received surgery at a TCC. After exclusion criteria, we observed that 120 patients received neoadjuvant therapy and 119 patients received adjuvant therapy. For neoadjuvant patients, no difference in overall survival was observed between treatment received at a TCC versus an outside facility. However, a significant improvement in survival was observed in patients who received adjuvant therapy at a TCC ( P = 0.01). Thus, the location of postoperative adjuvant therapy shows improvement in 10-year survival at a TCC versus elsewhere. Thus, standardization of care can impact outcomes for invasive rectal cancer patients. The limitations of this study are its retrospective nature and relatively small sample size.

Intergroup randomized phase III study of postoperative irinotecan, 5-fluorouracil, and leucovorin versus oxaliplatin, 5-fluorouracil, and leucovorin versus 5-fluorouracil and leucovorin for patients with stage II or III rectal cancer receiving either preoperative radiation and 5-fluorouracil or postoperative radiation and 5-fluorouracil: ECOG E3201—An updated survival analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14711-e14711 ◽  
Author(s):  
Halla Sayed Nimeiri ◽  
Yang Feng ◽  
Paul J. Catalano ◽  
Neal J. Meropol ◽  
Bruce J. Giantonio ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Small Sample Size ◽  
Anal Verge ◽  
Single Agent ◽  
Data Monitoring Committee ◽  
Small Sample ◽  
Stage Ii ◽  
Phase Iii ◽  
Preoperative Radiation

e14711 Background: Postoperative adjuvant chemotherapy has been historically limited to single agent 5FU in stage II/III rectal cancer pts. This phase III trial evaluated differences between pts treated with adjuvant FOLFOX versus FOLFIRI versus FU alone in stage II/III rectal cancer. Methods: Eligibility: resectable (T3-4 N0,Tany N1-3) adenocarcinoma rectum ≤12cm from anal verge. Pts had the option to receive FU with pre or postoperative XRT (50.4Gy). Preoperative FU/XRT pts were randomized to adjuvant FOLFIRI (arm A), FOLFOX (arm B), FU/LV(arm C). Postoperative FU/XRT pts were randomized to adjuvant FOLFIRI (arm D), FOLFOX (arm E), FU/LV (arm F). Pts received 8 cycles. Overall survival (OS) was the primary endpoint. Secondary endpoints included toxicity, sphincter preservation and patterns of failure. Results: 225pts out of planned 3150 were enrolled (10/03 to 10/05). Data Monitoring Committee closed E3201 when the GI Intergroup developed an alternative trial with bevacizumab (E5204). 179 pts were randomized; (A:28, B:25, C:30, D:31, E:33, F:32). There was increased grade 3/4 toxicity, mainly diarrhea,in postoperative FU/XRT arms (D:39%), (E:28%), (F:48%). Twenty-two (12%) pts did not receive adjuvant therapy. At a median follow up of 7.4yrs, the five-year recurrence free rate was 69%. Median OS was 8.3 yrs. There was no statistical difference in OS between all randomized groups. Five-year OS in arms (A:B:C:D:E:F) were (73%, 83%, 83%, 73%, 78%, 73%) respectively. Conclusions: FOLFOX can be safely administered to rectal cancer pts following chemo radiation. Given limitations of early trial closure and small sample size, there was no difference in OS between pts who received FU alone, oxaliplatin based or irinotecan based adjuvant therapy. Clinical trial information: NCT00068692.

Organ preservation in rectal cancer patients treated with total neoadjuvant therapy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 692-692
Author(s):  
Rosa Maria Jimenez-Rodriguez ◽  
Felipe Fernando Quezada-Diaz ◽  
Irbaz Hameed ◽  
Sujata Patil ◽  
Jesse Joshua Smith ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Rectal Adenocarcinoma ◽  
Case Series ◽  
Complete Response ◽  
Stage Ii ◽  
Clinical Complete Response ◽  
Mri Staging ◽  
Total Neoadjuvant Therapy

692 Background: Retrospective case series suggest that watch-and-wait (WW) is a safe alternative to total mesorectal excision (TME) in selected patients with a clinical complete response (cCR) after chemoradiotherapy (CRT). Because treatment strategies vary widely and total numbers of patients treated at different institutions have not been reported, the proportion of rectal cancer patients who can potentially benefit from WW is not known. Here, we report the results of a treatment strategy incorporating WW in a cohort of rectal cancer patients treated with total neoadjuvant therapy (TNT). Methods: Consecutive patients with stage II/III (MRI staging) rectal adenocarcinoma treated with TNT from 2012 to 2017 by a single surgeon were included. TNT consisted of mFOLFOX6 (8 cycles) or CapeOX (5 cycles) either before or after CRT (5600 cGy in 28 fractions with sensitizing fluorouracil or capecitabine). Tumor response was assessed with a digital rectal exam, endoscopy, and MRI according to predefined criteria. Patients with a cCR were offered WW, and patients with residual tumor were offered TME. WW and TME patients were compared based on intention to treat, using the chi-square or rank sum test. Relapse-free survival (RFS) was evaluated by Kaplan-Meier analysis. Results: A total of 109 patients were identified. One patient died during CRT. Of the 108 patients, 64 (59%) had an incomplete clinical response; 4 of the 64 patients declined surgery or had local excision, and 60 underwent TME. The remaining 44 patients (41%) had a cCR and underwent WW. On average, patients in the WW group were older and had smaller, more distal tumors. Median radiation dose, number of chemotherapy cycles, number ofadverse events, or length of follow-up (28 months) did not differ between the TME and WW groups. Five (11%) of the 44 WW patients had local tumor regrowth, at a median of 14 (4–25) months after TNT; 2 of the 5 also had distant metastasis. Six (10%) of the 60 TME patients had a pathological complete response. RFS did not differ between the TME and WW groups (log rank P= 0.09). Conclusions: Approximately 40% of patients with stage II/III rectal cancer treated with TNT achieve a clinical complete response and can benefit from a WW approach with the aim of preserving the rectum.

scholarly journals Survival benefits and trends in use of adjuvant therapy among elderly stage II and III rectal cancer patients in the general population

Cancer ◽  
2008 ◽  
Vol 112 (4) ◽  
pp. 789-799 ◽  
Author(s):  
Sharon A. Dobie ◽  
Joan L. Warren ◽  
Barbara Matthews ◽  
David Schwartz ◽  
Laura-Mae Baldwin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
General Population ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Stage Ii

Nomogram incorporated the number of adjuvant chemotherapy cycles for predicting the prognosis in stage II-III rectal cancer patients without neoadjuvant therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15163-e15163
Author(s):  
Weiwei Chen ◽  
Wenling Wang
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Stage Ii

e15163 Background: Current recommendations for adjuvant chemotherapy in rectal cancer are based on the studies in colon cancer. However, it is now known that rectal cancer differs from colon cancer significantly regarding clinical course and biology. No RCTs in the TME era have evaluated the value of postoperative chemotherapy and are unlikely to be performed as neoadjuvant treatment has become a “gold standard” approach. However, we found that not all patients with locally advanced rectal cancer underwent neoadjuvant chemoradiotherapy before TME in real-world clinical practice in China. Whether the number of adjuvant chemotherapy cycles is significantly related to the prognosis of these patients deserves further study. Methods: A total of 246 patients with stage II-III rectal cancer from January 2013 to April 2018 were enrolled. All patients underwent surgery and had not received neoadjuvant therapy. The survival curve was drawn by the Kaplan-Meier method, and the log-rank method was used for statistical analysis. The Cox proportional hazard model was used for multivariate analysis to determine the independent prognostic factors. Then, MFP(Multiple Fractional Polynominal) and stepwiseAIC were used for variable selection. The R software was used to establish the nomogram. The bootstrap method was employed to internal verification. Concordance index(C-index) was applied to evaluate the predictive power of nomogram. Calibration curves were drawn to compare the 3-year overall survival rate predicted by nomogram and that of actual observation. Results: 87.8% of patients received adjuvant chemotherapy including oxaliplatin combined with fluorouracil or capecitabine. Univariate and multivariate analysis showed that the number of adjuvant chemotherapy cycles was independent prognostic factors. Patients who received more than 5 cycles of chemotherapy (HR = 0.09, 95%CI(0.01,0.80)) had a significantly better overall survival than patients with less than 5 cycles (HR = 0.33,95%CI(0.12,0.89)) or no chemotherapy (p < 0.05).Through MFP and the stepwiseAIC screening, a nomogram was established based on CEA, PLR, N, and the number of chemotherapy cycles, and the C-index of the model was 0.86. Conclusions: The number of adjuvant chemotherapy cycles is an independent prognostic factor in stage II-III rectal cancer patients without neoadjuvant therapy. Moreover, nomogram incorporated the number of chemotherapy cycles was accurate and visible.

scholarly journals Clinical manifestations and treatment outcomes of human brucellosis at a tertiary care center in Saudi Arabia

2021 ◽  
Vol 41 (2) ◽  
pp. 109-114
Author(s):  
Jameela Edathodu ◽  
Maha Alamri ◽  
Khadijah Ahmed Alshangiti ◽  
Noura S. Alfagyh ◽  
Ahmed S. Alnaghmush ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Sample Size ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Small Sample ◽  
Human Brucellosis ◽  
Tertiary Care Center ◽  
Positive Serology

BACKGROUND: Brucellosis, which has profound public health and economic consequences, is endemic to Saudi Arabia. Brucella is transmitted to humans by direct contact with infected animals or by consumption of unpasteurized dairy products. Manifestations of brucellosis are protean and require a combination of drugs to prevent the emergence of resistance. The WHO recommends the use of doxycycline with rifampicin or an aminoglycoside for brucellosis, but experts in Saudi Arabia prefer to avoid the use of rifampicin and aminoglycosides to lessen the possibility of emergence of drug-resistant tuberculosis. OBJECTIVES: Compare rifampicin and doxycycline in the treatment of human brucellosis versus various combinations of doxycycline, with either trimethoprim-sulfamethoxazole (co-trimoxazole), quinolones or aminoglycosides, and describe the clinical manifestations of brucellosis. DESIGN: Retrospective medical record review. SETTING: Single tertiary care center. PATIENTS AND METHODS: Diagnosis of brucellosis was based on positive serology by standard agglutination test (SAT), or isolation by culture of Brucella species from blood, body fluid or tissue. MAIN OUTCOME MEASURES: Cure rate with the use of doxycycline in combination with either co-trimoxazole, quinolone or aminoglyco-sides in comparison to doxycycline/rifampicin and the clinical features of brucellosis. SAMPLE SIZE: 123. RESULTS: In 118 (96%) patients, the median IgG/IgM antibody titers at diagnosis and at 6 and 12 months were 1:1280/1:1280, 1:640/1:640, and 1:320/1:160, respectively. There were no differences in outcome between treatment regimens, as evidenced by a significant decrease in SAT titers and symptom resolution within six months. Five (4%) patients relapsed from non-adherence to treatment, but responded well to a second course of treatment. Blood cultures were positive in 50 patients (41%) patients. Fever, arthralgia and back pain were the most common symptoms. Good serological and clinical responses were achieved in 96% of patients. Relapse in 4% (n=5) was due to self-reported non-adherence. LIMITATIONS: Retrospective, relatively small sample size. CONCLUSIONS: Doxycycline with co-trimoxazole is as efficacious as doxycycline/rifampicin in non-focal brucellosis and is preferred in countries with a high prevalence of tuberculosis. CONFLICT OF INTEREST: None.

Anterior Skull Base Sarcomas: Report of Characteristics and Outcomes at a Tertiary Care Cancer Center

2021 ◽  
Author(s):  
Sallie Long ◽  
Panagiotis Asimakopoulos ◽  
Marlena McGill ◽  
Marc A. Cohen ◽  
Snehal G. Patel ◽  
...  
Keyword(s):  
Skull Base ◽  
Small Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Anterior Skull Base ◽  
Cancer Center ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
High Grade

Abstract Objective This study was aimed to describe our institutional experience on characteristics and treatment outcomes of sinonasal sarcomas invading the anterior skull base. Design Present study is a retrospective review. Setting The study was conducted at an academic cancer care center. Participants Thirty-one patients with skull base sarcomas treated with primary surgery from 1979 to 2015 were identified for this study from a preexisting database. Main Outcome Measures Survival and recurrence outcomes using the Kaplan–Meier method were the focus areas of the study. Results The median age was 44 years (range: 13–69 years). Twenty patients were male (64.5%). Twenty-nine patients underwent open craniofacial resection (93.5%) and two patients underwent endoscopic resection (6.5%). The majority of tumors were staged pT4 (77.4%). The most common pathologies were leiomyosarcoma (19.4%), osteosarcoma (16.1%), and chondrosarcoma (12.9%). Of those with known margin status, 10 patients had positive/close margins (32.2%) and 16 patients had negative margins (51.6%). Most tumors were high grade (74.2%). Twenty-three patients (74.2%) received adjuvant radiation and four patients (12.9%) received adjuvant chemotherapy. There were nine postoperative complications (29%) including one mortality and three cerebrospinal fluid leaks. There were 10 local, 2 regional, and 5 distant recurrences over a median follow-up of 74 months (range: 1–300 months). The 5-year disease-specific survival (DSS) was 69.8%. The 5-year locoregional recurrence-free probability (RFP) was 63.2% and the 10-year distant RFP was 71.7%. The 5-year DSS for high grade tumors was 64.2 and 85.7% for low grade tumors (p = 0.117). Conclusion This study contributes an updated analysis of anterior skull base sarcomas. Five-year DSS is approximately 70%. Analysis of survival outcomes based on grade, tumor size, and other factors is limited by small sample size and the rarity of these tumors.

scholarly journals Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

2018 ◽  
Vol 17 (1) ◽  
pp. e129-e142 ◽  
Author(s):  
Masoud Babaei ◽  
Lina Jansen ◽  
Yesilda Balavarca ◽  
Annika Sjövall ◽  
Amanda Bos ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Clinical Stage ◽  
European Countries ◽  
Stage Ii

scholarly journals Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

2018 ◽  
Vol 38 (1) ◽  
pp. 18-23
Author(s):  
Gustavo Sevá-Pereira ◽  
Roberta Nascimento Cypreste ◽  
Joaquim José Oliveira Filho ◽  
Sandra Pedroso de Moraes ◽  
Paula Buozzi Tarabay
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Recurrence Pattern ◽  
Tertiary Care Center ◽  
Treatment Analysis

Short term outcome for colorectal cancer patients undergoing surgery in Tertiary care center in Eastern India

2021 ◽  
Vol 47 (2) ◽  
pp. e50-e51
Author(s):  
Abhitesh Singh ◽  
Anshul Jain ◽  
Dillip Muduly ◽  
Mahesh Sultania ◽  
Jyoti Ranjan Swain ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Eastern India ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Colorectal Cancer Patients

scholarly journals Clinicopathological Profile of Patients with Lung Carcinoma in a Tertiary Care Center

2020 ◽  
Author(s):  
M.T. Chandramouli ◽  
Giridhar Belur Hosmane
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Lung Carcinoma ◽  
Care Center ◽  
Tertiary Care ◽  
Smoking History ◽  
Tertiary Care Center ◽  
Cell Type ◽  
Lung Cancer Patients ◽  
Incidence And Mortality

Abstract Introduction Among malignant diseases, lung carcinoma is the most common cancer in men worldwide in terms of both incidence and mortality. Its increasing incidence in developing countries like India is an important public health problem. This work aimed to study the demographic, clinical, radiological, and histological features of patients with confirmed lung cancer. Materials and Methods A total of 50 patients with histologically confirmed lung cancer at a tertiary care center in India from August 2016 to September 2018 were studied and analyzed. Results Out of 50 diagnosed lung cancer patients, 86% were men and 14% women; 31 (62%) patients were aged more than 60 years. Majority were smokers (84%) and all were men. Cough (94%) was the most common presenting symptom followed by dyspnea (68%), chest pain (48%), and hemoptysis (38%). Of the 50 patients, 29 (58%) had soft tissue density mass lesion on radiograph. Squamous cell carcinoma (SCC) was the diagnosed histological cell type in 24 (48%) patients and adenocarcinoma in 21 (42%) patients. Distant metastasis was observed in 20 (40%) patients. Conclusion In this study, the most common histopathological cell type is SCC. Patients aged more than 50 years and smokers are at high risk of lung cancer. Patients with a smoking history and persistent respiratory symptoms should be promptly evaluated for lung malignancy.

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